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Open Access 01-12-2018 | Research article

Evaluation of continuous constant current and continuous pulsed current in sweat induction for cystic fibrosis diagnosis

Authors: Carla Cristina Souza Gomez, Fernando Augusto Lima Marson, Maria Fátima Servidoni, Antônio Fernando Ribeiro, Maria Ângela Gonçalves Oliveira Ribeiro, Veruska Acioli Lopes Gama, Eduardo Tavares Costa, José Dirceu Ribeiro, Francisco Ubaldo Vieira Junior

Published in: BMC Pulmonary Medicine | Issue 1/2018

Abstract

Background

The sweat test (ST) is the gold standard for the diagnosis of cystic fibrosis (CF). However, little is known about sweat induction using different types of currents and waves. In this context, our objective was to develop a device to induce sweat and compare the use of continuous constant current (CCC) and continuous pulsed current (CPC) in individuals with CF and healthy controls.

Methods

A prospective cross-sectional study with experimental intervention. The variables of gender, ethnicity, age, and body mass index (BMI) were considered. The method of Gibson and Cooke was used, and the following markers were evaluated: sweat weight, electrical impedance, sufficient sweat amount, and CF diagnosis. Triangular (TPC) or sinusoidal (SPC) pulsed current was applied to the right arm, and CCC was applied to the left arm.

Results

The study analyzed 260 individuals, 141/213 (54.2%) were female participants, 135/260 (51.9%) were Caucasians. The distribution of individuals by concentration of chloride at the ST was: (CF) 26/260 (10%); (borderlines) 109/260 (41.9%); (healthy) 97/260 (37.3%); (insufficient weight in sweat) 28/260 (10.8%). No association was observed between the sufficient sweat amount to perform the ST when we compared the currents. However, the SPC showed a higher amount of sweat weight. Using Bland and Altman plot considering the agreement between the sweat chloride values achieved from CPC [SPC and TPC] and CCC, there was no proportional bias and mean values are unrelated and only explain less than 8% of the variation. Moreover, TPC presented higher electrical impedance when compared with SPC and CCC. SPC presented lower electrical impedance and higher sweat weight than CCC. Male participants presented lower electrical impedance and higher sweat weight with CCC and TPC, and higher sweat weight with SPC.

Conclusions

The evaluated currents are safe and able to induce and produce sweat in sufficient quantities for the ST. SPC presented lower electrical impedance when compared with other currents. The use of SPC is recommended to induce sweat in patients with sweat problems. Finally, ethnicity, gender, age and BMI did not influence sweat induction at the ST, and no side effect was observed in our study.

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Gibson LE, Cooke RE. A test for concentration of electrolytes in sweat in cystic fibrosis of the pancreas utilizing pilocarpine iontophoresis. Pediatrics. 1959;23:545–9.PubMed

Collie JT, Massie RJ, Jones OA, LeGrys VA, Greaves RF. Sixty-five years since the New York heat wave: advances in sweat testing for cystic fibrosis. Pediatr Pulmonol. 2014;49:106–17. https://doi.org/10.1002/ppul.22945.CrossRefPubMed

Marson FAL, Bertuzzo CS, Ribeiro JD. Personalized drug therapy in cystic fibrosis: from fiction to reality. Curr Drug Targets. 2015;16:1007. https://doi.org/10.2174/1389450115666141128121118.CrossRef

Marson FAL, Bertuzzo CS, Ribeiro JD. Personalized or precision medicine? The example of cystic fibrosis. Front Pharmacol. 2017;8:390. https://doi.org/10.3389/fphar.2017.00390.CrossRefPubMedPubMedCentral

Marson FAL. Disease-modifying genetic factors in cystic fibrosis. Curr Opin Pulm Med. 2018;24(3):296–308. https://doi.org/10.1097/MCP.0000000000000479.CrossRefPubMed

LeGrys VA, Yankaskas JR, Quittell LM, Marshall BC, Mogayzel PJ Jr. Diagnostic sweat testing: the cystic fibrosis foundation guidelines. J Pediatr. 2007;151:85–9. https://doi.org/10.1016/j.jpeds.2007.03.002.CrossRefPubMed

Castellani C, Southern KW, Brownlee K, Dankert RJ, Duff A, Farrell M, et al. European best practice guidelines for cystic fibrosis neonatal screening. J Cyst Fibros. 2009;8(Suppl 3):153–73. https://doi.org/10.1016/j.jcf.2009.01.004.CrossRefPubMed

Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, et al. Diagnosis of cystic fibrosis: consensus guidelines from the cystic fibrosis foundation. J Pediatr. 2017;181:S4–S15. https://doi.org/10.1016/j.jpeds.2016.09.064.CrossRef

Kirk JM. Inconsistencies in sweat testing in UK laboratories. Arch Dis Child. 2000;82:425–7. https://doi.org/10.1136/adc.82.5.425.CrossRefPubMedPubMedCentral

10.

Beauchamp M, Grey V, Lands LC. Sweat collection for testing in Canadian cystic fibrosis centers: is it optimal? Clin Biochem. 2005;38:934–7. https://doi.org/10.1016/j.clinbiochem.2005.05.007.CrossRefPubMed

11.

Mackay R, George P, Kirk J. Sweat testing for cystic fibrosis: a review of New Zealand laboratories. J Paediatr Child Health. 2006;42:160–4. https://doi.org/10.1111/j.1440-1754.2006.00822.x.CrossRefPubMed

12.

Barben J, Casaulta C, Spinas R, Schöni MH. Sweat testing practice in Swiss hospitals. Swiss Med Wkly. 2007;137:192–8. https://doi.org/10.4414/smw.2007.11719.CrossRefPubMed

13.

Cirilli N, Podan R, Raia V. Audit of sweat testing: a first report from Italian cystic fibrosis centres. J Cyst Fibros. 2008;7(Suppl 5):415–22. https://doi.org/10.1016/j.jcf.2008.03.005.CrossRefPubMed

14.

Castellani C, Conway S, Smyth AR, Stern M, Elborn JS. Standards of care for cystic fibrosis ten years later. J Cyst Fibros. 2014;13(Suppl 1):S1–2. https://doi.org/10.1016/j.jcf.2014.03.008.CrossRefPubMed

15.

Heap S, Griffiths P, Elborn S, Harris B, Wayte B, Wallis CE, Weller P, Sheldrake A, Nixon W, Lacy D. Guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK v. 2. An evidence-based guideline; 2014. p. 1–151.

16.

Massie J, Greaves R, Metz M, Wiley V, Graham P, Shepherd S, Mackay R. Australasian guideline (2^nd edition): an annex to the CLSI and UK guidelines for the performance of the sweat test for the diagnosis of cystic fibrosis. Clin Biochem Rev. 2017;38(Suppl 3):115–30.PubMedPubMedCentral

17.

Salvatore M, Floridia G, Amato A, Censi F, Carta C, de Stefano MC, et al. The Italian pilot external quality assessment program for cystic fibrosis sweat test. Clin Biochem. 2016;49(Suppl 7–8):601–5. https://doi.org/10.1016/j.clinbiochem.2015.12.014.CrossRefPubMed

18.

Webster HL. A clinical appraisal of cystic fibrosis sweat-testing guidelines. Am Clin Lab. 2001;20:39–42.PubMed

19.

Hammond KB, Nelson L, Gibson LE. Clinical evaluation of the macroduct sweat collection system and conductivity analyzer in the diagnosis of cystic fibrosis. J Pediatr. 1994;124:255–60. https://doi.org/10.1016/S0022-3476(94)70314-0.CrossRefPubMed

20.

Servidoni MF, Gomez CCS, Marson FAL, Toro AADC, Ribeiro MAGO, Ribeiro JD, et al. Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil. J Bras Pneumol. 2017;43(Suppl 2):121–8. https://doi.org/10.1590/S1806-37562016000000076.CrossRefPubMedPubMedCentral

21.

Bagniefski T, Burnette RR. A comparison of pulsed and continuous current iontophoresis. J Control Release. 1990;11:113–22. https://doi.org/10.1016/0168-3659(90)90125-D.CrossRef

22.

Knoblauch P, Moll F. In vitro pulsatile and continuous transdermal delivery of buserelin by iontophoresis. J Control Release. 1993;26(Suppl 3):203–12. https://doi.org/10.1016/0168-3659(93)90187-A.CrossRef

23.

Gomez CC, Servidoni MF, Marson FAL, Canavezi PJ, Vinagre AM, Costa ET, et al. Pulsed direct and constant direct currents in the pilocarpine iontophoresis sweat chloride test. BMC Pulm Med. 2014;14:198. https://doi.org/10.1186/1471-2466-14-198.CrossRefPubMedPubMedCentral

24.

The Clinical and Laboratory Standards Institute (CLSI). Sweat testing: sample collection and quantitative chloride analysis; approved guideline - third edition. C34-A3:2009. Wayne: CLSI; 2009.

25.

Faria AG, Marson FAL, Gomez CC, Ribeiro MAGO, Morais L, Servidoni M, et al. Quality of sweat test (ST) based on the proportion of sweat sodium (Na) and sweat chloride (Cl) as diagnostic parameter of cystic fibrosis: are we on the right way? Diagn Pathol. 2016;11(Suppl 1):103. https://doi.org/10.1186/s13000-016-0555-6.CrossRefPubMedPubMedCentral

26.

Faria AG, Marson FAL, Gomez CCS, Servidoni MF, Ribeiro AF, Ribeiro JD. Thirty years of sweat chloride testing at one referral center. Front Pediatr. 2017;5:222. https://doi.org/10.3389/fped.2017.00222.CrossRefPubMedPubMedCentral

27.

Faria AG, Marson FAL, Ribeiro AF, Ribeiro JD. The correlation between age and sweat chloride levels in sweat tests. Rev Port Pneumol (2006). 2017;23(Suppl 4):227–30. https://doi.org/10.1016/j.rppnen.2016.11.001.CrossRef

28.

Wallis C. Diagnosing cystic fibrosis: blood, sweat, and tears. Arch Dis Child. 1997;76:85–8. https://doi.org/10.1136/adc.76.2.85.CrossRefPubMedPubMedCentral

29.

Taylor CJ, Hardcastle J, Southern KW. Physiological measurements confirming the diagnosis of cystic fibrosis: the sweat test and measurements of transepithelial potential difference. Paediatr Respir Rev. 2009;10:220–6. https://doi.org/10.1016/j.prrv.2009.05.002.CrossRefPubMed

30.

Beauchamp M, Lands LC. Sweat-testing: a review of current technical requirements. Pediatr Pulmonol. 2005;39:507–11. https://doi.org/10.1002/ppul.20226.CrossRefPubMed

31.

LeGrys VA. Sweat analysis proficiency testing for cystic fibrosis. Pediatr Pulmonol. 2000;30(Suppl 6):476–80. https://doi.org/10.1002/1099-0496(200012)30:6<476::AID-PPUL7>3.0.CO;2-O.CrossRefPubMed

32.

Jakobsson BM, Salomonnson S, Hjelte L. Sweat test in Sweden 2002 - a cross sectional study. J Cyst Fibros. 2004;(Suppl 1):E441.

33.

Naehrlich L. Sweat testing practices in German cystic fibrosis centers. Klim Padiatr. 2007;219(Suppl 2):70–3.CrossRef

34.

Umino M. Research of transcutaneous and transmucosal drug delivery and it’s perspective. J Stomatol Soc Jpn. 2009;76:1–7.

35.

Ledger PW. Skin biological issues in electrically enhanced transdermal delivery. Adv Drug Deliv Ver. 1992;9:289–307. https://doi.org/10.1016/0169-409X(92)90027-N.CrossRef

36.

Chien YW, Lelawongs P, Siddiqui O, Sun Y, Shi WM. Facilitated transdermal delivery of therapeutic peptides and proteins by iontophoretic delivery devices. J Control Release. 1990;13:263–78. https://doi.org/10.1016/0168-3659(90)90017-N.CrossRef

37.

Panzade P, Heda A, Puranik P, Patni M, Mogal V. Enhanced transdermal delivery of granisetron by using iontophoresis. Iran J Pharm Res. 2012;11(Suppl 2):503–12. https://doi.org/10.15272/jmpi.v1i01.6.CrossRefPubMedPubMedCentral

38.

Banga AK, Chien YW. Iontophoretic delivery of drugs: fundamentals, developments and biomedical application. J Control Release. 1988;7(Suppl 1):1–24. https://doi.org/10.1016/0168-3659(88)90075-2.CrossRef

39.

Chen LLH, Chien YW. Transdermal iontophoretic permeation of luteinizing hormone releasing hormone: characterization of electric parameters. J Control Release. 1996;40:187–98. https://doi.org/10.1016/0168-3659(95)00181-6.CrossRef

40.

Chien YW, Siddiqui O, Shi WM, Lelawongs P, Liu JC. Direct current iontophoretic transdermal delivery of peptide and protein drugs. J Pharm Sci. 1989;78:376–83. https://doi.org/10.1002/jps.2600780507.CrossRefPubMed

41.

Hirvonen J, Hueber F, Guy RH. Current profile regulates iontophoretic delivery of amino acids across the skin. J Control Release. 1995;37:239–49. https://doi.org/10.1016/0168-3659(95)00081-X.CrossRef

42.

Kanebako M, Inagi T, Takayama K. Transdermal delivery of iondomethacin by iontophoresis. Biol Pharm Bull. 2002;25:779–82. https://doi.org/10.1248/bpb.25.779.CrossRefPubMed

43.

Elias PM. Epidermal barrier function: intercellular lamellar lipid structures, origin, composition and metabolism. J Control Release. 1991;15(Suppl 3):199–208. https://doi.org/10.1016/0168-3659(91)90111-P.CrossRef

44.

Lee JB, Kim JH, Murota H. Perspiration functions in different ethnic, age, and sex populations: modification of sudomotor function. Curr Probl Dermatol. 2016;51:109–19. https://doi.org/10.1159/000447370.CrossRefPubMed

45.

Kyle UG, Bosaeu I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr. 2004;23(Suppl 5):1226–43. https://doi.org/10.1016/j.clnu.2004.06.004.CrossRefPubMed

46.

Nakakura M, Kato Y, Hayakawa E, Kuroda T. Effect of pulse on iontophoretic delivery of desmopressin acetate in rats. Biol Pharm Bull. 1996;19:738–40. https://doi.org/10.1248/bpb.19.738.CrossRefPubMed

47.

Barry BW. Drug delivery routes in skin: a novel approach. Adv Drug Deliv Rev. 2002;4:S31–40. https://doi.org/10.1016/S0169-409X(02)00113-8.CrossRef

48.

Pikal MJ. The role of electroosmotic flow in transdermal iontophoresis. Adv Drug Deliv Rev. 1992;9:201–37. https://doi.org/10.1016/S0169-409X(00)00138-1.CrossRef

49.

Sagi-Dolev AM, Prutchi D, Nathan RH. Three-dimensional current density distribution under surface stimulation electrodes. Med Biol Eng Comput. 1995;33(Suppl 3):403–8.CrossRefPubMed

50.

Chizmadzhev YA, Indenbom AV, Kuzmin PI, Galichenko SV, Weaver JC, Potts RO. Electrical properties of skin at moderate voltages: contribution of appendageal macropores. Biophys J. 1998;74(Suppl 2):843–56.CrossRefPubMedPubMedCentral

51.

Ya-Xian Z, Suetake T, Tagami H. Number of cell layers of the stratum corneum in normal skin - relationship to the anatomical location on the body, age, sex and physical parameters. Arch Dermatol Res. 1999;291(Suppl 10):555–9.CrossRefPubMed

52.

Quinton PM. Defective epithelial ion transport in cystic fibrosis. Clin Chem. 1989;35(Suppl 5):726–30.PubMed

53.

Baker LB, Barnes KA, Anderson ML, Passe DH, Stofan JR. Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes. J Sports Sci. 2016;34(Suppl 4):358–68. https://doi.org/10.1080/02640414.2015.1055291.CrossRefPubMed

54.

Meyer F, Bar-Or O, MacDougall D, Heigenhauser GJ. Sweat electrolyte loss during exercise in the heat: effects of gender and maturation. Med Sci Sports Exerc. 1992;24:776–81. https://doi.org/10.1249/00005768-199207000-00007.CrossRefPubMed

Title: Evaluation of continuous constant current and continuous pulsed current in sweat induction for cystic fibrosis diagnosis
Authors: Carla Cristina Souza Gomez
Fernando Augusto Lima Marson
Maria Fátima Servidoni
Antônio Fernando Ribeiro
Maria Ângela Gonçalves Oliveira Ribeiro
Veruska Acioli Lopes Gama
Eduardo Tavares Costa
José Dirceu Ribeiro
Francisco Ubaldo Vieira Junior
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pulmonary Medicine / Issue 1/2018
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-018-0696-3

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