Position paper: The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction.

Alex J Thompson, Michael Hughes, Salzitsa Anastasova, Laurie S Conklin, Tudor Thomas, Cadman Leggett, William A Faubion, Thomas J Miller, Peter Delaney, François Lacombe, Sacha Loiseau, Alexander Meining, Rebecca Richards-Kortum, Guillermo J Tearney, Paul Kelly, Guang-Zhong Yang

Journal: Nature reviews. Gastroenterology & hepatology 2017;14(12):727-738

PMID: 29139480

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Abstract

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.

Address: Hamlyn Centre for Robotic Surgery, Bessemer Building, Imperial College London, South Kensington, London, SW7 2AZ, UK.; Surgical Innovation Centre, Paterson Building, St Mary's Hospital, Imperial College London, South Wharf Road, London, W2 1NY, UK.; Applied Optics Group, School of Physical Sciences, Ingram Building, University of Kent, Canterbury, Kent, CT2 7NH, UK.; Division of Gastroenterology, Hepatology, and Nutrition, Children's National Health Systems, 111 Michigan Avenue, NW, Washington District of Columbia 20010, USA.; Olympus Surgical Technologies Europe, Fortran Road, Cardiff, CF3 0LT, UK.; Division of Gastroenterology and Hepatology, Mayo College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.; GreyBird Ventures, 31 Pond View Lane, Concord, Massachusetts 01742, USA.; OptiScan, 16 Miles Street, Mulgrave, Victoria 3170, Australia.; Mauna Kea Technologies, 9 rue d'Enghien, 75010 Paris, France.; Department of Internal Medicine I, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany.; Department of Bioengineering, Rice University, 6500 Main Street, Suite 1030, Houston, Texas 77030, USA.; Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA.; Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.; Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.

DOI: 10.1038/nrgastro.2017.147

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MeSH Terms: Biopsy, Environmental Exposure, Humans, Intestinal Diseases, Intestine, Small, Malabsorption Syndromes, Optical Imaging, Photoacoustic Techniques, Spectrometry, Fluorescence, Tomography, Optical Coherence