Shedding light on scleroderma - cause and mechanism
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Andrea Murray is developing light-based imaging techniques like nailfold capillaroscopy, laser Doppler imaging, and multispectral imaging to better measure and monitor scleroderma disease severity, progression, and treatment response. These non-invasive techniques could provide improved disease management. Specifically, her research has advanced nailfold capillaroscopy by automating capillary measurement, shown laser Doppler imaging can measure blood flow changes in digital ulcers, and a pilot study found multispectral imaging can differentiate oxygenation changes between scleroderma patients and healthy controls. The overall aim is to validate these techniques to better target and monitor scleroderma treatments.
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Shedding light on scleroderma - cause and mechanism
- 1. Andrea Murray Shedding light on scleroderma
- 2. Aim and drive for developing technologies To develop better, more sensitive and robust imaging techniques to measure disease severity, progression & treatment response Better targeting and monitoring of treatments Improved disease management
- 3. Light based - techniques • Advancement of nailfold capillaroscopy • Laser Doppler imaging • Multispectral imaging
- 4. Light based - techniques • Advancement of nailfold capillaroscopy • Laser Doppler imaging • Multispectral imaging
- 6. Nailfold capillaroscopy in action
- 8. Nailfold capillaroscopy • Developed software for automated capillary recognition • Capable of measuring individual and average capillary width, density, tortuosity… Berks et al. Med Image Comput Comput Assist Interv. 2014;17(Pt 1):658-65.
- 9. Comparison of capillary measures between subject groups
- 10. Blood flow in nailfold capillaroscopy Tresadern et al. Conf Proc IEEE Eng Med Biol Soc. 2013;2013
- 11. Light based - techniques • Advancement of nailfold capillaroscopy • Laser Doppler imaging • Multispectral imaging
- 13. Measuring blood flow in digital ulcers • LDI can image ischaemia/hyperaemia in ulceration • 61 DU imaged; 60% ulcers were ischaemic Murray A, et al. Arthritis and Rheumatism 2011; 63: s574
- 14. Measurement of healing in digital ulcers LDI can measure healing of ulcers with respect to blood flow – increase in ulcer blood flow and decrease in adjacent blood flow Baseline At healing (as clinically assessed ) Murray A, et al. Arthritis and Rheumatism 2011; 63: s574
- 16. Pilot iontophoresis - perfusion increase with time Good local method of delivery (no side effects) – we need a longer lasting drug…
- 17. Light based - techniques • Advancement of nailfold capillaroscopy • Laser Doppler imaging • Multispectral imaging
- 18. Hyperspectral or Multispectral imaging Spectroscopy spectrometer White light
- 19. Hyperspectral or Multispectral imaging Spectroscopy spectrometer White light
- 20. Hyperspectral or Multispectral imaging Spectroscopy spectrometer
- 21. Hyperspectral or Multispectral imaging Spectroscopy spectrometer
- 22. Hyperspectral or Multispectral imaging Spectroscopy spectrometer
- 23. • 10 HC, 10 LcSSc, 7 DcSSc • Digital occlusion; 200 mmHg, 2 mins • Imaged baseline, during, upon release and after 1 minute, after 5 mins • Oxygenation Pilot study of multispectral imaging in patients with systemic sclerosis and healthy controls Poxon I et al. Rheumatology (2015) 54 : i161.
- 24. Pilot study of multispectral imaging in patients with systemic sclerosis and healthy controls – oxygenation • Oxygenation
- 25. Pilot study of multispectral imaging in patients with systemic sclerosis and healthy controls – oxygenation • Oxygenation Possible to differentiate between controls and patients with SSc using changes in oxygenation Poxon I et al. Rheumatology (2015) 54 : i161.
- 26. Summary • Light based imaging techniques help us to learn more about Raynaud’s phenomenon and scleroderma non-invasively • Some techniques remain in the research arena, others move towards clinical diagnostic status • Aim is to validate techniques in order to measure disease severity, progression & treatment response • Improve disease management
- 27. Ariane Herrick Tonia Moore Joanne Manning Paul New Sarah Leggett Christopher Griffiths Mark Dickinson Chris Taylor Danny Allen Phil Tresadern Mike Berks Graham Dinsdale Donna Arthur Ian Poxon Mike Hughes Elizabeth Evans I am grateful to: All our volunteers – who make it possible! Our funders
Editor's Notes
- So if we look again that images I showed, and consider the bottom two – can we measure the how the progress of the middle image turning into the bottom one. If we can, that would beneficial both for assessment in clinics, but would also provide proper biomarkers for clinical trials assessing drug efficacy.