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Önder CE, Ziegler TJ, Becker R, Brucker SY, Hartkopf AD, Engler T, Koch A. Advancing Cancer Therapy Predictions with Patient-Derived Organoid Models of Metastatic Breast Cancer. Cancers (Basel) 2023; 15:3602. [PMID: 37509265 PMCID: PMC10377262 DOI: 10.3390/cancers15143602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The poor outcome of metastasized breast cancer (BC) stresses the need for reliable personalized oncology and the significance of models recapitulating the heterogeneous nature of BC. Here, we cultured metastatic tumor cells derived from advanced BC patients with malignant ascites (MA) or malignant pleural effusion (MPE) using organoid technology. We identified the characteristics of tumor organoids by applying immunohistochemistry and mutation analysis. Tumor organoids preserved their expression patterns and hotspot mutations when compared to their original metastatic counterpart and are consequently a well-suited in vitro model for metastasized BC. We treated the tumor organoids to implement a reliable application for drug screenings of metastasized cells. Drug assays revealed that responses are not always in accord with expression patterns, pathway activation, and hotspot mutations. The discrepancy between characterization and functional testing underlines the relevance of linking IHC stainings and mutational analysis of metastasized BC with in vitro drug assays. Our metastatic BC organoids recapitulate the characteristics of their original sample derived from MA and MPE and serve as an invaluable tool that can be utilized in a preclinical setting for guiding therapy decisions.
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Affiliation(s)
- Cansu E Önder
- Research Institute for Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - Teresa J Ziegler
- Research Institute for Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - Ronja Becker
- Research Institute for Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - Sara Y Brucker
- Research Institute for Women's Health, University of Tübingen, 72076 Tübingen, Germany
- Department of Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - Andreas D Hartkopf
- Department of Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University of Tübingen, 72076 Tübingen, Germany
| | - André Koch
- Research Institute for Women's Health, University of Tübingen, 72076 Tübingen, Germany
- Department of Women's Health, University of Tübingen, 72076 Tübingen, Germany
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Vitos N, Gerlee P. Model-based inference of metastatic seeding rates in de novo metastatic breast cancer reveals the impact of secondary seeding and molecular subtype. Sci Rep 2022; 12:9455. [PMID: 35676303 PMCID: PMC9177582 DOI: 10.1038/s41598-022-12500-1] [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: 09/09/2021] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
We present a stochastic network model of metastasis spread for de novo metastatic breast cancer, composed of tumor to metastasis (primary seeding) and metastasis to metastasis spread (secondary seeding), parameterized using the SEER (Surveillance, Epidemiology, and End Results) database. The model provides a quantification of tumor cell dissemination rates between the tumor and metastasis sites. These rates were used to estimate the probability of developing a metastasis for untreated patients. The model was validated using tenfold cross-validation. We also investigated the effect of HER2 (Human Epidermal Growth Factor Receptor 2) status, estrogen receptor (ER) status and progesterone receptor (PR) status on the probability of metastatic spread. We found that dissemination rate through secondary seeding is up to 300 times higher than through primary seeding. Hormone receptor positivity promotes seeding to the bone and reduces seeding to the lungs and primary seeding to the liver, while HER2 expression increases dissemination to the bone, lungs and primary seeding to the liver. Secondary seeding from the lungs to the liver seems to be hormone receptor-independent, while that from the lungs to the brain appears HER2-independent.
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Affiliation(s)
- Noemi Vitos
- Bla Kustens Halsocentral, 57251, Oskarshamn, Sweden
| | - Philip Gerlee
- Mathematical Sciences, Chalmers University of Technology, 41296, Gothenburg, Sweden. .,Mathematical Sciences, University of Gothenburg, 41296, Gothenburg, Sweden.
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3
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Sproll C, Freund AK, Hassel A, Hölbling M, Aust V, Storb SH, Handschel J, Teichmann C, Depprich R, Behrens B, Neves RPL, Kübler NR, Kaiser P, Baldus SE, Tóth C, Kaisers W, Stoecklein NH. Immunohistochemical detection of lymph node-DTCs in patients with node-negative HNSCC. Int J Cancer 2017; 140:2112-2124. [PMID: 28120418 DOI: 10.1002/ijc.30617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/29/2016] [Indexed: 01/15/2023]
Abstract
This study was performed to systematically assess the prevalence, topography and prognostic impact of disseminated tumor cells (DTCs) in lymph nodes (LN) of patients with primary, regional and distant metastasis-free head and neck squamous cell carcinoma (HNSCC) who underwent resection with elective neck dissection. From the routinely processed resection specimen, we could prospectively analyze a total of 1.137 exactly mapped LNs of 50 pN0-HNSCC patients, classified as tumor free by routine histopathology. Three immunohistochemistry (IHC) assays using antibodies directed against CK5/14, a broad spectrum of CKs (1-8, 10, 14-16 and 19), and CD44v6, respectively, were applied on 4.190 LN sections to detect DTCs. The IHC results were correlated with clinicopathologic parameters and clinical follow-up data. We detected seven micrometastases (MM) in five patients and 31 DTCs in 12 patients. Overall, 15 (30%) patients were positive for DTCs or MMs. Strikingly, the anatomical distribution of LN affected with DTCs was not random, but was dependent on the lateralization of the primary tumor and clustered significantly most proximal to the primary tumor. None of the investigated patients developed loco-regional lymphatic or distant metastasis during the mean follow-up period of 71 months. Our results reveal clinically occult tumor cell dissemination as an early and frequent event in HNSCC. Considering that higher rates of recurrences in therapeutic LN dissection concepts have been reported than in elective neck dissection strategies, our DTC-data support to perform elective neck dissections, since they appear to be effective in preventing loco-regional lymphatic recurrence from LN DTCs or MMs.
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Affiliation(s)
- Christoph Sproll
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Anna Karen Freund
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Andrea Hassel
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Marianne Hölbling
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Verena Aust
- Department of Otorhinolaryngology, Protestant Hospital Bethesda, Duisburg, Germany
| | - Sebastian H Storb
- Department of Otorhinolaryngology, Protestant Hospital Bethesda, Duisburg, Germany
| | - Jörg Handschel
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Carina Teichmann
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Rita Depprich
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Bianca Behrens
- Department of General, Visceral and Pediatric Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Rui Pedro Lousa Neves
- Department of General, Visceral and Pediatric Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Norbert R Kübler
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Peter Kaiser
- Department of Pathology, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
| | - Stephan E Baldus
- Institute of Pathology, Cytology and Molecular Pathology, Bergisch, Gladbach, Germany
| | - Csaba Tóth
- Department of Pathology, Medical Faculty, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Kaisers
- Mathematical Institute, Heinrich-Heine-University of Düsseldorf, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Germany
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Breast cancer-secreted miR-939 downregulates VE-cadherin and destroys the barrier function of endothelial monolayers. Cancer Lett 2016; 384:94-100. [PMID: 27693459 DOI: 10.1016/j.canlet.2016.09.013] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022]
Abstract
Exosomes-secreted microRNAs play an important role in metastatic spread. During this process breast cancer cells acquire the ability to transmigrate through blood vessels by inducing changes in the endothelial barrier. We focused on miR-939 that is predicted to target VE-cadherin, a component of adherens junction involved in vessel permeability. By in silico analysis miR-939 was found highly expressed in the basal-like tumor subtypes and in our cohort of 63 triple-negative breast cancers (TNBCs) its expression significantly interacted with lymph node status in predicting disease-free survival probability. We demonstrated, in vitro, that miR-939 directly targets VE-cadherin leading to an increase in HUVECs monolayer permeability. MDA-MB-231 cells transfected with a miR-939 mimic, released miR-939 in exosomes that, once internalized in endothelial cells, favored trans-endothelial migration of MDA-MB-231-GFP cells by the disruption of the endothelial barrier. Notably, when up taken in endothelial cells exosomes caused VE-cadherin down-regulation specifically through miR-939 as we demonstrated by inhibiting miR-939 expression in exosomes-releasing TNBC cells. Together, our data indentify an extracellular pro-tumorigenic role for tumor-derived, exosome-associated miR-939 that can explain its association with worse prognosis in TNBCs.
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Abstract
INTRODUCTION Metastasis contributes to over 90% of cancer-related deaths. Numerous nanoparticle platforms have been developed to target and treat cancer, yet efficient delivery of these systems to the appropriate site remains challenging. Leukocytes, which share similarities to tumor cells in terms of their transport and migration through the body, are well suited to serve as carriers of drug delivery systems to target cancer sites. AREAS COVERED This review focuses on the use and functionalization of leukocytes for therapeutic targeting of metastatic cancer. Tumor cell and leukocyte extravasation, margination in the bloodstream, and migration into soft tissue are discussed, along with the potential to exploit these functional similarities to effectively deliver drugs. Current nanoparticle-based drug formulations for the treatment of cancer are reviewed, along with methods to functionalize delivery vehicles to leukocytes, either on the surface and/or within the cell. Recent progress in this area, both in vitro and in vivo, is also discussed, with a particular emphasis on targeting cancer cells in the bloodstream as a means to interrupt the metastatic process. EXPERT OPINION Leukocytes interact with cancer cells both in the bloodstream and at the site of solid tumors. These interactions can be utilized to effectively deliver drugs to targeted areas, which can reduce both the amount of drug required and various nonspecific cytotoxic effects within the body. If drug delivery vehicle functionalization does not interfere with leukocyte function, this approach may be utilized to neutralize tumor cells in the bloodstream to prevent the formation of new metastases, and also to deliver drugs to metastatic sites within tissues.
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Affiliation(s)
- Michael J Mitchell
- Cornell University, Department of Biomedical Engineering , Ithaca, NY 14853 , USA
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Walter CB, Taran FA, Wallwiener M, Rothmund R, Kraemer B, Krawczyk N, Blassl C, Melcher C, Wallwiener D, Fehm T, Hartkopf AD. Prevalence and prognostic value of disseminated tumor cells in primary endometrial, cervical and vulvar cancer patients. Future Oncol 2014; 10:41-8. [PMID: 24328408 DOI: 10.2217/fon.13.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Disseminated tumor cell (DTC) detection in bone marrow (BM) of primary breast cancer patients predicts poor prognosis. This study investigates the prevalence of DTCs and their prognostic significance in primary gynecologic malignancies. PATIENTS & METHODS DTCs from BM aspirates of 603 patients with endometrial (311), cervical (228) and vulvar cancer (64) were identified by the pancytokeratin antibody A45B/B3. RESULTS DTCs were detected in 18% of BM aspirates (21, 16 and 16% in endometrial, cervical and vulvar cancer, respectively). In cervical cancer, DTCs were associated with International Federation of Gynecology and Obstetrics stage, nodal status and lymphangiosis. There was no association between BM status and prognosis. CONCLUSION Tumor cell dissemination is common in gynecological cancer. In contrast to breast cancer, DTCs that derive from cervical, endometrial or vulvar cancer have less potential to initiate metastatic regrow. The molecular mechanisms underlying this observation warrant further investigation.
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Affiliation(s)
- Christina Barbara Walter
- Department of Obstetrics & Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
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Chandrasekaran S, McGuire MJ, King MR. Sweeping lymph node micrometastases off their feet: an engineered model to evaluate natural killer cell mediated therapeutic intervention of circulating tumor cells that disseminate to the lymph nodes. LAB ON A CHIP 2014; 14:118-27. [PMID: 23934067 DOI: 10.1039/c3lc50584g] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Approximately 90% of cancer related deaths are due to metastasis. Cells from the primary tumor can metastasize through either the vascular or lymphatic circulation. Cancer cells in circulation are called circulating tumor cells (CTCs) and it has been shown that bone marrow is a niche for homing of blood borne CTCs from several epithelial tumors. Cancer cells found in bone marrow are termed disseminated tumor cells (DTCs). Likewise, CTCs in the lymphatic circulation are more often seeded in the sentinel lymph nodes (SLN) that drain the tumor. Micrometastases (<2 mm) occur after the arrest and implantation of DTCs in lymph nodes over time. This paper presents a cell culture platform termed microbubbles formed in polydimethylsiloxane (PDMS) from a microfabricated silicon wafer for mimicking lymph node micrometastases. We cultured lymph node seeking cancer cells in microbubbles to evaluate the efficacy of natural killer (NK) mediated therapy for targeting lymph node micrometastasis. The microbubble platform consists of an array of microcavities that provides a unique microenvironment for mimicking the deep cortical unit of the lymph nodes. We show that cancer cells cultured in microbubbles with therapeutic NK cells undergo apoptosis after 24 h in culture. Since lymph node metastases are prevalent across several types of cancer, this platform may be useful for developing improved cancer therapies for targeting lymph node micrometastases.
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MESH Headings
- Antibodies, Immobilized/chemistry
- Antibodies, Immobilized/immunology
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/immunology
- Apoptosis
- CD57 Antigens/immunology
- CD57 Antigens/metabolism
- Cell Line, Tumor
- Humans
- Killer Cells, Natural/chemistry
- Killer Cells, Natural/immunology
- Liposomes/chemistry
- Lymph Nodes/cytology
- Lymph Nodes/metabolism
- Lymphatic Metastasis/prevention & control
- Microbubbles
- Models, Biological
- Neoplasm Micrometastasis/prevention & control
- Neoplastic Cells, Circulating/immunology
- Neoplastic Cells, Circulating/metabolism
- Silicon/chemistry
- TNF-Related Apoptosis-Inducing Ligand/chemistry
- TNF-Related Apoptosis-Inducing Ligand/metabolism
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Affiliation(s)
- Siddarth Chandrasekaran
- Department of Biomedical Engineering, Cornell University, Weill Hall, Ithaca, NY 14853, USA.
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Demircioglu F, Demirci U, Kilic D, Ozkan S, Karahacioglu E. Clinical significance of lymph node ratio in locally advanced breast cancer molecular subtypes. ACTA ACUST UNITED AC 2013; 36:637-40. [PMID: 24192767 DOI: 10.1159/000355663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ratio of metastatic to dissected lymph nodes (lymph node ratio; LNR) is a sensitive and superior prognostic factor for lymph node evaluation, but its relationship to cancer subtypes is unclear. PATIENTS AND METHODS Data from 469 patients with axillary lymph node metastasis out of 640 early breast cancer cases were retrospectively analyzed. They were classified into 4 molecular subtypes; luminal A, luminal B HER2(+), HER2 overexpression, basal-like. LNRs were compared between groups and with other prognostic factors. RESULTS The distribution of LNRs was 35.2% in luminal A, 43.2% in luminal B HER2(+), 46.9% in HER2 over-expression, and 39.1% in basal-like. A significant difference was found between luminal A and HER2 over-expression subtypes (p = 0.023). LNR was significantly correlated with tumor size and lymphovascular invasion, but not with other prognostic factors including menopausal status, laterality, grade, and perineural invasion. An LNR of 29.8% was defined as the cut-off value, and significant differences in survival rates were identified accordingly between basal-like and both luminal A (p = 0.003) and luminal B HER2(+) (p = 0.04). CONCLUSION The LNR differs between some molecular subtypes of breast cancer, and it correlates with certain prognostic factors and survival. These data support using the LNR to assess breast cancer patients.
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Affiliation(s)
- Fatih Demircioglu
- Rize Recep Tayyip Erdogan University Hospital, Department of Radiation Oncology, Rize, Turkey
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9
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Storci G, Bertoni S, De Carolis S, Papi A, Nati M, Ceccarelli C, Pirazzini C, Garagnani P, Ferrarini A, Buson G, Delledonne M, Fiorentino M, Capizzi E, Gruppioni E, Taffurelli M, Santini D, Franceschi C, Bandini G, Bonifazi F, Bonafé M. Slug/β-catenin-dependent proinflammatory phenotype in hypoxic breast cancer stem cells. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:1688-1697. [PMID: 24036252 DOI: 10.1016/j.ajpath.2013.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/16/2013] [Accepted: 07/30/2013] [Indexed: 11/26/2022]
Abstract
Cancer stem cell survival relies on the activation of inflammatory pathways, which is speculatively triggered by cell autonomous mechanisms or by microenvironmental stimuli. Here, we observed that hypoxic bone marrow stroma-derived transforming growth factor-β 1 promotes the growth of human breast cancer stem cells as mammospheres. The ensuing Slug-dependent serine 139 phosphorylation of the DNA damage sensor H2AX in breast cancer stem cells induces tumor necrosis factor-α and IL-8 mRNAs, whose stability is enhanced by cytoplasmic β-catenin. β-Catenin also up-regulates and binds miR-221, reducing the stability of the miR-221 targets Rad51 and ERα mRNAs. Our data show that the Slug/β-catenin-dependent activation of DNA damage signaling triggered by the hypoxic microenvironment sustains the proinflammatory phenotype of breast cancer stem cells.
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Affiliation(s)
- Gianluca Storci
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Sara Bertoni
- Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sabrina De Carolis
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessio Papi
- Department of Biological, Geological and Environmental Sciences, Functional Genomics Center, University of Verona, Verona, Italy
| | - Marina Nati
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Ceccarelli
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Chiara Pirazzini
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Ferrarini
- Department of Biotechnologies, Functional Genomics Center, University of Verona, Verona, Italy
| | - Genny Buson
- Department of Biotechnologies, Functional Genomics Center, University of Verona, Verona, Italy
| | - Massimo Delledonne
- Department of Biotechnologies, Functional Genomics Center, University of Verona, Verona, Italy
| | - Michelangelo Fiorentino
- Pathology Unit, Addarii Institute of Oncology, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Elisa Capizzi
- Pathology Unit, Addarii Institute of Oncology, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Elisa Gruppioni
- Pathology Unit, Addarii Institute of Oncology, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mario Taffurelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Donatella Santini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giuseppe Bandini
- Institute of Haematology "L & A Seragnoli", St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Bonifazi
- Institute of Haematology "L & A Seragnoli", St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimiliano Bonafé
- Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, Bologna, Italy.
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Bednarz-Knoll N, Alix-Panabières C, Pantel K. Plasticity of disseminating cancer cells in patients with epithelial malignancies. Cancer Metastasis Rev 2013; 31:673-87. [PMID: 22733306 DOI: 10.1007/s10555-012-9370-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Current models suggest that at a certain but yet undefined time point of tumour development malignant cells with an aggressive phenotype start to disseminate via the blood stream into distant organs. This invasive phenotype appears to be associated with an epithelial-mesenchymal transition (EMT), which enables detachment of tumour cells from a primary site and migration. The reverse process of mesenchymal-epithelial transition (MET) might play a crucial role in the further steps of metastasis when circulating tumour cells (CTCs) settle down in distant organs and establish (micro-)metastasis. Nevertheless, the exact mechanisms and interplay of EMT and MET are only partially understood and their relevance in cancer patients is unclear. Research groups have just started to apply EMT-related markers in their studies on CTCs in cancer patients. In the present review, we summarize and discuss the current state of investigations on CTCs in the context of research on EMT/MET.
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Affiliation(s)
- Natalia Bednarz-Knoll
- Department of Tumour Biology, Center of Experimental Medicine, University Cancer Center Hamburg, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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The HER2 status of disseminated tumor cells in the bone marrow of early breast cancer patients is independent from primary tumor and predicts higher risk of relapse. Breast Cancer Res Treat 2013; 138:509-17. [PMID: 23494674 DOI: 10.1007/s10549-013-2470-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 02/03/2023]
Abstract
Overexpression of the HER2-receptor in early breast cancer (EBC) patients is associated with aggressive tumor behavior. However, women suffering from HER2-positive EBC benefit from trastuzumab treatment. As the HER2 status of the primary tumor may differ from that of disseminated tumor cells (DTC) in bone marrow (BM), the aim of this study was (1) to compare the HER2 status of the primary tumor (prim-HER2-status) with that of DTC (DTC-HER2-status) and (2) to analyze the influence of the DTC-HER2-status on patient survival. For this purpose, BM aspirates from 569 EBC patients were analyzed for the presence of DTC. The DTC-HER2-status was identified by a double-staining procedure against cytokeratin and the HER2-receptor. DTC were detected in 151 (27 %) patients. The concordance between the HER2 status of DTC and the primary tumor was 51 %. In patients with detectable DTC, mean disease-free survival was 77.44 (95 % CI 74.72-80.17) months for DTC-HER2-negative and 55.15 (95 % CI 48.57-61.79) months for DTC-HER2-positive patients (p = 0.044). The multivariate analysis showed that the DTC-HER2-status was an independent predictor of disease-free survival. In conclusion, the presence of HER2-positive DTC in EBC patients is associated with an increased risk of relapse. Due to the low concordance between the HER2 status of the primary tumor and DTC, only a minority (13 %) of the DTC-HER2-positive patients was treated with trastuzumab. These patients might, however, benefit from HER2-directed therapy.
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12
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Krishnamurthy S, Bischoff F, Ann Mayer J, Wong K, Pham T, Kuerer H, Lodhi A, Bhattacharyya A, Hall C, Lucci A. Discordance in HER2 gene amplification in circulating and disseminated tumor cells in patients with operable breast cancer. Cancer Med 2013; 2:226-33. [PMID: 23634290 PMCID: PMC3639661 DOI: 10.1002/cam4.70] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 12/12/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) gene amplification in circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) might be useful for modifying Herceptin therapy in breast cancer. In the process of investigating the utility of a microfluidic platform for detecting HER2 gene amplification in these cells, we observed novel results on discordance of HER2 status. Peripheral blood (8.5 mL) and bone marrow (BM) (7.5-10 mL) were collected prospectively from patients with clinical stages I-IV breast cancer. Mononuclear cells were recovered, stained with cytokeratin (CK), CD45, and DAPI, and processed through microfluidic channels for fluorescence in situ hybridization (FISH). A ratio of HER2:CEP17 >2 in any CK+/CD45 or CK-/CD45 cell was regarded as positive for HER2 gene amplification. Peripheral blood from 95 patients and BM from 78 patients were studied. We found CK+/CD45-/DAPI+ CTCs in 27.3% of patients. We evaluated HER2 gene amplification by FISH in 88 blood and 78 BM specimens and found HER2+ CTCs in 1 of 9 (11.1%) and HER2+ DTCs (27.2%) in 3 of 11 patients with HER2+ primary tumor. Among patients with a HER2- primary tumor, 5 of 79 had HER2+ CTCs (6.3%) and 14 of 67 had HER2+ DTCs (20.8%). The overall rate of discordance in HER2 status was 15% between primary tumor and CTCs and 28.2% between primary tumor and DTCs. HER2 was amplified in CTCs and DTCs in a portion of both HER2+ and HER2- primary tumors. HER2 discordance was more frequent for DTCs. The clinical implications of evaluating HER2 status in CTCs and DTCs in breast cancer needs to be established in prospective clinical trials. The cell enrichment and extraction microfluidic technology provides a sensitive platform for evaluation of HER2 gene amplification in CTCs and DTCs.
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Affiliation(s)
- Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Texas 77030, USA.
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Hartkopf AD, Taran FA, Wallwiener M, Hagenbeck C, Melcher C, Krawczyk N, Hahn M, Wallwiener D, Fehm T. The presence and prognostic impact of apoptotic and nonapoptotic disseminated tumor cells in the bone marrow of primary breast cancer patients after neoadjuvant chemotherapy. Breast Cancer Res 2013; 15:R94. [PMID: 24099325 PMCID: PMC3978634 DOI: 10.1186/bcr3496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/27/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neoadjuvant systemic therapy of primary breast cancer (PBC) patients offers the possibility to monitor treatment response. However, patients might have metastatic relapse despite achieving a pathologic complete response (pCR). This indicates that local response to therapy must not be representative for systemic treatment efficacy. Therefore, the aim of this study was to compare local response with systemic tumor cell dissemination by determining the presence of disseminated tumor cells (DTCs), including apoptotic tumor cells, in the bone marrow (BM) of PBC patients after neoadjuvant chemotherapy (NACT). METHODS DTCs were detected by immunocytochemistry (pancytokeratin antibody A45-B/B3) and cytomorphology (DTC status). The presence of apoptotic tumor cells was determined by using the M30 antibody (M30 status). This antibody detects a neo-epitope that is expressed only during early apoptosis. RESULTS BM aspirates from 400 PBC patients that had completed NACT were eligible for this study. Of these, 167 (42%) patients were DTC positive (DTC status). The M30 status was investigated in 308 patients. Apoptotic (M30-positive) tumor cells were detected in 89 (29%) of these. Whereas the DTC status was not correlated (P = 0.557) to local treatment response (that is, pCR or a clinical complete/partial response), the presence of M30-positive tumor cells was significantly higher in patients that responded to therapy (P = 0.026). Additionally, DTC-positive patients were at an increased risk for disease relapse (hazard ratio, 1.87; 95% CI, 1.11 to 3.15; P = 0.019). CONCLUSION The presence of DTC is independent of therapy response of the primary tumor. As patients that are DTC positive after NACT have an unfavorable outcome, they might benefit from additional systemic treatment.
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Affiliation(s)
- Andreas Daniel Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Carola Melcher
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Markus Hahn
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwer Strasse 7, 72076 Tuebingen, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
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Abstract
The detection of circulating tumor cells (CTC) aids in diagnosis of disease, prognosis, disease recurrence, and therapeutic response. The molecular aspects of metastasis are reviewed including its relevance in the identification and characterization of putative markers that may be useful in the detection thereof. Also discussed are methods for CTC enrichment using molecular strategies. The clinical application of CTC in the metastatic disease process is also summarized.
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