1
|
Hakim M, Khorasheh F, Alemzadeh I, Vossoughi M. A new insight to deformability correlation of circulating tumor cells with metastatic behavior by application of a new deformability-based microfluidic chip. Anal Chim Acta 2021; 1186:339115. [PMID: 34756251 DOI: 10.1016/j.aca.2021.339115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Isolation and characterization of circulating tumor cells (CTCs) found in blood samples of cancer patients have been considered as a reliable source for cancer prognosis and diagnosis. A new continuous microfluidic platform has been designed in this investigation for simultaneous capture and characterization of CTCs based on their deformability. The deformability-based chip (D-Chip) consists of two sections of separation and characterization where slanted weirs with a gap of 7 μm were considered. Although sometimes CTCs and leukocytes have the same size, the deformability differs in such a way that can be exploited for enrichment purposes. MCF7 and MDA-MB-231 cell lines were used for the initial evaluation of the D-Chip performance. In the separation section, cancer cells were isolated based on deformability differences with an efficiency of higher than 93% (∼average capturing capacity of 2085 out of 2200 cancer cells ml-1) and with significantly high purity (15-40 WBCs ml-1; ∼5 log depletion of WBCs). Cancer cells were categorized based on the deformability difference in the characterization section. Subsequently, 15 clinical blood samples from breast cancer patients were analyzed by the D-Chip. Suggest 'The chip detected CTCs in all patient samples, processed the blood sample at a high throughput of 5.3 ml/h, and properly categorized CTCs based on deformability differences. Further characterization showed that the highly deformable breast cancer CTCs in our patient samples also showed higher potential of metastasis in support of a broader correlation between deformability of CTCs and metastatic behavior.
Collapse
Affiliation(s)
- Maziar Hakim
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Farhad Khorasheh
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Iran Alemzadeh
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Manouchehr Vossoughi
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran.
| |
Collapse
|
2
|
Perillo A, Agbaje Olufemi MV, De Robbio J, Mancuso RM, Roscigno A, Tirozzi M, Scognamiglio IR. Liquid biopsy in NSCLC: a new challenge in radiation therapy. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021; 2:156-173. [PMID: 36046142 PMCID: PMC9400754 DOI: 10.37349/etat.2021.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the most common cancer and the leading cause of cancer mortality worldwide. To date, tissue biopsy has been the gold standard for the diagnosis and the identification of specific molecular mutations, to guide choice of therapy. However, this procedure has several limitations. Liquid biopsy could represent a solution to the intrinsic limits of traditional biopsy. It can detect cancer markers such as circulating tumor DNA or RNA (ctDNA, ctRNA), and circulating tumor cells, in plasma, serum or other biological fluids. This procedure is minimally invasive, reproducible and can be used repeatedly. The main clinical applications of liquid biopsy in non-small cell lung cancer (NSCLC) patients are the early diagnosis, stratification of the risk of relapse, identification of mutations to guide application of targeted therapy and the evaluation of the minimum residual disease. In this review, the current role of liquid biopsy and associated markers in the management of NSCLC patients was analyzed, with emphasis on ctDNA and CTCs, and radiotherapy.
Collapse
Affiliation(s)
- Annarita Perillo
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Mohamed Vincenzo Agbaje Olufemi
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Jacopo De Robbio
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Rossella Margherita Mancuso
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Anna Roscigno
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Maddalena Tirozzi
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Ida Rosalia Scognamiglio
- Department of Advanced Biomedical Sciences, University “Federico II” School of Medicine, Via Sergio Pansini 5, 80131 Napoli, Italy
| |
Collapse
|
3
|
Künzel J, Gribko A, Lu Q, Stauber RH, Wünsch D. Nanomedical detection and downstream analysis of circulating tumor cells in head and neck patients. Biol Chem 2020; 400:1465-1479. [PMID: 30903749 DOI: 10.1515/hsz-2019-0141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/14/2019] [Indexed: 12/27/2022]
Abstract
The establishment of novel biomarkers in liquid biopsies of cancer patients has come more into focus in prognostic and diagnostic research efforts. Due to their prognostic relevance disseminated tumor cells or circulating tumor cells are the subject of intensive research and are discussed as early diagnostic indicators for treatment failure and the formation of micrometastases. A potential association of this early-systemic tumor component with poor prognosis of cancer patients could be already demonstrated for various entities including breast, colon, lung, melanoma, ovarian and prostate cancers. Thus, the detection of circulating tumor cells seems to be also applicable for minimal-invasive monitoring of therapy progress in head and neck cancer patients. A major problem of the use in clinical routine is that circulating tumor cells could not be detected by modern imaging techniques. To overcome these limitations highly sensitive detection methods and techniques for their molecular characterization are urgently needed allowing mechanistic understanding and targeting of circulating tumor cells. Especially the medical application of nanotechnology (nanomedical methods) has made valuable contributions to the field. Here, we want to provide a comprehensive overview on (nanomedical) detection methods for circulating tumor cells and discuss their merits, pitfalls and future perspectives especially for head and neck solid squamous cell carcinoma (HNSCC) patients.
Collapse
Affiliation(s)
- Julian Künzel
- Nanobiomedicine Department/Department of Otorhinolaryngology-Head and Neck Surgery/ENT, University Medical Center Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany
| | - Alena Gribko
- Nanobiomedicine Department/Department of Otorhinolaryngology-Head and Neck Surgery/ENT, University Medical Center Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany
| | - Qiang Lu
- Nanobiomedicine Department/Department of Otorhinolaryngology-Head and Neck Surgery/ENT, University Medical Center Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany
| | - Roland H Stauber
- Nanobiomedicine Department/Department of Otorhinolaryngology-Head and Neck Surgery/ENT, University Medical Center Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany
| | - Désirée Wünsch
- Nanobiomedicine Department/Department of Otorhinolaryngology-Head and Neck Surgery/ENT, University Medical Center Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany
| |
Collapse
|
4
|
Zhou J, Papautsky I. Size-dependent enrichment of leukocytes from undiluted whole blood using shear-induced diffusion. LAB ON A CHIP 2019; 19:3416-3426. [PMID: 31490514 DOI: 10.1039/c9lc00786e] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Little work has been done in microfluidics with separation of cells directly from whole blood, and the handful of microfluidic systems reported the literature offer only limited throughput. Yet high throughput is highly desirable to avoid degradation of samples, which can result in loss of information critical to disease diagnosis or monitoring. In this work, we investigated particle migration dynamics in whole blood flow at a single-particle level and subsequently successfully demonstrated the preferential enrichment of white blood cells (WBCs) in unprocessed whole blood flows flanking a buffer flow. Our in-depth investigation reveals a counter-intuitive, size-based migration of cells in whole blood flow and their tendency to accumulate in the regions near flow interfaces, which is employed for inherent enrichment of WBCs. More importantly, we found the strong size-dependent migration in blood flow stemming from the differentiated downstream velocity of particles, which inversely scales with particle size. Our new insights improve understanding of this counterintuitive microfluidics field, offering guidance for new device design to directly handle whole blood and to expand the applications to meet the real-world need for ultra-fast cell separation.
Collapse
Affiliation(s)
- Jian Zhou
- University of Illinois Cancer Center, Chicago, IL 60612, USA
| | | |
Collapse
|
5
|
Dielectrophoresis Microfluidic Enrichment Platform with Built-In Capacitive Sensor for Rare Tumor Cell Detection. BIOCHIP JOURNAL 2018. [DOI: 10.1007/s13206-017-2204-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
6
|
Nie L, Li F, Huang X, Aguilar ZP, Wang YA, Xiong Y, Fu F, Xu H. Folic Acid Targeting for Efficient Isolation and Detection of Ovarian Cancer CTCs from Human Whole Blood Based on Two-Step Binding Strategy. ACS APPLIED MATERIALS & INTERFACES 2018; 10:14055-14062. [PMID: 29620849 DOI: 10.1021/acsami.8b02583] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Studies regarding circulating tumor cells (CTCs) have great significance for cancer prognosis, treatment monitoring, and metastasis diagnosis. However, due to their extremely low concentration in peripheral blood, isolation and enrichment of CTCs are the key steps for early detection. To this end, targeting the folic acid receptors (FRs) on the CTC surface for capture with folic acid (FA) using bovine serum albumin (BSA)-tether for multibiotin enhancement in combination with streptavidin-coated magnetic nanoparticles (MNPs-SA) was developed for ovarian cancer CTC isolation. The streptavidin-biotin-system-mediated two-step binding strategy was shown to capture CTCs from whole blood efficiently without the need for a pretreatment process. The optimized parameters for this system exhibited an average capture efficiency of 80%, which was 25% higher than that of FA-decorated magnetic nanoparticles based on the one-step CTC separation method. Moreover, the isolated cells remained highly viable and were cultured directly without detachment from the MNPs-SA-biotin-CTC complex. Furthermore, when the system was applied for the isolation and detection of CTCs in ovarian cancer patients' peripheral blood samples, it exhibited an 80% correlation with clinical diagnostic criteria. The results indicated that FA targeting, in combination with BSA-based multibiotin enhancement magnetic nanoparticle separation, is a promising tool for CTC enrichment and detection of early-stage ovarian cancer.
Collapse
Affiliation(s)
- Liju Nie
- State Key Laboratory of Food Science and Technology , Nanchang University , Nanchang 330047 , China
- The Second Affiliated Hospital of Nanchang University , Nanchang 330006 , China
- Jiangxi Maternal and Child Health Hospital , Nanchang 330000 , China
| | - Fulai Li
- State Key Laboratory of Food Science and Technology , Nanchang University , Nanchang 330047 , China
| | - Xiaolin Huang
- State Key Laboratory of Food Science and Technology , Nanchang University , Nanchang 330047 , China
| | | | | | - Yonghua Xiong
- State Key Laboratory of Food Science and Technology , Nanchang University , Nanchang 330047 , China
| | - Fen Fu
- The Second Affiliated Hospital of Nanchang University , Nanchang 330006 , China
| | - Hengyi Xu
- State Key Laboratory of Food Science and Technology , Nanchang University , Nanchang 330047 , China
| |
Collapse
|
7
|
Garg N, Westerhof TM, Liu V, Liu R, Nelson EL, Lee AP. Whole-blood sorting, enrichment and in situ immunolabeling of cellular subsets using acoustic microstreaming. MICROSYSTEMS & NANOENGINEERING 2018; 4:17085. [PMID: 0 DOI: 10.1038/micronano.2017.85] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/20/2017] [Accepted: 09/23/2017] [Indexed: 05/21/2023]
Abstract
AbstractAnalyzing undiluted whole human blood is a challenge due to its complex composition of hematopoietic cellular populations, nucleic acids, metabolites, and proteins. We present a novel multi-functional microfluidic acoustic streaming platform that enables sorting, enrichment and in situ identification of cellular subsets from whole blood. This single device platform, based on lateral cavity acoustic transducers (LCAT), enables (1) the sorting of undiluted donor whole blood into its cellular subsets (platelets, RBCs, and WBCs), (2) the enrichment and retrieval of breast cancer cells (MCF-7) spiked in donor whole blood at rare cell relevant concentrations (10 mL−1), and (3) on-chip immunofluorescent labeling for the detection of specific target cellular populations by their known marker expression patterns. Our approach thus demonstrates a compact system that integrates upstream sample processing with downstream separation/enrichment, to carry out multi-parametric cell analysis for blood-based diagnosis and liquid biopsy blood sampling.
Collapse
|
8
|
Kairdolf BA, Qian X, Nie S. Bioconjugated Nanoparticles for Biosensing, in Vivo Imaging, and Medical Diagnostics. Anal Chem 2017; 89:1015-1031. [DOI: 10.1021/acs.analchem.6b04873] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Brad A. Kairdolf
- Department of Biomedical
Engineering, Emory University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, Georgia 30322, United States
| | - Ximei Qian
- Department of Biomedical
Engineering, Emory University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, Georgia 30322, United States
| | - Shuming Nie
- Department of Biomedical
Engineering, Emory University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, Georgia 30322, United States
| |
Collapse
|
9
|
Schreier S, Sawaisorn P, Udomsangpetch R, Triampo W. Advances in rare cell isolation: an optimization and evaluation study. J Transl Med 2017; 15:6. [PMID: 28057026 PMCID: PMC5216602 DOI: 10.1186/s12967-016-1108-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Rare nucleated CD45 negative cells in peripheral blood may be malignant such as circulating tumor cells. Untouched isolation thereof by depletion of normal is favored yet still technological challenging. We optimized and evaluated a novel magnetic bead-based negative selection approach for enhanced enrichment of rare peripheral blood nucleated CD45 negative cells and investigated the problem of rare cell contamination during phlebotomy. Methods Firstly, the performance of the magnetic cell separation system was assessed using leukocytes and cultivated fibroblast cells in regard to depletion efficiency and the loss of cells of interest. Secondly, a negative selection assay was optimized for high performance, simplicity and cost efficiency. The negative selection assay consisted of; a RBC lysis step, two depletion cycles comprising direct magnetically labelling of leukocytes using anti-CD45 magnetic beads followed by magnetic capture of leukocytes using a duopole permanent magnet. Thirdly, assay evaluation was aligned to conditions of rare cell frequencies and comprised cell spike recovery, cell viability and proliferation, and CD45 negative cell detection. Additionally, the problem of CD45 negative cell contamination during phlebotomy was investigated. Results The depletion factor and recovery of the negative selection assay measured at most 1600-fold and 96%, respectively, leaving at best 1.5 × 104 leukocytes unseparated and took 35 min. The cell viability was negatively affected by chemical RBC lysis. Proliferation of 100 spiked ovarian cancer cells in culture measured 37% against a positive control. Healthy donor testing revealed findings of nucleated CD45 negative cells ranging from 1 to 22 cells /2.5 × 107 leukocytes or 3.5 mL whole blood in 89% (23/26) of the samples. Conclusion Our assay facilitates high performance at shortest assay time. The enrichment assay itself causes minor harm to cells and allows proliferation. Our findings suggest that rare cell contamination is unavoidable. An unexpected high variety of CD45 negative cells have been detected. It is hypothesized that a rare cell profile may translate into tumor marker independent screening.
Collapse
Affiliation(s)
- Stefan Schreier
- Department of Physics, Faculty of Science, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, 73170, Thailand
| | - Piamsiri Sawaisorn
- Faculty of Medical Technology, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, 73170, Thailand
| | - Rachanee Udomsangpetch
- Faculty of Medical Technology, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, 73170, Thailand.
| | - Wannapong Triampo
- Department of Physics, Faculty of Science, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, 73170, Thailand. .,Centre of Excellence in Mathematics, CHE, 328 Si Ayutthaya Road, Bangkok, 10400, Thailand. .,Thailand Center of Excellence in Physics, 328 Si Ayutthaya Road, Bangkok, 10400, Thailand.
| |
Collapse
|
10
|
Zhang H, Gong S, Liu Y, Liang L, He S, Zhang Q, Si M, Yu Z. Enumeration and molecular characterization of circulating tumor cell using an in vivo capture system in squamous cell carcinoma of head and neck. Chin J Cancer Res 2017; 29:196-203. [PMID: 28729770 PMCID: PMC5497206 DOI: 10.21147/j.issn.1000-9604.2017.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Detection rate and isolation yield of circulating tumor cell (CTC) are low in squamous cell carcinoma of head and neck (SCCHN) with in vitro approaches due to limited sample volumes. In this study, we applied the CellCollector to capture CTC in vivo from peripheral blood.
Methods In total, the study included 22 cases with 37 times of detection. All of the patients were newly diagnosed with locally advanced or metastatic SCCHN, including laryngocarcinoma (40.9%, 9/22) and hypopharyngeal carcinoma (59.1%, 13/22). All patients received CTC analysis before treatment. Three patients received induction chemotherapy. Sixteen patients received surgical therapy, of which 13 patients received postoperative detection. Two patients received both induction chemotherapy and surgery treatment. Patients underwent two successive CellCollector applications 24 h before and 7 d after surgical therapy. Nine healthy volunteers were enrolled as the control group. Epidermal growth factor receptor variant type III (EGFRVIII) expression was analyzed with fluorescent dye labeled antibody. Results With CellCollector isolation, 72.7% (16/22) of the patients were positive for ≥1 CTC (CTC; range, 1–17 cells) before treatments and 46.7% (7/15) of patients were CTC positive for ≥1 CTC (CTC; range, 1–29 cells) after surgical therapy. Moreover, the detection rate of CellCollector (82.4%, 14/17; CTC count range, 0–17) in advanced SCCHN (stage III–IV) was much higher than that in early stages (stage I–II, 40.0%, 2/5; CTC count range, 0–2) (P<0.05). EGFRVIII expression of CTC was also analyzed with fluorescence staining. One CTCEGFRVIII-positive patient was detected from six CTC-positive patients, and the positive expression of EGFRVIII was also found in the tumor tissue of this patient.
Conclusions In vivo detection of CTCs had high sensitivity in SCCHN, which might improve CTC application in clinic.
Collapse
Affiliation(s)
- Haidong Zhang
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Shanchun Gong
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Yaqun Liu
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Longjun Liang
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Shuangba He
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Qingxiang Zhang
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Mingyuan Si
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| | - Zhenkun Yu
- Otorhinolaryngology and Head and Neck Surgery Department, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing 211100, China
| |
Collapse
|
11
|
An integrated on-chip platform for negative enrichment of tumour cells. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1028:153-164. [DOI: 10.1016/j.jchromb.2016.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 01/04/2023]
|
12
|
Bünger S, Zimmermann M, Habermann JK. Diversity of assessing circulating tumor cells (CTCs) emphasizes need for standardization: a CTC Guide to design and report trials. Cancer Metastasis Rev 2016; 34:527-45. [PMID: 26323491 DOI: 10.1007/s10555-015-9582-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hematogenous spreading of tumor cells from primary tumors is a crucial step in the cascade to metastasis, the latter being the most limiting factor for patients' survival prognosis. Therefore, circulating tumor cells (CTCs) have become a field of intensive research. However, the process of isolation and identification of CTCs lacks standardization. This article presents an overview of 71 CTC studies reported in PUBMED since 2000 and focusing on colorectal cancer. These studies are evaluated regarding standardization of CTC isolation and identification, marker proteins used, study population and blood sample quality management, clinical performance, and quality measures. Overall, standardization of CTC assessment seems insufficient. Thus, comparability of CTC studies is hampered and results should be interpreted carefully. We here propose a standardized CTC guideline (CTC Guide) to prospectively design and report studies/trials in a harmonized form. Despite the current interstudy heterogeneity, the data indicate that CTC detection is of clinical relevance and CTCs should be considered as a surrogate prognostic marker. Many studies indicate the high potential for CTCs as prognostic markers, e.g., in colorectal cancer treatment. However, standardized, large-scale multicenter validation studies are still needed to pave the way for clinical implementation of CTC detection that could ameliorate individualized medicine regimes.
Collapse
Affiliation(s)
- S Bünger
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Zimmermann
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J K Habermann
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| |
Collapse
|
13
|
Forte VA, Barrak DK, Elhodaky M, Tung L, Snow A, Lang JE. The potential for liquid biopsies in the precision medical treatment of breast cancer. Cancer Biol Med 2016; 13:19-40. [PMID: 27144060 PMCID: PMC4850125 DOI: 10.28092/j.issn.2095-3941.2016.0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Currently the clinical management of breast cancer relies on relatively few prognostic/predictive clinical markers (estrogen receptor, progesterone receptor, HER2), based on primary tumor biology. Circulating biomarkers, such as circulating tumor DNA (ctDNA) or circulating tumor cells (CTCs) may enhance our treatment options by focusing on the very cells that are the direct precursors of distant metastatic disease, and probably inherently different than the primary tumor's biology. To shift the current clinical paradigm, assessing tumor biology in real time by molecularly profiling CTCs or ctDNA may serve to discover therapeutic targets, detect minimal residual disease and predict response to treatment. This review serves to elucidate the detection, characterization, and clinical application of CTCs and ctDNA with the goal of precision treatment of breast cancer.
Collapse
Affiliation(s)
- Victoria A Forte
- Department of Medicine, Division of Medical Oncology, University of Southern California (USC), Los Angeles, CA 90033, USA; USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Dany K Barrak
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
| | - Mostafa Elhodaky
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Stem Cell and Regenerative Medicine, USC, Los Angeles, CA 90033, USA
| | - Lily Tung
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
| | - Anson Snow
- Department of Medicine, Division of Medical Oncology, University of Southern California (USC), Los Angeles, CA 90033, USA; USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Julie E Lang
- USC Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA; Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, USC, Los Angeles, CA 90033, USA
| |
Collapse
|
14
|
Abstract
Isolation and analysis of cancer cells from body fluids have significant implications in diagnosis and therapeutic treatment of cancers. Circulating tumor cells (CTCs) are cancer cells circulating in the peripheral blood or spreading iatrogenically into blood vessels, which is an early step in the cascade of events leading to cancer metastasis. Therefore, CTCs can be used for diagnosing for therapeutic treatment, prognosing a given anticancer intervention, and estimating the risk of metastatic relapse. However, isolation of CTCs is a significant technological challenge due to their rarity and low recovery rate using traditional purification techniques. Recently microfluidic devices represent a promising platform for isolating cancer cells with high efficiency in processing complex cellular fluids, with simplicity, sensitivity, and throughput. This review summarizes recent methods of CTC isolation and analysis, as well as their applications in clinical studies.
Collapse
Affiliation(s)
- J Zhang
- University of Florida, Gainesville, FL, United States
| | - K Chen
- University of Florida, Gainesville, FL, United States
| | - Z H Fan
- University of Florida, Gainesville, FL, United States.
| |
Collapse
|
15
|
Dent BM, Ogle LF, O'Donnell RL, Hayes N, Malik U, Curtin NJ, Boddy AV, Plummer ER, Edmondson RJ, Reeves HL, May FEB, Jamieson D. High-resolution imaging for the detection and characterisation of circulating tumour cells from patients with oesophageal, hepatocellular, thyroid and ovarian cancers. Int J Cancer 2015; 138:206-16. [PMID: 26178530 PMCID: PMC4737101 DOI: 10.1002/ijc.29680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/09/2015] [Indexed: 12/11/2022]
Abstract
Interest has increased in the potential role of circulating tumour cells in cancer management. Most cell‐based studies have been designed to determine the number of circulating tumour cells in a given volume of blood. Ability to understand the biology of the cancer cells would increase the clinical potential. The purpose of this study was to develop and validate a novel, widely applicable method for detection and characterisation of circulating tumour cells. Cells were imaged with an ImageStreamX imaging flow cytometer which allows detection of expression of multiple biomarkers on each cell and produces high‐resolution images. Depletion of haematopoietic cells was by red cell lysis, leukocyte common antigen CD45 depletion and differential centrifugation. Expression of epithelial cell adhesion molecule, cytokeratins, tumour‐type‐specific biomarkers and CD45 was detected by immunofluorescence. Nuclei were identified with DAPI or DRAQ5 and brightfield images of cells were collected. The method is notable for the dearth of cell damage, recoveries greater than 50%, speed and absence of reliance on the expression of a single biomarker by the tumour cells. The high‐quality images obtained ensure confidence in the specificity of the method. Validation of the methodology on samples from patients with oesophageal, hepatocellular, thyroid and ovarian cancers confirms its utility and specificity. Importantly, this adaptable method is applicable to all tumour types including those of nonepithelial origin. The ability to measure simultaneously the expression of multiple biomarkers will facilitate analysis of the cancer cell biology of individual circulating tumour cells. What's new? Circulating tumour cells (CTCs) are disseminated malignant cells from which biological and therapeutic information may be obtained non‐invasively. Detection of small CTC populations within the large number of normal blood cells is a challenge. This study describes a novel method for the detection and high‐resolution imaging of CTCs. Unlike most other studies, CTC detection is not reliant upon expression of a single biomarker. The method is applicable to all cancers; the authors present preliminary results from four tumour types. The high quality of the images allows biological characterisation of the tumour cells and increases the clinical potential of the approach.
Collapse
Affiliation(s)
- Barry M Dent
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Laura F Ogle
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rachel L O'Donnell
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Nicholas Hayes
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Ujjal Malik
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Nicola J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan V Boddy
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - E Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Richard J Edmondson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, The Liver Unit, Newcastle upon Tyne, United Kingdom
| | - Felicity E B May
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
16
|
Sajay BNG, Chang CP, Ahmad H, Khuntontong P, Wong CC, Wang Z, Puiu PD, Soo R, Rahman ARA. Microfluidic platform for negative enrichment of circulating tumor cells. Biomed Microdevices 2015; 16:537-48. [PMID: 24668439 DOI: 10.1007/s10544-014-9856-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Negative enrichment is the preferred approach for tumor cell isolation as it does not rely on biomarker expression. However, size-based negative enrichment methods suffer from well-known recovery/purity trade-off. Non-size based methods have a number of processing steps that lead to compounded cell loss due to extensive sample processing and handling which result in a low recovery efficiency. We present a method that performs negative enrichment in two steps from 2 ml of whole blood in a total assay processing time of 60 min. This negative enrichment method employs upstream immunomagnetic depletion to deplete CD45-positive WBCs followed by a microfabricated filter membrane to perform chemical-free RBC depletion and target cells isolation. Experiments of spiking two cell lines, MCF-7 and NCI-H1975, in the whole blood show an average of >90 % cell recovery over a range of spiked cell numbers. We also successfully recovered circulating tumor cells from 15 cancer patient samples.
Collapse
Affiliation(s)
- Bhuvanendran Nair Gourikutty Sajay
- BioElectronics Programme, Institute of Microelectronics, A*STAR (Agency for Science, Technology and Research), 1 Science Park Road, Singapore, 117528, Singapore
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Enrichment of circulating melanoma cells (CMCs) using negative selection from patients with metastatic melanoma. Oncotarget 2015; 5:2450-61. [PMID: 24811334 PMCID: PMC4058018 DOI: 10.18632/oncotarget.1683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Circulating tumor cells have emerged as prognostic biomarkers in the treatment of metastatic cancers of epithelial origins viz., breast, colorectal and prostate. These tumors express Epithelial Cell Adhesion Molecule (EpCAM) on their cell surface which is used as an antigen for immunoaffinity capture. However, EpCAM capture technologies are of limited utility for non-epithelial cancers such as melanoma. We report a method to enrich Circulating Melanoma Cells (CMCs) that does not presuppose malignant cell characteristics. CMCs were enriched by centrifugation of blood samples from healthy (N = 10) and patient (N = 11) donors, followed by RBC lysis and immunomagnetic depletion of CD45-positive leukocytes in a specialized magnetic separator. CMCs were identified by immunocytochemistry using Melan-A or S100B as melanoma markers and enumerated using automated microscopy image analyses. Separation was optimized for maximum sensitivity and recovery of CMCs. Our results indicate large number of CMCs in Stage IV melanoma patients. Analysis of survival suggested a trend toward decreased survival with increased number of CMCs. Moreover, melanoma-associated miRs were found to be higher in CMC-enriched fractions in two patients when compared with the unseparated samples, validating this method as applicable for molecular analyses. Negative selection is a promising approach for isolation of CMCs and other EpCAM -negative CTCs, and is amenable to molecular analysis of CMCs. Further studies are required to validate its efficacy at capturing specific circulating cells for genomic analysis, and xenograft studies.
Collapse
|
18
|
Kang H, Kiess A, Chung CH. Emerging biomarkers in head and neck cancer in the era of genomics. Nat Rev Clin Oncol 2014; 12:11-26. [PMID: 25403939 DOI: 10.1038/nrclinonc.2014.192] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Head and neck cancer (HNC) broadly includes carcinomas arising from the mucosal epithelia of the head and neck region as well as various cell types of salivary glands and the thyroid. As reflected by the multiple sites and histologies of HNC, the molecular characteristics and clinical outcomes of this disease vary widely. In this Review, we focus on established and emerging biomarkers that are most relevant to nasopharyngeal carcinoma and head and neck squamous-cell carcinoma (HNSCC), which includes primary sites in the oral cavity, oropharynx, hypopharynx and larynx. Applications and limitations of currently established biomarkers are discussed along with examples of successful biomarker development. For emerging biomarkers, preclinical or retrospective data are also described in the context of recently completed comprehensive molecular analyses of HNSCC, which provide a broad genetic landscape and molecular classification beyond histology and clinical characteristics. We will highlight the ongoing effort that will see a shift from prognostic to predictive biomarker development in HNC with the goal of delivering individualized cancer therapy.
Collapse
Affiliation(s)
- Hyunseok Kang
- Department of Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| | - Ana Kiess
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| | - Christine H Chung
- 1] Department of Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA. [2] Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 1650 Orleans Street, CRB-1 Room 344, Baltimore, MD 21287-0013, USA
| |
Collapse
|
19
|
Guo M, Li X, Zhang S, Song H, Zhang W, Shang X, Zheng Y, Jiang H, Lv Q, Jiang Y, Hao H. Real-time quantitative RT-PCR detection of circulating tumor cells from breast cancer patients. Int J Oncol 2014; 46:281-9. [PMID: 25353649 DOI: 10.3892/ijo.2014.2732] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/22/2014] [Indexed: 11/06/2022] Open
Abstract
Circulating tumor cells (CTCs) were recognized as novel tumor biomarker for prognostic and predictive purposes in various cancers. Various detection technologies and devices have been developed to enumerate and characterize CTCs. Most of those approaches are based on the positive enrichment strategy and immunocytological techniques. However, the sensitivity of these approaches proved to be limited in metastatic tumors and the detection of early tumor cell dissemination was problematic. In the present study, we developed a novel CTC detection method by real-time RT-PCR technique in combination of negative enrichment strategy. The developed enrichment approach could recover more than 75% of spiked breast cancer cells from peripheral blood. The detection limit of duplex real-time RT-PCR assay using KRT19 and ERBB2 as targeted genes was consistently one breast tumor cell. Moreover, CTC detection by duplex real-time RT-PCR assay had higher detection sensitivity than that by immunostaining, especially in early breast cancer. In summary, the results of the present study indicated the potential clinical utilities of CTCs identification on breast cancer by duplex real-time RT-PCR in combination with negative enrichment.
Collapse
Affiliation(s)
- Maowen Guo
- School of Pharmacy, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Xiaotian Li
- School of Pharmacy, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Shaohua Zhang
- Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Hua Song
- Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Wenhui Zhang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Xueyi Shang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Yuling Zheng
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Hua Jiang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Qingyu Lv
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Yongqiang Jiang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Huaijie Hao
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| |
Collapse
|
20
|
Grisanti S, Almici C, Consoli F, Buglione M, Verardi R, Bolzoni-Villaret A, Bianchetti A, Ciccarese C, Mangoni M, Ferrari L, Biti G, Marini M, Ferrari VD, Nicolai P, Magrini SM, Berruti A. Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: prognostic and predictive significance. PLoS One 2014; 9:e103918. [PMID: 25105871 PMCID: PMC4126745 DOI: 10.1371/journal.pone.0103918] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/03/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction We investigated the frequency of detection and the prognostic and predictive significance of circulating tumor cells (CTCs) in patients with recurrent/metastatic (R/M) head and neck carcinoma (HNC) before starting systemic therapy. Patients and methods Using the CellSearch technology, CTCs were assessed prospectively in peripheral blood of 53 R/M-HNC patients. We performed spiking experiments to test the diagnostic performance of the CellSearch platform in identifying squamous carcinoma cells. Results CTCs were identified in 14 (26%) and 22 (41%) patients at baseline and at any time point, respectively. In univariate analysis ≥2 CTCs had a poorer prognostic role than 0–1 CTC. In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53–6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48–6.0, p 0.002]. A disease control after systemic therapy was obtained in 8% of CTC-positive patients as opposed to 45% in CTC-negative ones (p 0.03). The epidermal growth factor receptor (EGFR) expression was identified in 45% of CTC-positive patients. Discussion In conclusion, CTCs are detected in one out of three patients with RM-HNC. CTC detection is a strong prognostic parameter and may be predictive of treatment efficacy. The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor.
Collapse
Affiliation(s)
- Salvatore Grisanti
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
- * E-mail:
| | - Camillo Almici
- Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy
| | - Francesca Consoli
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Rosanna Verardi
- Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy
| | - Andrea Bolzoni-Villaret
- Otorhinolaryngology, Head and Neck Surgery Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Andrea Bianchetti
- Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy
| | - Chiara Ciccarese
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Monica Mangoni
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Laura Ferrari
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Gianpaolo Biti
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Mirella Marini
- Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy
| | - Vittorio D. Ferrari
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Piero Nicolai
- Otorhinolaryngology, Head and Neck Surgery Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Stefano M. Magrini
- Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| |
Collapse
|
21
|
Chen GH, Huang CT, Wu HH, Zamay TN, Zamay AS, Jen CP. Isolating and concentrating rare cancerous cells in large sample volumes of blood by using dielectrophoresis and stepping electric fields. BIOCHIP JOURNAL 2014. [DOI: 10.1007/s13206-014-8201-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
22
|
Lustberg MB, Balasubramanian P, Miller B, Garcia-Villa A, Deighan C, Wu Y, Carothers S, Berger M, Ramaswamy B, Macrae ER, Wesolowski R, Layman RM, Mrozek E, Pan X, Summers TA, Shapiro CL, Chalmers JJ. Heterogeneous atypical cell populations are present in blood of metastatic breast cancer patients. Breast Cancer Res 2014; 16:R23. [PMID: 24602188 PMCID: PMC4053256 DOI: 10.1186/bcr3622] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 02/10/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Circulating tumor cells (CTCs) are commonly isolated from the blood by targeting the epithelial cell adhesion molecule (EpCAM) through positive selection. However, EpCAM can be downregulated during metastatic progression, or it can be initially not present. We designed the present prospective trial to characterize CTCs as well as other circulating cell populations in blood samples from women with metastatic breast cancer without EpCAM-dependent enrichment and/or isolation technology. METHODS A total of 32 patients with metastatic breast cancer were enrolled, and blood samples were processed using a previously described negative depletion immunomagnetic methodology. Samples from healthy volunteers were run as controls (n = 5). Multistep sequential labeling was performed to label and fix cell-surface markers followed by permeabilization for cytokeratins (CK) 8, 18 and 19. Multiparametric flow cytometry (FCM) analysis was conducted using a BD LSR II flow cytometer or a BD FACSAria II or FACSAria III cell sorter. Immunocytochemical staining on postenrichment specimens for DAPI, EpCAM, CD45, CK, epidermal growth factor receptor and vimentin was performed. Expression of these markers was visualized using confocal microscopy (CM). RESULTS CD45-negative/CK-positive (CD45- CK+) populations with EpCAM + and EpCAM - expression were identified with both FCM and CM from the negatively enriched patient samples. In addition, EpCAM + and EpCAM - populations that were CK + and coexpressing the pan-hematopoietic marker CD45 were also noted. There were more CK + EpCAM - events/ml than CK + EpCAM + events/ml in both the CD45- and CD45+ fractions (both statistically significant at P ≤ 0.0005). The number of CK + CD45- and CK + CD45+ events per milliliter in blood samples (regardless of EpCAM status) was higher in patient samples than in normal control samples (P ≤ 0.0005 and P ≤ 0.026, respectively). Further, a significant fraction of the CK + CD45+ events also expressed CD68, a marker associated with tumor-associated macrophages. Higher levels of CD45-CK + EpCAM - were associated with worse overall survival (P = 0.0292). CONCLUSIONS Metastatic breast cancer patients have atypical cells that are CK + EpCAM - circulating in their blood. Because a substantial number of these patients do not have EpCAM + CTCs, additional studies are needed to evaluate the role of EpCAM - circulating cells as a prognostic and predictive marker.
Collapse
MESH Headings
- Adult
- Aged
- Antigens, CD/blood
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/blood
- Antigens, Differentiation, Myelomonocytic/metabolism
- Antigens, Neoplasm/blood
- Antigens, Neoplasm/metabolism
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/blood
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Cell Adhesion Molecules/blood
- Cell Adhesion Molecules/metabolism
- Cell Line, Tumor
- Epithelial Cell Adhesion Molecule
- ErbB Receptors/blood
- ErbB Receptors/metabolism
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- Keratin-18/blood
- Keratin-18/metabolism
- Keratin-19/blood
- Keratin-19/metabolism
- Keratin-8/blood
- Keratin-8/metabolism
- Leukocyte Common Antigens/blood
- Leukocyte Common Antigens/metabolism
- MCF-7 Cells
- Microscopy, Confocal
- Middle Aged
- Neoplasm Metastasis
- Neoplastic Cells, Circulating/metabolism
- Prognosis
- Prospective Studies
- Vimentin/blood
- Vimentin/metabolism
Collapse
Affiliation(s)
- Maryam B Lustberg
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Priya Balasubramanian
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Brandon Miller
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Alejandra Garcia-Villa
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Clayton Deighan
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Yongqi Wu
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Sarah Carothers
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Michael Berger
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Bhuvaneswari Ramaswamy
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Erin R Macrae
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Robert Wesolowski
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Rachel M Layman
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Ewa Mrozek
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University, 2012 Kenny Road, Columbus, OH 43221, USA
| | - Thomas A Summers
- Department of Pathology and Laboratory Services, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Charles L Shapiro
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43212, USA
- The Breast Cancer Research Program, The Ohio State University Comprehensive Cancer Center–Arthur G James Cancer Hospital and Solove Research Institute, 300 W 10th Avenue, Columbus, OH 43210, USA
| | - Jeffrey J Chalmers
- William G Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125A Koffolt Laboratories, 140 W 19th Ave, Columbus, OH 43210, USA
| |
Collapse
|
23
|
Karabacak NM, Spuhler PS, Fachin F, Lim EJ, Pai V, Ozkumur E, Martel JM, Kojic N, Smith K, Chen PI, Yang J, Hwang H, Morgan B, Trautwein J, Barber TA, Stott SL, Maheswaran S, Kapur R, Haber DA, Toner M. Microfluidic, marker-free isolation of circulating tumor cells from blood samples. Nat Protoc 2014; 9:694-710. [PMID: 24577360 DOI: 10.1038/nprot.2014.044] [Citation(s) in RCA: 502] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ability to isolate and analyze rare circulating tumor cells (CTCs) has the potential to further our understanding of cancer metastasis and enhance the care of cancer patients. In this protocol, we describe the procedure for isolating rare CTCs from blood samples by using tumor antigen-independent microfluidic CTC-iChip technology. The CTC-iChip uses deterministic lateral displacement, inertial focusing and magnetophoresis to sort up to 10⁷ cells/s. By using two-stage magnetophoresis and depletion antibodies against leukocytes, we achieve 3.8-log depletion of white blood cells and a 97% yield of rare cells with a sample processing rate of 8 ml of whole blood/h. The CTC-iChip is compatible with standard cytopathological and RNA-based characterization methods. This protocol describes device production, assembly, blood sample preparation, system setup and the CTC isolation process. Sorting 8 ml of blood sample requires 2 h including setup time, and chip production requires 2-5 d.
Collapse
Affiliation(s)
- Nezihi Murat Karabacak
- 1] Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. [2]
| | - Philipp S Spuhler
- 1] Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. [2]
| | - Fabio Fachin
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eugene J Lim
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vincent Pai
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emre Ozkumur
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph M Martel
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikola Kojic
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle Smith
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pin-i Chen
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer Yang
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Henry Hwang
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bailey Morgan
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie Trautwein
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas A Barber
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon L Stott
- 1] Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. [2] Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Ravi Kapur
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Haber
- 1] Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA. [2] Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | - Mehmet Toner
- Department of Surgery and Center for Engineering in Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Wen CY, Wu LL, Zhang ZL, Liu YL, Wei SZ, Hu J, Tang M, Sun EZ, Gong YP, Yu J, Pang DW. Quick-response magnetic nanospheres for rapid, efficient capture and sensitive detection of circulating tumor cells. ACS NANO 2014; 8:941-9. [PMID: 24313365 DOI: 10.1021/nn405744f] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The study on circulating tumor cells (CTCs) has great significance for cancer prognosis, treatment monitoring, and metastasis diagnosis, in which isolation and enrichment of CTCs are key steps due to their extremely low concentration in peripheral blood. Herein, magnetic nanospheres (MNs) were fabricated by a convenient and highly controllable layer-by-layer assembly method. The MNs were nanosized with fast magnetic response, and nearly all of the MNs could be captured by 1 min attraction with a commercial magnetic scaffold. In addition, the MNs were very stable without aggregation or precipitation in whole blood and could be re-collected nearly at 100% in a monodisperse state. Modified with anti-epithelial-cell-adhesion-molecule (EpCAM) antibody, the obtained immunomagnetic nanospheres (IMNs) successfully captured extremely rare tumor cells in whole blood with an efficiency of more than 94% via only a 5 min incubation. Moreover, the isolated cells remained viable at 90.5 ± 1.2%, and they could be directly used for culture, reverse transcription-polymerase chain reaction (RT-PCR), and immunocytochemistry (ICC) identification. ICC identification and enumeration of the tumor cells in the same blood samples showed high sensitivity and good reproducibility. Furthermore, the IMNs were successfully applied to the isolation and detection of CTCs in cancer patient peripheral blood samples, and even one CTC in the whole blood sample was able to be detected, which suggested they would be a promising tool for CTC enrichment and detection.
Collapse
Affiliation(s)
- Cong-Ying Wen
- Key Laboratory of Analytical Chemistry for Biology and Medicine (Ministry of Education), College of Chemistry and Molecular Sciences, State Key Laboratory of Virology, and Wuhan Institute of Biotechnology, Wuhan University , Wuhan 430072, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Warkiani ME, Guan G, Luan KB, Lee WC, Bhagat AAS, Chaudhuri PK, Tan DSW, Lim WT, Lee SC, Chen PCY, Lim CT, Han J. Slanted spiral microfluidics for the ultra-fast, label-free isolation of circulating tumor cells. LAB ON A CHIP 2014; 14:128-37. [PMID: 23949794 DOI: 10.1039/c3lc50617g] [Citation(s) in RCA: 353] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The enumeration and characterization of circulating tumor cells (CTCs), found in the peripheral blood of cancer patients, provide a potentially accessible source for cancer diagnosis and prognosis. This work reports on a novel spiral microfluidic device with a trapezoidal cross-section for ultra-fast, label-free enrichment of CTCs from clinically relevant blood volumes. The technique utilizes the inherent Dean vortex flows present in curvilinear microchannels under continuous flow, along with inertial lift forces which focus larger CTCs against the inner wall. Using a trapezoidal cross-section as opposed to a traditional rectangular cross-section, the position of the Dean vortex core can be altered to achieve separation. Smaller hematologic components are trapped in the Dean vortices skewed towards the outer channel walls and eventually removed at the outer outlet, while the larger CTCs equilibrate near the inner channel wall and are collected from the inner outlet. By using a single spiral microchannel with one inlet and two outlets, we have successfully isolated and recovered more than 80% of the tested cancer cell line cells (MCF-7, T24 and MDA-MB-231) spiked in 7.5 mL of blood within 8 min with extremely high purity (400-680 WBCs mL(-1); ~4 log depletion of WBCs). Putative CTCs were detected and isolated from 100% of the patient samples (n = 10) with advanced stage metastatic breast and lung cancer using standard biomarkers (CK, CD45 and DAPI) with the frequencies ranging from 3-125 CTCs mL(-1). We expect this simple and elegant approach can surmount the shortcomings of traditional affinity-based CTC isolation techniques as well as enable fundamental studies on CTCs to guide treatment and enhance patient care.
Collapse
Affiliation(s)
- Majid Ebrahimi Warkiani
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Wu Y, Deighan CJ, Miller BL, Balasubramanian P, Lustberg MB, Zborowski M, Chalmers JJ. Isolation and analysis of rare cells in the blood of cancer patients using a negative depletion methodology. Methods 2013; 64:169-82. [PMID: 24056212 PMCID: PMC3874448 DOI: 10.1016/j.ymeth.2013.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022] Open
Abstract
A variety of enrichment/isolation technologies exist for the characterization of rare cells in the blood of cancer patients. In this article, a negative depletion process is presented and discussed which consists of red blood cell (RBC) lysis and the subsequent removal of CD45 expressing cells through immunomagnetic depletion. Using this optimized assembly on 120 whole blood specimens, from 71 metastatic breast cancer patients, after RBC lysis, the average nucleated cell log depletion was 2.56 with a 77% recovery of the nucleated cells. The necessity of exploring different anti-CD45 antibody clones to label CD45 expressing cells in this enrichment scheme is also presented and discussed. An optimized, four-color immunofluorescence staining is conducted on the cells retained after the CD45-based immunomagnetic depletion process. Different types of rare non-hematopoietic cells are found in these enriched peripheral blood samples and a wide range of external and internal markers have been characterized, which demonstrates the range and heterogeneity of the rare cells.
Collapse
Affiliation(s)
- Yongqi Wu
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, United States
| | - Clayton J. Deighan
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, United States
| | - Brandon L. Miller
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, United States
| | - Priya Balasubramanian
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, United States
| | - Maryam B. Lustberg
- Stefanie Spielman Comprehensive Breast Center, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, United States
| | - Maciej Zborowski
- Department of Biomedical Engineering, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Jeffrey J. Chalmers
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, United States
- Analytical Cytometry Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States
| |
Collapse
|
27
|
Kin C, Kidess E, Poultsides GA, Visser BC, Jeffrey SS. Colorectal cancer diagnostics: biomarkers, cell-free DNA, circulating tumor cells and defining heterogeneous populations by single-cell analysis. Expert Rev Mol Diagn 2013; 13:581-99. [PMID: 23895128 DOI: 10.1586/14737159.2013.811896] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Reliable biomarkers are needed to guide treatment of colorectal cancer, as well as for surveillance to detect recurrence and monitor therapeutic response. In this review, the authors discuss the use of various biomarkers in addition to serum carcinoembryonic antigen, the current surveillance method for metastatic recurrence after resection. The clinical relevance of mutations including microsatellite instability, KRAS, BRAF and SMAD4 is addressed. The role of circulating tumor cells and cell-free DNA with regards to their implementation into clinical use is discussed, as well as how single-cell analysis may fit into a monitoring program. The detection and characterization of circulating tumor cells and cell-free DNA in colorectal cancer patients will not only improve the understanding of the development of metastasis, but may also supplant the use of other biomarkers.
Collapse
Affiliation(s)
- Cindy Kin
- Department of Surgery, Stanford University School of Medicine, CA, USA.
| | | | | | | | | |
Collapse
|
28
|
Joshi P, Zborowski M, Triozzi PL. Circulating melanoma cells: scoping the target. Front Oncol 2013; 3:189. [PMID: 23964346 PMCID: PMC3740478 DOI: 10.3389/fonc.2013.00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/07/2013] [Indexed: 01/05/2023] Open
Affiliation(s)
- Powrnima Joshi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Cleveland, OH, USA
| | | | | |
Collapse
|
29
|
Arya SK, Lim B, Rahman ARA. Enrichment, detection and clinical significance of circulating tumor cells. LAB ON A CHIP 2013; 13:1995-2027. [PMID: 23625167 DOI: 10.1039/c3lc00009e] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Circulating Tumor Cells (CTCs) are shed from primary or secondary tumors into blood circulation. Accessing and analyzing these cells provides a non-invasive alternative to tissue biopsy. CTCs are estimated to be as few as 1 cell among a few million WBCs and few billion RBCs in 1 ml of patient blood and are rarely found in healthy individuals. CTCs are FDA approved for prognosis of the major cancers, namely, Breast, Colon and Prostate. Currently, more than 400 clinical trials are ongoing to establish their clinical significance beyond prognosis, such as, therapy selection and companion diagnostics. Understanding the clinical relevance of CTCs typically involves isolation, detection and molecular characterization of cells, ideally at single cell level. The need for highly reliable, standardized and robust methodologies for isolating and analyzing CTCs has been widely expressed by clinical thought leaders. In the last decade, numerous academic and commercial technology platforms for isolation and analysis of CTCs have been reported. A recent market report highlighted the presence of more than 100 companies offering products and services related to CTCs. This review aims to capture the state of the art and examines the technical merits and limitations of contemporary technologies for clinical use.
Collapse
Affiliation(s)
- Sunil K Arya
- Bioelectronics Programme, Institute of Microelectronics, A*STAR (Agency for Science, Technology and Research), 11 Science Park Road, Singapore Science Park II, Singapore 117685.
| | | | | |
Collapse
|
30
|
|
31
|
Lustberg M, Jatana KR, Zborowski M, Chalmers JJ. Emerging technologies for CTC detection based on depletion of normal cells. Recent Results Cancer Res 2012; 195:97-110. [PMID: 22527498 PMCID: PMC3775349 DOI: 10.1007/978-3-642-28160-0_9] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Properly conducted, an enrichment step can improve selectivity, sensitivity, yield, and most importantly, significantly reduce the time needed to isolate rare circulating tumor cells (CTCs). The enrichment process can be broadly categorized as positive selection versus negative depletion, or in some cases, a combination of both. We have developed a negative depletion CTC enrichment strategy that relies on the removal of normal cells using immunomagnetic separation in the blood of cancer patients. This method is based on the combination of magnetic and fluid forces in an axial, laminar flow in long cylinders placed in quadrupole magnets. Using this technology, we have successfully isolated CTCs from patients with breast carcinoma and squamous cell carcinoma of the head and neck. In contrast to a positive selection methodology, this approach provides an unbiased characterization of these cells, including markers associated with epithelial mesenchymal transition.
Collapse
Affiliation(s)
- Maryam Lustberg
- Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kris R. Jatana
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH, USA
| | - Maciej Zborowski
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey J. Chalmers
- Professor William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 140 W. 19th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
32
|
Abstract
The separation and or isolation of rare cells using magnetic forces are commonly used and growing in use ranging from simple sample prep for further studies to a FDA approved, clinical diagnostic test. This growth is the result of both the demand to obtain homogeneous rare cells for molecular analysis and the dramatic increases in the power of permanent magnets that even allow the separation of some unlabeled cells based on intrinsic magnetic moments, such as malaria parasite-infected red blood cells.
Collapse
Affiliation(s)
- Maciej Zborowski
- Department of Biomedical Engineering/ND-20, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, United States
| | | |
Collapse
|
33
|
Xu H, Aguilar ZP, Yang L, Kuang M, Duan H, Xiong Y, Wei H, Wang A. Antibody conjugated magnetic iron oxide nanoparticles for cancer cell separation in fresh whole blood. Biomaterials 2011; 32:9758-65. [PMID: 21920599 DOI: 10.1016/j.biomaterials.2011.08.076] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 08/26/2011] [Indexed: 01/06/2023]
Abstract
A highly efficient process using iron oxide magnetic nanoparticles (IO)-based immunomagnetic separation of tumor cells from fresh whole blood has been developed. The process involved polymer coated 30 nm IO that was modified with antibodies (Ab) against human epithelial growth factor receptor 2 (anti-HER2 or anti-HER2/neu) forming IO-Ab. HER2 is a cell membrane protein that is overexpressed in several types of human cancer cells. Using a HER2/neu overexpressing human breast cancer cell line, SK-BR3, as a model cell, the IO-Ab was used to separate 73.6% (with a maximum capture of 84%) of SK-BR3 cells that were spiked in 1 mL of fresh human whole blood. The IO-Ab preferentially bound to SK-BR3 cells over normal cells found in blood due to the high level of HER2/neu receptor on the cancer cells unlike the normal cell surfaces. The results showed that the nanosized magnetic nanoparticles exhibited an enrichment factor (cancer cells over normal cells) of 1:10,000,000 in a magnetic field (with gradient of 100 T/m) through the binding of IO-Ab on the cell surface that resulted in the preferential capture of the cancer cells. This research holds promise for efficient separation of circulating cancer cells in fresh whole blood.
Collapse
Affiliation(s)
- Hengyi Xu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, PR China
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Yu M, Stott S, Toner M, Maheswaran S, Haber DA. Circulating tumor cells: approaches to isolation and characterization. ACTA ACUST UNITED AC 2011; 192:373-82. [PMID: 21300848 PMCID: PMC3101098 DOI: 10.1083/jcb.201010021] [Citation(s) in RCA: 789] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Circulating tumor cells (CTCs) shed from primary and metastatic cancers are admixed with blood components and are thus rare, making their isolation and characterization a major technological challenge. CTCs hold the key to understanding the biology of metastasis and provide a biomarker to noninvasively measure the evolution of tumor genotypes during treatment and disease progression. Improvements in technologies to yield purer CTC populations amenable to better cellular and molecular characterization will enable a broad range of clinical applications, including early detection of disease and the discovery of biomarkers to predict treatment responses and disease progression.
Collapse
Affiliation(s)
- Min Yu
- Howard Hughes Medical Institute, Harvard Medical School, Charlestown, MA 02129, USA
| | | | | | | | | |
Collapse
|
35
|
Jatana KR, Balasubramanian P, Lang JC, Yang L, Jatana CA, White E, Agrawal A, Ozer E, Schuller DE, Teknos TN, Chalmers JJ. Significance of circulating tumor cells in patients with squamous cell carcinoma of the head and neck: initial results. ACTA ACUST UNITED AC 2011; 136:1274-9. [PMID: 21173379 DOI: 10.1001/archoto.2010.223] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES to present and discuss a high-performance negative depletion method for the isolation of circulating tumor cells (CTCs) in the blood of patients with head and neck cancer and to determine the correlation between the presence of CTCs and early clinical outcome in these patients. DESIGN prospective clinical follow-up study of patients with squamous cell carcinoma of the head and neck (SCCHN) undergoing surgical intervention, who had peripheral blood examined for the presence of CTCs. PATIENTS the study population comprised 48 patients diagnosed as having SCCHN and undergoing surgical intervention. INTERVENTION a negative depletion process to isolate and quantify CTCs from the blood of patients with SCCHN using immunomagnetic separation was developed and validated. Immunostaining for cytokeratin was performed on the enriched samples to determine the number of CTCs extracted from each patient's blood sample. Correlation of the presence of CTCs, tumor stage, nodal status, clinical characteristics, and outcome was made. MAIN OUTCOME MEASURE disease-free survival. RESULTS our initial data, that have a mean follow-up of 19.0 months, suggest that patients with no detectable CTCs per milliliter of blood had a significantly higher probability of disease-free survival (P = .01). There was no correlation between the presence of CTCs with regard to age, sex, tumor site, stage, or nodal involvement. CONCLUSIONS our enrichment technology, based on the removal of normal cells, has been used on the peripheral blood of patients with head and neck cancer for which follow-up data were collected. If no CTCs were present, a statistically significant improved disease-free survival was observed in SCCHN. A blood test with such a prognostic capability could have important implications in the treatment of patients with head and neck cancer.
Collapse
Affiliation(s)
- Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University and Nationwide Children's Hospital, 555 S 18th St, Columbus, OH 43205, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Chalmers JJ, Xiong Y, Jin X, Shao M, Tong X, Farag S, Zborowski M. Quantification of non-specific binding of magnetic micro- and nanoparticles using cell tracking velocimetry: Implication for magnetic cell separation and detection. Biotechnol Bioeng 2010; 105:1078-93. [PMID: 20014141 DOI: 10.1002/bit.22635] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The maturation of magnetic cell separation technology places increasing demands on magnetic cell separation performance. While a number of factors can cause sub-optimal performance, one of the major challenges can be non-specific binding of magnetic nano- or microparticles to non-targeted cells. Depending on the type of separation, this non-specific binding can have a negative effect on the final purity, the recovery of the targeted cells, or both. In this work, we quantitatively demonstrate that non-specific binding of magnetic nanoparticles can impart a magnetization to cells such that these cells can be retained in a separation column and thus negatively impact the purity of the final product and the recovery of the desired cells. Through experimental data and theoretical arguments, we demonstrate that the number of MACS magnetic particles needed to impart a magnetization that is sufficient to cause non-targeted cells to be retained in the column to be on the order of 500-1,000 nanoparticles. This number of non-specifically bound particles was demonstrated experimentally with an instrument, cell tracking velocimeter, CTV, and it is demonstrated that the sensitivity of the CTV instrument for Fe atoms contained in magnetic nanoparticles on the order of 1 x 10(-15) g/mL of Fe.
Collapse
Affiliation(s)
- J J Chalmers
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 140 West 19th Avenue, Columbus, OH 43210, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Honeywell R, Yarzadah K, Giovannetti E, Losekoot N, Smit E, Walraven M, Lind J, Tibaldi C, Verheul H, Peters G. Simple and selective method for the determination of various tyrosine kinase inhibitors used in the clinical setting by liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:1059-68. [PMID: 20382575 DOI: 10.1016/j.jchromb.2010.03.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 12/24/2009] [Accepted: 03/08/2010] [Indexed: 01/21/2023]
|
38
|
Balasubramanian P, Yang L, Lang JC, Jatana KR, Schuller D, Agrawal A, Zborowski M, Chalmers JJ. Confocal images of circulating tumor cells obtained using a methodology and technology that removes normal cells. Mol Pharm 2009; 6:1402-8. [PMID: 19445481 DOI: 10.1021/mp9000519] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A completely negative enrichment technology was used to detect circulating tumor cells, CTCs, in the peripheral blood of head and neck cancer patients. Of 32 blood samples, 63% contained CTCs and the number of CTCs identified per mL of blood collected ranged from 0 to 214. The final purity ranged from 1 CTC in 9 total cells to 1 CTC in 20,000 total cells, the final purity being both a function of the number of CTCs and the performance of the specific enrichment. Consistent with previous reports, CTC were positively identified if: (1) they contained a nucleus based on DAPI stain, (2) stained positive for cytokeratins, and (3) have a high nuclei to cytoplasmic ratio. In addition, for a blood sample to be considered positive for CTCs, the enriched sample must be positive for epithelial growth factor receptor, EGFR, as measured by RT-PCR. While most of the blood samples were obtained during surgery, a number were taken prior to and during surgery. In all of the pre- and postsurgery paired samples, significant numbers of CTCs were detected. A number of these enriched samples were observed under confocal microscope in addition to the microscopic observations under traditional wide-field fluorescent microscope. As expected, the FITC stained cytokeratins appeared in the cytoplasm and the average size of these positively stained cells, on the cytospin, was in the range of 8-12 mum. Future studies will involve the investigation if cancer stem cell and mesenchymal markers are present on these CTCs and correlations of patient outcome to the number and type of CTC present.
Collapse
Affiliation(s)
- Priya Balasubramanian
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, 125 Koffolt Laboratories, 140 West 19th Avenue, Columbus, Ohio 43210, USA
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Winter SC, Stephenson SA, Subramaniam SK, Paleri V, Ha K, Marnane C, Krishnan S, Rees G. Long term survival following the detection of circulating tumour cells in head and neck squamous cell carcinoma. BMC Cancer 2009; 9:424. [PMID: 19961621 PMCID: PMC3087340 DOI: 10.1186/1471-2407-9-424] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 12/06/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Techniques for detecting circulating tumor cells in the peripheral blood of patients with head and neck cancers may identify individuals likely to benefit from early systemic treatment. METHODS Reconstruction experiments were used to optimise immunomagnetic enrichment and RT-PCR detection of circulating tumor cells using four markers (ELF3, CK19, EGFR and EphB4). This method was then tested in a pilot study using samples from 16 patients with advanced head and neck carcinomas. RESULTS Seven patients were positive for circulating tumour cells both prior to and after surgery, 4 patients were positive prior to but not after surgery, 3 patients were positive after but not prior to surgery and 2 patients were negative. Two patients tested positive for circulating cells but there was no other evidence of tumor spread. Given this patient cohort had mostly advanced disease, as expected the detection of circulating tumour cells was not associated with significant differences in overall or disease free survival. CONCLUSION For the first time, we show that almost all patients with advanced head and neck cancers have circulating cells at the time of surgery. The clinical application of techniques for detection of spreading disease, such as the immunomagnetic enrichment RT-PCR analysis used in this study, should be explored further.
Collapse
Affiliation(s)
- Stuart C Winter
- Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Bégaud-Grimaud G, Battu S, Liagre B, Beneytout J, Jauberteau M, Cardot P. Development of a downscale sedimentation field flow fractionation device for biological event monitoring. J Chromatogr A 2009; 1216:9125-33. [DOI: 10.1016/j.chroma.2009.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/18/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022]
|
41
|
Gascoyne PRC, Noshari J, Anderson TJ, Becker FF. Isolation of rare cells from cell mixtures by dielectrophoresis. Electrophoresis 2009; 30:1388-98. [PMID: 19306266 PMCID: PMC3754902 DOI: 10.1002/elps.200800373] [Citation(s) in RCA: 307] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The application of dielectrophoretic field-flow fractionation (depFFF) to the isolation of circulating tumor cells (CTCs) from clinical blood specimens was studied using simulated cell mixtures of three different cultured tumor cell types with peripheral blood. The depFFF method can not only exploit intrinsic tumor cell properties so that labeling is unnecessary but can also deliver unmodified, viable tumor cells for culture and/or all types of molecular analysis. We investigated tumor cell recovery efficiency as a function of cell loading for a 25 mm wide x 300 mm long depFFF chamber. More than 90% of tumor cells were recovered for small samples but a larger chamber will be required if similarly high recovery efficiencies are to be realized for 10 mL blood specimens used CTC analysis in clinics. We show that the factor limiting isolation efficiency is cell-cell dielectric interactions and that isolation protocols should be completed within approximately 15 min in order to avoid changes in cell dielectric properties associated with ion leakage.
Collapse
Affiliation(s)
- Peter R C Gascoyne
- Department of Molecular Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | |
Collapse
|
42
|
Yang L, Lang JC, Balasubramanian P, Jatana KR, Schuller D, Agrawal A, Zborowski M, Chalmers JJ. Optimization of an enrichment process for circulating tumor cells from the blood of head and neck cancer patients through depletion of normal cells. Biotechnol Bioeng 2009; 102:521-34. [PMID: 18726961 DOI: 10.1002/bit.22066] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The optimization of a purely negative depletion, enrichment process for circulating tumor cells (CTCs) in the peripheral blood of head and neck cancer patients is presented. The enrichment process uses a red cell lysis step followed by immunomagnetic labeling, and subsequent depletion, of CD45 positive cells. A number of relevant variables are quantified, or attempted to be quantified, which control the performance of the enrichment process. Six different immunomagnetic labeling combinations were evaluated as well as the significant difference in performance with respect to the blood source: buffy coats purchased from the Red Cross, fresh, peripheral blood from normal donors, and fresh peripheral blood from human cancer patients. After optimization, the process is able to reduce the number of normal blood cells in a cancer patient's blood from 4.05 x 10(9) to 8.04 x 10(3) cells/mL and still recover, on average, 2.32 CTC per mL of blood. For all of the cancer patient blood samples tested in which CTC were detected (20 out of 26 patients) the average recovery of CTCs was 21.7 per mL of blood, with a range of 282 to 0.53 CTC. Since the initial number of CTC in a patient's blood is unknown, and most probably varies from patient to patient, the recovery of the CTC is unknown. However, spiking studies of a cancer cell line into normal blood, and subsequent enrichment using the optimized protocol indicated an average recovery of approximately 83%. Unlike a majority of other published studies, this study focused on quantifying as many factors as possible to facilitate both the optimization of the process as well as provide information for current and future performance comparisons. The authors are not aware any other reported study which has achieved the performance reported here (a 5.66 log(10)) in a purely negative enrichment mode of operation. Such a mode of operation of an enrichment process provides significant flexibility in that it has no bias with respect to what attributes define a CTC; thereby allowing the researcher or clinician to use any maker they choose to define whether the final, enrich product contains CTCs or other cell type relevant to the specific question (i.e., does the CTC have predominantly epithelial or mesenchymal characteristics?).
Collapse
Affiliation(s)
- Liying Yang
- Department of Chemical and Biomolecular Engineering, The Ohio State University, 125 Koffolt Laboratories, 140 West 19th Avenue, Columbus, Ohio 43210, USA
| | | | | | | | | | | | | | | |
Collapse
|