Sweat induction using Pilocarpine microneedle patches for sweat testing in healthy adults

Dissolving microneedles in transdermal drug delivery: A critical analysis of limitations and translation challenges

Microneedles (MNs) have emerged as an innovative approach for transdermal drug delivery, offering an efficient and minimally invasive alternative to conventional injections and oral delivery systems. While their potential has been widely recognized and extensively studied, the translation of MN technology into clinical practice remains limited. Despite the vast amount of published research, much of it involves over-complexification without addressing the core barriers to practical application. For example, dissolving/degradable MNs face key limitations such as poor drug loading capacity, low dosing consistency, and challenges in delivering effective therapeutic concentrations. These constraints restrict their utility to niche applications, such as vaccination or delivering potent drugs that require minimal doses. Additionally, the lack of standardized quality control measures, the complex manufacturing processes, and the high costs associated specifically with sterile/aseptic production further impede clinical translation. Regulatory frameworks for MNs remain vague, slowing the development of products that meet approval standards. This review critically examines the fundamental barriers to dissolving/degradable MN commercialization, as the most studied type of MN, while exploring promising strategies to overcome them. Advances in formulation science, fabrication techniques, and material engineering have demonstrated potential in enhancing drug loading efficiency and delivery consistency. Moreover, the establishment of clearer regulatory guidelines and scalable production strategies could significantly accelerate the commercialization of MN technology. By shifting focus toward pragmatic and clinically relevant solutions, this review aims to bridge the gap between research innovations and real-world applications, paving the way for broader implementation of MN technology in medicine.

Diagnosing cystic fibrosis in low- and middle-income countries: challenges and strategies

BACKGROUND

Cystic Fibrosis is caused by recessively inherited variants of the cystic fibrosis transmembrane regulator. It is associated with diverse clinical presentations that can affect the respiratory, digestive, and reproductive systems and inhibit nutrient absorption and growth.

MAIN BODY

The current estimation of people affected by Cystic Fibrosis is likely underestimated as this disease remains undiagnosed in countries with limited diagnostic capacity. Recent evidence indicates that Cystic Fibrosis is more common than initially thought and is likely underreported in low- and middle-income countries. The sweat chloride test remains the gold standard for diagnosing Cystic Fibrosis. However, the costs of commercially available instruments, consumables, and laboratory reagents remain relatively high for widespread implementation in low- and middle-income countries.

CONCLUSION

Alternative, cost-effective, and simpler approaches to sweat electrolyte measurement, may present more feasible options for CF diagnosis in the setting of low- and middle-income countries. Novel low-cost, point-of-care innovations for measuring sweat chloride should be explored and further validated as suitable alternatives. It will be important to consider how to implement these options and adjust the diagnostic algorithm to meet the needs of low- and middle-income countries. Future Cystic Fibrosis research in low- and middle-income countries should focus on finding a lower-cost and resource-intensive pathway for CF screening and diagnosis to improve its availability.

Remote endpoints for clinical trials in cystic fibrosis: Report from the U.S. CF foundation remote endpoints task force

The COVID-19 pandemic necessitated a rapid shift in clinical research to perform virtual visits and remote endpoint assessments, providing a key opportunity to optimize the use of remote endpoints for clinical trials in cystic fibrosis. The use of remote endpoints could allow more diverse participation in clinical trials while minimizing participant burden but must be robustly evaluated to ensure adequate performance and feasibility. In response, the Cystic Fibrosis Foundation convened the Remote Endpoint Task Force (Supplemental Table 1), a multidisciplinary group of CF researchers with remote endpoint expertise and community members tasked to better understand the current and future use of remote endpoints for clinical research. Here, we describe the current use of remote endpoints in CF clinical research, address key unanswered questions regarding their use and feasibility, and discuss the next steps to determine clinical trial readiness.