A self-assembled implantable microtubular pacemaker for wireless cardiac electrotherapy

Instantaneous Piezoelectric Nanogenerator for Pacemaker Applications

Implantable nanogenerators (NG) are a promising solution to the self-sustainable power source for cardiovascular implantable electronic devices (CIEDs), such as pacemakers, by harvesting biomechanical energy from heartbeats. Nevertheless, the conversion efficiency of mechanical energy into electrical energy has long been a significant challenge, limiting the practical application of NGs to effectively charge a power storage component. In this work, we report an instantaneous piezoelectric NG (i-PENG) design that converted the wave-like output of a regular PENG into output spikes with ~7 times higher amplitude. Due to the largely raised electrical energy, the i-PENG exhibited a substantially faster charging rate on a capacitor. The i-PENG was further integrated with a rectifier and a micro capacitor, serving as both the contact electrodes and an electrical regulating circuit. When implanted on a pig's heart surface, this integrated power system was able to charge a capacitance of 100 μF to 4 V in 13 minutes. This level of electrical power was able to operate a commercial pacemaker to provide regular stimulation signals. This study provides a design principle that can raise the electrical energy of the piezoelectricity, leading toward practical applications of PENG for powering implantable biomedical devices.

Millimetre-scale bioresorbable optoelectronic systems for electrotherapy

Temporary pacemakers are essential for the care of patients with short-lived bradycardia in post-operative and other settings1-4. Conventional devices require invasive open-heart surgery or less invasive endovascular surgery, both of which are challenging for paediatric and adult patients5-8. Other complications9-11 include risks of infections, lacerations and perforations of the myocardium, and of displacements of external power supplies and control systems. Here we introduce a millimetre-scale bioresorbable optoelectronic system with an onboard power supply and a wireless, optical control mechanism with generalized capabilities in electrotherapy and specific application opportunities in temporary cardiac pacing. The extremely small sizes of these devices enable minimally invasive implantation, including percutaneous injection and endovascular delivery. Experimental studies demonstrate effective pacing in mouse, rat, porcine, canine and human cardiac models at both single-site and multi-site locations. Pairing with a skin-interfaced wireless device allows autonomous, closed-loop operation upon detection of arrhythmias. Further work illustrates opportunities in combining these miniaturized devices with other medical implants, with an example of arrays of pacemakers for individual or collective use on the frames of transcatheter aortic valve replacement systems, to provide unique solutions that address risks for atrioventricular block following surgeries. This base technology can be readily adapted for a broad range of additional applications in electrotherapy, such as nerve and bone regeneration, wound therapy and pain management.

Self-powered biomedical devices: biology, materials, and their interfaces

Integrating biomedical electronic devices holds profound promise for advancements in healthcare and enhancing individuals' quality of life. However, the persistent challenges associated with the traditional batteries' limited lifespan and bulkiness hinder these devices' long-term functionality and consistent power supply. Here, we delve into the biology and material interfaces in self-powered medical devices by summarizing the intrinsic electric demands in humans, analyzing material and biological mechanisms for electricity generation and storage, and discussing the pathways toward self-chargeable powering. As a result, the current challenges in material designs and biological integrations emerged to shape the future directions in advancing self-powered medical devices. This paper calls on the community to integrate biology and material science to develop self-powering medical devices and improve their clinical prospects.

Advances in integrated power supplies for self-powered bioelectronic devices

Bioelectronic devices with medical functions have attracted widespread attention in recent years. Power supplies are crucial components in these devices, which ensure their stable operation. Biomedical devices that utilize external power supplies and extended electrical wires limit patient mobility and increase the risk of discomfort and infection. To address these issues, self-powered devices with integrated power supplies have emerged, including triboelectric nanogenerators, piezoelectric nanogenerators, thermoelectric generators, batteries, biofuel cells, solar cells, wireless power transfer, and hybrid energy systems. This mini-review highlights the recent advances in the power supplies utilized in these self-powered devices. A concluding section discusses the subsisting challenges and future perspectives in integrated power supply technologies and design and manufacturing of self-powered devices.

Flexible Electrode Arrays Based on a Wide Bandgap Semiconductors for Chronic Implantable Multiplexed Sensing and Heart Pacemakers

Implantable systems with chronic stability, high sensing performance, and extensive spatial-temporal resolution are a growing focus for monitoring and treating several diseases such as epilepsy, Parkinson's disease, chronic pain, and cardiac arrhythmias. These systems demand exceptional bendability, scalable size, durable electrode materials, and well-encapsulated metal interconnects. However, existing chronic implantable bioelectronic systems largely rely on materials prone to corrosion in biofluids, such as silicon nanomembranes or metals. This study introduces a multielectrode array featuring a wide bandgap (WBG) material as electrodes, demonstrating its suitability for chronic implantable applications. Our devices exhibit excellent flexibility and longevity, taking advantage of the low bending stiffness and chemical inertness in WBG nanomembranes and multimodalities for physical health monitoring, including temperature, strain, and impedance sensing. Our top-down manufacturing process enables the formation of distributed electrode arrays that can be seamlessly integrated onto the curvilinear surfaces of skins. As proof of concept for chronic cardiac pacing applications, we demonstrate the effective pacing functionality of our devices on rabbit hearts through a set of ex vivo experiments. The engineering approach proposed in this study overcomes the drawbacks of prior WBG material fabrication techniques, resulting in an implantable system with high bendability, effective pacing, and high-performance sensing.

Multi-functional adhesive hydrogel as bio-interface for wireless transient pacemaker

Traditional temporary cardiac pacemakers (TCPs), which employ transcutaneous leads and external wired power systems are battery-dependent and generally non-absorbable with rigidity, thereby necessitating surgical retrieval after therapy and resulting in potentially severe complications. Wireless and bioresorbable transient pacemakers have, hence, emerged recently, though hitting a bottleneck of unfavorable tissue-device bonding interface subject to mismatched mechanical modulus, low adhesive strength, inferior electrical performances, and infection risks. Here, to address such crux, we develop a multifunctional interface hydrogel (MIH) with superior electrical performance to facilitate efficient electrical exchange, comparable mechanical strength to natural heart tissue, robust adhesion property to enable stable device-tissue fixation (tensile strength: ∼30 kPa, shear strength of ∼30 kPa, and peel-off strength: ∼85 kPa), and good bactericidal effect to suppress bacterial growth. Through delicate integration of this versatile MIH with a leadless, battery-free, wireless, and transient pacemaker, the entire system exhibits stable and conformal adhesion to the beating heart while enabling precise and constant electrical stimulation to modulate the cardiac rhythm. It is envisioned that this versatile MIH and the proposed integration framework will have immense potential in overcoming key limitations of traditional TCPs, and may inspire the design of novel bioelectronic-tissue interfaces for next-generation implantable medical devices.

Unleashing the Potential of Electroactive Hybrid Biomaterials and Self-Powered Systems for Bone Therapeutics

The incidence of large bone defects caused by traumatic injury is increasing worldwide, and the tissue regeneration process requires a long recovery time due to limited self-healing capability. Endogenous bioelectrical phenomena have been well recognized as critical biophysical factors in bone remodeling and regeneration. Inspired by bioelectricity, electrical stimulation has been widely considered an external intervention to induce the osteogenic lineage of cells and enhance the synthesis of the extracellular matrix, thereby accelerating bone regeneration. With ongoing advances in biomaterials and energy-harvesting techniques, electroactive biomaterials and self-powered systems have been considered biomimetic approaches to ensure functional recovery by recapitulating the natural electrophysiological microenvironment of healthy bone tissue. In this review, we first introduce the role of bioelectricity and the endogenous electric field in bone tissue and summarize different techniques to electrically stimulate cells and tissue. Next, we highlight the latest progress in exploring electroactive hybrid biomaterials as well as self-powered systems such as triboelectric and piezoelectric-based nanogenerators and photovoltaic cell-based devices and their implementation in bone tissue engineering. Finally, we emphasize the significance of simulating the target tissue's electrophysiological microenvironment and propose the opportunities and challenges faced by electroactive hybrid biomaterials and self-powered bioelectronics for bone repair strategies.

Frontiers in artificial intelligence-directed light-sheet microscopy for uncovering biological phenomena and multi-organ imaging

Light-sheet fluorescence microscopy (LSFM) introduces fast scanning of biological phenomena with deep photon penetration and minimal phototoxicity. This advancement represents a significant shift in 3-D imaging of large-scale biological tissues and 4-D (space + time) imaging of small live animals. The large data associated with LSFM requires efficient imaging acquisition and analysis with the use of artificial intelligence (AI)/machine learning (ML) algorithms. To this end, AI/ML-directed LSFM is an emerging area for multi-organ imaging and tumor diagnostics. This review will present the development of LSFM and highlight various LSFM configurations and designs for multi-scale imaging. Optical clearance techniques will be compared for effective reduction in light scattering and optimal deep-tissue imaging. This review will further depict a diverse range of research and translational applications, from small live organisms to multi-organ imaging to tumor diagnosis. In addition, this review will address AI/ML-directed imaging reconstruction, including the application of convolutional neural networks (CNNs) and generative adversarial networks (GANs). In summary, the advancements of LSFM have enabled effective and efficient post-imaging reconstruction and data analyses, underscoring LSFM's contribution to advancing fundamental and translational research.

Advanced Energy Harvesters and Energy Storage for Powering Wearable and Implantable Medical Devices

Wearable and implantable active medical devices (WIMDs) are transformative solutions for improving healthcare, offering continuous health monitoring, early disease detection, targeted treatments, personalized medicine, and connected health capabilities. Commercialized WIMDs use primary or rechargeable batteries to power their sensing, actuation, stimulation, and communication functions, and periodic battery replacements of implanted active medical devices pose major risks of surgical infections or inconvenience to users. Addressing the energy source challenge is critical for meeting the growing demand of the WIMD market that is reaching valuations in the tens of billions of dollars. This review critically assesses the recent advances in energy harvesting and storage technologies that can potentially eliminate the need for battery replacements. With a key focus on advanced materials that can enable energy harvesters to meet the energy needs of WIMDs, this review examines the crucial roles of advanced materials in improving the efficiencies of energy harvesters, wireless charging, and energy storage devices. This review concludes by highlighting the key challenges and opportunities in advanced materials necessary to achieve the vision of self-powered wearable and implantable active medical devices, eliminating the risks associated with surgical battery replacement and the inconvenience of frequent manual recharging.

Robust, stretchable bioelectronic interfaces for cardiac pacing enabled by interfacial transfer of laser-induced graphene via water-response, nonswellable PVA gels

Implantable cardiac pacemakers are crucial therapeutic tools for managing various cardiac conditions. For effective pacing, electrodes should exhibit flexibility, deformability, biocompatibility, and high conductivity/capacitance. Laser-induced graphene (LIG) shows promise due to its exceptional electrical and electrochemical properties. However, the fragility of LIG and the non-stretchability of polyimide substrates pose challenges when interfacing with the beating heart. Here, we present a simple method for fabricating robust, flexible, and stretchable bioelectronic interfaces by transferring LIG via water-responsive, nonswellable polyvinyl alcohol (PVA) gels. PVA solution penetrates the porous structure of LIG and solidifies into PVA xerogel as the solvent evaporates. The robust PVA xerogel enables the smooth transfer of LIG and prevents stretching of the LIG network during this process, which helps maintain its conductivity. When hydrated, the xerogel becomes a stable, nonswellable hydrogel. This gives the LIG-PVA hydrogel (LIG-PVA-H) composites with excellent conductivity (119.7 ± 4.3Ω sq-1), high stretchability (up to 420%), reliability (cyclic stretch under 15% strain, with ∼ 1-time resistance increase), and good stability in phosphate buffered saline. The LIG-PVA-H composites were used as biointerfaces for electrocardiogram signal recording and electrical pacing on rat hearts ex vivo and in vivo, using commercial setups and a custom-built implantable wireless device. This work expands the application of LIG in bioelectronic interfaces and facilitates the development of electrotherapy for cardiac diseases.

Soft Bioelectronics for Heart Monitoring

Cardiovascular diseases (CVDs) are a predominant global health concern, accounting for over 17.9 million deaths in 2019, representing approximately 32% of all global fatalities. In North America and Europe, over a million adults undergo cardiac surgeries annually. Despite the benefits, such surgeries pose risks and require precise postsurgery monitoring. However, during the postdischarge period, where monitoring infrastructures are limited, continuous monitoring of vital signals is hindered. In this area, the introduction of implantable electronics is altering medical practices by enabling real-time and out-of-hospital monitoring of physiological signals and biological information postsurgery. The multimodal implantable bioelectronic platforms have the capability of continuous heart sensing and stimulation, in both postsurgery and out-of-hospital settings. Furthermore, with the emergence of machine learning algorithms into healthcare devices, next-generation implantables will benefit artificial intelligence (AI) and connectivity with skin-interfaced electronics to provide more precise and user-specific results. This Review outlines recent advancements in implantable bioelectronics and their utilization in cardiovascular health monitoring, highlighting their transformative deployment in sensing and stimulation to the heart toward reaching truly personalized healthcare platforms compatible with the Sustainable Development Goal 3.4 of the WHO 2030 observatory roadmap. This Review also discusses the challenges and future prospects of these devices.

Bioelectronics for electrical stimulation: materials, devices and biomedical applications

Bioelectronics is a hot research topic, yet an important tool, as it facilitates the creation of advanced medical devices that interact with biological systems to effectively diagnose, monitor and treat a broad spectrum of health conditions. Electrical stimulation (ES) is a pivotal technique in bioelectronics, offering a precise, non-pharmacological means to modulate and control biological processes across molecular, cellular, tissue, and organ levels. This method holds the potential to restore or enhance physiological functions compromised by diseases or injuries by integrating sophisticated electrical signals, device interfaces, and designs tailored to specific biological mechanisms. This review explains the mechanisms by which ES influences cellular behaviors, introduces the essential stimulation principles, discusses the performance requirements for optimal ES systems, and highlights the representative applications. From this review, we can realize the potential of ES based bioelectronics in therapy, regenerative medicine and rehabilitation engineering technologies, ranging from tissue engineering to neurological technologies, and the modulation of cardiovascular and cognitive functions. This review underscores the versatility of ES in various biomedical contexts and emphasizes the need to adapt to complex biological and clinical landscapes it addresses.

Ultrasound-nanovesicles interplay for theranostics

Nanovesicles (NVs) are widely used in the treatment and diagnosis of diseases due to their excellent vascular permeability, good biocompatibility, high loading capacity, and easy functionalization. However, their yield and in vivo penetration depth limitations and their complex preparation processes still constrain their application and development. Ultrasound, as a fundamental external stimulus with deep tissue penetration, concentrated energy sources, and good safety, has been proven to be a patient-friendly and highly efficient strategy to overcome the restrictions of traditional clinical medicine. Recent research has shown that ultrasound can drive the generation of NVs, increase their yield, simplify their preparation process, and provide direct therapeutic effects and intelligent control to enhance the therapeutic effect of NVs. In addition, NVs, as excellent drug carriers, can enhance the targeting efficiency of ultrasound-based sonodynamic therapy or sonogenetic regulation and improve the accuracy of ultrasound imaging. This review provides a detailed introduction to the classification, generation, and modification strategies of NVs, emphasizing the impact of ultrasound on the formation of NVs and summarizing the enhanced treatment and diagnostic effects of NVs combined with ultrasound for various diseases.

Flexible Metasurfaces for Multifunctional Interfaces

Optical metasurfaces, capable of manipulating the properties of light with a thickness at the subwavelength scale, have been the subject of extensive investigation in recent decades. This research has been mainly driven by their potential to overcome the limitations of traditional, bulky optical devices. However, most existing optical metasurfaces are confined to planar and rigid designs, functions, and technologies, which greatly impede their evolution toward practical applications that often involve complex surfaces. The disconnect between two-dimensional (2D) planar structures and three-dimensional (3D) curved surfaces is becoming increasingly pronounced. In the past two decades, the emergence of flexible electronics has ushered in an emerging era for metasurfaces. This review delves into this cutting-edge field, with a focus on both flexible and conformal design and fabrication techniques. Initially, we reflect on the milestones and trajectories in modern research of optical metasurfaces, complemented by a brief overview of their theoretical underpinnings and primary classifications. We then showcase four advanced applications of optical metasurfaces, emphasizing their promising prospects and relevance in areas such as imaging, biosensing, cloaking, and multifunctionality. Subsequently, we explore three key trends in optical metasurfaces, including mechanically reconfigurable metasurfaces, digitally controlled metasurfaces, and conformal metasurfaces. Finally, we summarize our insights on the ongoing challenges and opportunities in this field.

Biomaterials and bioelectronics for self-powered neurostimulation

Self-powered neurostimulation via biomaterials and bioelectronics innovation has emerged as a compelling approach to explore, repair, and modulate neural systems. This review examines the application of self-powered bioelectronics for electrical stimulation of both the central and peripheral nervous systems, as well as isolated neurons. Contemporary research has adeptly harnessed biomechanical and biochemical energy from the human body, through various mechanisms such as triboelectricity, piezoelectricity, magnetoelasticity, and biofuel cells, to power these advanced bioelectronics. Notably, these self-powered bioelectronics hold substantial potential for delivering neural stimulations that are customized for the treatment of neurological diseases, facilitation of neural regeneration, and the development of neuroprosthetics. Looking ahead, we expect that the ongoing advancements in biomaterials and bioelectronics will drive the field of self-powered neurostimulation toward the realization of more advanced, closed-loop therapeutic solutions, paving the way for personalized and adaptable neurostimulators in the coming decades.