Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2015; 7(11): 361-368
Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.361
Tumor neoangiogenesis detection by confocal laser endomicroscopy and anti-CD105 antibody: Pilot study
Adriana Ciocâlteu, Adrian Săftoiu, Daniel Pirici, Claudia-Valentina Georgescu, Tatiana Cârţână, Dan Ionuț Gheonea, Lucian Gheorghe Gruionu, Cosmin Gabriel Cristea, Gabriel Gruionu
Adriana Ciocâlteu, Adrian Săftoiu, Tatiana Cârţână, Dan Ionuț Gheonea, Lucian Gheorghe Gruionu, Cosmin Gabriel Cristea, Gabriel Gruionu, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Daniel Pirici, Department of Research Methodology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Claudia-Valentina Georgescu, Department of Pathology, Emergency County Hospital, 200642 Craiova, Romania
Lucian Gheorghe Gruionu, Department of Mechanical Engineering, University of Craiova, 200585 Craiova, Romania
Gabriel Gruionu, Edwin Steele Laboratory of Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: Ciocâlteu A, Săftoiu A and Gruionu G designed the research; Săftoiu A, Ciocâlteu A, Cârţână T and Gheonea DI performed the research; Pirici D, Gruionu LG and Georgescu CV contributed newreagents/analytic tools; Ciocâlteu A, Cristea CG, Pirici D and Georgescu CV analyzed the data; Ciocâlteu A wrote the paper; Săftoiu A, Gruionu G, Pirici D and Cristea CG revised and edited the paper.
Supported by National Research Council (CNCS), Romania, entitled ‘‘Clinical and Biomathematical Modeling of Vascular Changes Following Anti-Angiogenic Therapy in Advanced Colorectal Carcinoma’’, contract number PN-II-ID-PCE-2011-3-0664, and the European Social Found, Human Resources Development Operational Programme 2007- 2013, No. POSDRU/159/1.5/S/136893.
Institutional review board statement: The current study was conducted according to the Code of Ethics of the World Medical Association (Declaration of Helsinki, 1964, as revised in 2004) and approved by the local Ethics Committee (No. 71/29.05.2014).
Clinical trial registration statement: Not applicable.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Adrian Săftoiu, MD, PhD, MSc, FASGE, Professor, Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania, 2 Petru Rares str., Craiova, Dolj 200349, Romania.
Telephone: +40-744-823355 Fax: +40-251-310287
Received: April 3, 2015
Peer-review started: April 4, 2015
First decision: May 18, 2015
Revised: June 9, 2015
Accepted: August 25, 2015
Article in press: September 7, 2015
Published online: November 15, 2015

AIM: To evaluate neoangiogenesis in patients with colon cancer by two fluorescently labeled antibodies on fresh biopsy samples imaged with confocal laser endomicroscopy (CLE).

METHODS: CLE is an imaging technique for gastrointestinal endoscopy providing in vivo microscopy at subcellular resolution. An important question in validating tumor angiogenesis is what proportion of the tumor vascular network is represented by pre-existing parent tissue vessels and newly formed vessels. CD105 (endoglin) represents a proliferation-associated endothelial cell adhesion molecule. In contrast to pan-endothelial markers, such as CD31, CD105 is preferentially expressed in activated endothelial cells that participate in neovascularization. Thus, we evaluated CD105 and CD31 expression from samples of ten patients with primary rectal adenocarcinoma, using a dedicated endomicroscopy system. A imaging software was used to obtain the Z projection of the confocal serial images from each biopsy sample previously combined into stacks. Vascular density and vessel diameters were measured within two 50 μm x 475 μm rectangular regions of interest centered in the middle of each image in the horizontal and vertical direction. The results were averaged over all the patients and were expressed as the mean ± SE.

RESULTS: The use of an anti-CD105 antibody was found to be suitable for the detection of blood vessels in colon cancer. Whereas anti-CD31 antibodies stained blood vessels in both normal and pathologic colon equally, CD105 expression was observed primarily in malignant lesions, with little or no expression in the vessels of the normal mucosa (244.21 ± 130.7 vessels/mm3 in only four patients). The average diameter of anti-CD105 stained vessels was 10.97 ± 0.6 μm in tumor tissue, and the vessel density was 2787.40 ± 134.8 vessels/mm3. When using the anti-CD31 antibody, the average diameter of vessels in the normal colon tissue was 7.67 ± 0.5 μm and the vessel density was 3191.60 ± 387.8 vessels/mm3, while in the tumors we obtained an average diameter of 10.88 ± 0.8 μm and a vessel density of 4707.30 ± 448.85 vessels/mm3. Thus, there were more vessels stained with CD31 than CD105 (P < 0.05). The average vessel diameter was similar for both CD31 and CD105 staining. A qualitative comparison between CLE vs immunohistochemistry lead to similar results.

CONCLUSION: Specific imaging and quantification of tumor microvessels are feasible in human rectal cancer using CLE examination and CD105 immunostaining of fresh tissue samples.

Keywords: Rectal cancer, Neoangiogenesis, Confocal laser endomicroscopy, Panendothelial markers, Anti-CD105 antibody

Core tip: We evaluated CD105 expression from fresh tissue samples of human rectal adenocarcinoma, using confocal laser endomicroscopy (CLE). While vessels marked with fluorescent CD31 were visible in both normal and malignant tissue, CD105 was predominantly expressed in tumor lesions, having reduced affinity for normal rectal mucosa. Our data showed that CLE using CD105 antibody for tumor vascular network imaging is feasible and that CD105 represents a more specific marker for rectal cancer neoangiogenesis than panendothelial markers. To our knowledge, this is the first study to report the use of fluorescently-labeled CD105 antibody in conjunction with CLE in patients with rectal tumor.