Molecular detection and characterisation of circulating tumour cells and micrometastases in solid tumours

TUMOR MARKERS EXPRESSION LEVELS IN GASTRIC CANCER PATIENT'S PERIPHERAL BLOOD BY RT-PCR ASSESSMENT

BACKGROUND

Hematological recurrence is the second most frequent cause of failure in the treatment of gastric cancer. The detection of circulating tumor markers in peripheral blood by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) method may be a useful tool to predict recurrence and determine the patient's prognosis. However, no consensus has been reached regarding the association between the tumor markers level in peripheral blood and its impact on patient survival.

AIMS

To evaluate the expression of the circulating tumor markers CK20 and MUC1 in peripheral blood samples from patients with gastric cancer by qRT-PCR, and to verify the association of their expression levels with clinicopathological characteristics and survival.

METHODS

A total of 31 patients with gastric adenocarcinoma were prospectively included in this study. CK20 and MUC1 expression levels were analyzed from peripheral blood by the qRT-PCR technique.

RESULTS

There was no statistically significant (p>0.05) association between CK20 expression levels and clinical, pathological, and surgical features. Higher MUC1 expression levels were associated with female patients (p=0.01). There was a correlation between both gene levels (R=0.81, p<0.001), and CK20 level and tumor size (R=0.39, p=0.034).

CONCLUSIONS

CK20 and MUC1 expression levels could be assessed by qRT-PCR from total peripheral blood samples of patients with gastric cancer. CK20 levels were correlated to MUC1 levels as well as to tumor size. There was no difference in disease-free survival and overall survival regarding both genetic markers expression in this series.

Quartz Crystal Microbalance-Based Aptasensors for Medical Diagnosis

Aptamers are important materials for the specific determination of different disease-related biomarkers. Several methods have been enhanced to transform selected target molecule-specific aptamer bindings into measurable signals. A number of specific aptamer-based biosensors have been designed for potential applications in clinical diagnostics. Various methods in combination with a wide variety of nano-scale materials have been employed to develop aptamer-based biosensors to further increase sensitivity and detection limit for related target molecules. In this critical review, we highlight the advantages of aptamers as biorecognition elements in biosensors for target biomolecules. In recent years, it has been demonstrated that electrode material plays an important role in obtaining quick, label-free, simple, stable, and sensitive detection in biological analysis using piezoelectric devices. For this reason, we review the recent progress in growth of aptamer-based QCM biosensors for medical diagnoses, including virus, bacteria, cell, protein, and disease biomarker detection.

Fabrication of Au/Fe 3 O 4 /RGO based aptasensor for measurement of miRNA‐128, a biomarker for acute lymphoblastic leukemia (ALL)

Due to their high sensitivity, simplicity, portability, self‐contained, and low cost, the development of electrochemical biosensors is a beneficial way to diagnose and anticipate many types of cancers. An electrochemical nanocomposite‐based aptasensor is fabricated for the determination of miRNA‐128 concentration as the acute lymphoblastic leukemia (ALL) biomarker for the first time. The aptamer chains were immobilized on the surface of the glassy carbon electrode (GCE) through gold nanoparticles/magnetite/reduced graphene oxide (AuNPs/Fe₃O₄/RGO). Fast Fourier transform infrared (FTIR), X‐ray diffraction (XRD), vibrating sample magnetometer (VSM), and transmission electron microscopy (TEM) were used to characterize synthesized nanomaterials. Cyclic voltammetry (CV), square wave voltammetry (SWV), and electrochemical impedance spectroscopy (EIS) were used to characterize the modified GCE in both label‐free and labeled methods. The results indicate that the modified working electrode has high selectivity and for miRNA‐128 over other biomolecules. The hexacyanoferrate redox system typically operated at around 0.3 V (vs. Ag/AgCl), and the methylene blue redox system ran at about 0 V, were used as an electrochemical probe. The detection limit and linear detection range for hexacyanoferrate and methylene blue are 0.05346 fM, 0.1–0.9 fM, and 0.005483 fM, 0.01–0.09 fM, respectively. The stability and diffusion control analyses were performed as well. In both label‐free and labeled methods, the modified electron showed high selectivity for miRNA‐128. The use of methylene blue as a safer redox mediator caused miRNA‐128 to be detected with greater accuracy at low potentials in PBS media. The findings also show the substantial improvement in detection limit and linearity by using reduced graphene oxide‐magnetite‐gold nanoparticles that can be verified by comparing with previous studies on the detection of other miRNAs.

A non-invasive tool for early detection of acute leukemia in children using a paper-based optoelectronic nose based on an array of metallic nanoparticles

Volatile organic compounds (VOCs) in blood samples can be used as useful biomarkers to diagnose various human diseases. This study describes the potential of a paper-based sensor array for detecting leukemia using blood VOCs. Blood samples were collected from 59 new leukemia cases and 47 healthy cases as a control group. Each blood sample was divided into two parts; one for a laboratory test and the other was used in our study. Samples were mixed with heparin and then transferred to a sterile container, and a sensor was stacked on its cap. This sensor array contains 16 nanoparticles deposited on a sheet of hydrophobic paper in a 4 × 4 array format. Containers were stored in an oven at 60 °C for 4.5 h. Then, the image of sensors was recorded by a scanner and compared to the image before exposing the blood vapor. The sensor responses were subjected to different multivariate statistical methods to develop models that discriminate between control and leukemia samples. The interaction of nanoparticles with the volatile metabolome of blood caused aggregation and consequently changing in the color of nanoparticles. The color changes resulted in a specific pattern for blood samples with leukemia, which is different from those obtained from healthy specimens. The discrimination analysis was approved by pattern recognition methods such as principal component analysis with 97% accuracy. Among 59 patients, the mean age was 6.02 ± 4.55 years (range 1-16 y). The mean total response was 652.83 ± 117.02. The rock curve showed an accuracy of 96% for classifying patients from the control group. The logistic regression model showed that 93.6% of healthy and 93.2% of patients were classified correctly by using this method. These statistics agree with the classification results obtained by principal component analysis. For every 5000-unit increase in platelet count, the chance of leukemia decreased by 9%. Additionally, the chance of being categorized as a patient decreased by 10% for every 20-unit increase in total response. The electronic nose using VOC's of blood is a non-invasive and inexpensive tool for detecting new cases of leukemia with high sensitivity and specificity. Platelet count is an essential para-clinical parameter determining the total response of the sensors. Follow up studies with a larger sample size are warranted to elucidate its clinical applicability.

One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma

BACKGROUND

In head and neck squamous cell carcinoma (HNSCC) 30% of cN0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for cN0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging.

OBJECTIVE

To compare OSNA analysis to pathological analysis in cN0 HNSCC.

MATERIALS AND METHODS

157 LN from 26 cN0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-qPCR of CK19, PVA and EPCAM on the LN lysate of discordant cases.

RESULTS

OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%.

CONCLUSION

Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results. Study registered under clinicaltrials.gov database number NCT02852343.

Aptamer/magnetic nanoparticles decorated with fluorescent gold nanoclusters for selective detection and collection of human promyelocytic leukemia (HL-60) cells from a mixture

In the present work, a fluorescent gold nanoclusters (GNCs)/superparamagnetic (Fe₃O₄/GNCs) nanoprobe was prepared via a facile approach for the selective detection and imaging of human leukemica cancer cells (HL-60). (γ-Mercaptopropyl)trimethoxysilane (MPS) was used as a stabilizer to prepare functionalized GNCs. The prepared GNCs@MPS was then self-assembly decorated on the surface of Fe₃O₄@SiO₂ nanoparticles followed by poly(ethylene glycol) dimethacrylate (PGD) addition at room temperature to form Fe₃O₄/GNCs nanoprobe. Surface functionalization of the Fe₃O₄/GNCs with the thiol-modified KH1C12 aptamer was done through thiol-en click reaction between PGD and the thiol group of the aptamer. An extensive characterization of the Fe₃O₄/GNCs revealed strong red fluorescence (λ _em = 627 nm), T ₂-based contrast agent for MRI and excellent colloidal and photo stability in buffer medium. So, the aptamer-functionalized Fe₃O₄/GNCs nanoprobe (Fe₃O₄/GNCs/Aptamer) is capable to uptake and dual-image HL-60 cancer cells from a mixture. Furthermore, the MRI signal intensity of the pictures decreased linearly with an increase in the concentrations of the nanoprobe. It is also enable to detect cancer cells from a range of concentrations 10 up to 200 cells μL^-1. The fluorescent/magnetic characteristics of the nanoprobe are of great significance for MRI-based and fluorescence imaging and collection of HL-60 cancer cells which implies potential help for the development of early diagnosis of highly malignant human leukemia.

Three Markers in Cancerous and Healthy Cells of Patients with Non-Small-Cell Lung Carcinoma (NSCLC)

Introduction: Lung cancer is the most common cause of cancer-related death among males and females. The diagnosis of lung cancer is of great importance for clinical considerations and follow-up treatment. This study aimed to examine the expression of CEA, LUNX, and CK19 biomarkers in the cancerous and healthy tissues of patients suffering from NSCLC. Methods: In this study, 30 patients with NSCLCs referring to Masih Daneshvari Hospital in Tehran were voluntarily selected prior to taking any treatment. A tissue sample from the center and a sample of healthy tissues close to the cancerous masses were prepared by a specialist in the bronchoscopy sector and tested using real-time RT-PCR. Results: Positive CEA mRNA was observed in cancerous tissues in the center of tumors of 25 out of 30 cases. In the healthy tissue group, the same was found in 10 out of 30 cases (P<0.001). The markers CK19 and LUNX mRNAs showed to be positive in cancerous samples in the center of tumors of 15 and 22 out of 30 cases, and in the healthy tissue group, the expression was observed in 5 and 4 out of 30 cases, respectively(P<0.001). Conclusion: This study confirms that the aformentioed markers are the ones with a relatively appropriate sensitivity and specificity for the diagnosis of lung cancer.

Prediction of breast cancer metastasis risk using circulating tumor markers: A follow-up study

Distant organ tumor dissemination is a major cause of breast cancer-related deaths. In 2010, we analyzed the prognostic importance of the circulating tumor markers (CTMs) cytokeratin 19 (CK19), CK20, epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) in relation to the clinical and pathological characteristics of patients with breast cancer (BC). To assess the clinical utility of CK19, CK20 and EGFR in predicting distant metastasis in BC, here we report 7-year follow-up results of 77 patients. The patients with at least one positive CTM were classified as CTM(+) and those negative for all CTMs were assigned to CTM(-) group. In patients who received no treatment following CTM analysis, 25.0% had metastasis in CTM(+) and 10.0% in CTM(-) group. In patients who received one of the following therapies: chemotherapy, radiotherapy or hormone therapy, or the combinations of these therapies, the rate of metastasis was 33.3% in CTM(+) and 20.0% in CTM(-) group. Disease-free time was shorter in CTM(+) patients compared to CTM(-) group (28.83 ± 10.76 and 41.38 ± 9.5 months, respectively). According to multivariate Cox proportional hazard regression analysis, the presence of regional lymph node metastasis, Ki-67 expression, higher tumor grade and CTM expression status were predictors of poor prognosis associated with distant metastasis (p < 0.05). Also, CTM positivity was a factor associated with metastasis-related poor prognosis (HR = 0.492, p = 0.026). The mean survival for CTM(+) patients was shorter than that for CTM(-) patients (90.671 ± 2.66 and 101.23 ± 3.92 months, respectively; p > 0.05). Our findings demonstrate that CTM positivity may indicate a high metastasis risk; however, CTM negativity does not guarantee low metastasis risk. These results may encourage further preclinical investigation of CTMs, to evaluate the possible implications of these findings to the clinical setting.

Highly sensitive and specific cytosensing of HT 29 colorectal cancer cells using folic acid functionalized-KCC-1 nanoparticles

Functionalized fibrous nano-silica (KCC-1) was applied to specific electrochemical detection of HT 29 colorectal cancer cells based on folate (FA)/folate receptor (FR) interactions. KCC-1 fibrous materials were synthesized using a hydrothermal method and then functionalized with FA molecules to produce KCC-1-NH₂-FA nanoparticles. The KCC-1-NH₂-FA fibrous nanoparticles offer favorable bleaching stability and exceptional surface area-to-volume ratio which provide facility to design more sensitive cytosensors. The morphology, size and surface charge of KCC-1, KCC-1-NH₂ and KCC-1-NH₂-FA were approved by field emission scanning electron microscope (FESEM), transmission electron microscopy (TEM), dynamic light scattering (DLS) and zeta potential, respectively. The porosity of the negatively charged KCC-1-NH₂-FA was also tested with Brunauer-Emmett-Teller (BET) which approves the high surface area-to-volume ratio of the KCC-1 based materials. Flow cytometry and fluorescence imaging were applied to approve quantitative and qualitative attaching of KCC-1-NH₂-FA to the HT 29 FR-positive cancer cells. Also, the specific capturing of the nanoparticles were approved by FR-negative HEK 293 normal cells as FR-negative cells through cellular uptake assay which showed the smart differentiation by KCC-1-NH₂-FA nanomaterials. The cytotoxicity results revealed the biocompatible nature of KCC-1 based materials, implying that the developed method could be used in in vivo applications under the optimized conditions. The developed cytosensor response is linear from 50 to 1.2 × 10⁴ cells/mL with a lower limit of detection (LLOQ) of 50 cells/mL. As advantage of the developed cytosensor is simple and provides excellent specificity and sensitivity which enables us to design point of care devices for clinical uses.

DNA Aptamers in the Detection of Leukemia Cells by the Thickness Shear Mode Acoustics Method

By using the thickness shear mode acoustics method (TSM) and single-molecule force spectroscopy (SMFS) we studied the interactions between DNA aptamers (sgc8c) specific to the protein tyrosine kinase 7 (PTK7), which is localized in the membranes of leukemia lymphoblastics (MOLT-4), and lymphocyte (Jurkat) cell lines, as well with PTK7-negative U266 myeloid leukemia cells. The TSM method allowed the development of a highly sensitive, label-free biosensor for the detection leukemia cells with a limit of detection of (195±20) cells/mL. SMFS approved the high selectivity of the sgc8c aptamers to the PTK7 receptors at the cell surface and allowed determining the binding probability of the aptamers to the PTK7 receptors at different cell lines.

Simultaneous isolation and detection of single breast cancer cells using surface-enhanced Raman spectroscopy

Nowadays, cancer is one of the most dangerous and deadly disease all around the world. Cancer that is diagnosed at early stages is more likely to be treated successfully. Treatment of progressed cancer is very difficult, and generally surviving rates are much lower. Therefore, much research has been focused on developing non-invasive methods for detection of cancer and monitoring of its progress. Within this contribution, we present a novel strategy for selective isolation and detection of breast cancer cell lines (MCF-7 and BT-20) based on surface enhanced Raman scattering (SERS). A simplified protocol based on cell-aptamer interaction has been developed in which core-shell (Au@Fe₃O₄) nanoparticles (CSNs) were functionalized with a mucin 1 (MUC1) specific aptamer (Apt1) to capture cells through the interaction between Apt1 and overexpressed protein (MUC1) on the surface of the tumor cells. Meanwhile, a SERS nano-tag, synthesized by the conjugation of Apt1 to the surface of BSA coated and with 4-mercaptopyridine (4-Mpy) functionalized gold nanoparticles, was used to detect the isolated cells. As a conclusion, the proposed strategy can be extended to isolate and detect cells more precisely based on the detection of different kinds of biomarkers on the surface of cancer cells, simultaneously.

CK19, CK20, EGFR and HER2 Status of Circulating Tumor Cells in Patients with Breast Cancer

Aims and background

The major cause of death in breast cancer patients is metastasis. Various biomarkers have been used for the early detection of circulating tumor cells in the peripheral blood of breast cancer patients. The aims of the current study were to analyze circulating tumor cells in the blood of breast cancer patients by investigating EGFR, CK19, CK20 and HER2 expression profiles and to evaluate their prognostic importance.

Methods

CK19, CK20 and EGFR gene expression profiles were evaluated in the blood samples of 84 female patients with primary invasive ductal breast cancer and 20 healthy female volunteers using SYBR green-based real-time qPCR assays. HER2 expression analyses were conducted in 46 patients who had an HER2-positive primary tumor and in 30 healthy women to determine the cutoff level of positivity.

Results

The positive rates of CK20, EGFR, CK19 and HER2 mRNA expression in the peripheral blood were 28.57% (24/84), 20.23% (17/84), 5.95% (5/84) and 2.17% (1/46), respectively. The high positive ratio of CK20 mRNA expression in the peripheral blood of breast cancer was identified for the first time in the current study. Significant differences were identified in CK20 expression status and several clinical parameters related with aggressiveness of tumors using a binary logistic regression analysis. Higher CK20-positive levels were observed in patients who had lymph node metastasis and advanced-grade primary tumors, which were estrogen receptor-negative. We have demonstrated that CK20 may be a novel biomarker that is useful to identify circulating tumor cells and predict breast cancer progression.

Conclusions

The results suggest that the investigation of CK20 mRNA with other biomarkers in the peripheral blood of breast cancer patients may be useful to monitor the presence of disseminated tumor cells in the blood circulation and to predict the prognosis of breast cancer.

Amplified detection of leukemia cancer cells using an aptamer-conjugated gold-coated magnetic nanoparticles on a nitrogen-doped graphene modified electrode

The increasing demands for early, accurate and ultrasensitive diagnosis of cancers demonstrate the importance of the development of new amplification strategies or diagnostic technologies. In the present study, an aptamer-based electrochemical biosensor for ultrasensitive and selective detection of leukemia cancer cells has been introduced. The thiolated sgc8c aptamer was immobilized on gold nanoparticles-coated magnetic Fe₃O₄ nanoparticles (Apt-GMNPs). Ethidium bromide (EB), intercalated into the stem of the aptamer hairpin, provides the read-out signal for the quantification of the leukemia cancer cells. After introduction of the leukemia cancer cells onto the Apt-GMNPs, the hairpin structure of the aptamer is disrupted and the intercalator molecules are released, resulting in a decrease of the electrochemical signal. The immobilization of nitrogen-doped graphene nanosheets on the electrode surface provides an excellent platform for amplifying the read-out signal. Under optimal conditions, the aptasensor exhibits a linear response over a wide dynamic range of leukemia cancer cells from 10 to 1×10⁶cellmL^-1. The present protocol provides a highly sensitive, selective, simple, and robust method for early stage detection of leukemia cancer. Furthermore, the fabricated aptasensor was successfully used for the detection of leukemia cancer cells in complex media such as human blood plasma, without any serious interference.

Aptamer-Functionalized Fluorescent Silica Nanoparticles for Highly Sensitive Detection of Leukemia Cells

A simple, highly sensitive method to detect leukemia cells has been developed based on aptamer-modified fluorescent silica nanoparticles (FSNPs). In this strategy, the amine-labeled Sgc8 aptamer was conjugated to carboxyl-modified FSNPs via amide coupling between amino and carboxyl groups. Sensitivity and specificity of Sgc8-FSNPs were assessed using flow cytometry and fluorescence microscopy. These results showed that Sgc8-FSNPs detected leukemia cells with high sensitivity and specificity. Aptamer-modified FSNPs hold promise for sensitive and specific detection of leukemia cells. Changing the aptamer may allow the FSNPs to detect other types of cancer cells.

Rational Design of Materials Interface for Efficient Capture of Circulating Tumor Cells

Originating from primary tumors and penetrating into blood circulation, circulating tumor cells (CTCs) play a vital role in understanding the biology of metastasis and have great potential for early cancer diagnosis, prognosis and personalized therapy. By exploiting the specific biophysical and biochemical properties of CTCs, various material interfaces have been developed for the capture and detection of CTCs from blood. However, due to the extremely low number of CTCs in peripheral blood, there exists a need to improve the efficiency and specificity of the CTC capture and detection. In this regard, a critical review of the numerous reports of advanced platforms for highly efficient and selective capture of CTCs, which have been spurred by recent advances in nanotechnology and microfabrication, is essential. This review gives an overview of unique biophysical and biochemical properties of CTCs, followed by a summary of the key material interfaces recently developed for improved CTC capture and detection, with focus on the use of microfluidics, nanostructured substrates, and miniaturized nuclear magnetic resonance-based systems. Challenges and future perspectives in the design of material interfaces for capture and detection of CTCs in clinical applications are also discussed.

Capturing Cancer: Emerging Microfluidic Technologies for the Capture and Characterization of Circulating Tumor Cells

Circulating tumor cells (CTCs) escape from primary or metastatic lesions and enter into circulation, carrying significant information of cancer progression and metastasis. Capture of CTCs from the bloodstream and the characterization of these cells hold great significance for the detection, characterization, and monitoring of cancer. Despite the urgent need from clinics, it remains a major challenge to capture and retain these rare cells from human blood with high specificity and yield. Recent exciting advances in micro/nanotechnology, microfluidics, and materials science have enable versatile, robust, and efficient cell isolation and processing through the development of new micro/nanoengineered devices and biomaterials. This review provides a summary of recent progress along this direction, with a focus on emerging methods for CTC capture and processing, and their application in cancer research. Furthermore, classical as well as emerging cellular characterization methods are reviewed to reveal the role of CTCs in cancer progression and metastasis, and hypotheses are proposed in regard to the potential emerging research directions most desired in CTC-related cancer research.

A signal-on fluorescent aptasensor based on single-stranded DNA-sensitized luminescence of terbium (III) for label-free detection of breast cancer cells

Breast cancer is the most common type of malignant tumor in women. Recently, it has been shown that detection of breast cancer tumor cells outside the primitive tumor is an effective early diagnosis with great prognostic and clinical utility. For this purpose, we developed a signal-on fluorescence aptasensor for label-free, facile and sensitive detection of MCF-7 breast cancer cells. Due to target-aptamer specific recognition and single-stranded DNA-sensitized luminescence of terbium (III), the proposed aptasensor exhibits excellent sensitivity with detection limit as low as 70 cells mL(-1). Compared with common organic dyes and the emerging nano-technological probes, the combination of terbium (III) and single-stranded DNA signal probe (Tb(3+)-SP) serves as a more powerful bio-probe because of its stable optical property, good biocompatibility and free from complex synthesis. The feasibility investigations have illustrated the potential applicability of this aptasensor for selective and sensitive detection of MCF-7 breast cancer cells. Moreover, this proposed aptasensor can be also extended for the determination of other tumor cancers or bio-molecules by altering corresponding aptamers. Taken together, this easy-to-perform aptasensor may represent a promising way for early screening and detection of tumor cancers or other bio-molecules in clinical diagnosis.

A novel aptamer-based competition strategy for ultrasensitive electrochemical detection of leukemia cells

A robust, nanobiotechnology-based electrochemical cytosensing platform for the detection of acute leukemia cells was developed with high sensitivity, selectivity, acceptable rapidity and excellent extensibility. It utilized the competitive binding of cell-specific aptamers to acute leukemia cells and subsequent voltammetric quantification of the metal signature. Greatly enhanced sensitivity was achieved with dual signal amplification by using Fe3O4 magnetic nanoparticles (MNPs) as carriers to load a large amount of gold nanoparticles (AuNPs) and AuNP-catalyzed silver deposition. The proposed competitive cytosensor showed high sensitivity with a detection limit down to 10 cells. This simple and low-cost electrochemical cytosensing approach offers great promise to extend its application to early detection of human leukemia and possibly to other cancer cells.

An aptamer-based quartz crystal microbalance biosensor for sensitive and selective detection of leukemia cells using silver-enhanced gold nanoparticle label

An aptamer-based quartz crystal microbalance (QCM) biosensor was developed for the selective and sensitive detection of leukemia cells. In this strategy, aminophenylboronic acid-modified gold nanoparticles (APBA-AuNPs) which could bind to cell membrane were used for the labeling of cells followed by silver enhancement, through which significant signal amplification was achieved. Both the QCM and fluorescence microscopy results manifested the selectivity of the sensor designed. A good linear relationship between the frequency response and cell concentration over the range of 2×10(3)-1×10(5)cells/mL was obtained, with a detection limit of 1160cells/mL. This approach provides a simple, rapid, and economical method for leukemia cell analysis which might have great potential for further use.

Multiplex acute leukemia cytosensing using multifunctional hybrid electrochemical nanoprobes at a hierarchically nanoarchitectured electrode interface

We have developed a robust, nanobiotechnology-based electrochemical cytosensing approach with high sensitivity, selectivity, and reproducibility toward the simultaneous multiplex detection and classification of both acute myeloid leukemia and acute lymphocytic leukemia cells. The construction of the electrochemical cytosensor involves the hierarchical assembly of dual aptamer-functionalized, multilayered graphene-Au nanoparticle electrode interface and the utilization of hybrid electrochemical nanoprobes co-functionalized with redox tags, horseradish peroxidase, and cell-targeting nucleic acid aptamers. The hybrid nanoprobes are multifunctional, capable of specifically targeting the cells of interest, amplifying the electrochemical signals, and generating distinguishable signals for multiplex cytosensing. The as-assembled electrode interface not only greatly facilitates the interfacial electron transfer process due to its high conductivity and surface area but also exhibits excellent biocompatibility and specificity for cell recognition and adhesion. A superstructured sandwich-type sensor geometry is adopted for electrochemical cytosensing, with the cells of interest sandwiched between the nanoprobes and the electrode interface. Such an electrochemical sensing strategy allows for ultrasensitive, multiplex acute leukemia cytosensing with a detection limit as low as ~350 cells per mL and a wide linear response range from 5 × 10(2) to 1 × 10(7) cells per mL for HL-60 and CEM cells, with minimal cross-reactivity and interference from non-targeting cells. This electrochemical cytosensing approach holds great promise as a new point-of-care diagnostic tool for early detection and classification of human acute leukemia and may be readily expanded to multiplex cytosensing of other cancer cells.

Significant overexpression of DVL1 in Taiwanese colorectal cancer patients with liver metastasis

Undetected micrometastasis plays a key role in the metastasis of cancer in colorectal cancer (CRC) patients. The aim of this study is to identify a biomarker of CRC patients with liver metastasis through the detection of circulating tumor cells (CTCs). Microarray and bioinformatics analysis of 10 CRC cancer tissue specimens compared with normal adjacent tissues revealed that 31 genes were up-regulated (gene expression ratio of cancer tissue to paired normal tissue > 2) in the cancer patients. We used a weighted enzymatic chip array (WEnCA) including 31 prognosis-related genes to investigate CTCs in 214 postoperative stage I–III CRC patients and to analyze the correlation between gene expression and clinico-pathological parameters. We employed the immunohistochemistry (IHC) method with polyclonal mouse antibody against DVL1 to detect DVL1 expression in 60 CRC patients. CRC liver metastasis occurred in 19.16% (41/214) of the patients. Using univariate analysis and multivariate proportional hazards regression analysis, we found that DVL1 mRNA overexpression had a significant, independent predictive value for liver metastasis in CRC patients (OR: 5.764; 95% CI: 2.588–12.837; p < 0.0001 on univariate analysis; OR: 3.768; 95% CI: 1.469–9.665; p = 0.006 on multivariate analysis). IHC staining of the immunoreactivity of DVL1 showed that DVL1 was localized in the cytoplasm of CRC cells. High expression of DVL1 was observed in 55% (33/60) of CRC tumor specimens and was associated significantly with tumor depth, perineural invasion and liver metastasis status (all p < 0.05). Our experimental results demonstrated that DVL1 is significantly overexpressed in CRC patients with liver metastasis, leading us to conclude that DVL1 could be a potential prognostic and predictive marker for CRC patients.

Enrichment, detection and clinical significance of circulating tumor cells

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.

Aptamer-aided target capturing with biocatalytic metal deposition: an electrochemical platform for sensitive detection of cancer cells

A novel aptamer biosensor for cancer cell assay has been reported on the basis of ultrasensitive electrochemical detection. Cancer cell capturing is first accomplished via aptamer-aided recognition, and the cell-aptamer binding events then mediate an alkaline phosphatase-catalyzed silver deposition reaction which can be probed by electrochemical detection. Following biocatalytic silver deposition, an efficient amplification approach for sensitive electrochemical measurements is demonstrated, for cell detection with high sensitivity. Ramos cell are used as a model case, a typical biomarker of the acute blood cell cancer, Burkitt's lymphoma. The results reveal that the developed technique displays desirable selectivity in Ramos cell discrimination, and linear response range from 10 to 10(6) cells with a detection limit as low as 10 cells. Due to the simple procedures, label-free and electrochemistry based detection format, this technique is simple and cost-effective, and exhibits excellent compatibility with miniaturization technologies. The electrochemical cell detection strategy may create an intrinsically specific and sensitive platform for cancer cell assay and associated studies.

Visual and high-throughput detection of cancer cells using a graphene oxide-based FRET aptasensing microfluidic chip

Rapid and efficient measurement of cancer cells is a major challenge in early cancer diagnosis. In the present study, a miniature multiplex chip was created for in situ detection of cancer cells by implementing a novel graphene oxide (GO)-based Förster resonance energy transfer (FRET) biosensor strategy, i.e. assaying the cell-induced fluorescence recovery from the dye-labeled aptamer/graphene oxide complex. Fluorescence intensity measurement and image analyses demonstrated that this microfluidic biosensing method exhibited rapid, selective and sensitive fluorescence responses to the quantities of the target cancer cells, CCRF-CEM cells. Seven different cancer cell samples can be measured at the same time in such a microfluidic chip. The linear response for target CCRF-CEM cells in a concentration range from 2.5 × 10(1) to 2.5 × 10(4) cells mL(-1) was obtained, with a detection limit about 25 cells mL(-1), which is about ten times lower than those of normal biosensors. The novel fluorescence biosensing microfluidic chip supplies a rapid, visible and high-throughput approach for early cancer diagnosis with high sensitivity and specificity.

Carcinocythaemia (carcinoma cell leukaemia) in a dog: an acute leukaemia-like picture due to metastatic carcinoma

An eight-year-old entire female boxer was presented with a two-week history of anorexia and lethargy and two-day history of unilateral left epistaxis. Clinical findings and laboratory test results suggested disseminated intravascular coagulation. On blood smear evaluation, occasional large epithelioid-like unclassified cells were detected. Occasionally these cells were organised in small clusters. Bone marrow examination revealed a marked infiltration by a malignant population of the same epithelioid-like cells. The dog was euthanased because of the guarded prognosis. Following histology and immunohistochemistry, a widespread undifferentiated carcinoma of unknown primary origin was diagnosed. To the authors' knowledge, this is the first case of carcinoma cell leukaemia reported in a dog. Carcinoma cell leukaemia is a rare oncological condition previously described in humans, characterised by non-haematopoietic neoplastic cells in peripheral blood.

Electrochemiluminescent determination of cancer cells based on aptamers, nanoparticles, and magnetic beads

Herein we report a polymerase chain reaction (PCR)-free electrochemiluminescence (ECL) approach that uses ECL nanoprobes for the determination of cancer cells with high sensitivity. The ECL nanoprobe consists of gold nanoparticles (AuNPs), linker DNA, and tris(2,2'-bipyridyl)ruthenium (TBR)-labeled signal DNA. The linker DNA and signal DNA were modified on the surface of the AuNPs through Au-S bonds. The linker DNA can partly hybridize with the aptamers of cancer cells loaded onto the magnetic beads (MB1) to construct the magnetic biocomplexes. In the presence of the cancer cells, the aptamers conjugated with the cancer cells with higher affinity. The ECL nanoprobe was released from the biocomplexes and subsequently hybridized with the capture DNA loaded onto another magnetic bead (MB2) to form the magnetic nanocomposite. The nanocomposites can be easily separated and firmly attached to an electrode on account of their excellent magnetic properties. The ECL intensity of the TBR loaded onto the nanocomposites directly reflected the amount of cancer cells. By using cell lines of Burkitt's lymphoma (Ramos cells) as a model, the ECL response was proportional to the cell concentration in the range from 5 to 100 cells ml(-1); a limit of detection as low as 5 cells ml(-1) of Ramos cells could be achieved. The proposed method described here is ideal for the diagnosis of cancers due to its high sensitivity, simplicity, and low cost.

Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction.

METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malignant biliary tract diseases. Quantitative real-time reverse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.

RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expression, patient’s age and serum bilirubin were each independently associated with overall survival.

CONCLUSION: CK19 mRNA expression levels in peripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

Peripheral blood reverse transcription PCR assay for prostate stem cell antigen correlates with androgen-independent progression in advanced prostate cancer

Recent studies show that prostate stem cell antigen (PSCA) mRNA positivity in peripheral blood correlates with disease progression in prostate cancer (PCa). Our study is to evaluate the association between peripheral blood PSCA status and androgen-independent progression (AIP) in a cohort of patients with advanced PCa under androgen deprivation therapy (ADT). PSCA mRNA was measured by reverse transcriptase polymerase chain reaction (RT-PCR) assay in peripheral blood samples from 116 patients with locally advanced or metastatic PCa who were treated with primary ADT and from 40 healthy controls. The Kaplan-Meier and the Cox proportional hazards methods were used to assess potential predictors of AIP. Pretreatment RT-PCR-PSCA was positive in 37 (31.9%) of 116 patients. All healthy volunteers were negative for PSCA mRNA. Although seven (14.9%) of 47 patients with Gleason score ≤7 were PSCA positive, 30 (43.5%) of 69 patients with Gleason score >7 were PSCA positive (p = 0.016). PSCA mRNA was detected in 28 (58.3%) of 48 patients with metastatic PCa, compared to nine (13.2%) of 68 patients with locally advanced disease (p = 0.012). AIP developed in 59 (50.9%) patients during a median follow-up period of 35.4 months (range: 4-78 months). Patients with PSCA negativity experienced significantly longer remissions compared to those with PSCA positivity (log-rank test: p < 0.001). Multivariate Cox regression analysis further demonstrated that PSCA positivity had a significantly increased risk of AIP (HR = 4.303, 95% CI: 3.761-7.482, p < 0.001). Pretreatment RT-PCR PSCA positivity in peripheral blood independently signals the presence of AIP in patients with advanced PCa treated with ADT.

EVI2B, ATP2A2, S100B, TM4SF3, and OLFM4 as potential prognostic markers for postoperative Taiwanese colorectal cancer patients

Undetected micrometastasis may play a key role in the early relapse of colorectal cancer (CRC) patients. The aim of this study was to detect circulating tumor cells (CTCs) for predicting early relapse of CRC patients by a weighted enzymatic chip array (WEnCA) and analyze 15 candidate genes associated with CRC carcinogenesis. The genes of 105 postoperative CRC patients were analyzed by membrane array and direct sequencing. We constructed a WEnCA platform including five prognosis-related genes and analyzed the detection rate of WEnCA for CTCs in 30 clinically confirmed CRC relapse patients. Postoperative relapse was significantly correlated with gene overexpression, including EVI2B (p=0.001, OR=4.622), ATP2A2 (p=0.006, OR=4.688), S100B (p=0.001, OR=11.521), TM4SF3 (p=0.001, OR=6.756), and OLFM4 (p=0.008, OR=3.545). Using WEnCA (weighting score of each gene: 5 to EVI2B, 5 to ATP2A2, 12 to S100B, 7 to TM4SF3, and 4 to OLFM4), we could detect CTCs presenting these genotypes in relapsed CRC patients. The sensitivity, specificity, and accuracy were 94.7%, 93.5%, and 97%, respectively. The results of the present study suggest that EVI2B, ATP2A2, S100B, TM4SF3, and OLFM4 could be potential prognostic markers for CRC patients.

Overexpression of S100B, TM4SF4, and OLFM4 genes is correlated with liver metastasis in Taiwanese colorectal cancer patients

Distant metastasis of colorectal cancer (CRC) occurs mainly in the liver and is the major cause of death. This study explored the overexpression of liver metastasis-associated mRNAs in human CRC by using a well-established, weighted enzymatic chip array platform. Analysis of 10 CRC tissue specimens compared with their normal adjacent tissues revealed that ATP2A2, ELAVL4, hTERT, KCTD2, MUC1, OLFM4, S100B, and TM4SF4 genes were upregulated (gene expression ratio of cancer tissue to paired normal tissue was >2) by microarray and bioinformatics analysis. A gene chip including eight candidate genes was constructed to investigate the circulating tumor cells in blood specimens of 103 preoperative CRC patients and further validated by reverse transcriptase-polymerase chain reaction. Liver metastasis was significantly correlated with overexpression of S100B (p=0.001, OR=9.217), TM4SF3 (p=0.011, OR=4.385), and OLFM4 (p=0.015, OR=3.438). These results suggest that S100B, TM4SF3, and OLFM4 overexpression may affect metastatic behavior of tumor cells in Taiwanese CRC patients.

Nanodevices in diagnostics

The real-time, personalized and highly sensitive early-stage diagnosis of disease remains an important challenge in modern medicine. With the ability to interact with matter at the nanoscale, the development of nanotechnology architectures and materials could potentially extend subcellular and molecular detection beyond the limits of conventional diagnostic modalities. At the very least, nanotechnology should be able to dramatically accelerate biomarker discovery, as well as facilitate disease monitoring, especially of maladies presenting a high degree of molecular and compositional heterogeneity. This article gives an overview of several of the most promising nanodevices and nanomaterials along with their applications in clinical practice. Significant work to adapt nanoscale materials and devices to clinical applications involving large interdisciplinary collaborations is already underway with the potential for nanotechnology to become an important enabling diagnostic technology.

Electrochemical and electrochemiluminescence determination of cancer cells based on aptamers and magnetic beads

The electrochemical and electrochemiluminescence (ECL) detection of cell lines of Burkitt's lymphoma (Ramos) by using magnetic beads as the separation tool and high-affinity DNA aptamers for signal recognition is reported. Au nanoparticles (NPs) bifunctionalized with aptamers and CdS NPs were used for electrochemical signal amplification. The anodic stripping voltammetry technology employed for the analysis of cadmium ions dissolved from CdS NPs on the aggregates provided a means to quantify the amount of the target cells. This electrochemical method could respond down to 67 cancer cells per mL with a linear calibration range from 1.0×10(2) to 1.0×10(5) cells mL(-1), which shows very high sensitivity. In addition, the assay was able to differentiate between target and control cells based on the aptamer used in the assay, indicating the wide applicability of the assay for diseased cell detection. ECL detection was also performed by functionalizing the signal DNA, which was complementary to the aptamer of the Ramos cells, with tris(2,2-bipyridyl) ruthenium. The ECL intensity of the signal DNA, replaced by the target cells from the ECL probes, directly reflected the quantity of the amount of the cells. With the use of the developed ECL probe, a limit of detection as low as 89 Ramos cells per mL could be achieved. The proposed methods based on electrochemical and ECL should have wide applications in the diagnosis of cancers due to their high sensitivity, simplicity, and low cost.

Multiplex RT-PCR-based detections of CEA, CK20 and EGFR in colorectal cancer patients

AIM: To develop a multiplex reverse transcription polymerase chain reaction (RT-PCR) method detecting circulating tumor cells in the peripheral blood of colorectal cancer (CRC) patients.

METHODS: Peripheral blood samples were collected from 88 CRC patients and 40 healthy individuals from the blood donors’ clinic and subsequently analyzed by multiplex RT-RCR for the expression of carcinoembryonic antigen (CEA), cytokeratin 20 (CK20) and epidermal growth factor receptor (EGFR) mRNA. The analysis involved determining the detection rates of CEA, CK20 and EGFR transcripts vs disease stage and overall survival. Median follow-up period was 19 mo (range 8-28 mo).

RESULTS: Rates of CEA, CK20 and EGFR detection in CRC patients were 95.5%, 78.4% and 19.3%, respectively. CEA transcripts were detected in 3 healthy volunteer samples (7.5%), whereas all control samples were tested negative for CK20 and EGFR transcripts. The increasing number of positive detections for CEA, CK20 and EGFR transcripts in each blood sample was positively correlated with Astler-Coller disease stage (P < 0.001) and preoperative serum levels of CEA (P = 0.029) in CRC patients. Data analysis using Kaplan-Meier estimator documented significant differences in the overall survival of the different CRC patient groups as formed according to the increasing number of positivity for CEA, CK20 and EGFR transcripts.

CONCLUSION: These data suggest that multiplex RT-PCR assay can provide useful information concerning disease stage and overall survival of CRC patients.

The detection of disseminated tumor cells in bone marrow and peripheral blood of gastric cancer patients by multimarker (CEA, CK20, TFF1 and MUC2) quantitative real-time PCR

OBJECTIVE

To investigate the suitability of multimarker detection of DTCs in PB and BM of GC patients.

DESIGN AND METHOD

A qRT-PCR assay was developed to estimate the number of CEA, CK20, TFF1 and MUC2 transcripts in PB and BM samples of 35 GC patients prior to the initiation of therapy. PB samples from healthy volunteers and BM from patients with hematological malignancies were used as negative controls.

RESULTS

In PB analysis; 22.9%, 37.1%, 31.4%, and 22.9% of GC patients and in BM analysis; 20%, 28.6%, 45.7%, and 22.9% of GC patients were positive for CEA, CK20, TFF1 and MUC2 mRNAs, respectively. Samples from the control group were negative for the expression of all the markers tested in this study. A higher positive ratio was obtained with the multimarker detection in comparison to the single marker detection. There was a significant correlation between the PB and BM samples for DTC detection.

CONCLUSION

Multimarker detection assay is a reliable and powerful tool for the early detection of DTCs in GC patients.

Methods of detection of circulating melanoma cells: a comparative overview

Disease dissemination is the major cause of melanoma-related death. A crucial step in the metastatic process is the intravascular invasion and circulation of melanoma cells in the bloodstream with subsequent development of distant micrometastases that is initially clinically undetectable and will eventually progress into clinically apparent metastasis. Therefore, the use of molecular methods to detect circulating melanoma cells may be of value in risk stratification and clinical management of such patients. Herein, we review the currently applied techniques for the detection, isolation, enrichment and further characterization of circulating melanoma cells from peripheral blood samples in melanoma patients. Furthermore, we provide a brief overview of the various molecular markers currently being evaluated as prognostic indicators of melanoma progression.

Aptamer-based and DNAzyme-linked colorimetric detection of cancer cells

This paper reports a novel method to detect human leukemic lymphoblasts (CCRF-CEM cells). While the aptamer of the cancer cells was employed as the recognition element to target cancer cells, peroxidase-active DNAzyme was used as the sensing element to produce catalysis-induced colorimetric signals. The elegant architecture integrating the aptamer and DNAzyme made it feasible to detect cancer cells easily and rapidly by the color change of the substrate for DNAzyme. Experimental results showed that 500 cells can well indicate the cancer, while as control, 250,000 Islet Island Beta cells only show tiny signals, suggesting that the method proposed in this paper has considerable sensitivity and selectivity. Furthermore, since it does not require expensive apparatus, or modification or label of DNA chains, the method we present here is also cost-effective and conveniently operated, implying potential applications in future cancer diagnosis.

Simultaneous analysis of the methylation profile of 26 cancer related regions in invasive breast carcinomas by MS-MLPA and drMS-MLPA

Genetic and epigenetic events play a critical role in the tumorigenic process of breast cancer. The more genes are studied, the more accurate the epigenetic "signature" can be established. The aim of our work has been to apply the technique Methylation-Specific Multiplex Ligation dependent Probe Amplification (MS-MLPA) to study the methylation profile of 26 cancer related gene regions in breast cancers. Secondly, we aimed to establish if the epigenetic "signature" could serve to detect circulating tumor DNA (ctDNA) in breast cancer patients. The MS-MLPA was successfully setup and allowed to establish which regions were preferentially associated with the tumor process. The analysis permitted also to detect significant concurrent methylation between some genes. The detection of ctDNA could be performed by a "double-round" MS-MLPA (drMS-MLPA) approach and nested-Methyl Specific PCR (Nested-MSP). This development is an important novelty and served to detect a small amount of tumor DNA shaded into the blood stream of breast cancer patients. We conclude that MS-MLPA is an excellent assay to analyze the methylation profile of a tumor. The 82 studied samples presented a specific methylation "mark". These studies serve to enhance the knowledge of the role of epigenetic alterations in breast tumors and can contribute to the development of personalized diagnosis, surveillance and treatment strategies.

Selective collection and detection of leukemia cells on a magnet-quartz crystal microbalance system using aptamer-conjugated magnetic beads

A novel method for selective collection and detection of human acute leukemia cells has been proposed using aptamer-conjugated magnetic beads (apt-MBs) and a magnet-quartz crystal microbalance (QCM) system. The sgc8c aptamer-conjugated MBs specifically binding to CCRF-CEM cells were used for target cell extraction from complex matrixes, and the magnet-QCM system was successfully applied for quantitative cell detection, requiring no further labeling of cells. The accumulation of MBs-conjugated CCRF-CEM cells on a quartz crystal gold electrode surface under a magnetic field resulted in decreased resonant frequency. A linear relationship between the frequency shift and cell concentration over the range of 1 x 10(4)-1.5 x 10(5)cells mL(-1) was obtained, with a detection limit of 8 x 10(3)cells mL(-1). The applicability of the method for target cell detection from cell mixture was satisfactory.

A sensitive fluorescence anisotropy method for the direct detection of cancer cells in whole blood based on aptamer-conjugated near-infrared fluorescent nanoparticles

Based on the aptamer-conjugated core-shell near-infrared fluorescent nanoparticles (NIR-Nps) and fluorescence anisotropy measurement, the present study reported proof-of-principle for a rapid homogeneous assay approach that can detect target cancer cells without the need of the complicated separation steps in whole blood samples. Experimental investigation showed that the novel NIR-Nps have negligible background fluorescence and low inner filtration interference in complex biologic systems such as whole blood. The specific recognition characteristic of aptamer in whole blood samples was investigated by using the proposed fluorescence anisotropy method. The results showed that the fluorescent nanoparticle-tagged aptamer probes sequence could achieve specific recognition of the target cancer cells from complex mixtures including whole blood samples. And the reaction conditions for the binding between fluorescent nanoparticle-conjugated aptamer probes and target cancer cells were optimized. The present approach can exhibit sensitive and reproducible fluorescence anisotropy responses to the target cells concentration and the calibration curve showed good linearity when the target cells concentration is in the range from 4.0 x 10(3) to 7.0 x 10(5)cells/mL. Moreover, the present fluorescence anisotropy assay technique could be practically utilized for the detection of acute leukemia samples with improved capabilities and be comparable to the immunophenotyping methods clinically used.