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Roy HK, Turzhitsky V, Wali R, Radosevich AJ, Jovanovic B, Della'Zanna G, Umar A, Rubin DT, Goldberg MJ, Bianchi L, De La Cruz M, Bogojevic A, Helenowski IB, Rodriguez L, Chatterton R, Skripkauskas S, Page K, Weber CR, Huang X, Richmond E, Bergan RC, Backman V. Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin. Gut 2017; 66:285-292. [PMID: 26503631 PMCID: PMC5108693 DOI: 10.1136/gutjnl-2015-309996] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A major impediment to translating chemoprevention to clinical practice has been lack of intermediate biomarkers. We previously reported that rectal interrogation with low-coherence enhanced backscattering spectroscopy (LEBS) detected microarchitectural manifestations of field carcinogenesis. We now wanted to ascertain if reversion of two LEBS markers spectral slope (SPEC) and fractal dimension (FRAC) could serve as a marker for chemopreventive efficacy. DESIGN We conducted a multicentre, prospective, randomised, double-blind placebo-controlled, clinical trial in subjects with a history of colonic neoplasia who manifested altered SPEC/FRAC in histologically normal colonic mucosa. Subjects (n=79) were randomised to 325 mg aspirin or placebo. The primary endpoint changed in FRAC and SPEC spectral markers after 3 months. Mucosal levels of prostaglandin E2 (PGE2) and UDP-glucuronosyltransferase (UGT)1A6 genotypes were planned secondary endpoints. RESULTS At 3 months, the aspirin group manifested alterations in SPEC (48.9%, p=0.055) and FRAC (55.4%, p=0.200) with the direction towards non-neoplastic status. As a measure of aspirin's pharmacological efficacy, we assessed changes in rectal PGE2 levels and noted that it correlated with SPEC and FRAC alterations (R=-0.55, p=0.01 and R=0.57, p=0.009, respectively) whereas there was no significant correlation in placebo specimens. While UGT1A6 subgroup analysis did not achieve statistical significance, the changes in SPEC and FRAC to a less neoplastic direction occurred only in the variant consonant with epidemiological evidence of chemoprevention. CONCLUSIONS We provide the first proof of concept, albeit somewhat underpowered, that spectral markers reversion mirrors antineoplastic efficacy providing a potential modality for titration of agent type/dose to optimise chemopreventive strategies in clinical practice. TRIAL NUMBER NCT00468910.
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Affiliation(s)
- Hemant K Roy
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Vladimir Turzhitsky
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Ramesh Wali
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrew J Radosevich
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Borko Jovanovic
- Department of Preventive Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Gary Della'Zanna
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - David T Rubin
- Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael J Goldberg
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Laura Bianchi
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Mart De La Cruz
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrej Bogojevic
- Department of Medicine, NorthShore University Health Systems, Evanston, Illinois, USA
| | - Irene B Helenowski
- Department of Preventive Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Luz Rodriguez
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert Chatterton
- Department of Obstetrics and Gynecology, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Silvia Skripkauskas
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Katherine Page
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Christopher R Weber
- Department of Pathology, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Xiaoke Huang
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Ellen Richmond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Raymond C Bergan
- Department of Medicine, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Vadim Backman
- Department of Biomedical Engineering, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
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Abstract
BACKGROUND In 10% to 15% of individuals, inflammatory bowel disease (IBD) is difficult to classify as ulcerative colitis (UC) or Crohn's disease (CD). Previous work has demonstrated that probe-based elastic scattering spectroscopy (ESS) can produce spectra, informed by parameters like tissue ultrastructure and hemoglobin content, capable of differentiating pathologies. This study investigates whether ESS is an in vivo optical biomarker for the presence, activity, and type of IBD in the colon. METHODS Pilot study, a retrospective data analysis. ESS spectra of endoscopically normal and inflamed colon were obtained from 48 patients with IBD and 46 non-IBD controls. Measurements from patients with IBD were categorized as CD or UC based on clinical diagnosis. Spectra were analyzed using high-dimensional methods. Leave-one-patient-out cross-validation was used to obtain diagnostic performance estimates. RESULTS Patients with IBD were distinguishable from non-IBD controls with a sensitivity of 0.93 and specificity of 0.91 based on readings from endoscopically normal mucosa, and 0.94 and 0.93 from inflamed mucosa. In patients with IBD, histologically normal and inflamed colon were distinguishable with per-class accuracies of 0.83 and 0.89, respectively; histologically normal from inactive inflammation with accuracies of 0.73 and 0.89, respectively; and inactive from active colitis with accuracies of 0.87 and 0.84, respectively. The diagnosis of CD versus UC was made with per-class accuracies of 0.92 and 0.87 in normal and 0.87 and 0.85 in inflamed mucosa, respectively. CONCLUSIONS ESS, a simple, low-cost clinically friendly optical biopsy modality, has the potential to enhance the endoscopic assessment of IBD and its activity in real time and may help to distinguish CD from UC.
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Yi J, Radosevich AJ, Stypula-Cyrus Y, Mutyal NN, Azarin SM, Horcher E, Goldberg MJ, Bianchi LK, Bajaj S, Roy HK, Backman V. Spatially resolved optical and ultrastructural properties of colorectal and pancreatic field carcinogenesis observed by inverse spectroscopic optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:36013. [PMID: 24643530 PMCID: PMC4019430 DOI: 10.1117/1.jbo.19.3.036013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 05/18/2023]
Abstract
Field carcinogenesis is the initial stage of cancer progression. Understanding field carcinogenesis is valuable for both cancer biology and clinical medicine. Here, we used inverse spectroscopic optical coherence tomography to study colorectal cancer (CRC) and pancreatic cancer (PC) field carcinogenesis. Depth-resolved optical and ultrastructural properties of the mucosa were quantified from histologically normal rectal biopsies from patients with and without colon adenomas (n=85) as well as from histologically normal peri-ampullary duodenal biopsies from patients with and without PC (n=22). Changes in the epithelium and stroma in CRC field carcinogenesis were separately quantified. In both compartments, optical and ultra-structural alterations were consistent. Optical alterations included lower backscattering (μb) and reduced scattering (μs') coefficients and higher anisotropy factor g. Ultrastructurally pronounced alterations were observed at length scales up to ∼450 nm, with the shape of the mass density correlation function having a higher shape factor D, thus implying a shift to larger length scales. Similar alterations were found in the PC field carcinogenesis despite the difference in genetic pathways and etiologies. We further verified that the chromatin clumping in epithelial cells and collagen cross-linking caused D to increase in vitro and could be among the mechanisms responsible for the observed changes in epithelium and stroma, respectively.
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Affiliation(s)
- Ji Yi
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Andrew J. Radosevich
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Yolanda Stypula-Cyrus
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Nikhil N. Mutyal
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Samira Michelle Azarin
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Elizabeth Horcher
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
| | - Michael J. Goldberg
- NorthShore University Health Systems, Department of Internal Medicine, Evanston, Illinois 60201
| | - Laura K. Bianchi
- NorthShore University Health Systems, Department of Internal Medicine, Evanston, Illinois 60201
| | - Shailesh Bajaj
- NorthShore University Health Systems, Department of Internal Medicine, Evanston, Illinois 60201
| | - Hemant K. Roy
- Boston Medical Center, Department of Medicine, Boston, Massachusetts 02118
| | - Vadim Backman
- Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, Evanston, Illinois 60208
- Address all correspondence to: Vadim Backman, E-mail:
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Gomes AJ, Ruderman S, DelaCruz M, Wali RK, Roy HK, Backman V. In vivo measurement of the shape of the tissue-refractive-index correlation function and its application to detection of colorectal field carcinogenesis. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:047005. [PMID: 22559696 PMCID: PMC3382344 DOI: 10.1117/1.jbo.17.4.047005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Polarization-gated spectroscopy is an established method to depth-selectively interrogate the structural properties of biological tissue. We employ this method in vivo in the azoxymethane (AOM)-treated rat model to monitor the morphological changes that occur in the field of a tumor during early carcinogenesis. The results demonstrate a statistically significant change in the shape of the refractive-index correlation function for AOM-treated rats versus saline-treated controls. Since refractive index is linearly proportional to mass density, these refractive-index changes can be directly linked to alterations in the spatial distribution patterns of macromolecular density. Furthermore, we found that alterations in the shape of the refractive-index correlation function shape were an indicator of both present and future risk of tumor development. These results suggest that noninvasive measurement of the shape of the refractive-index correlation function could be a promising marker of early cancer development.
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Affiliation(s)
- Andrew J. Gomes
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
| | - Sarah Ruderman
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
| | - Mart DelaCruz
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Ramesh K. Wali
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Hemant K. Roy
- NorthShore University Health System, Department of Internal Medicine, Evanston, Illinois 60218
| | - Vadim Backman
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois 60218
- Address all correspondence to: Vadim Backman, Northwestern University, Department of Biomedical Engineering, 2145 Sheridan Road, BME-E310, Evanston, Illinois 60218. Tel: +847 4913536; Fax: +847 4914928; E-mail:
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Ghosh N, Vitkin IA. Tissue polarimetry: concepts, challenges, applications, and outlook. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:110801. [PMID: 22112102 DOI: 10.1117/1.3652896] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Polarimetry has a long and successful history in various forms of clear media. Driven by their biomedical potential, the use of the polarimetric approaches for biological tissue assessment has also recently received considerable attention. Specifically, polarization can be used as an effective tool to discriminate against multiply scattered light (acting as a gating mechanism) in order to enhance contrast and to improve tissue imaging resolution. Moreover, the intrinsic tissue polarimetry characteristics contain a wealth of morphological and functional information of potential biomedical importance. However, in a complex random medium-like tissue, numerous complexities due to multiple scattering and simultaneous occurrences of many scattering and polarization events present formidable challenges both in terms of accurate measurements and in terms of analysis of the tissue polarimetry signal. In order to realize the potential of the polarimetric approaches for tissue imaging and characterization/diagnosis, a number of researchers are thus pursuing innovative solutions to these challenges. In this review paper, we summarize these and other issues pertinent to the polarized light methodologies in tissues. Specifically, we discuss polarized light basics, Stokes-Muller formalism, methods of polarization measurements, polarized light modeling in turbid media, applications to tissue imaging, inverse analysis for polarimetric results quantification, applications to quantitative tissue assessment, etc.
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Affiliation(s)
- Nirmalya Ghosh
- Indian Institute of Science Education and Research (IISER), Department of Physical Sciences, Kolkata, Mohanpur, West Bengal, India.
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Terry N, Zhu Y, Thacker JKM, Migaly J, Guy C, Mantyh CR, Wax A. Detection of intestinal dysplasia using angle-resolved low coherence interferometry. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:106002. [PMID: 22029349 PMCID: PMC3206922 DOI: 10.1117/1.3631799] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Angle-resolved low coherence interferometry (a/LCI) is an optical biopsy technique that allows for depth-resolved, label-free measurement of the average size and optical density of cell nuclei in epithelial tissue to assess the tissue health. a/LCI has previously been used clinically to identify the presence of dysplasia in Barrett's Esophagus patients undergoing routine surveillance. We present the results of a pilot, ex vivo study of tissues from 27 patients undergoing partial colonic resection surgery, conducted to evaluate the ability of a/LCI to identify dysplasia. Performance was determined by comparing the nuclear morphology measurements with pathological assessment of co-located physical biopsies. A statistically significant correlation between increased average nuclear size, reduced nuclear density, and the presence of dysplasia was noted at the basal layer of the epithelium, at a depth of 200 to 300 μm beneath the tissue surface. Using a decision line determined from a receiver operating characteristic, a/LCI was able to separate dysplastic from healthy tissues with a sensitivity of 92.9% (13/14), a specificity of 83.6% (56/67), and an overall accuracy of 85.2% (69/81). The study illustrates the extension of the a/LCI technique to the detection of intestinal dysplasia, and demonstrates the need for future in vivo studies.
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Affiliation(s)
- Neil Terry
- Duke University, Department of Biomedical Engineering, 136 Hudson Hall, Durham, North Carolina 27708, USA.
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Abstract
Second Harmonic Generation microscopy has emerged as a powerful new optical imaging modality. This Feature describes its chemical and physical principles and highlights current applications in disease diagnostics.
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Lauwers GY, Badizadegan K. New Endoscopic Techniques: Challenges and Opportunities for Surgical Pathologists. Surg Pathol Clin 2010; 3:411-28. [PMID: 26839138 DOI: 10.1016/j.path.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, significant clinical and technological advances have been made in endoscopic methods for diagnosis and treatment of early gastrointestinal neoplasms. However, essential information related to these novel techniques and their implications for practicing surgical pathologists have largely been missing in the general pathology literature. This article provides a general introduction to these novel therapeutic and diagnostic methods, and discusses their indications, contraindications, and potential limitations. The article aims to enable surgical pathologists to interact more efficiently with basic scientists and clinical colleagues to help implement and improve the existing clinical methods and to advance the new technologies.
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Affiliation(s)
- Gregory Y Lauwers
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Kamran Badizadegan
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
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Abstract
It has become increasingly evident that the study of DNA is inadequate to explain many, if not most, aspects of the development and progression of neoplastic lesions from pre-invasive lesions to metastasis. Thus, the term "genetic" can no longer refer to just the study of the genome. Much of the action in genetic research now shifts to the methods by which the pre-mRNA from one gene is processed to yield multiple different proteins, different quantities of the same protein as well as other forms of regulating RNA. Thus, the age of post-transcriptional processing and epigenetic control of the transfer of information from the genome has arrived. The mechanisms of post-transcriptional processing and epigenetic control that must be characterized in greater detail including alternate splicing, regulation of mRNA degradation, RNA regulatory factors including those factors which extensively edit mRNAs, control of translation, and control of protein stability and degradation. This chapter reviews many of the processes that control information from the genome to proteins and how these factors lead from less than 40,000 genes to more than an order of magnitude increase more proteins which actually control the phenotypes of cells - normal or neoplastic. It is usually the products of genes (e.g., mRNA, microRNA and proteins) that are the molecular markers that will control translational research and ultimately, individualized (personal) medical approaches to disease. This chapter emphasizes how the process of neoplasia "hijacks" the normal processes of cellular operations, especially those processes that are important in the normal development of the organisms - including proliferation, cellular death, angiogenesis, cellular mobility and invasion, and immunoregulation to ensure neoplastic development, survival and progression. This chapter reviews the wide range of processes controlling the information that flows from the genome to proteins and emphasizes how molecular steps in pure processes can be used as biomarkers to study prevention, treatment and/or management of diseases.
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Affiliation(s)
- Sudhir Srivastava
- National Cancer Institute, National Institutes of Health, Bethesda MD, USA.
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Roy HK, Turzhitsky V, Kim Y, Goldberg MJ, Watson P, Rogers JD, Gomes AJ, Kromine A, Brand RE, Jameel M, Bogovejic A, Pradhan P, Backman V. Association between rectal optical signatures and colonic neoplasia: potential applications for screening. Cancer Res 2009; 69:4476-83. [PMID: 19417131 DOI: 10.1158/0008-5472.can-08-4780] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Field carcinogenesis detection represents a promising means for colorectal cancer (CRC) screening, although current techniques (e.g., flexible sigmoidoscopy) lack the requisite sensitivity. The novel optical technology low-coherence enhanced backscattering (LEBS) spectroscopy, allows identification of microscale architectural consequences of the field carcinogenesis in preclinical CRC models with unprecedented accuracy. To investigate the potential clinical translatability of this approach, we obtained biopsies from the normal-appearing rectal mucosa from patients undergoing colonoscopy (n = 219). LEBS signals were recorded through a bench-top instrument. Four parameters characterizing LEBS signal were linearly combined into a single marker. We found that LEBS signal parameters generally mirrored neoplasia progression from patients with no neoplasia, to 5 to 9 mm adenoma and to advanced adenomas. The composite LEBS marker calculated from the LEBS signal paralleled this risk status (ANOVA P < 0.001). Moreover, this was independent of CRC risk factors, benign colonic findings, or clinically unimportant lesions (diminutive adenomas, hyperplastic polyps). For advanced adenomas, the LEBS marker had a sensitivity of 100%, specificity of 80%, and area under the receiver operator characteristic curve of 0.895. Leave-one-out cross-validation and an independent data set (n = 51) supported the robustness of these findings. In conclusion, we provide the first demonstration that LEBS-detectable alterations in the endoscopically normal rectum were associated with the presence of neoplasia located elsewhere in the colon. This study provides the proof of concept that rectal LEBS analysis may potentially provide a minimally intrusive CRC screening technique. Further studies with an endoscopically compatible fiber optic probe are under way for multicenter clinical validation.
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Affiliation(s)
- Hemant K Roy
- Department of Medicine, Evanston-Northwestern Healthcare, Northwestern University, Evanston, IL 60201, USA.
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