Tiresias - But there is mere, much more

My friends,

This week two interesting Optiscan pieces of news came into Tiresias’s purview. The first, another publication from the Neurological Institute at Barrow, Dept. Neurosurgery. This elaborates the specificity and sensitivity of con focal laser endomicroscopy in glioma (malignant brain tumour) and in other brain tumours, showing a 98% sensitivity, and very high positive predictive value of Optiscan’s confocal endomicroscopy ex-vivo. This, friends, is big news. The papers highly technical and does not necessarily recommend his friends to read it in full. Suffice to say, as Tiresias has always known, this confirms that this will be the standard care for brain tumour surgery and pathology. More importantly however, this technology, in-vivo and ex-vivo confocal lase microscopy will replace frozen section biopsy in all cancer surgery. Now, that is big.

The second piece was that Professor Michael McCullough, from the Melbourne Dental Hospital presented on the oral cancer study to the leading dental hospitals in Shanghai, at the China Smart Health Conference. You realise the greater Shanghai is probably as big is the whole of Australia and with high incidence of oral cancer. This will be the standard of care for all cancer and does not institution of this in China does not require FDA approval, CE mark, or TGA. Tiresias does not need to elaborate any further on this. The implications for Optiscan are self-evident.

At the risk loquaciousness, and tiring his readers, what Tiresias really wanted is to talk about today is something that has not been raised previously; immunopathology. You will recall that his previous missives, Tiresias has talked about possible future applications of Optiscan technology that have not even been thought of. Well, if they have been thought of, they certainly have not been written about. So, what is this immunopathology?

First even all immunopathology, as it is at present, is ex-vivo. A blood or tissue samples is taken and then analysed in laboratories. It all involves fluorescence labelling of immune pathology. Fluorescence! Now you are talking Optiscan language. Immunopathology is done in several different ways, but suffice to say it is very labour-intensive, subjective, imprecise, non-quantitative, and harks back more than 70 years, back to when full blood examinations were done manually with a pathology technician with a microscope examining blood on a slide. All this kind of pathology is now fully automated, carried out on industrial scale, on millions of samples processed in Australia every day. Immunopathology, to repeat, is largely done by scientist who looks at slides under and visually grade the level of fluorescent pathology. Furthermore, no in-vivo immunopathology. Optiscan can revolutionise laboratory immunopathology and jumpstart in-vivo immunopathology. In fact, the Memorial Sloan Kettering fluorescent PARP-1 Inhibitor for oral cancer is the first instantiation of in -vivo immune pathology, but for cancer. It would not require very much development to automate much of immunopathology. Done manually and subjective, with laser endomicroscopy, with or without AI, it would make it more accurate more sensitive and more quantitative. This would be a huge advance and for Optiscan it is exceptionally low hanging fruit.

However, what really excites Tiresias is that immunopathology could also be done, for the first time in-vivo. Just like monoclonal antibody florescent labelled antibodies seen ex-vivo, fluorescent labelled markers, directed against immunological marker could be used for autoimmune and inflammatory conditions could be seen conditions could be in-vivo. This would be particularly in conditions of the skin, mucous membrane such as mouth, bladder, cervix, gut, and lungs.

Let me explain. Currently, patients presenting with inflammatory conditions of the skin, are scraped, and cultured for fungi, bacteria and viruses, or biopsies are taken for all of these and for cancer. Autoimmune and inflammatory skin conditions are common. Currently, lesions such as rashes, blisters and ulcers are punch biopsied. The biopsy is then sent to pathologists who then processes it, using conventional stains, and nowadays, almost always, specific labelled targeted antibodies for specific markers and inflammatory cells. This whole process could be made much easier and much better using a confocal microscope. But in addition, there are other problems of doing all this ex-vivo. Punch biopsy is fraught with sampling error. If there is a skin ulcer for example, pathology sample depends on where of the ulcer biopsy was taken. More importantly most of these conditions are chronic, and pathologically monitoring the disease requires repeated biopsies. This is often impractical, impossible, inaccurate, and expensive. However, in-vivo microscopy would allow instant detailed microscopic examination, as frequently as necessary. This would be invaluable for monitoring and management of these common and difficult disorders. In other words, the lesion can be examined at the cellular level, daily, to see the effect of treatment without the inaccurate sampling biased errors and trauma involved with repeated.

Please forgive Tiresias for this rather long epistle, but sometimes he just can’t help himself, as even he gets carried away with the excitement and potential.