Identification of Epithelial Gaps in Human Small and Large Intestine by Confocal Endomicroscopy

Kießlich, Ralf; Goetz, Martin; Angus, Elizabeth M.; Hu, Qian-Nan; Guan, Yanfang; Potten, Christopher S; Allen, Terence D; Neurath, Markus F.; Shroyer, Noah F.; Montrose, Marshall H.; Watson, Alastair

doi:10.1053/j.gastro.2007.09.011

Cited by 203 publications

(172 citation statements)

References 26 publications

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“…Fluorescence endomicroscopy also enables observation of gaps or breaks in the intestinal epithelial lining [59][60][61] . For patients with IBS 60,61 the leakage of intravenous fluorescein into the lumen has been visualized in real time 61 , indicating that endomicroscopy can be used to monitor dynamic, cellular level changes in gut function and permeability.…”

Section: Microbiota Changesmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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Section: Microbiota Changesmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…Such gap formation seems to be part of normal epithelial regeneration, and gaps smaller or just the size of a single epithelial cell seem to be present in a large number but sealed by a yet unidentified substance to preserve epithelial barrier function [93]. In a further step, the characteristics of such gaps have been defined in healthy mice in vivo and after the induction of colitis, and subsequently have been visualized with eCLE in healthy patients [94]. In subsequent studies it has been found that gap density is increased in patients with Crohn's Disease.…”

Section: Functional Imagingmentioning

confidence: 99%

Confocal Laser Endomicroscopy: Applications in Clinical and Translational Science—A Comprehensive Review

Goetz

2012

ISRN Pathology

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Confocal laser endomicroscopy (CLE) is a novel tool in the endoscopist's armamentarium. It allows on-site histological information. The ability of gastroenterologists to interpret such microscopic information has been demonstrated in multiple studies from the upper and lower gastrointestinal tract. Recently, the field of application has expanded to provide hepatobiliary and intra-abdominal CLE imaging. CLE allows "smart," targeted biopsies and is able to guide endoscopic interventions. But CLE is also translational in its approach and permits functional imaging that significantly impacts on our understanding of gastrointestinal diseases. Molecular imaging with CLE allows detection and characterization of lesions and may even be used for prediction of response to targeted therapy. This paper provides a comprehensive review over current applications of CLE in clinical applications and translational science.

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“…10 Molecular imaging with tagged monoclonal antibody has enabled imaging of antiendothelial growth factor receptor monoclonal antibody binding to targets and predication of response to endothelial growth factor receptor chemotherapy. 5,9,11 Imaging of overt and microscopic inflammation is now well established. Kiesslich et al 9,11 demonstrated epithelial cell shedding in the small bowel of patients with inflammatory bowel disease and further demonstrated that residual inflammation was predictive of relapse.…”

mentioning

confidence: 99%

“…5,9,11 Imaging of overt and microscopic inflammation is now well established. Kiesslich et al 9,11 demonstrated epithelial cell shedding in the small bowel of patients with inflammatory bowel disease and further demonstrated that residual inflammation was predictive of relapse. Others have shown that CLE can detect subtle inflammatory changes in celiac disease 12 and collagenous colitis, 13 diseases that have previously been seen only with ex vivo microscopy.…”

mentioning

confidence: 99%

“…3 The authors rigorously conformed to reporting guidelines for the conduct of meta-analyses. 11 Although the combined number of HCC cases was 3,912 in >1.2 million participants, vegetable and fruit consumption were mostly evaluated separately in a subset of the 19 studies (17 evaluating vegetable intake, 14 fruit intake, and 2 both vegetable and fruit intake). Vegetable consumption had a significant although weak association with lower HCC risk, and fruit intake did not alter HCC risk.…”

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confidence: 99%

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Imaging the Leaky Gut

et al. 2014

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Identification of Epithelial Gaps in Human Small and Large Intestine by Confocal Endomicroscopy

Cited by 203 publications

References 26 publications

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Confocal Laser Endomicroscopy: Applications in Clinical and Translational Science—A Comprehensive Review

Imaging the Leaky Gut

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