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Optical imaging studies of oral premalignant lesions have shown that optical markers, including loss of autofluorescence and altered morphology of epithelial cell nuclei, are predictive of high-grade pathology. While these optical markers are consistently positive in lesions with moderate/severe dysplasia or cancer, they are positive only in a subset of lesions with mild dysplasia. This study compared the gene expression profiles of lesions with mild dysplasia (stratified by optical marker status) to lesions with severe dysplasia and without dysplasia.Forty oral lesions imaged in patients undergoing oral surgery were analyzed: nine without dysplasia, nine with severe dysplasia, and 22 with mild dysplasia. Samples were submitted for high throughput gene expression analysis.The analysis revealed 116 genes differentially expressed among sites without dysplasia and sites with severe dysplasia; 50 were correlated with an optical marker quantifying altered nuclear morphology. Ten of 11 sites with mild dysplasia and positive optical markers (91%) had gene expression similar to sites with severe dysplasia. Nine of 11 sites with mild dysplasia and negative optical markers (82%) had similar gene expression as sites without dysplasia.This study suggests that optical imaging may help identify patients with mild dysplasia who require more intensive clinical follow-up. If validated, this would represent a significant advance in patient care for patients with oral premalignant lesions.

Oral cancer causes significant global mortality and has a five‐year survival rate of around 64%. Poor prognosis results from late‐stage diagnosis, highlighting an important need to develop better approaches to detect oral premalignant lesions (OPLs) and identify which OPLs are at highest risk of progression to oral squamous cell carcinoma (OSCC). An appropriate animal model that reflects the genetic, histologic, immunologic, molecular and gross visual features of human OSCC would aid in the development and evaluation of early detection and risk assessment strategies. Here, we present an experimental PIK3CA + 4NQO transgenic mouse model of oral carcinogenesis that combines the PIK3CA oncogene mutation with oral exposure to the chemical carcinogen 4NQO, an alternate experimental transgenic mouse model with PIK3CA as well as E6 and E7 mutations, and an existing wild‐type mouse model based on oral exposure to 4NQO alone. We compare changes in dorsal and ventral tongue gross visual appearance, histologic features and molecular biomarker expression over a time course of carcinogenesis. Both transgenic models exhibit cytological and architectural features of dysplasia that mimic human disease and exhibit slightly increased staining for Ki‐67, a cell proliferation marker. The PIK3CA + 4NQO model additionally exhibits consistent lymphocytic infiltration, presents with prominent dorsal and ventral tongue tumours, and develops cancer quickly relative to the other models. Thus, the PIK3CA + 4NQO model recapitulates the multistep genetic model of human oral carcinogenesis and host immune response in carcinogen‐induced tongue cancer, making it a useful resource for future OSCC studies.

Preliminary results are presented from a clinical study in which an integrated multimodal optical imaging system (combining autofluorescence imaging and high-resolution microendoscopy) is used for real-time automated in vivo evaluation of oral lesions.

Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.

Despite an enormous population and growing economy, the nation of Indonesia has some of the world's highest concentrations of neglected tropical diseases (NTDs). These NTDs may thwart future national growth and recent gains. Yet, Indonesia and its Ministry of Health, together with the World Health Organization (WHO), have embarked on an ambitious effort to quickly assemble a health and scientific infrastructure suitable for eliminating its NTDs. The nation of Indonesia is the world's largest island nation (approximately 17,000 islands of which 5,000–6,000 are inhabited) and the fourth most populated nation behind China, India, and the United States (Figure 1) [1]. The nation is tied with the Netherlands as the world's 16th largest economy [1]. According to the World Bank, Indonesia together with South Korea and the BRIC (Brazil, Russia, India, and China) countries will account for more than half of the world's economic growth by 2025 [2]. Figure 1 Map of Indonesia. Despite the future promise of these economic gains, Indonesia is also simultaneously hobbled by a staggering level of extreme poverty. According to the World Bank, of Indonesia's estimated population of 242 million [3], an estimated 46% (approximately 111 million people) live on less than $2 per day [4], while 18% (44 million people) live on less than $1.25 per day [5]. Today, one of the most potent forces that currently traps Indonesia's poorest 111 million people in poverty and could eventually threaten Indonesia's economic potential is a group of NTDs affecting the region. The NTDs are chronic conditions with clinical features similar to many noncommunicable diseases [6]. When they become widespread [6], these diseases have the ability to thwart or stall economies because of their adverse impact on child development, labor, and the health of girls and women [7]. Indeed, Indonesia's “bottom 111” million suffer from an extraordinary level of NTDs, led by widespread helminth infections, such as soil-transmitted helminth (STH) infections and lymphatic filariasis (LF), and neglected bacterial infections, such as yaws and leptospirosis (Table 1) [8]. Moreover, Indonesia is the only country in the WHO's South-East Asia Region with endemic schistosomiasis [8] (the other Asian countries with endemic schistosomiasis are in WHO's Western Pacific region), and the nation is facing a serious and emerging threat from dengue fever [9]. Table 1 The major neglected tropical diseases of Indonesia.