Otto Hertzberg

In vivo noninvasive monitoring of glucose concentration in human epidermis by mid-infrared pulsed photoacoustic spectroscopy.

The noninvasive determination of glucose in the interstitial layer of the human skin by mid-infrared spectroscopy is reported. The sensitivity for this measurement was obtained by combining the high pulse energy from an external cavity quantum cascade laser (EC-QCL) tunable in the infrared glucose fingerprint region (1000-1220 cm(-1)) focused on the skin, with a detection of the absorbance process by photoacoustic spectroscopy in the ultrasound region performed by a gas cell coupled to the skin. This combination facilitates a quantitative measurement for concentrations of skin glucose in the range from <50 mg/dL to >300 mg/dL, which is the relevant range for the glucose monitoring in diabetes patients. Since the interstitial fluid glucose level is representative of the blood glucose level and follows it without significant delay (<10 min), this method could be applied to establish a noninvasive, painless glucose measurement procedure that is urgently awaited by diabetes patients. We report here the design of the photoacoustic experiments, the spectroscopy of glucose in vivo, and the calibration method for the quantitative determination of glucose in skin. Finally, a preliminary test with healthy volunteers and volunteers suffering from diabetes mellitus demonstrates the viability of a noninvasive glucose monitoring for patients based on the combination of infrared QCL and photoacoustic detection.

Windowless ultrasound photoacoustic cell for in vivo mid-IR spectroscopy of human epidermis: Low interference by changes of air pressure, temperature, and humidity caused by skin contact opens the possibility for a non-invasive monitoring of glucose in the interstitial fluid

The application of a novel open, windowless cell for the photoacoustic infrared spectroscopy of human skin is described. This windowless cavity is tuned for optimum performance in the ultrasound range between 50 and 60 kHz. In combination with an external cavity tunable quantum cascade laser emitting in the range from ~1000 cm(-1) to 1245 cm(-1), this approach leads to high signal-to-noise-ratio (SNR) for mid-infrared spectra of human skin. This opens the possibility to measure in situ the absorption spectrum of human epidermis in the mid-infrared region at high SNR in a few (~5) seconds. Rapid measurement of skin spectra greatly reduces artifacts arising from movements. As compared to closed resonance cells, the windowless cell exhibits the advantage that the influence of air pressure variations, temperature changes, and air humidity buildup that are caused by the contact of the cell to the skin surface can be minimized. We demonstrate here that this approach can be used for continuous and non-invasive monitoring of the glucose level in human epidermis, and thus may form the basis for a non-invasive monitoring of the glucose level for diabetes patients.

IR‐spectroscopy of skin in vivo: Optimal skin sites and properties for non‐invasive glucose measurement by photoacoustic and photothermal spectroscopy

We have reported two methods to analyze glucose in the interstitial fluid of skin based on mid-infrared excitation with a tunable quantum cascade laser and photoacoustic or photothermal detection. These methods were evaluated for optimum skin locations to obtain reproducible glucose information. The lower part of the arm, the hypothenar, the tips of the index finger and the thumb were tested. The thumb appears to be the optimal skin location, followed by the index finger. Basic requirements for an optimum site are good capillary blood perfusion, low Stratum corneum thickness and the absence of fat layers. To obtain a correlation on such a site, spectra were recorded on volunteers continuously after blood glucose manipulation. However, continuous measurements on an in vivo sample such as the skin have to cope with physiological alterations such as the formation of sweat. We have used both detection schemes to investigate the acid mantle reformation after washing during time scales similar to continuous measurements for calibration spectra. We found that reconstitution of the acid mantle of skin may be seen in less than one hour. Precleaning of the measurement site may thus be useful for intermittent, but not for long term continuous measurements.

Infrared reflectometry of skin: Analysis of backscattered light from different skin layers

We have recently reported infrared spectroscopy of human skin in vivo using quantum cascade laser excitation and photoacoustic or photothermal detection for non-invasive glucose measurement . Here, we analyze the IR light diffusely reflected from skin layers for spectral contributions of glucose. Excitation of human skin by an external cavity tunable quantum cascade laser in the spectral region from 1000 to 1245cm-1, where glucose exhibits a fingerprint absorption, yields reflectance spectra with some contributions from glucose molecules. A simple three-layer model of skin was used to calculate the scattering intensities from the surface and from shallow and deeper layers using the Boltzmann radiation transfer equation. Backscattering of light at wavelengths around 10μm from the living skin occurs mostly from the Stratum corneum top layers and the shallow layers of the living epidermis. The analysis of the polarization of the backscattered light confirms this calculation. Polarization is essentially unchanged; only a very small fraction (<3%) is depolarized at 90° with respect to the laser polarization set at 0°. Based on these findings, we propose that the predominant part of the backscattered light is due to specular reflectance and to scattering from layers close to the surface. Diffusely reflected light from deeper layers undergoing one or more scattering processes would appear with significantly altered polarization. We thus conclude that a non-invasive glucose measurement based on backscattering of IR light from skin would have the drawback that only shallow layers containing some glucose at concentrations only weakly related to blood glucose are monitored.

Mid-1 R spectroscopy in medical diagnostics using FTIR-spectroscopy and tunable quantum cascade lasers

Mid-Infrared spectroscopy has proven to be highly specific for the spectroscopic analysis of body fluids, cells and tissues. With the advent of the quantum cascade laser (QCL) in the late nineties, powerful narrow-band single wavelength IR emitters, multi-wavelength sources, or, with an external cavity (EC), tunable EC-QCLs are now available. Their power reaches to hundreds of mW and their tunability can extend over several 100 cm-1, sufficiently broad to scan the entire IR fingerprint region within some msec. Probably their most pronounced advantage is their use in a pulsed mode, which makes them an ideal IR light source for photometric measurement of IR radiation absorbed in skin or tissues in combination with photoacoustic or photothermal detection. On this basis, IR spectroscopy can provide a highly sensitive and specific detection of body fluid constituents and lead to point-of-care methods that - at least partly - will substitute clinical laboratory analysis. The lecture presents our most recent developments in QCL applications for the measurement of skin parameters and body fluids in vitro and in vivo in comparison with FT-IR experiments. A photoacoustic detection technology optimized for the ultrasound range (around 50 kHz) with an open absorber/resonator cell is described for the detection of IR absorption in skin layers [1]. More recently, a photothermal detection method was developed that combines an Internal Reflection Element with PhotoThermal Detection (IRE-PTD) [2]. The latter allows the detection of IR absorbance using visible light and appears to be ideal for skin analysis, in particular with a depth profiling on the basis of different modulation frequencies.