Environmental enteric dysfunction (EED) is a subclinical disorder of intestinal function common in tropical countries and settings of poverty and economic disadvantage. EED manifests during infancy and is associated with undernutrition, poor sanitation, and gut infections. EED is characterised by inflammation, reduced absorptive capacity, and reduced barrier function (i.e., increased permeability) in the small intestine. The precise mechanisms underlying changes in gut barrier function (and other aspects of intestinal function) in EED remain elusive. Furthermore, current diagnostic methods to assess gut permeability (e.g., endoscopic biopsies or permeability assays such as the Lactulose:Mannitol test) are invasive, unreliable and/or challenging to perform in infants and patients with other coexisting urological conditions. Consequently, there is an urgent need to develop diagnostic technologies that can non-invasively and affordably monitor intestinal permeability in low-resource settings where EED is prevalent.
To address this need, we present a prototype semi-wearable, wireless sensor for non-invasive assessment of intestinal permeability via transcutaneous fluorescence spectroscopy. The approach relies on the ingestion of a fluorescent contrast agent (fluorescein) and the subsequent detection of its permeation from the gut into the bloodstream using a wearable probe. We outline the development of the semi-wearable sensor and report preliminary in vivo deployment. This showcases the potential of transcutaneous fluorescence spectroscopy as a wearable and non-invasive diagnostic tool for assessing gut function in low-resource settings.
SignificanceThe integrity of the intestinal barrier is gaining recognition as a significant contributor to various pathophysiological conditions, including inflammatory bowel disease, celiac disease, environmental enteric dysfunction (EED), and malnutrition. EED, for example, manifests as complex structural and functional changes in the small intestine leading to increased intestinal permeability, inflammation, and reduced absorption of nutrients. Despite the importance of gut function, current techniques to assess intestinal permeability (such as endoscopic biopsies or dual sugar assays) are either highly invasive, unreliable, and/or difficult to perform in certain patient populations (e.g., infants).AimWe present a portable, optical sensor based on transcutaneous fluorescence spectroscopy to assess gut function (in particular, intestinal permeability) in a fast and noninvasive manner.ApproachParticipants receive an oral dose of a fluorescent contrast agent, and a wearable fiber-optic probe detects the permeation of the contrast agent from the gut into the blood stream by measuring the fluorescence intensity noninvasively at the fingertip. We characterized the performance of our compact optical sensor by comparing it against an existing benchtop spectroscopic system. In addition, we report results from a human study in healthy volunteers investigating the impact of skin tone and contrast agent dose on transcutaneous fluorescence signals.ResultsThe first study with eight healthy participants showed good correlation between our compact sensor and the existing benchtop spectroscopic system [correlation coefficient (r)>0.919, p<0.001]. Further experiments in 14 healthy participants revealed an approximately linear relationship between the ingested contrast agent dose and the collected signal intensity. Finally, a parallel study on the impact of different skin tones showed no significant differences in signal levels between participants with different skin tones (p>0.05).ConclusionsIn this paper, we demonstrate the potential of our compact transcutaneous fluorescence sensor for noninvasive monitoring of intestinal health.
Undernutrition is associated with approximately 45% of deaths among children under the age of 5. Furthermore, in 2020, around 149 million children suffered impaired physical/cognitive development due to lack of adequate nutrition. Environmental enteropathy (EE) is associated with undernutrition and is characterized by a multifaceted breakdown in gut function, including an increase in intestinal permeability that can lead to inflammatory responses. However, the role and mechanisms associated with EE (particularly gut permeability) are not well understood. This is partly because current techniques to assess changes in gut permeability, such as endoscopic biopsies, histopathology and chemical tests such as Lactulose:Mannitol assays, are either highly invasive, unreliable or difficult to perform on specific groups of patients (such as infants and patients with urine retention problems). Therefore, low-cost, non-invasive and reliable diagnostic tools are urgently needed for better evaluation of intestinal permeability. Here, we present a compact transcutaneous fluorescence spectroscopy sensor for non-invasive evaluation of gut permeability and report the first in vivo data collected from volunteers in an undernutrition trial. Using this technique and device, fluorescence signals are detected transcutaneously after oral ingestion of a fluorescent solution. Preliminary results demonstrate the potential use of the presented sensor for clinical assessment of gut permeability in low-income settings.
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