What question did this study set out to answer?

This study aims to evaluate automated imaging techniques for assessing intestinal barrier integrity and their predictive capabilities for outcomes in inflammatory bowel disease.

January 23, 2026

P0307Automated real-time imaging of intestinal barrier integrity and molecular profiling for early outcome prediction in inflammatory bowel disease - Endo-Histo-Barrier-Omics study

Key Points

This study aims to evaluate automated imaging techniques for assessing intestinal barrier integrity and their predictive capabilities for outcomes in inflammatory bowel disease.
Prospective enrollment of IBD patients and healthy controls for endoscopic assessment.
Utilization of ultra-high magnification endocytoscopy and confocal laser endomicroscopy for barrier evaluation.
Automated multiplex immunofluorescence for assessing epithelial and vascular markers.
Gene expression profiling in epithelial and lamina propria compartments.
AI-based analysis for evaluating barrier features captured by imaging.
Barrier healing observed in 21% of UC and 30% of CD patients.
Claudin-2 moderately correlated with various markers of epithelial impairment in UC.
PV-1 moderately correlated with blood flow and vessel architecture alterations in CD.
Integrated assessments effectively predicted adverse outcomes based on imaging and marker expression.
Gene expression confirmed upregulation of Claudin-2 and PV-1 in IBD.

Abstract

Abstract Background Intestinal barrier healing is an emerging therapeutic target in inflammatory bowel disease (IBD), though its assessment remains challenging. We evaluated automated advanced imaging for real-time barrier assessment, its correlation with epithelial and vascular barrier markers and its ability to predict adverse outcomes. Barrier-related gene expression was also assessed. Methods IBD patients undergoing endoscopic assessment, along with healthy controls, were prospectively enrolled. Intestinal barrier was evaluated using ultra-high magnification endocytoscopy and probe-based confocal laser endomicroscopy. Targeted biopsies were obtained from inflamed and non-inflamed bowel segments. Epithelial and vascular barriers were assessed through automated multiplex immunofluorescence for Claudin-2, ZO-1, E-cadherin, PV-1, and CD31. Gene expression profiling was performed separately in epithelial and lamina propria compartments. AI-based analysis was employed for automated evaluation of barrier features captured by advanced imaging. Results 103 patients were included (38 ulcerative colitis UC, 54 Crohn’s disease CD, 11 healthy controls. Advanced imaging revealed barrier healing in 21% (8/38) UC and 30% (16/54) CD patients. In UC, Claudin-2 moderately correlated with abnormal crypt architecture (r = 0.49), goblet cell depletion (r = 0.5), and overall endocytoscopy activity (r = 0.49). In CD, PV-1 moderately correlated with altered blood flow (r = 0.41) and vessel architecture (r = 0.40). Integrated assessment of advanced imaging with Claudin-2 and PV-1 expression effectively predicted adverse outcomes in UC and CD, respectively. AI tools accurately classified epithelial and vascular barrier features captured by advanced imaging. Finally, gene expression confirmed upregulation of Claudin-2 and PV-1 in IBD. Conclusion Automated advanced imaging enables real-time barrier assessment in IBD and correlates with markers of epithelial and vascular barrier impairment. AI integration can enhance standardization toward broader clinical applicability. Conflict of interest: Iacucci, Marietta: No conflict of interest Majumder, Snehali: No conflict of interest Dr. Zammarchi, Irene: No conflict of interest Santacroce, Giovanni: No conflict of interest Capobianco, Ivan: No conflict of interest Pugliano, Cecilia: No conflict of interest Chaudari, Ujwala: No conflict of interest Meseguer, Pablo: No conflict of interest Hayes, Brian: No conflict of interest Crotty, Rory: No conflict of interest Aburto, Maria: No conflict of interest Del Amor, Maria Rocio: No conflict of interest Kolawole, Bisi Bode: No conflict of interest Eckenberger, Julia: No conflict of interest Amamou, Asma: No conflict of interest Naranjo, Valery: No conflict of interest Grisan, Enrico: No conflict of interest Ghosh, Subrata: No conflict of interest

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Cite This Study

Iacucci et al. (Thu,) studied this question.

synapsesocial.com/papers/69730f34c8125b09b0d1f084 https://doi.org/https://doi.org/10.1093/ecco-jcc/jjaf231.488

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