학술논문

Needle-free iontophoresis-driven β-adrenergic sweat rate test.
Document Type
Article
Source
Journal of Cystic Fibrosis. May2022, Vol. 21 Issue 3, p407-415. 9p.
Subject
Language
ISSN
1569-1993
Abstract
• Iontophoresis provided successful transdermal delivery of drugs required to induce β-adrenergic sweat rate responses, including non-ionized or poorly ionized isoproterenol and aminophylline. • Modelling test responses by a nonlinear mixed-effects approach allowed evaluating metrics of CFTR-dependent effects while integrating inter- and intra-subject variability. • Secretory capacity and kinetic rate of CFTR-dependent sweating were blunted in CF. In carriers, kinetic rate was apparently lowered and secretory capacity was preserved. • The work promotes advances in the precision of biomarkers, needed to accelerate drug development in CF. Two CFTR-dependent β-adrenergic sweat rate tests applying intradermal drug injections were reported to better define diagnosis and efficacy of CFTR-directed therapies. The aim of this work was to develop and test a needle-free image-based test and to provide an accurate analysis of the responses. The modified method was conducted by applying two successive iontophoresis sessions using the Macroduct device. Efficiency of drug delivery was tested by evaporimetry. Cholinergically stimulated sweating was evoked by pilocarpine iontophoresis. β-adrenergically stimulated sweating was obtained by iontophoresis of isoproterenol and aminophylline in the presence of atropine and ascorbic acid. A nonlinear mixed-effects (NLME) approach was applied to model volumes of sweat and subject-specific effects displaying inter- and intra-subject variability. Iontophoresis provided successful transdermal delivery of all drugs, including almost neutral isoproterenol and aminophylline. Pilocarpine was used at a concentration ∼130-times lower than that used in the classical Gibson and Cooke sweat test. Addition of ascorbic acid lowered the pH of the solution, made it stable, prevented isoproterenol degradation and promoted drug iontophoresis. Maximal secretory capacity and kinetic rate of β-adrenergic responses were blunted in CF. A cutoff of 5.2 minutes for ET50, the time to reach the half maximal secretion, discriminated CF from controls with a 100% sensitivity and specificity. Heterozygous showed an apparently reduced kinetic rate and a preserved secretory capacity. We tested a safe, well-tolerated needle-free image-based sweat test potentially applicable in children. Modelling responses by NLME allowed evaluating metrics of CFTR-dependent effects reflecting secretory capacity and kinetic rate. [ABSTRACT FROM AUTHOR]