Proper regulation of airway surface layer (ASL) is essential for effective mucociliary clearance (MCC) in healthy airways. ASL depletion due to deficient cystic fibrosis transmembrane conductance regulator (CFTR)-mediated anion/fluid secretion plays an important role in the pathogenesis of mucociliary dysfunction and chronic muco-obstructive lung disease in patients with cystic fibrosis (CF). Quantitative measurement of ASL height by confocal fluorescence microscopy following addition of fluorescent dye has contributed important insight into the (dys)regulation of ASL in health and disease. Here, we present a novel method enabling studies of ASL regulation that does not require the addition of dye by using reflected light by confocal microscopy of primary airway epithelial cultures grown at air-liquid interface (ALI). After apical volume addition to primary tracheal mouse cultures, confocal reflection microscopy yielded comparable ASL height as confocal fluorescence microscopy on cultures of wild-type mice, and was sensitive to detect ASL depletion on cultures of
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