A Review of Recent Advancements in Sensor-Integrated Medical Tools

A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.

Ratiometric Nanothermometer Based on a Radical Excimer for In Vivo Sensing

Ratiometric fluorescent nanothermometers with near-infrared emission play an important role in in vivo sensing since they can be used as intracellular thermal sensing probes with high spatial resolution and high sensitivity, to investigate cellular functions of interest in diagnosis and therapy, where current approaches are not effective. Herein, the temperature-dependent fluorescence of organic nanoparticles is designed, synthesized, and studied based on the dual emission, generated by monomer and excimer species, of the tris(2,4,6-trichlorophenyl)methyl radical (TTM) doping organic nanoparticles (TTMd-ONPs), made of optically neutral tris(2,4,6-trichlorophenyl)methane (TTM-αH), acting as a matrix. The excimer emission intensity of TTMd-ONPs decreases with increasing temperatures whereas the monomer emission is almost independent and can be used as an internal reference. TTMd-ONPs show a great temperature sensitivity (3.4% K-1 at 328 K) and a wide temperature response at ambient conditions with excellent reversibility and high colloidal stability. In addition, TTMd-ONPs are not cytotoxic and their ratiometric outputs are unaffected by changes in the environment. Individual TTMd-ONPs are able to sense temperature changes at the nano-microscale. In vivo thermometry experiments in Caenorhabditis elegans (C. elegans) worms show that TTMd-ONPs can locally monitor internal body temperature changes with spatio-temporal resolution and high sensitivity, offering multiple applications in the biological nanothermometry field.

Real-Time, In Vivo Molecular Monitoring Using Electrochemical Aptamer Based Sensors: Opportunities and Challenges

The continuous, real-time measurement of specific molecules in situ in the body would greatly improve our ability to understand, diagnose, and treat disease. The vast majority of continuous molecular sensing technologies, however, either (1) rely on the chemical or enzymatic reactivity of their targets, sharply limiting their scope, or (2) have never been shown (and likely will never be shown) to operate in the complex environments found in vivo. Against this background, here we review electrochemical aptamer-based (EAB) sensors, an electrochemical approach to real-time molecular monitoring that has now seen 15 years of academic development. The strengths of the EAB platform are significant: to date it is the only molecular measurement technology that (1) functions independently of the chemical reactivity of its targets, and is thus general, and (2) supports in vivo measurements. Specifically, using EAB sensors we, and others, have already reported the real-time, seconds-resolved measurements of multiple, unrelated drugs and metabolites in situ in the veins and tissues of live animals. Against these strengths, we detail the platform's remaining weaknesses, which include still limited measurement duration (hours, rather than the more desirable days) and the difficulty in obtaining sufficiently high performance aptamers against new targets, before then detailing promising approaches overcoming these hurdles. Finally, we close by exploring the opportunities we believe this potentially revolutionary technology (as well as a few, possibly competing, technologies) will create for both researchers and clinicians.

Integrating Nanosensors into Macroporous Hydrogels for Implantation

Macroporous hydrogels are an attractive platform for implantable sensors because the network of interconnected macropores facilitates tissue integration. Embedded sensing elements, in our case, plasmonic gold nanoparticles, can transduce the presence, absence, and concentration of biochemical markers to the outside. We present here how to integrate such nanosensors into a macroporous hydrogel while preserving the nanosensor functionality in order to produce implantable sensors. We demonstrate that out of four different polymers, the poly(2-hydroxyethyl methacrylate-poly(ethylene glycole)diacrylate copolymer (pHEMA-PEGDA) results in a working sensor. Our approach of incorporating nanosized sensor elements into a hydrogel matrix generally identifies suitable polymers for implantable sensor systems.

In vivo sensing of rabbit cornea by terahertz technology

A Novel scalable approach using Terahertz (THz) waves together with the electromagnetic field simulation was applied to investigate four rabbits of eight rabbit corneas in vivo. One eye of each rabbits' corneas was edema induced; the other eye of the corneas served as the control. The simulation revealed the propagation of THz waves at a certain distance along the sub-surface of the cornea. THz spectra have been collected close to the corneal surface by deviating the direct reflection of the THz beam for the edema cornea, the reflected wave intensity for edema corneas is generally larger compared with the control cornea. Upon edema becomes severe at the end of the observation, the reflected wave intensities obtained by detector corresponding to the corneal deep stroma layer approach to the same value for all observed corneas. Good correlation is observed between central corneal thickness measurements and THz wave reflection signal intensities. Our results demonstrated that THz spectroscopy technique could obtain the information from different corneal sublayers.

Implantable Sensors Based on Gold Nanoparticles for Continuous Long-Term Concentration Monitoring in the Body

Implantable sensors continuously transmit information on vital values or biomarker concentrations in bodily fluids, enabling physicians to survey disease progression and monitor therapeutic success. However, currently available technologies still face difficulties with long-term operation and transferability to different analytes. We show the potential of a generalizable platform based on gold nanoparticles embedded in a hydrogel for long-term implanted biosensing. Using optical imaging and an intelligent sensor/reference-design, we assess the tissue concentration of kanamycin in anesthetized rats by interrogating our implanted sensor noninvasively through the skin. Combining a tissue-integrating matrix, robust aptamer receptors, and photostable gold nanoparticles, our technology has strong potential to extend the lifetime of implanted sensors. Because of the easy adaptability of gold nanoparticles toward different analytes, our concept will find versatile applications in personalized medicine or pharmaceutical development.

Microscale Biosensor Array Based on Flexible Polymeric Platform toward Lab-on-a-Needle: Real-Time Multiparameter Biomedical Assays on Curved Needle Surfaces

In vivo sensing of various physical/chemical parameters is gaining increased attention for early prediction and management of various diseases. However, there are major limitations on the fabrication method of multiparameter needle-based in vivo sensing devices, particularly concerning the uniformity between sensors. To address these challenges, we developed a microscale biosensor array for the measurement of electrical conductivity, pH, glucose, and lactate concentrations on a flexible polymeric polyimide platform with electrodeposited electrochemically active layers. The biosensor array was then transferred to a medical needle toward multiparametric in vivo sensing. The flexibility of the sensor platform allowed an easy integration to the curved surface (φ = 1.2 mm) of the needle. Furthermore, the electrodeposition process was used to localize various active materials for corresponding electrochemical sensors on the microscale electrodes with a high precision (patterning area = 150 μm × 2 mm). The biosensor array-modified needle was aimed to discriminate cancer from normal tissues by providing real-time discrimination of glucose, lactate concentration, pH, and electrical conductivity changes associated with the cancer-specific metabolic processes. The sensor performance was thus evaluated using solution samples, covering the physiological concentrations for cancer discrimination. Finally, the possibility of in vivo electrochemical biosensing during needle insertion was confirmed by utilizing the needle in a hydrogel phantom that mimicked the normal and cancer microenvironments.

Multiparametric real-time sensing of cytosolic physiology links hypoxia responses to mitochondrial electron transport

Hypoxia regularly occurs during plant development and can be induced by the environment through, for example, flooding. To understand how plant tissue physiology responds to progressing oxygen restriction, we aimed to monitor subcellular physiology in real time and in vivo. We establish a fluorescent protein sensor-based system for multiparametric monitoring of dynamic changes in subcellular physiology of living Arabidopsis thaliana leaves and exemplify its applicability for hypoxia stress. By monitoring cytosolic dynamics of magnesium adenosine 5'-triphosphate, free calcium ion concentration, pH, NAD redox status, and glutathione redox status in parallel, linked to transcriptional and metabolic responses, we generate an integrated picture of the physiological response to progressing hypoxia. We show that the physiological changes are surprisingly robust, even when plant carbon status is modified, as achieved by sucrose feeding or extended night. Inhibition of the mitochondrial respiratory chain causes dynamics of cytosolic physiology that are remarkably similar to those under oxygen depletion, highlighting mitochondrial electron transport as a key determinant of the cellular consequences of hypoxia beyond the organelle. A broadly applicable system for parallel in vivo sensing of plant stress physiology is established to map out the physiological context under which both mitochondrial retrograde signalling and low oxygen signalling occur, indicating shared upstream stimuli.

Activatable T1 Relaxivity Recovery Nanoconjugates for Kinetic and Sensitive Analysis of Matrix Metalloprotease 2

Sensitive detection of matrix metalloproteinase 2 (MMP-2, an important cancer marker associated with tumor invasion and metastasis) activity in vitro and at cellular level is of great significance to clinical diagnosis and medical treatment. With unique physical properties, nanoparticles are emerging as a platform for the construction of conjugates of various biological molecules, which can be expected to generate new types of biosensors. In this work, Fe₃O₄ NPs were modified with Gd chelates via linking peptides to construct NP-substrate (Fe₃O₄-pep-Gd) conjugates for kinetic MMP-2 activity assessment in vitro at the cellular level and in vivo. Superparamagnetic Fe₃O₄ quenched the longitudinal relaxation effect (T₁ relaxivity) of the attached Gd chelates by perturbing proton relaxation process under an external magnetic field. MMP-2 cleaved the peptide substrates and released Gd chelates from the local magnetic fields accompanied by T₁ relaxivity recovery and T₁ contrast enhancement. Benefiting from signal amplification through binding multiple Gd chelates to one linking peptide, Fe₃O₄-pep-Gd conjugates exhibited high sensitivity for the detection of MMP-2 (as low as 0.5 nM). Enzymatic processes were in good agreement with the integrated Michaelis-Menten model, revealing an unexpected activity enhancement in the initial stage. Fe₃O₄-pep-Gd conjugates could also probe MMP-2 at cellular level and in vivo that indicates a great promise in in vitro diagnosis (IVD) and disease monitoring.

Novel molecular and nanosensors for in vivo sensing

In vivo sensors are an emerging field with the potential to revolutionize our understanding of basic biology and our treatment of disease. In this review, we highlight recent advances in the fields of in vivo electrochemical, optical, and magnetic resonance biosensors with a focus on recent developments that have been validated in rodent models or human subjects. In addition, we discuss major challenges in the development and translation of in vivo biosensors and present potential solutions to these problems. The field of nanotechnology, in particular, has recently been instrumental in driving the field of in vivo sensors forward. We conclude with a discussion of emerging paradigms and techniques for the development of future biosensors.