Harnessing MXene for Integrated Wearable Health Monitoring and Bioelectronic Devices: A Mini Review

MXene-based wearable supercapacitors have generated a lot of interest due to their revolutionary power in biomedical wearable devices and medical monitoring [1,2]. MXenes, primarily includes the family of two-dimensional (2D) transition metal nitrides and carbides, which possess superb properties like great electrical conductivity, large surface area, mechanical flexibility, hydrophilic nature, and strong mechanical robustness [3,4]. The high electrical conductivity for sensitive electrical signal transduction, mechanical flexibility, the layered and thin morphology enables conformal contact with dynamic, curved skin surfaces, hydrophilicity and surface functionality that enable integration with polymers and biomolecules to achieve multifunctional sensing, biocompatibility and chemical inertness reduce negative biological reactions during contact with skin and the stability endow MXenes for wearable electronics [5,6]. Wearable body sensors need to detect faint physiological signals like arterial pulse waves, muscle movements, and chemical biomarkers in sweat or interstitial fluids. The metallic conductivity of MXenes paired with their mechanical flexibility make it possible to create highly sensitive and flexible sensors that can record these signals with high sensitivity [5]. Pressure and strain sensors based on MXene have ultrahigh sensitivity (up to 138.8kPa⁻¹) and fast response rates (<100ms), essential in tracking dynamic physiological variables like pulse, respiration, vocalization, and facial expressions [7]. Porous MXene networks and polymer composite films containing polymers such as polydopamine (PDA) films are enhanced with respect to sensitivity and mechanical robustness [8]. Bioelectronic interfaces in MXene electrodes provide low skin-electrode impedance (<10kΩ at 10Hz) without the need for conductive gels, enabling high-quality electrophysiological recordings such as electroencephalography (EEG), electromyography (EMG), and electrocardiography (ECG) [9]. Compatibility with clinical imaging modalities (MRI, CT) also enables biomedical applications [10]. The high surface chemistry of MXenes enables functionalization for biomarker detection such as heavy metal ions and metabolites in sweat, making non-invasive biochemical monitoring feasible [11].

MXene supercapacitors, being flexible, light weight and biocompatible can be utilized as perfect power sources for wearable devices to monitor health. Such wearable devices will enable continuous monitoring of physiological parameters including heart rate, blood pressure, temperature, and breathing rate and make possible the real-time health monitoring and the early detection of the health threats. Besides, self-powered MXene-based integrated devices have also become significant topics, especially in wearable electronics. The production of MXene-based wearable sensors includes etching and delaminating MAX phases to yield nanosheets, which are then fabricated into films, hydrogels, or composites. Integration with flexible substrates like elastomers or textiles enables conformal, stretchable devices that retain performance under mechanical deformation. Hybrid composites of MXenes with polymers or nanoparticles leverage synergistic effects to improve sensitivity, stretchability, and environmental safety. Things like personal health monitoring systems and the Internet of Things (IoT) have enormous potential for the future of humanity in smart cities. Electronics must be safe, wearable, and ecologically friendly in order to meet this superior objective.

However, there are still several obstacles in the way of producing self-sufficient electronic systems on a wide scale by utilizing multifunctional materials. Multifunctional aqueous printable MXene inks are described as a conductive binder, metalfree interconnector, highly conducting current collector, sensitive pressure-sensing material, and high-capacitance electrode without additives [12]. Zheng et al. [12] manufactured Lithium-ion microbatteries (LIMBs) and MXene-based micro-supercapacitors (MSCs) using variety of substrates by directly screen printing MXene inks. The MSCs while connected serially provided 60V which is a high nominal voltage, while MSCs showed an ultrahigh areal capacitance of 1.1F cm^-2. 154μWh cm^-2 was a robust areal energy density provided by the quasi-solid-state LIMBs. Additionally, the smooth integration of MXene hydrogel pressure sensor powered by the LIMB, which is recharged by a tandem solar cell, demonstrated an all-flexible self-powered integrated system on a single substrate based on the multitasking MXene inks and this integrated system obtained quick response time of 35ms and was incredibly sensitive to body movements [12]. As a result, this multifunctional MXene ink created a new way to power smart appliances in the future. Yi et al. [13] proposed the development and validation of a novel wearable MXene-based, self-powered, 3D-printed, flexible and integrated system for real-time monitoring of the physiological bio-signal. Triboelectric nanogenerators combined with extremely sensitive pressure sensors, operated by multipurpose flexible power efficient integrated circuit are all included in the system. Styrene-ethylenebutylene- styrene based skin like responsive substrate with good stretchability and a good triboelectric property is combined with MXene. With 816.6mW m-2 power delivery, combined with 6.03 kPa a sensitivity, supported with a 9 Pa low detection limit and 80ms quick response time enables the self-powered physiological sensing system to continuously monitor radial artery pulse waves makes the entire system a self-sustained and automated technology. They demonstrated the wireless data and power transmission via near-field communication and constant, on-demand, totally selfpowered RAP monitoring. This wearable device used to monitor physiological biosignals continuously in real-time [13]. Driscoll et al. [14] presented MXtrodes a family of large-scale, soft, highresolution bioelectronic interfaces made possible by scalable solution processing and the two-dimensional transition metal carbide nanomaterial Ti3C2 MXene. They demonstrated that when utilized in epidermal electronics, MXtrodes’ electrochemical qualities outperform those of traditional materials and eliminate the need for conductive gels. Additionally, evaluated MXtrodes in applications that range from micro-stimulation and cortical neural recording in swine and rodent models to mapping largescale neuromuscular networks in humans. Finally, they concluded that MXtrodes can be used with common clinical neuroimaging techniques [14]. Li et al. [15] designed high-temperature microsupercapacitors using sulfonated polybenzimidazole (SPBI) as the solid electrolyte and the MXene–V2O5–polyaniline (MVP) ternary composite material as the electrode material which significantly enhanced the electrode’s capacitance performance and guarantees its stability at high temperatures. In addition to having superior mechanical qualities and greater flexibility, the MVP electrode had a capacitance value of up to 3180mF cm^-3 (880 Fg^-1). Additionally, 79.2Wh L^-1 (22.1Wh kg-1) high energy density obtained for the built supercapacitor was an effective energy storage device designed for high-temperature applications [15]. Pradhan et al. [16] produced composites with partly oxidized- MXene quantum dots with reduced graphene oxide (PO-MXQDs/ rGO) makes a multilayer Artificial Neural Network (ANN) model with hyperparameter tuning with various input parameters. The optimized PO-MXQDs/rGO demonstrated a specific capacitance value of 1137.8 F g^-1 and was used to fabricate asymmetric coincell type supercapacitor devices (ACCDs) and flexible microsupercapacitors (FMSCs) devices using the mask-assisted vacuum filtration technique. In addition to having ultra-high cyclic stability up to 30000 cyclic voltammetry (CV) cycles, and provided an increased areal capacitance of 5.26mF cm^-2, leading to a high areal energy and power density of 0.46μWh cm^-2 and 210.48μW cm-2 respectively [16]. Fan et al. [17] suggested an efficient 3D production technique through needling and carbonization for the flexible, ultralight supercapacitors using MXene [17]. The biomimetic cellulose nanofibers with MXene made as a film was used to integrate mechanical toughness, electroconductivity and electrochemical behaviour, as well as sequential bridging with hydrogen and ionic bonds [18]. The intrinsic stretchable AgNWsbridged MXene porous electrode facilitated the production of high-resolution micro-wearable supercapacitors. More electron and ion transport channels with reduced resistivity were made available by the continuous AgNWs network, which improved the intrinsic stretchability of MXene electrodes to withstand bending and stretching pressures. The AgNWs-bridged MXene porous electrode has exceptional inherent stretchability (96.3% retention after 50% stretching strain), outstanding cycle stability (over 92% retention after 5000 cycles), and a capacitance of 287 F cm^-3 when used as a negative electrode [19]. Polypyrrole @ bacterial cellulose/MXene (PPy@BC/MXene) hybrid films organised in a “building frame structure.” using polypyrrole @ bacterial cellulose (PPy@BC) as the “pillar” and MXene as the “beam and slab. PPy@ BC/MXene-25% showed strong tension strength (about 310 MPa) and high strain at break (approximately 10.8%) and attained a high specific capacitance of 807Fg^-1 at 0.05mA cm^-2 and a capacitance retention of 97.51% after 10000 cycles at 20mA cm^-2 because of quick interlaminar electroconductivity, unhindered ion diffusion channels, and adequate reactivity [20].

Du et al. [21] designed a binder-free Ti₃C₂sTx MXene@PPy electrodes to both ends of the H_{3PO4@P (AYP K+ zwitterion) hydrogel electrolyte presented a flexible thermally chargeable supercapacitor (TCSC) that has a maximum figure of merit of 2.1 and a substantial thermal power of 35.2 mVK^-1 at 50% relative humidity. The high photothermal conversion efficiency and electrochemical performance of the electrodes, as well as the hydrogel’s tunable electrical, thermodynamic, thermoelectric and mechanical properties through the adjustment of its acid content and the proportion of the zwitterionic compound AYP K+, are responsible for the high performances of the devices that were fabricated. Furthermore, the TCSC’s exceptional and consistent thermo-voltage output (about 200mV) under various time conditions enables it to power strain sensor [21]. Sun et al. [22] successfully printed complex structures using inkjet technology, created a new 3D N-MXene/NiCo2S4 porous network, and used it to create long-lasting hybrid micro-supercapacitors [22].}

Zhang et al [23] Thin-walled lignin nanospheres’ microchamber design successfully increased the lignin-MXene contact area, enhancing ion and electron accessibility. Furthermore, by relieving stress through slip and deformation during the stretchrelease cycling, HLNPs which served as a protective phase for the MXene layer improved the mechanical characteristics of the wrinkled stretchable electrodes and significantly increased their structural integrity and capacitive stability. Flexible electrodes and symmetric flexible all-solid-state supercapacitors with high specific capacitances of 1273mF cm^-2 (241 F g^-1) and 514mF cm^-2 (95Fg^-1), respectively, were produced that can withstand 600% uniaxial tensile strain. Furthermore, even after 1000 cycles of 600% stretch-release cycling, their capacitances remained intact [23]. The binder-free MXene/reduced graphene oxide/W₁₈O₄₉ (MXene/ rGO/W₁₈O₄₉) sheet was developed to increase the interlamellar space to create additional active sites for multidirectional ion transport pathways and the built asymmetric supercapacitor (ASC), which has a 1.6V voltage window and an energy density of 43.2Wh kg^-1 at 799.8W kg^-1 power density demonstrated the feasibility of MXene development, the optimization technique for MXene/rGO/ W₁₈O₄₉ film as electrode provides strong technical support for its application in the upcoming generation of flexible electronics [24]. Zhang et al. [25] used a green one-step synthesis process for loading polypyrrole (PPy) and Ti₃C₂Tx MXene onto cotton fabrics to create a flexible and effective hydro-voltaic generator. With 5mL of 3.5 weight percent NaCl solution, this generator can generate an opencircuit voltage (VOC) of 0.35V and a short-circuit current (ISC) of around 260μA. The optimized device reached an output power of 35.76μW. ring and touch sensing [25].

Long-term in contact skin interactions demand materials free from provocation of irritation, allergic response, or toxicity. MXenes present low cytotoxicity and chemical inertness such that they produce minimal disruption in normal cellular behaviours. Their stability in biological fluids avoids degradation from biological environments without compromising sensor stability over time. MXene surface coatings also attenuate inflammatory response relative to some other materials to make them adaptable for wearable bioelectronics. Although promising, wearable devices based on MXene also have challenges: MXenes can be degraded upon exposure to water and oxygen and require protective coverings or chemical modifications. Large scale production of high quality MXene nanosheets with controlled surface chemistry in a uniform manner is a bottle neck. Integration of multimodal sensing especially incorporating strain, pressure and are efficient, flexible and MXene device compatible are required for completely autonomous wearables that boost good power supply along with system integration.

Wearable patches that integrate sensors, energy conversion, storage and localized treatment components are a fast-growing area in the healthcare sector. These multifunctional systems are designed to offer continuous, real-time health monitoring, selfpowered operation and on-demand therapy, all in a non-invasive, user-friendly and portable form. Health monitoring and diagnostic wearable patches integrated with self-powered sensors and transceivers, shall impact a wide usage for continuous physiological monitoring, especially in chronic disease management. Briefly, wearable self-powered vital sign monitoring systems enables the physicians with a real-time fluctuations of heart rate, ECG, blood pressure, respiratory rate (SPO₂), temperature and sweat compositions. Specific for metabolite, neurological and biomarker based interventional treatments, real-time monitoring systems enable a complex sensory patch to identify the glucose, lactate, uric acid, cortisol, alcohol, EEG based brain activity, stress and mood marker (cortisol, dopamine and seratonin) and cancer biomarkers. Further, with such real-time data, the integrated system shall enable medical physicians to identify the root cause and timely intervention with minimal efforts rather than a complex conventional routine. The capability of technology transfer of materials, and devices has enabled the communication and cumulative attention of patient, care takers, physicians and hospitals using AI and IOT based systems within the wearable health care systems.

This shall impact the quality, accuracy and timely treatment/ attention especially in elderly citizens. The form factors and biocompatibility of integrated system shall enable the options to implant an in vivo monitoring. Not only limited to such regular health care monitoring, the technology shall be extended to vaccine responses, infectious and contagious diseases spread which would protect the communal health eliminating risk of random check failures. To extend the capability of wearable patches, the application shall be extended to localized therapeutic treatments like, sensing and application of specific stimulative response to the current health conditions. For example, continuous monitoring of glucose combined with timely injections of prescribed medications shall leave the diabetic patients to retain a regular life style compared to the manual interventions. Such medications shall be prescribed and regulated in cloud by the physicians to the patch’s integrated systems. Further, for an instance to extend the alternative treatments in the high demanding applications like defence personnel and space explorations, the wearable patch sensor based identification of inflammation/wound or critical conditions shall be addressed by applying thermal therapy/ electrical stimulation therapy using a functional patches based on joule heating/phase change material based pain relief, muscle relaxation, nerve stimulation, muscle rehabilitation or essential drug delivery which are controlled by physician without the need to present with the patient. Wearable integrated energy conversion and storage enable self-sustainable operation of patches which are enabled by integrating self-powering, compact power storage, biocompatible effective sensors and transceivers within the wearable patches. MXenes play a pivotal role in the formation of flexible, biocompatible, effective energy conversion and storage. Briefly, energy conversion and storage include triboelectric/ piezoelectric generators to harvest energy from motion, body heat, body fluids as biofuel into electricity. On-body energy storage includes flexible supercapacitors/supercapattery, stretchable micro-batteries made of biocompatible materials.

Raja V and Sujin P Jose sincerely acknowledge the funding provided by UGC towards UGC Dr. DS Kothari Post-Doctoral Fellowship (No.F.4-2/2006 (BSR)/OT/20-21/0008). Raja V thank Easwari Engineering College, India, for the financial support, vide number SRM/EEC/RI/007. The authors are thankful for the funding provided by DST-MES, (DST/TMD/MES/2K17/94(G)) and the financial support through SERB ASEAN-India collaborative research project (No. CRD/2021/000482).

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