RoboCap: Robotic mucus-clearing capsule for enhanced drug delivery in the gastrointestinal tract

Nanozyme-functionalized microalgal biohybrid microrobots in inflammatory bowel disease treatment

Oral drugs are the most direct and effective strategy for the treatment of gastrointestinal diseases. However, the harsh environment of gastric juice, lack of targeted lesion sites, and rapid metabolism present difficulties in the development of oral drugs. This research introduces a nanozyme-functionalized microalgal biohybrid microrobot (Hp@CS-PNAs@PAA) with a novel mechanism for treating inflammatory bowel disease (IBD) by leveraging the therapeutic advantages of microalgae and nanozymes. The microrobot uniquely combines the natural antioxidant capacity of Hematococcus pluvialis (Hp) microalgae and the catalytically active enzyme-mimicking properties of platinum-based nanoparticle assemblies (PNAs), enabling enhanced scavenging of reactive oxygen species (ROS) and targeted anti-inflammatory effects. Through its layered design, the Hp@CS-PNAs@PAA microrobot can navigate the gastrointestinal tract, resist degradation, and target inflamed colon tissues via electrostatic interactions, achieving extended retention and prolonged therapeutic action at inflammation sites. This study demonstrated that the synergistic anti-inflammatory effects of the microrobot derive from its ability to reduce ROS, inhibit proinflammatory cytokines, and promote the expression of tight junction proteins critical for preserving the integrity of the intestinal barrier. Both in vitro and in vivo tests in a DSS-induced colitis mouse model revealed that this system effectively restores damaged tissues by reducing oxidative stress and inflammation, indicating significant potential for clinical application in the management of colitis and similar inflammatory diseases.

Hydrogel-based 3D printing technology: From interfacial engineering to precision medicine

Advances in 3D printing technology and the development of hydrogel-based inks have significantly enhanced the potential of precision medicine, promoting progress in medical diagnosis and treatment. The development of 3D printing enables the fabrication of complex gradient structures that emulate natural tissue environments, while advancements in interface engineering facilitate the precise control of interface properties, thereby enhancing the performance of hydrogels in biomedical applications. This review focuses on the latest advancements in three critical 3D printing application areas: efficient real-time detection, drug delivery systems, and regenerative medicine. The application of 3D printing technology enhances nucleic acid-based molecular diagnostic platforms and wearable biosensors for real-time monitoring of physiological parameters, thereby providing robust support for early disease diagnosis. Additionally, it facilitates the development of targeted and controlled drug delivery systems, which offer promising methods for efficient drug utilization, and enables the construction of complex tissue and organ structures with bioactivity and functionality, providing new solutions for regenerative medicine. Collectively, these advancements propel the ongoing progress and development of precision medicine. Furthermore, the challenges associated with 3D printing technology in these three major applications are discussed along with an outlook on prospects.

Regulation of the gelatin helix-to-coil transition through chain confinements at the polymer-protein interface and protein-protein interface

Gelatin is an essential material widely used in biomedical applications due to its characteristic temperature responsivity-helix-to-coil transition. However, the current helix-to-coil transition is limited by its single-step behavior and the difficulty in designing a specific onset temperature. In this study, we investigated the fundamentals of the helix-to-coil transition with a focus on gelatin chain mobility. We observed distinctive kinetics of the helix-to-coil transition, which is resilient and can actuate in multiple steps or with a controllable onset point. This was achieved by confining the gelatin chain with a hydrophilic polymer or gelatin itself. The confinement approach serves two purposes: first, it prevents excessive mobility of the generated coils, maintaining physical resilience after the helix-to-coil transition; second, the interfacial confinement between the polymer and gelatin, referred to as polymer-protein interface confinement, restricts the helix-to-coil transition, resulting in a multistep transition process. Additionally, strong confinement at the interface between gelatins of different origins, that is protein-protein interface confinement, shifts the onset temperature to a higher point. This fundamental comprehension of helix-to-coil transition could contribute to broadening the biomedical application potential of gelatin materials. STATEMENT OF SIGNIFICANCE: Gelatin is essential in biomedical applications due to its characteristic temperature responsivity-helix-to-coil transition. Herein, we fundamentally investigated the distinctive kinetics of the helix-to-coil transition, which is resilient and can actuate in multiple steps or with a controllable onset point. This was achieved by confining the gelatin chain with a hydrophilic polymer or gelatin itself. The gelatin chain confinement prevents excessive mobility of the generated coils, maintaining physical resilience after the helix-to-coil transition. The interfacial confinement between the polymer and gelatin restricts the helix-to-coil transition, resulting in a multistep transition process. Additionally, strong confinement at the interface between gelatins of different origins shifts the onset temperature to a higher point.

Bioactive nanomotor enabling efficient intestinal barrier penetration for colorectal cancer therapy

Oral drug delivery systems had natural potential for colorectal cancer drug therapy. While the drug delivery efficiency is severely hindered by the complex intestinal barriers, especially mucus and epithelium barriers, resulting in unsatisfactory therapeutic effects and limited clinical translation. In this work, a bioactive self-thermophoretic and gas dual-driven nanomotor is developed for colorectal cancer therapy through efficient intestinal mucus and epithelial barrier penetration. The nanomotor shows intestinal mucus barrier penetration and the paracellular pathway reversibly opening properties of intestinal epithelium barrier, increasing the delivery efficiency of cisplatin by 3.5 folds. Owing to the targeted delivery of cisplatin and the reduced side effects on normal intestinal tissues, the therapeutic efficiency of the nanomotor for colorectal cancer in vivo is as high as 98.6%. With autonomous and reversible intestinal barriers penetration property, the nanoplatform may innovate the current oral drug delivery.

Advances in Oral Biomacromolecule Therapies for Metabolic Diseases

Metabolic diseases like obesity and diabetes are on the rise, and therapies with biomacromolecules (such as proteins, peptides, antibodies, and oligonucleotides) play a crucial role in their treatment. However, these drugs are traditionally injected. For patients with chronic diseases (e.g., metabolic diseases), long-term injections are accompanied by inconvenience and low compliance. Oral administration is preferred, but the delivery of biomacromolecules is challenging due to gastrointestinal barriers. In this article, we introduce the available biomacromolecule drugs for the treatment of metabolic diseases. The gastrointestinal barriers to oral drug delivery and strategies to overcome these barriers are also explored. We then discuss strategies for alleviating metabolic defects, including glucose metabolism, lipid metabolism, and energy metabolism, with oral biomacromolecules such as insulin, glucagon-like peptide-1 receptor agonists, proprotein convertase subtilisin/kexin type 9 inhibitors, fibroblast growth factor 21 analogues, and peptide YY analogues.

Capsule robots for the monitoring, diagnosis, and treatment of intestinal diseases

Current evidence suggests that the intestine as the new frontier for human health directly impacts both our physical and mental health. Therefore, it is highly desirable to develop the intelligent tool for the enhanced diagnosis and treatment of intestinal diseases. During the past 20 years, capsule robots have opened new avenues for research and clinical applications, potentially revolutionizing human health monitor, disease diagnosis and treatment. In this review, we summarize the research progress of edible multifunctional capsule robots in intestinal diseases. To begin, we introduce the correlation between the intestinal microbiome, intestinal gas and human diseases. After that, we focus on the technical structure of edible multifunctional robots. Subsequently, the biomedical applications in the monitoring, diagnosis and treatment of intestinal diseases are discussed in detail. Last but not least, the main challenges of multifunctional capsule robots during the development process are summarized, followed by a vision for future development opportunities.

Experimental and Numerical Integrated Strategy for the Optimization of Microfluidic Parameters for Eudragit L100 Nanoparticles and Microparticles

Oral immunization offers a minimally invasive administration, inducing local and systemic immune responses and facilitating mass immunization without needle-related risks. However, the gastrointestinal environment poses challenges, compromising vaccine effectiveness through enzymatic degradation and poor absorption by Peyer's patches. Advances in nanoparticle and microparticle (NP/MP) technology protect vaccines from degradation and enhance targeted release. The aim of this study was to develop pH-controlled polymeric carriers for the oral delivery of protein vaccines in order to target the antigen-presenting cells and M cells in the region of Peyer's patches. Here, myoglobin was chosen as a model protein vaccine. This study focuses on Eudragit L100, a pH-responsive polymer stable in acidic conditions and dissolving at higher pH, to develop carriers for controlled myoglobin release in the intestinal tract. A microfluidic-based manufacturing process for Eudragit L100 NPs and MPs is optimized using a comprehensive experimental and computational approach to obtain NPs and MPs through the same setup. Integrating in silico and experimental methods highlights the potential of numerical simulations to streamline final product development. This approach improves the efficiency and cost-effectiveness of NP/MP production, demonstrating how the combination of design of experiment and numerical simulations can optimize production parameters and refine manufacturing processes for advanced drug delivery systems.

Magnetic Miniature Soft Robot with Reprogrammable Drug-Dispensing Functionalities: Toward Advanced Targeted Combination Therapy

Miniature robots are untethered actuators, which have great prospects to transform targeted drug delivery because they can potentially deliver high concentrations of medicine to the disease site(s) with minimal complications. However, existing miniature robots cannot perform advanced targeted combination therapy; majority of them can at most transport one type of drug, while those that can carry multiple drugs are unable to change their drug-dispensing sequence and dosage. Furthermore, the latter robots cannot transport more than three types of drugs, selectively dispense their drugs, maintain their mobility, or release their drugs at multiple sites. Here, a millimeter-scale soft robot is proposed, which can be actuated by alternating magnetic fields to dispense four types of drugs with reprogrammable drug-dispensing sequence and dosage (dispensing rates: 0.0992-0.231 µL h-1). This robot has six degrees-of-freedom motions, and it can deliver its drugs to multiple desired sites by rolling and two-anchor crawling across unstructured environments with negligible drug leakage. Such dexterity is highly desirable and unprecedented for miniature robots with drug-dispensing capabilities. The soft robot therefore has great potential to enable advanced targeted combination therapy, where four types of drugs must be delivered to various disease sites, each with a specific sequence and dosage of drugs.

Towards multifunctional robotic pills

Robotic pills leverage the advantages of oral pharmaceutical formulations-in particular, convenient encapsulation, high loading capacity, ease of manufacturing and high patient compliance-as well as the multifunctionality, increasing miniaturization and sophistication of microrobotic systems. In this Perspective, we provide an overview of major innovations in the development of robotic pills-specifically, oral pills embedded with robotic capabilities based on microneedles, microinjectors, microstirrers or microrockets-summarize current progress and applicational gaps of the technology, and discuss its prospects. We argue that the integration of multiple microrobotic functions within oral delivery systems alongside accurate control of the release characteristics of their payload provides a basis for realizing sophisticated multifunctional robotic pills that operate as closed-loop systems.

Wearable and Implantable Soft Robots

Soft robotics presents innovative solutions across different scales. The flexibility and mechanical characteristics of soft robots make them particularly appealing for wearable and implantable applications. The scale and level of invasiveness required for soft robots depend on the extent of human interaction. This review provides a comprehensive overview of wearable and implantable soft robots, including applications in rehabilitation, assistance, organ simulation, surgical tools, and therapy. We discuss challenges such as the complexity of fabrication processes, the integration of responsive materials, and the need for robust control strategies, while focusing on advances in materials, actuation and sensing mechanisms, and fabrication techniques. Finally, we discuss the future outlook, highlighting key challenges and proposing potential solutions.

Hybrid Hydrogel-Magnet Actuated Capsule for Automatic Gut Microbiome Sampling

OBJECTIVE

Non-invasive, pill-sized capsules can provide intestinal fluid sampling to easily retrieve site-specific gut microbiome samples for studies in nutrition and chronic diseases. However, capsules with both automatic sampling and active locomotion are uncommon due to limited onboard space. This paper presents a novel hybrid hydrogel-magnet actuated capsule featuring: i) pH-responsive hydrogels that will automatically trigger fluid sampling at an environmental pH of 6 and ii) active locomotion by an external rotating magnetic field.

METHOD

Two capsule designs were fabricated (Design A: 31 μL sampling volume with dimensions 8 mm × 19 mm, Design B: 41 μL sampling volume with dimensions 8 mm × 21 mm). They were immersed in simulated gastric (pH = 1.2) and simulated intestinal fluid (pH = 6.8) to test for automatic intestinal fluid sampling. An external rotating magnetic field was applied to test for active locomotion. Finally, seal tests were performed to demonstrate sample contamination mitigation.

RESULTS

Preliminary experiments showed that sampling occurred quickly and automatically in simulated intestinal fluid at 6-15 hours, active locomotion via rotation, rolling, and tumbling were possible at magnetic field magnitudes 10 mT, oil piston seals were better at mitigating sample contamination than water piston seals, and minimum o-ring seal pressures limits of 1.95 and 1.69 kPa for Design A and B respectively were sufficient against intra-abdominal pressures.

SIGNIFICANCE

This work presents the ability to impart capsule multi-functionality in a compact manner without onboard electronics or external triggering for sampling.

Wearable and implantable biosensors: mechanisms and applications in closed-loop therapeutic systems

This review article examines the current state of wearable and implantable biosensors, offering an overview of their biosensing mechanisms and applications. We also delve into integrating these biosensors with therapeutic systems, discussing their operational principles and incorporation into closed-loop devices. Biosensing strategies are broadly categorized into chemical sensing for biomarker detection, physical sensing for monitoring physiological conditions such as pressure and temperature, and electrophysiological sensing for capturing bioelectrical activities. The discussion extends to recent developments in drug delivery and electrical stimulation devices to highlight their significant role in closed-loop therapy. By integrating with therapeutic devices, biosensors enable the modulation of treatment regimens based on real-time physiological data. This capability enhances the patient-specificity of medical interventions, an essential aspect of personalized healthcare. Recent innovations in integrating biosensors and therapeutic devices have led to the introduction of closed-loop wearable and implantable systems capable of achieving previously unattainable therapeutic outcomes. These technologies represent a significant leap towards dynamic, adaptive therapies that respond in real-time to patients' physiological states, offering a level of accuracy and effectiveness that is particularly beneficial for managing chronic conditions. This review also addresses the challenges associated with biosensor technologies. We also explore the prospects of these technologies to address their potential to transform disease management with more targeted and personalized treatment solutions.

Oral administration microrobots for drug delivery

Oral administration is the most simple, noninvasive, convenient treatment. With the increasing demands on the targeted drug delivery, the traditional oral treatment now is facing some challenges: 1) biologics how to implement the oral treatment and ensure the bioavailability is not lower than the subcutaneous injections; 2) How to achieve targeted therapy of some drugs in the gastrointestinal tract? Based on these two issues, drug delivery microrobots have shown great application prospect in oral drug delivery due to their characteristics of flexible locomotion or driven ability. Therefore, this paper summarizes various drug delivery microrobots developed in recent years and divides them into four categories according to different driving modes: magnetic-controlled drug delivery microrobots, anchored drug delivery microrobots, self-propelled drug delivery microrobots and biohybrid drug delivery microrobots. As oral drug delivery microrobots involve disciplines such as materials science, mechanical engineering, medicine, and control systems, this paper begins by introducing the gastrointestinal barriers that oral drug delivery must overcome. Subsequently, it provides an overview of typical materials involved in the design process of oral drug delivery microrobots. To enhance readers' understanding of the working principles and design process of oral drug delivery microrobots, we present a guideline for designing such microrobots. Furthermore, the current development status of various types of oral drug delivery microrobots is reviewed, summarizing their respective advantages and limitations. Finally, considering the significant concerns regarding safety and clinical translation, we discuss the challenges and prospections of clinical translation for various oral drug delivery microrobots presented in this paper, providing corresponding suggestions for addressing some existing challenges.

Recent advances in nanostructured delivery systems for vancomycin

Despite the development of new generations of antibiotics, vancomycin remained as a high-efficacy antibiotic for treating the infections caused by MRSA. Researchers have explored various nanoformulations, aiming to enhance the therapeutic efficacy of vancomycin. Such novel formulations improve the effectiveness of drug cargoes in treating bacterial infections and minimizing the risk of adverse effects. The vast of researches have focuses on enhancing the permeation ability of vancomycin through different biological barriers especially those of gastrointestinal tract. Increasing the drug loading and tuning the drug release from nanocarrier are other important goal for many conducted studies. This study reviews the newest nano-based formulations for vancomycin as a key antibiotic in treating hospitalized bacterial infections.

An ingestible, battery-free, tissue-adhering robotic interface for non-invasive and chronic electrostimulation of the gut

Ingestible electronics have the capacity to transform our ability to effectively diagnose and potentially treat a broad set of conditions. Current applications could be significantly enhanced by addressing poor electrode-tissue contact, lack of navigation, short dwell time, and limited battery life. Here we report the development of an ingestible, battery-free, and tissue-adhering robotic interface (IngRI) for non-invasive and chronic electrostimulation of the gut, which addresses challenges associated with contact, navigation, retention, and powering (C-N-R-P) faced by existing ingestibles. We show that near-field inductive coupling operating near 13.56 MHz was sufficient to power and modulate the IngRI to deliver therapeutically relevant electrostimulation, which can be further enhanced by a bio-inspired, hydrogel-enabled adhesive interface. In swine models, we demonstrated the electrical interaction of IngRI with the gastric mucosa by recording conductive signaling from the subcutaneous space. We further observed changes in plasma ghrelin levels, the "hunger hormone," while IngRI was activated in vivo, demonstrating its clinical potential in regulating appetite and treating other endocrine conditions. The results of this study suggest that concepts inspired by soft and wireless skin-interfacing electronic devices can be applied to ingestible electronics with potential clinical applications for evaluating and treating gastrointestinal conditions.

Insect-Scale Biped Robots Based on Asymmetrical Friction Effect Induced by Magnetic Torque

Multimodal and controllable locomotion in complex terrain is of great importance for practical applications of insect-scale robots. Robust locomotion plays a particularly critical role. In this study, a locomotion mechanism for magnetic robots based on asymmetrical friction effect induced by magnetic torque is revealed and defined. The defined mechanism overcomes the design constraints imposed by both robot and substrate structures, enabling the realization of multimodal locomotion on complex terrains. Drawing inspiration from human walking and running locomotion, a biped robot based on the mechanism is proposed, which not only exhibits rapid locomotion across substrates with varying friction coefficients but also achieves precise locomotion along patterned trajectories through programmed controlling. Furthermore, apart from its exceptional locomotive capabilities, the biped robot demonstrates remarkable robustness in terms of load-carrying and weight-bearing performance. The presented locomotion and mechanism herein introduce a novel concept for designing magnetic robots while offering extensive possibilities for practical applications in insect-scale robotics.

Computational insights into colonic motility: Mechanical role of mucus in homeostasis and inflammation

Colonic motility plays a vital role in maintaining proper digestive function. The rhythmic contractions and relaxations facilitate various types of motor functions that generate both propulsive and non-propulsive motility modes which in turn generate shear stresses on the epithelial surface. However, the interplay between colonic mucus, shear stress, and epithelium remains poorly characterized. Here, we present a colonic computational model that describes the potential roles of mucus and shear stress in both homeostasis and ulcerative colitis (UC). Our model integrates several key features, including the properties of the mucus bilayer and faeces, intraluminal pressure, and crypt characteristics to predict the time-space mosaic of shear stress. We show that the mucus thickness which could vary based on the severity of UC, may significantly reduce the amount of shear stress applied to the colonic crypts and effect faecal velocity. Our model also reveals an important spatial shear stress variance in homeostatic colonic crypts that suggests shear stress may have a modulatory role in epithelial cell migration, differentiation, apoptosis, and immune surveillance. Together, our study uncovers the rather neglected roles of mucus and shear stress in intestinal cellular processes during homeostasis and inflammation.

Novel Drug Delivery Systems: An Important Direction for Drug Innovation Research and Development

The escalating demand for enhanced therapeutic efficacy and reduced adverse effects in the pharmaceutical domain has catalyzed a new frontier of innovation and research in the field of pharmacy: novel drug delivery systems. These systems are designed to address the limitations of conventional drug administration, such as abbreviated half-life, inadequate targeting, low solubility, and bioavailability. As the disciplines of pharmacy, materials science, and biomedicine continue to advance and converge, the development of efficient and safe drug delivery systems, including biopharmaceutical formulations, has garnered significant attention both domestically and internationally. This article presents an overview of the latest advancements in drug delivery systems, categorized into four primary areas: carrier-based and coupling-based targeted drug delivery systems, intelligent drug delivery systems, and drug delivery devices, based on their main objectives and methodologies. Additionally, it critically analyzes the technological bottlenecks, current research challenges, and future trends in the application of novel drug delivery systems.

Integrated Sensors for Soft Medical Robotics

Minimally invasive procedures assisted by soft robots for surgery, diagnostics, and drug delivery have unprecedented benefits over traditional solutions from both patient and surgeon perspectives. However, the translation of such technology into commercialization remains challenging. The lack of perception abilities is one of the obstructive factors paramount for a safe, accurate and efficient robot-assisted intervention. Integrating different types of miniature sensors onto robotic end-effectors is a promising trend to compensate for the perceptual deficiencies in soft robots. For example, haptic feedback with force sensors helps surgeons to control the interaction force at the tool-tissue interface, impedance sensing of tissue electrical properties can be used for tumor detection. The last decade has witnessed significant progress in the development of multimodal sensors built on the advancement in engineering, material science and scalable micromachining technologies. This review article provides a snapshot on common types of integrated sensors for soft medical robots. It covers various sensing mechanisms, examples for practical and clinical applications, standard manufacturing processes, as well as insights on emerging engineering routes for the fabrication of novel and high-performing sensing devices.

Magnetically driven capsules with multimodal response and multifunctionality for biomedical applications

Untethered capsules hold clinical potential for the diagnosis and treatment of gastrointestinal diseases. Although considerable progress has been achieved recently in this field, the constraints imposed by the narrow spatial structure of the capsule and complex gastrointestinal tract environment cause many open-ended problems, such as poor active motion and limited medical functions. In this work, we describe the development of small-scale magnetically driven capsules with a distinct magnetic soft valve made of dual-layer ferromagnetic soft composite films. A core technological advancement achieved is the flexible opening and closing of the magnetic soft valve by using the competitive interactions between magnetic gradient force and magnetic torque, laying the foundation for the functional integration of both drug release and sampling. Meanwhile, we propose a magnetic actuation strategy based on multi-frequency response control and demonstrate that it can achieve effective decoupled regulation of the capsule's global motion and local responses. Finally, through a comprehensive approach encompassing ideal models, animal ex vivo models, and in vivo assessment, we demonstrate the versatility of the developed magnetic capsules and their multiple potential applications in the biomedical field, such as targeted drug delivery and sampling, selective dual-drug release, and light/thermal-assisted therapy.

Miniaturized Capsule System Toward Real-Time Electrochemical Detection of H2 S in the Gastrointestinal Tract

Hydrogen sulfide (H2 S) is a gaseous inflammatory mediator and important signaling molecule for maintaining gastrointestinal (GI) homeostasis. Excess intraluminal H2 S in the GI tract has been implicated in inflammatory bowel disease and neurodegenerative disorders; however, the role of H2 S in disease pathogenesis and progression is unclear. Herein, an electrochemical gas-sensing ingestible capsule is developed to enable real-time, wireless amperometric measurement of H2 S in GI conditions. A gold (Au) three-electrode sensor is modified with a Nafion solid-polymer electrolyte (Nafion-Au) to enhance selectivity toward H2 S in humid environments. The Nafion-Au sensor-integrated capsule shows a linear current response in H2 S concentration ranging from 0.21 to 4.5 ppm (R2 = 0.954) with a normalized sensitivity of 12.4% ppm-1 when evaluated in a benchtop setting. The sensor proves highly selective toward H2 S in the presence of known interferent gases, such as hydrogen (H2 ), with a selectivity ratio of H2 S:H2 = 1340, as well as toward methane (CH4 ) and carbon dioxide (CO2 ). The packaged capsule demonstrates reliable wireless communication through abdominal tissue analogues, comparable to GI dielectric properties. Also, an assessment of sensor drift and threshold-based notification is investigated, showing potential for in vivo application. Thus, the developed H2 S capsule platform provides an analytical tool to uncover the complex biology-modulating effects of intraluminal H2 S.

Electromechanical convective drug delivery devices for overcoming diffusion barriers

Drug delivery systems which rely on diffusion for mass transport, such as hydrogels and nanoparticles, have enhanced drug targeting and extended delivery profiles to improve health outcomes for patients suffering from diseases including cancer and diabetes. However, diffusion-dependent systems often fail to provide >0.01-1% drug bioavailability when transporting macromolecules across poorly permeable physiological tissues such as the skin, solid tumors, the blood-brain barrier, and the gastrointestinal walls. Convection-enabling robotic ingestibles, wearables, and implantables physically interact with tissue walls to improve bioavailability in these settings by multiple orders of magnitude through convective mass transfer, the process of moving drug molecules via bulk fluid flow. In this Review, we compare diffusive and convective drug delivery systems, highlight engineering techniques that enhance the efficacy of convective devices, and provide examples of synergies between the two methods of drug transport.

Review article: Current status and future directions of ingestible electronic devices in gastroenterology

BACKGROUND

Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices.

AIM

To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract.

METHODS

We performed a detailed literature search to inform this narrative review.

RESULTS

Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment.

CONCLUSIONS

The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.

Bile Is a Selective Elevator for Mucosal Mechanics and Transport

Mucus mechanically protects the intestinal epithelium and impacts the absorption of drugs, with a largely unknown role for bile. We explored the impacts of bile on mucosal biomechanics and drug transport within mucus. Bile diffused with square-root-of-time kinetics and interplayed with mucus, leading to transient stiffening captured in Brillouin images and a concentration-dependent change from subdiffusive to Brownian-like diffusion kinetics within the mucus demonstrated by differential dynamic microscopy. Bile-interacting drugs, Fluphenazine and Perphenazine, diffused faster through mucus in the presence of bile, while Metoprolol, a drug with no bile interaction, displayed consistent diffusion. Our findings were corroborated by rat studies, where co-dosing of a bile acid sequestrant substantially reduced the bioavailability of Perphenazine but not Metoprolol. We clustered over 50 drugs based on their interactions with bile and mucin. Drugs that interacted with bile also interacted with mucin but not vice versa. This study detailed the dynamics of mucus biomechanics under bile exposure and linked the ability of a drug to interact with bile to its abbility to interact with mucus.

Smart pills and drug delivery devices enabling next generation oral dosage forms

Oral dosage forms are the preferred solution for systemic treatment and prevention of disease conditions. However, traditional dosage forms face challenges regarding treatment adherence and delivery of biologics. Oral therapies that require frequent administrations face difficulties with patient compliance. In addition, only a few peptide- and protein-based drugs have been commercialized for oral administration so far, presenting a bioavailability that is generally low. Therefore, research and development on novel formulation strategies for oral drug delivery has bloomed massively in the last decade to overcome these challenges. On the one hand, approaches based on lumen-release of drugs such as 3D-printed capsules and prolonged gastric residence dosage forms have been explored to offer personalized medicine to the patient and reduce frequent dosing of small drug compounds that are currently in the market as powdered tablet or capsules. On the other hand, strategies based on mucus interfacing such as gastrointestinal patches, or even epithelium injections have been investigated in order to enhance the permeability of biologic macromolecules, which are mostly commercialized in the form of subcutaneous injections. Despite the fact that these methods are at an early development stage, promising results have been revealed in terms of personalized medicine and improved bioavailability. In this review, we offer a critical overview of novel ingestible millimeter-sized devices and technologies for oral drug delivery that are currently used in the clinic as well as those that could emerge on the market in a not too distant future.

A Planar-Type Micro-Biopsy Tool for a Capsule-Type Endoscope Using a One-Step Nickel Electroplating Process

Millimeter-scale biopsy tools combined with an endoscope instrument have been widely used for minimal invasive surgery and medical diagnosis. Recently, a capsule-type endoscope was developed, which requires micromachining to fabricate micro-scale biopsy tools that have a sharp tip and other complex features, e.g., nanometer-scale end-tip sharpness and a complex scalpel design. However, conventional machining approaches are not cost-effective for mass production and cannot fabricate the micrometer-scale features needed for biopsy tools. Here, we demonstrate an electroplated nickel micro-biopsy tool which features a planar shape and is suitable to be equipped with a capsule-type endoscope. Planar-type micro-biopsy tools are designed, fabricated, and evaluated through in vitro tissue dissection experiments. Various micro-biopsy tools with a long shaft and sharp tip can be easily fabricated using a thick photoresist (SU8) mold via a simple one-step lithography and nickel electroplating process. The characteristics of various micro-biopsy tool design features, including a tip taper angle, different tool geometries, and a cutting scalpel, are evaluated for efficient tissue extraction from mice intestine. These fabricated biopsy tools have shown appropriate strength and sharpness with a sufficient amount of tissue extraction for clinical applications, e.g., cancer tissue biopsy. These micro-scale biopsy tools could be easily integrated with a capsule-type endoscope and conventional forceps.

Fabrication of a protein-dextran conjugates formed oral nanoemulsion and its application to deliver the essential oil from Alpinia zerumbet Fructus

The injury of vascular endothelial cells caused by high glucose (HG) is one of the driving factors of vascular complications of diabetes. Oral administration is the most common route of administration for the treatment of diabetes and its vascular complications. Essential oil extracts from Chinese medicine possess potential therapeutic effects on vascular endothelial injury. However, low solubility and volatility of essential oils generally result in poor oral absorption. Development of nanocarriers for essential oils is a promising strategy to overcome the physiological barriers of oral absorption. In this study, a nanoemulsion composed of bovine serum albumin (BSA)-dextran sulfate (DS) conjugate and sodium deoxycholate (SD) was constructed. The nanoemulsions were verified with promoted oral absorption and prolonged circulation time. After the primary evaluation of the nanoemulsion, essential oil from Alpinia zerumbet Fructus (EOFAZ)-loaded nanoemulsion (denoted as EOFAZ@BD5/S) was prepared and characterized. Compared to the free EOFAZ, EOFAZ@BD5/S increased the protective effects on HG-induced HUVEC injury in vitro and ameliorative effects on the vascular endothelium disorder and tunica media fibroelastosis in a T2DM mouse model. Collectively, this study provides a nanoemulsion for the oral delivery of essential oils, which holds strong promise in the treatment of diabetes-induced vascular endothelial injury.

Communication Protocols Integrating Wearables, Ingestibles, and Implantables for Closed-Loop Therapies

Body-conformal sensors and tissue interfacing robotic therapeutics enable the real-time monitoring and treatment of diabetes, wound healing, and other critical conditions. By integrating sensors and drug delivery devices, scientists and engineers have developed closed-loop drug delivery systems with on-demand therapeutic capabilities to provide just-in-time treatments that correspond to chemical, electrical, and physical signals of a target morbidity. To enable closed-loop functionality in vivo, engineers utilize various low-power means of communication that reduce the size of implants by orders of magnitude, increase device lifetime from hours to months, and ensure the secure high-speed transfer of data. In this review, we highlight how communication protocols used to integrate sensors and drug delivery devices, such as radio frequency communication (e.g., Bluetooth, near-field communication), in-body communication, and ultrasound, enable improved treatment outcomes.

Intestinal Villi-Inspired Mathematically Base-Layer Engineered Microneedles (IMBEMs) for Effective Molecular Exchange during Biomarker Enrichment and Drug Deposition in Diversified Mucosa

The mucosa-interfacing systems based on bioinspired engineering design for sampling/drug delivery have manifested crucial potential for the monitoring of infectious diseases and the treatment of mucosa-related diseases. However, their efficiency and validity are severely restricted by limited contact area for molecular transfer and dissatisfactory capture/detachment capability. Herein, inspired by the multilayer villus structure of the small intestine that enables high nutrient absorption, a trigonometric function-based periodic pattern was fabricated and integrated on the base layer of the microneedle patch, exhibiting a desirable synergistic effect with needle tips for deep sample enrichment and promising molecular transfer, significantly improving the device-mucosa bidirectional interaction. Moreover, mathematical modeling and finite element analysis were adopted to visualize and quantify the microcosmic molecular transmission process, guiding parameter optimization in actual situation. Encouragingly, these intestinal villi-inspired mathematically base-layer engineered microneedles (IMBEMs) have demonstrated distinguished applicability among mucosa tissue with varying surface curvatures, tissue toughness, and local environments, and simultaneously, have gained favorable support from healthy volunteers receiving preliminary test of IMBEMs patches. Overall, validated by numerous in vitro and in vivo tests, the IMBEMs were confirmed to act as a promising candidate to facilitate mucosa-based sampling and topical drug delivery, indicating highly clinical translation potential.

Gastrointestinal Delivery of an mRNA Vaccine Using Immunostimulatory Polymeric Nanoparticles

mRNA vaccines can be translated into protein antigens, in vivo, to effectively induce humoral and cellular immunity against these proteins. While current mRNA vaccines have generated potent immune responses, the need for ultracold storage conditions (- 80 °C) and healthcare professionals to administer the vaccine through the parenteral route has somewhat limited their distribution in rural areas and developing countries. Overcoming these challenges stands to transform future deployment of mRNA vaccines. In this study, we developed an mRNA vaccine that can trigger a systemic immune response through administration via the gastrointestinal (GI) tract and is stable at 4 °C. A library of cationic branched poly(β-amino ester) (PBAE) polymers was synthesized and characterized, from which a polymer with high intracellular mRNA delivery efficiency and immune stimulation capacity was down-selected. mRNA vaccines made with the lead polymer-elicited cellular and humoral immunity in mice. Furthermore, lyophilization conditions of the formulation were optimized to enable storage under refrigeration. Our results suggest that PBAE nanoparticles are potent mRNA delivery platforms that can elicit B cell and T cell activation, including antigen-specific cellular and humoral responses. This system can serve as an easily administrable, potent oral mRNA vaccine.

Microrobots for Biomedicine: Unsolved Challenges and Opportunities for Translation

Microrobots are being explored for biomedical applications, such as drug delivery, biological cargo transport, and minimally invasive surgery. However, current efforts largely focus on proof-of-concept studies with nontranslatable materials through a "design-and-apply" approach, limiting the potential for clinical adaptation. While these proof-of-concept studies have been key to advancing microrobot technologies, we believe that the distinguishing capabilities of microrobots will be most readily brought to patient bedsides through a "design-by-problem" approach, which involves focusing on unsolved problems to inform the design of microrobots with practical capabilities. As outlined below, we propose that the clinical translation of microrobots will be accelerated by a judicious choice of target applications, improved delivery considerations, and the rational selection of translation-ready biomaterials, ultimately reducing patient burden and enhancing the efficacy of therapeutic drugs for difficult-to-treat diseases.

Transformative Materials for Interfacial Drug Delivery

Drug delivery systems (DDS) are designed to temporally and spatially control drug availability and activity. They assist in improving the balance between on-target therapeutic efficacy and off-target toxic side effects. DDS aid in overcoming biological barriers encountered by drug molecules upon applying them via various routes of administration. They are furthermore increasingly explored for modulating the interface between implanted (bio)medical materials and host tissue. Herein, an overview of the biological barriers and host-material interfaces encountered by DDS upon oral, intravenous, and local administration is provided, and material engineering advances at different time and space scales to exemplify how current and future DDS can contribute to improved disease treatment are highlighted.

Recent progress of micro/nanomotors to overcome physiological barriers in the gastrointestinal tract

Oral administration is a convenient administration route for gastrointestinal disease therapy with good patient compliance. But the nonspecific distribution of the oral drugs may cause serious side effects. In recent years, oral drug delivery systems (ODDS) have been applied to deliver the drugs to the gastrointestinal disease sites with decreased side effects. However, the delivery efficiency of ODDS is tremendously limited by physiological barriers in the gastrointestinal sites, such as the long and complex gastrointestinal tract, mucus layer, and epithelial barrier. Micro/nanomotors (MNMs) are micro/nanoscale devices that transfer various energy sources into autonomous motion. The outstanding motion characteristics of MNMs inspired the development of targeted drug delivery, especially the oral drug delivery. However, a comprehensive review of oral MNMs for the gastrointestinal diseases therapy is still lacking. Herein, the physiological barriers of ODDS were comprehensively reviewed. Afterward, the applications of MNMs in ODDS for overcoming the physiological barriers in the past 5 years were highlighted. Finally, future perspectives and challenges of MNMs in ODDS are discussed as well. This review will provide inspiration and direction of MNMs for the therapy of gastrointestinal diseases, pushing forward the clinical application of MNMs in oral drug delivery.

Better therapeutic effect of oral administration of GS441524 compared with GC376

FIP is a fatal feline disease caused by FIPV. Two drugs (GS441524 and GC376) target FIPV and have good therapeutic effect when administered by subcutaneous injection. However, subcutaneous injection has limitations compared with oral administration. Additionally, the oral efficacy of the two drugs has not been determined. Here, GS441524 and GC376 were shown to efficiently inhibit FIPV-rQS79 (recombination virus with a full-length field type I FIPV and the spike gene replaced with type II FIPV) and FIPV II (commercially available type II FIPV 79-1146) at a noncytotoxic concentration in CRFK cells. Moreover, the effective oral dose was determined via the in vivo pharmacokinetics of GS441524 and GC376. We conducted animal trials in three dosing groups and found that while GS441524 can effectively reducing the mortality of FIP subjects at a range of doses, GC376 only reducing the mortality rate at high doses. Additionally, compared with GC376, oral GS441524 has better absorption, slower clearance and a slower rate of metabolism. Furthermore, there was no significant difference between the oral and subcutaneous pharmacokinetic parameters. Collectively, our study is the first to evaluate the efficacy of oral GS441524 and GC376 using a relevant animal model. We also verified the reliability of oral GS441524 and the potential of oral GC376 as a reference for rational clinical drug use. Furthermore, the pharmacokinetic data provide insights into and potential directions for the optimization of these drugs.

Soft robot-enabled controlled release of oral drug formulations

The creation of highly effective oral drug delivery systems (ODDSs) has long been the main objective of pharmaceutical research. Multidisciplinary efforts involving materials, electronics, control, and pharmaceutical sciences encourage the development of robot-enabled ODDSs. Compared with conventional rigid robots, soft robots potentially offer better mechanical compliance and biocompatibility with biological tissues, more versatile shape control and maneuverability, and multifunctionality. In this paper, we first describe and highlight the importance of manipulating drug release kinetics, i.e. pharmaceutical kinetics. We then introduce an overview of state-of-the-art soft robot-based ODDSs comprising resident, shape-programming, locomotive, and integrated soft robots. Finally, the challenges and outlook regarding future soft robot-based ODDS development are discussed.

Microrobots for Targeted Delivery and Therapy in Digestive System

Untethered miniature robots enable targeted delivery and therapy deep inside the gastrointestinal tract in a minimally invasive manner. By combining actuation systems and imaging tools, significant progress has been made toward the development of functional microrobots. These robots can be actuated by external fields and fuels while featuring real-time tracking feedback toward certain regions and can perform the therapeutic process by rational exertion of the local environment of the gastrointestinal tract (e.g., pH, enzyme). Compared with conventional surgical tools, such as endoscopic devices and catheters, miniature robots feature minimally invasive diagnosis and treatment, multifunctionality, high safety and adaptivity, embodied intelligence, and easy access to tortuous and narrow lumens. In addition, the active motion of microrobots enhances local penetration and retention of drugs in tissues compared to common passive oral drug delivery. Based on the dissimilar microenvironments in the various sections of the gastrointestinal tract, this review introduces the advances of miniature robots for minimally invasive targeted delivery and therapy of diseases along the gastrointestinal tract. The imaging modalities for the tracking and their application scenarios are also discussed. We finally evaluate the challenges and barriers that retard their applications and hint on future research directions in this field.

Clearing away barriers to oral drug delivery

Ingestible devices have the potential to clear away barriers to oral delivery of biologics to improve drug bioavailability.