The advanced artificial intelligence assisted endoscopic workstation will be constituted by last generation gastroscope, colonoscope, duodenoscope, cholangioscope, endoscopic ultrasound probe equipped with softwares to improve images and artificial intelligence. The workstation will be used 1) to detect and characterize benign and malignant gastrointestinal lesions, assess malignant lesion depth of invasion and establish the optimal management, 2) to develop a platform for autologous organoid creation for the liver regenerative medicine, and for the personalized medicine of liver diseases, and to develop a platform for overcoming the lack of renewable sources of human cells for the transplant-based treatment of liver diseases and diabetes based on autologous stem cells isolated from endoscopic biopsies. The research lines that will benefit from the integrated platform (workstation) are of a clinical, endoscopic, radiological and translational nature. Range of users go from surgeons, clinicians, radiologists, to anatomists and basic scientists. Five big Medical, Surgical, Diagnostic and Basic/Translational Discipline Departments governing two big "Sapienza'' medical poles, the Policlinico Umberto I of Rome and the Polo Pontino in Latina, within the Sapienza Health Hub, are involved in an integrated and systematic way in this project, for clinical reasons and for develop translational research lines. The same workstation will be largely used for further collaborative multicenter validation and follow-up studies within existing international research networks. Furthermore, constituting an almost unique instrument of its kind, will favor scientific excellence and the attractiveness of "Sapienza" University of Rome, both nationally and internationally. Finally, may also play an important role in completing a high-level specialist training, both for students, postgraduates, doctoral students and postdocs.
An advanced workstation for AI assisted investigation and characterization of upper and lower GI tract lesions, for innovative diagnostic approaches and treatments fills the unmet needs in terms of early diagnosis, sampling and treatment of preneoplastic and neoplastic lesions. In fact, compared to the endoscopic evaluation alone, even with the use of image magnification methods, it allows to obtain a better definition of the characteristics of lesions (WP#1). Moreover, the use of duodenoscopy, ERCP, cholangioscopy and EUS-FNAB allow us to obtain samples to develop personalized medicine tools and for the purposes of regenerative medicine of the liver. In fact, by using these techniques and tools, and based on the large experience of the proponents in endodermal stem cell isolation, AID will develop a platform for autologous organoid creation and expansion to obtain an innovative source for liver regenerative medicine, precision and personalized medicine of liver diseases (WP#2), and for overcoming one of the principle obstacle in regenerative medicine, the lack of renewable sources of human cells for the transplant-based treatment of liver diseases and diabetes (WP#3). Unfortunately, current diagnostic methods do not allow a personalized medicine approach for cholangiopathies and CCA. Therefore all the tools that allow obtaining disease models in order to characterize from a phenotypic/molecular point of view, and with respect to the biological properties in in vitro models, comrising response to drugs, are highly innovative and attractive for national and international collaborations.
Furthermore, the standardization of protocols for sampling, isolation and expansion of stem/progenitor cells from duodenal and biliary biopsies or cytology is highly innovative, unique and opens up the possibility of further development and implementations of these new autologous cell sources for regenerative medicine of liver and pancreas, particularly through broader international collaborations.
The development of an integrated platform and the achievement of the expected results will open the possibility that the same workstation will be largely used for further collaborative multicenter validation and follow-up studies within existing international research networks. . In particular, the research group is actively involved in the European Research Network (ERN) Rare Liver, for the management and research in rare liver diseases and rare liver tumors, and in the European Network for the Study of Cholangiocarcinoma. This latter is a group of active researchers (constituting research groups located in 13 European countries and representing CCA interesting from Basic, Translational and Clinical research) with a broad interest in this clinical area who have significantly contributed to the study into the pathophysiology of the biliary tree and development/onset of CCA, pursuing basic, translational and clinical research in an effort to identify treatment options with successful outcome for this type of cancer. Moreover, components of the research group are also involved in the activities of the International Society for Cell Therapy, a society focused on translational aspects of developing cell-based therapeutics, advancing scientific research into innovative treatments for patients. Finally, researchers collaborate with the International Primary Sclerosing Cholangitis Study Group, which coordinates Primary Sclerosing Cholangitis research projects between leading institutions worldwide, representing both basic and clinical research groups, allowing for translational research that would otherwise not be feasible. In particular, a joint database for registering patient data has been established, and several studies are presently being performed. All these national and international collaborations can have great advantages and will be strengthened by the achievements that the acquisition of the advanced endoscopic platform can bring. Furthermore, constituting an almost unique instrument of its kind, will favor scientific excellence and the attractiveness of "Sapienza" University of Rome, both nationally and internationally. Finally, the advanced endoscopic workstation may also play an important role in completing a high-level specialist training, both for students, for postgraduates, as well as for doctoral students and postdocs.