Abstract
The internet of health care things enables a remote connection between health care professionals and patients wearing smart biosensors. Wearable smart devices are potentially affordable, sensitive, specific, user-friendly, rapid, robust, lab-independent, and deliverable to the end user for point-of-care testing. The datasets derived from these devices are known as digital biomarkers. They represent a novel patient-centered approach to collecting longitudinal, context-derived health insights. Adding automated, analytical smartphone applications will enable their use in high-, middle-, and low-income countries. So far, digital biomarkers have been focused primarily on accelerometer data and heart rate due to well-established sensors originating from the consumer market. Novel emerging smart biosensors will detect biomarkers (or compounds) independent of a lab and noninvasively in sweat, saliva, and exhaled breath. These molecular digital biomarkers are a promising novel approach to reduce the burden from 2 major infectious diseases with urgent unmet needs: tuberculosis and infections with multidrug resistant pathogens. Active tuberculosis (aTbc) is one of the deadliest diseases from an infectious agent. However, a simple and reliable test for its detection is still missing. Furthermore, inappropriate antimicrobial use leads to the development of antimicrobial resistance, which is associated with high mortality and health care costs. From this perspective, we discuss the innovative approach of a noninvasive and lab-independent collection of novel biomarkers to detect aTbc, which at the same time may additionally serve as a scalable therapeutic drug monitoring approach for antibiotics. These molecular digital biomarkers are next-generation digital biomarkers and have the potential to shape the future of infectious diseases.
Highlights
A biomarker is defined as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” by the National Institutes of Health Biomarkers Definitions Working Group [1]
The emergence of smart devices as part of the internet of health care things allows for connecting a patient with health care workers in a location- and lab-independent way [4]
We explored novel smartphone-based biosensors to analyze sweat, saliva, and exhaled breath for 2 of the main global issues in infectious diseases
Summary
A biomarker is defined as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” by the National Institutes of Health Biomarkers Definitions Working Group [1]. We will summarize the remaining limitations that have prevented these approaches from being clinically implemented Biofluids such as sweat, saliva, and exhaled breath are noninvasively collectable and represent a promising pool of continuously available molecular biomarkers. Sweat and saliva analysis may provide deeper systematic insights into pulmonary and extrapulmonary aTbc. Detecting Antibiotics in Sweat, Saliva, and Exhaled Breath for Therapeutic Drug Monitoring. Lung diseases such as bacterial pneumonia or pulmonary tuberculosis with a defined MIC seem to be a further achievable monitoring approach Overall, it remains to be determined if antibiotic concentrations in sweat, saliva, and exhaled breath correlate with antibiotic concentrations in blood and may serve as systemic, noninvasive TDM in the future. It is highly intuitive that local antibiotic concentrations can potentially be used as a surrogate marker and support the adequate administration of antibiotic drugs in a foreseeable timeframe
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