Ludwig Demling Center

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Molecular imaging in mucosal inflammation and cancer

Ludwig Demling Center

Aim of our project is to conduct optical molecular imaging procedures in the context of endoscopic examinations in inflammatory and malignant diseases. Molecular imaging will enable the identification and characterization of mucosal lesions in vivo due to their molecular composition rather than their morphological structure alone. Through the interdisciplinary approach of our project, involving the departments of gastroenterology, urology, ENT, pathology and genetics, the use of molecular imaging approaches should be dispersed to new indications and new anatomical sites.

In the past decades enormous progress has been made in unravelling the pathogenesis of malignant and inflammatory disorders. These advances in basic science have especially been enabled by proteomic research that has led to the successful identification of specific cellular proteins critically involved in the immunopathogenesis of specific disease entities. These insights in basic science build the basis for the rapid transfer from the bench to preclinical and clinical implementation, as they come into consideration for molecular imaging in endoscopic procedures. The decision which molecular structure should be targeted in molecular imaging procedures by fluorescence labeled antibodies or peptides in preclinical and clinical studies is dependent on the clinical setting in which the endoscopic examination takes place.

The molecular imaging procedures will be performed using confocal laser endomicroscopy (CLE), which has recently emerged as a novel technique into experimental and clinical endoscopic practice for performing real time in vivo imaging in the mucosal tissue at the cellular and subcellular level. CLE is possible due to a miniaturised laser scanning microscope which has been either integrated into the distal tip of an otherwise conventional white light endoscope or can be inserted into the working channel of the endoscopic device used (probe based system). A solidstate laser provides an excitation wavelength of 488 nm that is focused onto a distinct imaging plane within the tissue. This enables 1000-fold magnification of the captured mucosal structures. Infiltration depth of the blue laser light is 0-250 μm. The potential clinical benefit of CLE is not only restricted to mere in vivo histopathology, as this method in the setting of molecular endoscopy clearly possesses the potential to further enhance the therapeutic yield of current endoscopic procedures. Our emerging field's project on cellular and molecular imaging using endomicroscopy has the potential to have a major impact on various clinical settings. One apparent application is the use of cellular and molecular imaging to increase the detection rate of aberrant lesions by identifying lesions based on their molecular signature rather than to rely on their morphological appearance alone. Moreover, as personalized medicine is an upcoming and emerging trend, molecular imaging could be the method of choice to stratify different patient groups and predict the response to specific therapeutic strategies. The technique of molecular endoscopic imaging could open a new frontier for clinical endoscopy and give hope for improved diagnosis and targeted therapies. The molecular imaging studies will be performed in a novel imaging centre which is denoted "Ludwig Demling Center for Molecular Imaging" according to the former world-leading endoscopist Ludwig Demling from Erlangen, who was the head of the department for internal medicine at the Friedrich-Alexander-University Erlangen-Nürnberg.