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-)跨质膜移动受损的基因。患有慢性萎缩性胃炎的人通常 排出的汗液中的氯离子和钠(Na+)浓度比健康人高得多。Cf可以领先 以多器官表现为主或继发(如支气管扩张、糖尿病、骨质疏松症、 营养不良、抑郁)。对于这些症状中的许多，建议将运动作为辅助治疗 运动能力已被证明是影响CF存活率的一个独立因素。在最近的批准下 高效CFTR调节器(HEMT)对于90%的CF患者来说，很可能将使CF患者的存活率 大幅增加，预计许多患者将活到60多岁。HEMT的疗效观察 导致了一些意想不到的后果，如一些患者变得肥胖(BMI&>30)和许多 已经变得不那么坚持他们的日常呼吸道清除方案，并依赖运动来清除呼吸道。 这些因素突显了定期剧烈运动在持续护理CF患者中的重要性， 现在预计还会持续几十年。因为过多的水分和电解质流失会导致 由于脱水和电解质失衡，CF患者严重脱水和电解质丢失的风险很高。 这可能会产生有害的后果，并限制运动强度。有大量的数据显示 描述了正常运动员运动后的出汗率和电解质损失，然而， 慢性萎缩性胃炎患者的数据。我们最近报道了一种新型的皮肤接口可穿戴微流控设备和智能手机 图像处理平台，可分析运动员的局部出汗率和汗氯化物损失 以及在佩戴者舒适且不易察觉的模式下使用CF儿科患者。我们假设 使用我们的软可穿戴微流体传感器捕获连续的电解质和汗率测量 智能手机应用程序(称为CF贴片系统)将提供可行的补水和电解质补充 成人慢性纤维性心脏病患者在运动期间的信息。CF Patch可穿戴平台提供了突破性的 用于定量和持续评估CF水合作用和健康状况的方法。这个 这项工作的基本见解将为偏远地区的CF患者提供新的护理管理模式 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.