Abstract

Colorectal cancer is a representative cancer where early diagnosis and proper treatment monitoring are important. Recently, cancer treatment using bacteria has actively progressed and has been successfully monitored using fluorescence imaging techniques. However, because subcutaneous tumor models are limited in reflecting the actual colorectal cancer situation, new imaging approaches are needed to observe cancers growing in the colon. The fluorescence endoscopic approach is an optimal monitoring modality to evaluate the therapeutic response of bacteria in orthotopic colon cancer. In this study, we developed dual-scaled fluorescence endoscopy (DSFE) by combining wide-field fluorescence endoscopy (WFE) and confocal fluorescence endomicroscopy (CFEM) and demonstrated its usefulness for evaluating bacterial therapy. Firstly, the endoscopic probe of DSFE was developed by integrating the CFEM probe into the guide sheath of WFE. Secondly, colorectal cancer tumor growth and tumors infiltrating the fluorescent bacteria were successfully monitored at the multi-scale using DSFE. Finally, the bacterial distribution of the tumor and organs were imaged and quantitatively analyzed using CFEM. DSFE successfully exhibited fluorescent bacterial signals in an orthotopic mouse colon tumor model. Thus, it can be concluded that the DSFE system is a promising modality to monitor bacterial therapy in vivo.

Highlights

  • Colorectal cancer is the second leading cause of cancer-related death in the United States, and the American Cancer Society (ACS) estimates that 51,020 people will die in 2019 [1]

  • We achieved in vivo dual-scale fluorescent bacterial imaging using the developed dual-scaled fluorescence endoscopy (DSFE) system in an orthotopic mouse colon tumor model

  • The DSFE system successfully demonstrated the bacterial accumulation of tumor tissue from the gross level to the cellular level

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Summary

Introduction

Colorectal cancer is the second leading cause of cancer-related death in the United States, and the American Cancer Society (ACS) estimates that 51,020 people will die in 2019 [1]. Various drugs have been evaluated to treat patients with advanced-stage cancer with conventional chemotherapeutic agents, such as monoclonal antibodies [2,3], receptor tyrosine kinase inhibitors [3], and immune checkpoint inhibitors [4,5]. Despite these efforts, the five-year survival rate of stage IV colorectal cancer remains 14% [1], and resistance to chemotherapy, radiotherapy, and immunotherapy causes cancer treatment to fail [6].

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