Wearable Microfluidic Systems for Measuring Sweat Biomarkers in Cystic Fibrosis Patients During Exercise in Remote Settings

摘要： 囊性纤维化（CF）是由囊性纤维化跨膜传导调节因子（CFTR）突变引起的 导致氯离子（Cl-）跨质膜运动受损的基因。CF患者通常 排出的汗液中Cl-和钠（Na+）浓度比健康人高得多。CF可以导致 原发或继发的多器官表现（即支气管扩张，糖尿病，骨质疏松， 营养不良、抑郁症）。运动被推荐作为许多这些表现的预防性治疗 运动能力已被证明是CF生存的独立因素。随着最近批准的 对于90%的CF患者来说，高效CFTR调节剂（HEMT），CF患者的存活率可能将 这一数字将大幅增加，预计许多患者将活到60多岁。HEMT的功效 导致了一些意想不到的后果，例如一些患者变得肥胖（BMI>30）， 已经变得不太坚持他们的每日气道清除方案，并且依赖于运动来进行气道清除。 这些因素强调了定期剧烈运动在CF患者的持续护理中的重要性， 现在预计将持续几十年。由于过多的水和电解质损失会导致 脱水和电解质失衡，CF患者严重脱水和电解质丢失的风险很高 这可能具有有害的后果并限制锻炼的强度。有大量数据表明， 描述了正常运动员对运动的出汗率和电解质损失，然而， CF患者的数据。我们最近报道了一种新颖的皮肤界面可穿戴微流体设备和智能手机 图像处理平台，能够分析运动员的局部出汗率和汗液氯化物损失 和CF儿科患者，其模式对佩戴者来说是舒适的和感觉不到的。我们假设 使用我们的软可穿戴微流体传感器捕获连续电解质和汗液速率测量， 智能手机应用程序（称为CF贴片系统）将提供可操作的水合作用和电解质补充 成人CF患者在运动期间的信息。CF Patch可穿戴平台提供了突破性的 这是一种定量和连续评估CF水合作用和健康状况的方法。的 这项工作的基本见解将使新的护理管理模式的CF患者在远程 设置.

Abstract: Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene which lead to impaired chloride (Cl-) movement across the plasma membrane. Individuals with CF typically excrete sweat with substantially higher Cl- and sodium (Na+) concentrations than healthy individuals. CF can lead to multi-organ manifestations, either primarily or secondarily (i.e. bronchiectasis, diabetes mellitus, osteoporosis, malnutrition, depression). Exercise is recommended as adjunctive treatment for many of these manifestations and exercise capacity has been shown to be an independent factor in CF survival. With the recent approval of highly effective CFTR modulators (HEMT) for 90% of CF patients, it is likely that survival for CF patients will increase substantially and it is anticipated that many patients will survive into their sixties. The efficacy of HEMT has led to some unintended consequences such as that some patients have become obese (BMI>30) and many have become less adherent to their daily airway clearance regimen and rely on exercise for airway clearance. These factors underscore the importance that regular vigorous exercise will play in ongoing care of CF patients, which is now expected to last many more decades. Since excessive water and electrolyte losses can contribute to dehydration and electrolyte imbalance, CF patients are at high risk for severe dehydration and electrolyte loss which can have deleterious consequences and limit intensity of exercise. There is substantial data that has described sweat rates and electrolyte loss in response to exercise in normal athletes, however, there is limited data for CF patients. We recently reported a novel skin-interfaced wearable microfluidic device and smartphone image processing platform that enables analysis of regional sweating rate and sweat chloride loss in athletes and CF pediatric patients in a mode that is comfortable and imperceptible to the wearer. We hypothesize that continuous electrolyte and sweat rate measurements captured with our soft wearable microfluidic sensors and smartphone application (called the CF Patch System) will provide actionable hydration and electrolyte repletion information for adult CF patients during exercise. The CF Patch wearable platform offers a groundbreaking approach for the quantitative and continuous assessment of CF hydration and health conditions. The foundational insights from this work will enable new care management paradigms for CF patients in remote settings.