Wireless neurochemical monitoring in humans

A Journey from the Drops of Mercury to the Mysterious Shores of the Brain: The 100-Year Adventure of Voltammetry

Voltammetry, which is at the core of electroanalytical chemistry, is an analytical method that investigates and evaluates the current-potential relationship obtained at a given working electrode. If it is used dropping mercury as working electrode, the method is called as polarography. The current year 2022 marks the 100th anniversary of the discovery of polarography by Czech Jaroslav Heyrovský. He received the Nobel Prize in Chemistry in 1959 for this discovery and his contribution to the scientific world. A hundred years, within the endless existence of the universe is maybe nothing. A hundred years, in the history of mankind is a line, maybe a short paragraph. But, in science, a hundred years can lead to very significant advances in a field and often to the birth and establishment of an entirely new scientific discipline. Indeed, in the last hundred years, the design and use of new electrochemical devices, depending on the progress in microelectronics and computer technologies, has almost revolutionized voltammetry. Besides these developments, due to the fact that the redox (oxidation/reduction) process is very basic for living organisms; the voltammetry, especially with the beginning of the 21st century, has started to be used as a very powerful tool in neuroscience to solve the mystery of the brain (the basic problems of biomolecules with physiological and genetic importance in brain tissue). This review article is an overview of the 100-year history and fascinating development of voltammetry from Heyrovský to the present.

Biomarkers for Deep Brain Stimulation in Animal Models of Depression

OBJECTIVES

Despite recent advances in depression treatment, many patients still do not respond to serial conventional therapies and are considered "treatment resistant." Deep brain stimulation (DBS) has therapeutic potential in this context. This comprehensive review of recent studies of DBS for depression in animal models identifies potential biomarkers for improving therapeutic efficacy and predictability of conventional DBS to aid future development of closed-loop control of DBS systems.

MATERIALS AND METHODS

A systematic search was performed in Pubmed, EMBASE, and Cochrane Review using relevant keywords. Overall, 56 animal studies satisfied the inclusion criteria.

RESULTS

Outcomes were divided into biochemical/physiological, electrophysiological, and behavioral categories. Promising biomarkers include biochemical assays (in particular, microdialysis and electrochemical measurements), which provide real-time results in awake animals. Electrophysiological tests, showing changes at both the target site and downstream structures, also revealed characteristic changes at several anatomic targets (such as the medial prefrontal cortex and locus coeruleus). However, the substantial range of models and DBS targets limits the ability to draw generalizable conclusions in animal behavioral models.

CONCLUSIONS

Overall, DBS is a promising therapeutic modality for treatment-resistant depression. Different outcomes have been used to assess its efficacy in animal studies. From the review, electrophysiological and biochemical markers appear to offer the greatest potential as biomarkers for depression. However, to develop closed-loop DBS for depression, additional preclinical and clinical studies with a focus on identifying reliable, safe, and effective biomarkers are warranted.

Recent Advances in In Vivo Neurochemical Monitoring

The brain is a complex network that accounts for only 5% of human mass but consumes 20% of our energy. Uncovering the mysteries of the brain's functions in motion, memory, learning, behavior, and mental health remains a hot but challenging topic. Neurochemicals in the brain, such as neurotransmitters, neuromodulators, gliotransmitters, hormones, and metabolism substrates and products, play vital roles in mediating and modulating normal brain function, and their abnormal release or imbalanced concentrations can cause various diseases, such as epilepsy, Alzheimer's disease, and Parkinson's disease. A wide range of techniques have been used to probe the concentrations of neurochemicals under normal, stimulated, diseased, and drug-induced conditions in order to understand the neurochemistry of drug mechanisms and develop diagnostic tools or therapies. Recent advancements in detection methods, device fabrication, and new materials have resulted in the development of neurochemical sensors with improved performance. However, direct in vivo measurements require a robust sensor that is highly sensitive and selective with minimal fouling and reduced inflammatory foreign body responses. Here, we review recent advances in neurochemical sensor development for in vivo studies, with a focus on electrochemical and optical probes. Other alternative methods are also compared. We discuss in detail the in vivo challenges for these methods and provide an outlook for future directions.

Next-Generation Diamond Electrodes for Neurochemical Sensing: Challenges and Opportunities

Carbon-based electrodes combined with fast-scan cyclic voltammetry (FSCV) enable neurochemical sensing with high spatiotemporal resolution and sensitivity. While their attractive electrochemical and conductive properties have established a long history of use in the detection of neurotransmitters both in vitro and in vivo, carbon fiber microelectrodes (CFMEs) also have limitations in their fabrication, flexibility, and chronic stability. Diamond is a form of carbon with a more rigid bonding structure (sp3-hybridized) which can become conductive when boron-doped. Boron-doped diamond (BDD) is characterized by an extremely wide potential window, low background current, and good biocompatibility. Additionally, methods for processing and patterning diamond allow for high-throughput batch fabrication and customization of electrode arrays with unique architectures. While tradeoffs in sensitivity can undermine the advantages of BDD as a neurochemical sensor, there are numerous untapped opportunities to further improve performance, including anodic pretreatment, or optimization of the FSCV waveform, instrumentation, sp2/sp3 character, doping, surface characteristics, and signal processing. Here, we review the state-of-the-art in diamond electrodes for neurochemical sensing and discuss potential opportunities for future advancements of the technology. We highlight our team's progress with the development of an all-diamond fiber ultramicroelectrode as a novel approach to advance the performance and applications of diamond-based neurochemical sensors.

Evaluation of electrochemical methods for tonic dopamine detection in vivo

Dysfunction in dopaminergic neuronal systems underlie a number of neurologic and psychiatric disorders such as Parkinson's disease, drug addiction, and schizophrenia. Dopamine systems communicate via two mechanisms, a fast "phasic" release (sub-second to second) that is related to salient stimuli and a slower "tonic" release (minutes to hours) that regulates receptor tone. Alterations in tonic levels are thought to be more critically important in enabling normal motor, cognitive, and motivational functions, and dysregulation in tonic dopamine levels are associated with neuropsychiatric disorders. Therefore, development of neurochemical recording techniques that enable rapid, selective, and quantitative measurements of changes in tonic extracellular levels are essential in determining the role of dopamine in both normal and disease states. Here, we review state-of-the-art advanced analytical techniques for in vivo detection of tonic levels, with special focus on electrochemical techniques for detection in humans.

Traumatic brain injury neuroelectrochemical monitoring: behind-the-ear micro-instrument and cloud application

Background

Traumatic Brain Injury (TBI) is a leading cause of fatality and disability worldwide, partly due to the occurrence of secondary injury and late interventions. Correct diagnosis and timely monitoring ensure effective medical intervention aimed at improving clinical outcome. However, due to the limitations in size and cost of current ambulatory bioinstruments, they cannot be used to monitor patients who may still be at risk of secondary injury outside the ICU.

Methods

We propose a complete system consisting of a wearable wireless bioinstrument and a cloud-based application for real-time TBI monitoring. The bioinstrument can simultaneously record up to ten channels including both ECoG biopotential and neurochemicals (e.g. potassium, glucose and lactate), and supports various electrochemical methods including potentiometry, amperometry and cyclic voltammetry. All channels support variable gain programming to automatically tune the input dynamic range and address biosensors’ falling sensitivity. The instrument is flexible and can be folded to occupy a small space behind the ear. A Bluetooth Low-Energy (BLE) receiver is used to wirelessly connect the instrument to a cloud application where the recorded data is stored, processed and visualised in real-time. Bench testing has been used to validate device performance.

Results

The instrument successfully monitored spreading depolarisations (SDs) - reproduced using a signal generator - with an SNR of 29.07 dB and NF of 0.26 dB. The potentiostat generates a wide voltage range from -1.65V to +1.65V with a resolution of 0.8mV and the sensitivity of the amperometric AFE was verified by recording 5 pA currents. Different potassium, glucose and lactate concentrations prepared in lab were accurately measured and their respective working curves were constructed. Finally,the instrument achieved a maximum sampling rate of 1.25 ksps/channel with a throughput of 105 kbps. All measurements were successfully received at the cloud.

Conclusion

The proposed instrument uniquely positions itself by presenting an aggressive optimisation of size and cost while maintaining high measurement accuracy. The system can effectively extend neuroelectrochemical monitoring to all TBI patients including those who are mobile and those who are outside the ICU. Finally, data recorded in the cloud application could be used to help diagnosis and guide rehabilitation.

Moving Fast-Scan Cyclic Voltammetry toward FDA Compliance with Capacitive Decoupling Patient Protection

Carbon-fiber microelectrodes allow for high spatial and temporal measurements of electroactive neurotransmitter measurements in vivo using fast-scan cyclic voltammetry (FSCV). However, common instrumentation for such measurements systems lack patient safety precautions. To add safety precautions as well as to overcome chemical and electrical noise, a two-electrode FSCV headstage was modified to introduce an active bandpass filter on the electrode side of the measurement amplifier. This modification reduced the measured noise and ac-coupled the voltammetric measurement and moved it from a classical direct current response measurement. ac-coupling not only reduces the measured noise, but also moves FSCV toward compliance with IEC-60601-1, enabling future human trials. Here, we develop a novel ac-coupled voltammetric measurement method of electroactive neurotransmitters. Our method allows for the modeling of a system to then calculate a waveform to compensate for added impedance and capacitance for the system. We describe how first by measuring the frequency response of the system and modeling the analogue response as a digital filter we can then calculate a predicted waveform. The predicted waveform, when applied to the bandpass filter, is modulated to create a desired voltage sweep at the electrode interface. Further, we describe how this modified FSCV waveform is stable, allowing for the measurement of electroactive neurotransmitters. We later describe a 32.7% sensitivity enhancement for dopamine with this new measurement as well as maintaining a calibration curve for dopamine, 3,4-dihydroxyphenylacetic acid, ascorbic acid, and serotonin in vitro. We then validate dopamine in vivo with stimulated release. Our developed measurement method overcame the added capacitance that would traditionally make a voltammetric measurement impossible, and it has wider applications in electrode sensor development, allowing for measurement with capacitive systems, which previously would not have been possible.

Approaches to Monitor Circuit Disruption after Traumatic Brain Injury: Frontiers in Preclinical Research

Mild traumatic brain injury (TBI) often results in pathophysiological damage that can manifest as both acute and chronic neurological deficits. In an attempt to repair and reconnect disrupted circuits to compensate for loss of afferent and efferent connections, maladaptive circuitry is created and contributes to neurological deficits, including post-concussive symptoms. The TBI-induced pathology physically and metabolically changes the structure and function of neurons associated with behaviorally relevant circuit function. Complex neurological processing is governed, in part, by circuitry mediated by primary and modulatory neurotransmitter systems, where signaling is disrupted acutely and chronically after injury, and therefore serves as a primary target for treatment. Monitoring of neurotransmitter signaling in experimental models with technology empowered with improved temporal and spatial resolution is capable of recording in vivo extracellular neurotransmitter signaling in behaviorally relevant circuits. Here, we review preclinical evidence in TBI literature that implicates the role of neurotransmitter changes mediating circuit function that contributes to neurological deficits in the post-acute and chronic phases and methods developed for in vivo neurochemical monitoring. Coupling TBI models demonstrating chronic behavioral deficits with in vivo technologies capable of real-time monitoring of neurotransmitters provides an innovative approach to directly quantify and characterize neurotransmitter signaling as a universal consequence of TBI and the direct influence of pharmacological approaches on both behavior and signaling.

Closed-Loop Implantable Therapeutic Neuromodulation Systems Based on Neurochemical Monitoring

Closed-loop or intelligent neuromodulation allows adjustable, personalized neuromodulation which usually incorporates the recording of a biomarker, followed by implementation of an algorithm which decides the timing (when?) and strength (how much?) of stimulation. Closed-loop neuromodulation has been shown to have greater benefits compared to open-loop neuromodulation, particularly for therapeutic applications such as pharmacoresistant epilepsy, movement disorders and potentially for psychological disorders such as depression or drug addiction. However, an important aspect of the technique is selection of an appropriate, preferably neural biomarker. Neurochemical sensing can provide high resolution biomarker monitoring for various neurological disorders as well as offer deeper insight into neurological mechanisms. The chemicals of interest being measured, could be ions such as potassium (K⁺), sodium (Na⁺), calcium (Ca²⁺), chloride (Cl⁻), hydrogen (H⁺) or neurotransmitters such as dopamine, serotonin and glutamate. This review focusses on the different building blocks necessary for a neurochemical, closed-loop neuromodulation system including biomarkers, sensors and data processing algorithms. Furthermore, it also highlights the merits and drawbacks of using this biomarker modality.

Bioapplications of Electrochemical Sensors and Biosensors

Recent progress in the electrochemical field enabled development of miniaturized sensing devices that can be used in biological settings to obtain fundamental and practical biochemically relevant information on physiology, metabolism, and disease states in living systems. Electrochemical sensors and biosensors have demonstrated potential for rapid, real-time measurements of biologically relevant molecules. This chapter provides an overview of the most recent advances in the development of miniaturized sensors for biological investigations in living systems, with focus on the detection of neurotransmitters and oxidative stress markers. The design of electrochemical (bio)sensors, including their detection mechanism and functionality in biological systems, is described as well as their advantages and limitations. Application of these sensors to studies in live cells, embryonic development, and rodent models is discussed.

Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

BACKGROUND

The clinical and neurobiological underpinnings of transient nonmotor (TNM) psychiatric symptoms during the optimization of stimulation parameters in the course of subthalamic nucleus deep brain stimulation (STN-DBS) remain under intense investigation.

METHODS

Forty-nine patients with refractory Parkinson's disease underwent bilateral STN-DBS implants and were enrolled in a 24-week prospective, naturalistic follow-up study. Patients who exhibited TNM psychiatric manifestations during DBS parameter optimization were evaluated for potential associations with clinical outcome measures.

RESULTS

Twenty-nine TNM+ episodes were reported by 15 patients. No differences between TNM+ and TNM- groups were found in motor outcome. However, unlike the TNM- group, TNM+ patients did not report improvement in subsyndromal depression or quality of life. TNM+ episodes were more likely to emerge during bilateral monopolar stimulation of the medial STN.

CONCLUSIONS

The occurrence of TNM psychiatric symptoms during optimization of stimulation parameters was associated with the persistence of subsyndromal depression and with lower quality of life ratings at 6 months. The neurobiological underpinnings of TNM symptoms are investigated yet remain difficult to explain.

Astrocyte/neuron ratio and its importance on glutamate toxicity: an in vitro voltammetric study

The purpose of this study was to clarify the relationship between neuron cells and astrocyte cells in regulating glutamate toxicity on the 10th and 20th day in vitro. A mixed primary culture system from newborn rats that contain cerebral cortex neurons cells was employed to investigate the glutamate toxicity. All cultures were incubated with various glutamate concentrations, then viability tests and histological analyses were performed. The activities of glutamate transporters were determined by using in vitro voltammetry technique. Viable cell number was decreased significantly on the 10th day at 10(-7) M and at 10(-6) M glutamate applications, however, viable cell number was not decreased at 20th day. Astrocyte number was increased nearly six times on the 20th day as compared to the 10th day. The peak point of glutamate reuptake capacity was about 2 × 10(-4) M on the 10th day and 10(-3) M on the 20th day. According to our results, we suggested that astrocyte age was important to maintain neuronal survival against glutamate toxicity. Thus, we revealed activation or a trigger point of glutamate transporters on astrocytes due to time since more glutamate was taken up by astrocytes when glutamate transporters on the astrocyte were triggered with high exogenous glutamate concentrations. In conclusion, the present investigation is the first voltammetric study on the reuptake parameters of glutamate in vitro.

Toward sophisticated basal ganglia neuromodulation: Review on basal ganglia deep brain stimulation

This review presents state-of-the-art knowledge about the roles of the basal ganglia (BG) in action-selection, cognition, and motivation, and how this knowledge has been used to improve deep brain stimulation (DBS) treatment of neurological and psychiatric disorders. Such pathological conditions include Parkinson's disease, Huntington's disease, Tourette syndrome, depression, and obsessive-compulsive disorder. The first section presents evidence supporting current hypotheses of how the cortico-BG circuitry works to select motor and emotional actions, and how defects in this circuitry can cause symptoms of the BG diseases. Emphasis is given to the role of striatal dopamine on motor performance, motivated behaviors and learning of procedural memories. Next, the use of cutting-edge electrochemical techniques in animal and human studies of BG functioning under normal and disease conditions is discussed. Finally, functional neuroimaging studies are reviewed; these works have shown the relationship between cortico-BG structures activated during DBS and improvement of disease symptoms.

Electrochemical Analysis of Neurotransmitters

Chemical signaling through the release of neurotransmitters into the extracellular space is the primary means of communication between neurons. More than four decades ago, Ralph Adams and his colleagues realized the utility of electrochemical methods for the study of easily oxidizable neurotransmitters, such as dopamine, norepinephrine, and serotonin and their metabolites. Today, electrochemical techniques are frequently coupled to microelectrodes to enable spatially resolved recordings of rapid neurotransmitter dynamics in a variety of biological preparations spanning from single cells to the intact brain of behaving animals. In this review, we provide a basic overview of the principles underlying constant-potential amperometry and fast-scan cyclic voltammetry, the most commonly employed electrochemical techniques, and the general application of these methods to the study of neurotransmission. We thereafter discuss several recent developments in sensor design and experimental methodology that are challenging the current limitations defining the application of electrochemical methods to neurotransmitter measurements.

Implantable (Bio)sensors as new tools for wireless monitoring of brain neurochemistry in real time

Implantable electrochemical microsensors are characterized by high sensitivity, while amperometric biosensors are very selective in virtue of the biological detecting element. Each sensor, specific for every neurochemical species, is a miniaturized high-technology device resulting from the combination of several factors: electrode material, shielding polymers, applied electrochemical technique, and in the case of biosensors, biological sensing material, stabilizers, and entrapping chemical nets. In this paper, we summarize the available technology for the in vivo electrochemical monitoring of neurotransmitters (dopamine, norepinephrine, serotonin, acetylcholine, and glutamate), bioenergetic substrates (glucose, lactate, and oxygen), neuromodulators (ascorbic acid and nitric oxide), and exogenous molecules such as ethanol. We also describe the most represented biotelemetric technologies in order to wirelessly transmit the signals of the above-listed neurochemicals. Implantable (Bio)sensors, integrated into miniaturized telemetry systems, represent a new generation of analytical tools that could be used for studying the brain’s physiology and pathophysiology and the effects of different drugs (or toxic chemicals such as ethanol) on neurochemical systems.

Simultaneous telemetric monitoring of brain glucose and lactate and motion in freely moving rats

A new telemetry system for simultaneous detection of extracellular brain glucose and lactate and motion is presented. The device consists of dual-channel, single-supply miniature potentiostat-I/V converter, a microcontroller unit, a signal transmitter, and a miniaturized microvibration sensor. Although based on simple and inexpensive components, the biotelemetry device has been used for accurate transduction of the anodic oxidation currents generated on the surface of implanted glucose and lactate biosensors and animal microvibrations. The device was characterized and validated in vitro before in vivo experiments. The biosensors were implanted in the striatum of freely moving animals and the biotelemetric device was fixed to the animal's head. Physiological and pharmacological stimulations were given in order to induce striatal neural activation and to modify the motor behavior in awake, untethered animals.