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Biochemist Oliver Bruns plans to revolutionize imaging in cancer surgery with a novel method. Using short-wave infrared light, fluorescent dyes and cutting-edge cameras, it could be possible in future to detect individual cancer cells on tumor margins and in lymph nodes during an operation. The scientist and his team conduct research at the intersection between biology, chemistry, engineering and medicine, and integrate the latest technology from industry to improve treatment for patients.

The National Center for Tumor Diseases Dresden (NCT/UCC) is a joint institution of the German Cancer Research Center (DKFZ), University Hospital Carl Gustav Carus Dresden, the Faculty of Medicine Carl Gustav Carus of TU Dresden and the Helmholtz-Zentrum Dresden-Rossendorf (HZDR).

When a tumor is removed, it is often just a few millimeters that determine whether the operation is a success: if surgeons cut too close to the tumor, cancer cells can be left in the body. If they leave too wide a margin, they can damage important adjacent structures like nerves. Until now, the main randomized assessment method for tumor margins involves taking tissue samples during an operation, which are immediately examined by pathologists under the microscope for remaining tumor cells. In future, it is hoped that a refinement of fluorescence imaging will set new standards for high-precision tumor surgery.

"If surgeons were able to reliably distinguish between tumor tissue and healthy structures already during surgery, the chances of recovery for cancer patients could be significantly improved in many cases. The DKFZ has therefore worked hard to establish a professorship for functional imaging at the NCT site in Dresden. We expect that the further development of these imaging techniques will directly benefit many patients in the future," says Prof. Michael Baumann, Chairman of the DKFZ.

In fluorescence imaging, infrared light in combination with special dyes causes tissue, vessels or body fluids to glow. Until now, the non-invasive infrared method has been working with wavelengths of 700 to 900 nanometers and is used, for example, to check blood flow in newly attached anatomic structures during an operation. By contrast, Bruns and his team are focusing on short-wave infrared (SWIR) with wavelengths greater than 1,000 nanometers. “Shortwave infrared light offers a better contrast and sharper images,” says Professor Oliver Bruns (42), who took up the new post of Professor of Functional Imaging in Surgical Oncology at the National Center for Tumor Diseases Dresden (NCT/UCC) on February 1. “From our findings in basic research, we are convinced that the method has potential in future to see cancer cells left in tumor margins at a depth of several millimeters. It may even be possible to obtain images of just a few tumor cells in lymph nodes,” he adds. “Obtaining images of individual tumor cells in an entire tumor margin and in lymph nodes during an operation is an unresolved problem,” says Professor Jürgen Weitz, a member of the managing directorate of the NCT/UCC and Director of the Department for Visceral, Thoracic and Vascular Surgery at University Hospital Carl Gustav Carus Dresden. “Ideally, the new imaging method will be so precise that, for instance, tumor cells will appear red, nerves green and blood vessels blue. If the method develops in this direction, it could increase the precision and safety of tumor surgery significantly.”

One reason why SWIR imaging has only recently become a fast-growing research field for medicine is that, until a short time ago, there was no suitable imaging technology available. The rapid developments in camera technology in industry – for example in the area of autonomous vehicles – has now created the necessary technology and made it affordable for clinical research and application. Furthermore, until now, only a few fluorescent dyes that are also suitable for SWIR imaging, and that can be used to make specific tissues and structures, such as tumors or blood vessels, visible, have been approved for clinical use. “My vision is that in ten to twenty years, every large hospital will be using SWIR imaging and will have the necessary technology and suitable contrast agents,” says Bruns, who previously led a research group on the Helmholtz Pioneer Campus in Munich.

To achieve this aim, Bruns intends to start by extending the available clinical options for fluorescent imaging at University Hospital Dresden for various oncological operations. Building on this, he then intends to gradually create the technology necessary to work with short-wave infrared. “It is very important for us to receive direct feedback from the surgeons,” he says. “For instance, feedback about the main problems the new method is needed for, and about how well the application works. The chance to translate our research directly to the clinic and the sense of excitement among our surgical colleagues, who are eager to explore new avenues with us, were a key reason behind my decision to move to Dresden,” says Bruns. “In Oliver Bruns we have managed to acquire an imaging expert with an excellent track record for Dresden’s university medicine hub,” says Professor Michael Albrecht, Medical Director of University Hospital Dresden. “We are convinced that, with his scientific expertise, we will be able to further increase the precision of cancer surgery.” The technology also offers application possibilities outside the field of cancer surgery and could, for instance, be used in certain screening examinations in the future as well, such as colonoscopies.

Bruns, who has for years been conducting pioneering research in the field of SWIR imaging, works closely with research groups all over the world on the development of new dyes and the integration of the latest technological developments in medical imaging units, including with groups at Stanford University, the University of California (Los Angeles), the National Cancer Institute (NCI/NIH, Maryland), Imperial College London and the University of Hannover. “We are convinced that the new technology is much better than the current standard,” he says. “So it is important to join forces – including with other research institutions in Dresden – to achieve improved treatments as soon as possible.”

Oliver Bruns, born 1980, studied biochemistry and molecular biology at the University of Hamburg and completed his PhD at University Hospital Hamburg-Eppendorf. As a research associate, he conducted research at the Leibniz Institute for Experimental Virology in Hamburg and worked for several years at the Massachusetts Institute of Technology (MIT). In 2018 he became a principal investigator at the Helmholtz Pioneer Campus in Munich and is being supported through the Emmy Noether Program by the German Research Foundation (DFG). Oliver Bruns has already received a number of scientific awards and grants, including the position as leader of an Emmy Noether junior research group, a Long-Term Fellowship from the European Molecular Biology Organization (EMBO) and the Karl-Heinz Hölzer Award for Interdisciplinary Research (2010). He coordinates a consortium funded by a USD 1 million grant from the Chan Zuckerberg Initiative (CZI) and, starting this year, has funding from the German Federal Ministry of Education and Research (BMBF) through the BetterView network (project budget: EUR 4.1 million). Oliver Bruns is the author of 43 publications and the inventor behind 13 patents.