Precise and non-invasive circulating tumor cell isolation based on optical force using homologous erythrocyte binding

New insights into red blood cells in tumor precision diagnosis and treatment

Red blood cells (RBCs), which function as material transporters in organisms, are rich in materials that are exchanged with metabolically active tumor cells. Recent studies have demonstrated that tumor cells can regulate biological changes in RBCs, including influencing differentiation, maturation, and morphology. RBCs play an important role in tumor development and immune regulation. Notably, the novel scientific finding that RBCs absorb fragments of tumor-carrying DNA overturns the conventional wisdom that RBCs do not contain nucleic acids. RBC membranes are excellent biomimetic materials with significant advantages in terms of their biocompatibility, non-immunogenicity, non-specific adsorption resistance, and biodegradability. Therefore, RBCs provide a new research perspective for the development of tumor liquid biopsies, molecular imaging, drug delivery, and other tumor precision diagnosis and treatment technologies.

3D Multispheroid Assembly Strategies towards Tissue Engineering and Disease Modeling

Cell spheroids (esp. organoids) as 3D culture platforms are popular models for representing cell-cell and cell-extracellular matrix (ECM) interactions, bridging the gap between 2D cell cultures and natural tissues. 3D cell models with spatially organized multiple cell types are preferred for gaining comprehensive insights into tissue pathophysiology and constructing in vitro tissues and disease models because of the complexities of natural tissues. In recent years, an assembly strategy using cell spheroids (or organoids) as living building blocks has been developed to construct complex 3D tissue models with spatial organization. Here, a comprehensive overview of recent advances in multispheroid assembly studies is provided. The different mechanisms of the multispheroid assembly techniques, i.e., automated directed assembly, noncontact remote assembly, and programmed self-assembly, are introduced. The processing steps, advantages, and technical limitations of the existing methodologies are summarized. Applications of the multispheroid assembly strategies in disease modeling, drug screening, tissue engineering, and organogenesis are reviewed. Finally, this review concludes by emphasizing persistent issues and future perspectives, encouraging researchers to adopt multispheroid assembly techniques for generating advanced 3D cell models that better resemble real tissues.

Advances in circulating tumor cells for early detection, prognosis and metastasis reduction in lung cancer

Globally, lung cancer stands as the leading type of cancer in terms of incidence and is the major source of mortality attributed to cancer. We have outlined the molecular biomarkers for lung cancer that are available clinically. Circulating tumor cells (CTCs) spread from the original location, circulate in the bloodstream, extravasate, and metastasize, forming secondary tumors by invading and establishing a favorable environment. CTC analysis is considered a common liquid biopsy method for lung cancer. We have enumerated both in vivo and ex vivo techniques for CTC separation and enrichment, examined the advantages and limitations of these methods, and also discussed the detection of CTCs in other bodily fluids. We have evaluated the value of CTCs, as well as CTCs in conjunction with other biomarkers, for their utility in the early detection and prognostic assessment of patients with lung cancer. CTCs engage with diverse cells of the metastatic process, interfering with the interaction between CTCs and various cells in metastasis, potentially halting metastasis and enhancing patient prognosis.

Acoustic Assembly and Scanning of Superlens Arrays for High-Resolution and Large Field-of-View Bioimaging

High-resolution and dynamic bioimaging is essential in life sciences and biomedical applications. In recent years, microspheres combined with optical microscopes have offered a low cost but promising solution for super-resolution imaging, by breaking the diffraction barrier. However, challenges still exist in precisely and parallelly superlens controlling using a noncontact manner, to meet the demands of large-area scanning imaging for desired targets. This study proposes an acoustic wavefield-based strategy for assembling and manipulating micrometer-scale superlens arrays, in addition to achieving on-demand scanning imaging through phase modulation. In experiments, acoustic pressure nodes are designed to be comparable in size to microspheres, allowing spatially dispersed microspheres to be arranged into arrays with one unit per node. Droplet microlenses with various diameters can be adapted in the array, allowing for a wide range of spacing periods by applying different frequencies. In addition, through the continuous phase shifting in the x and y directions, this acoustic superlens array achieves on-demand moving for the parallel high-resolution virtual image capturing and scanning of nanostructures and biological cell samples. As a comparison, this noncontact and cost-effective acoustic manner can obtain more than ∼100 times the acquisition efficiency of a single lens, holding promise in advancing super-resolution microscopy and subcellular-level bioimaging.

Acoustic quasi-periodic bioassembly based diverse stem cell arrangements for differentiation guidance

Arrangement patterns and geometric cues have been demonstrated to influence cell function and fate, which calls for efficient and versatile cell patterning techniques. Despite constant achievements that mainly focus on individual cells and uniform cell patterns, simultaneously constructing cellular arrangements with diverse patterns and positional relationships in a flexible and contact-free manner remains a challenge. Here, stem cell arrangements possessing multiple geometries and structures are proposed based on powerful and diverse pattern-building capabilities of quasi-periodic acoustic fields, with advantages of rich patterns and structures and flexibility in structure modulation. Eight-fold waves' interference produces regular potentials that result in higher rotational symmetry and more complex arrangement of geometric units. Moreover, through flexible modulation of the phase relations among these wave vectors, a wide variety of cellular pattern units are arranged in this potential, such as circular-, triangular- and square-shape, simultaneously. It is proved that these diverse cellular patterns conveniently build human mesenchymal stem cell (hMSC) models, for research on the effect of cellular arrangement on stem cell differentiation. This work fills the gap of acoustic cell patterning in quasi-periodic patterns and shows promising potential in tissue engineering and regenerative medicine.

Biosensors for the Isolation and Detection of Circulating Tumor Cells (CTCs) in Point-of-Care Settings

Circulating tumor cells (CTCs) are cells that have been shed from tumors and circulate in the bloodstream. These cells can also be responsible for further metastases and the spread of cancer. Taking a closer look and analyzing CTCs through what has come to be known as "liquid biopsy" has immense potential to further researchers' understanding of cancer biology. However, CTCs are very sparse and are therefore difficult to detect and capture. To combat this issue, researchers have attempted to create devices, assays, and further techniques to successfully isolate CTCs for analysis. In this work, new and existing biosensing techniques for CTC isolation, detection, and release/detachment are discussed and compared to evaluate their efficacy, specificity, and cost. Here, we specifically aim to evaluate and identify the potential success of these techniques and devices in point-of-care (POC) settings.

Red blood cell rosetting enables size-based separation of specific lymphocyte subsets from blood in a microfluidic device

The isolation of a specific lymphocyte subset from blood is the required first step in the manufacturing of many novel cellular immunotherapies. Microfluidic size-based separation methods are poised to significantly simplify this process because they require neither centrifugation nor magnetic or fluorescent labeling to operate. Lymphocytes can be separated from red blood cells (RBCs) and platelets as well as monocytes and granulocytes because their size differs from each of these cell types. However, further separation of a specific lymphocyte subset from other unwanted lymphocytes using size-based methods is impossible because all lymphocytes have approximately the same size and can only be distinguished by surface markers. This paper describes a new approach that made it possible for a size-based separation method to isolate a desired subset of lymphocytes by making unwanted lymphocytes as well as other blood cells artificially larger. The separation was enabled by selectively binding multiple RBCs to each unwanted cell to create 'rosettes' with an effective size significantly larger than the diameter of a typical lymphocyte. The desired lymphocytes remained unaffected by rosetting and were separated from the rosettes by passing the mixture through a microfluidic size-based separation device based on controlled incremental filtration (CIF). This new rosette-enabled size-based (RESIZE) separation approach demonstrated recovery of 80-90% for all lymphocyte subsets tested (CD3⁺, CD4⁺, CD56⁺) which was ∼2.5-fold higher than that for the standard immunodensity method (RBC rosetting followed by density gradient centrifugation). The purity of separation was >90% for CD3⁺ cells but declined with increasing cell rarity. Unlike the immunodensity approach, RESIZE required neither centrifugation nor cell washing after the separation and was ∼2.5-fold faster when processing the same sample volume. The results of this study suggest that integration of the RESIZE approach for high-yield isolation of lymphocyte subsets from blood could significantly streamline the manufacturing workflow and thus have a potentially transformative impact on the cost and availability of novel cellular immunotherapies.

SAIF: Label-Free Separation of Circulating Tumor Cells Using a Self-Amplified Inertial Focusing Microfluidic Chip

Circulating tumor cells (CTCs) are rare cells existing in the bloodstream with a relatively low number, which facilitate as a predictor of cancer progression. However, it is difficult to obtain highly purified intact CTCs with desired viability due to their low percentage among blood cells. In this chapter, we demonstrate the detailed steps for the fabrication and application of the novel self-amplified inertial-focused (SAIF) microfluidic chip that enables size-based, high-throughput, label-free separation of CTCs from the patient blood. The SAIF chip introduced in this chapter demonstrates the feasibility of an extremely narrow zigzag channel (with 40 μm channel width) connected with two expansion regions to effectively separate different-sized cells with amplified separation distance.

On-demand liquid microlens arrays by non-contact relocation of inhomogeneous fluids in acoustic fields

Microlens arrays (MLAs) are key micro-optical components that possess a high degree of parallelism and ease of integration. However, rapid and low-cost fabrication of MLAs with flexible focusing remains a challenge. Herein, liquid MLAs with dynamic tunability are presented using non-contact acoustic relocation of inhomogeneous fluids. By designing ring-shaped acoustic pressure node (PN) arrays, the denser fluid of miscible liquids is relocated to PNs, and liquid MLAs with ideal morphology are obtained. The experimental results demonstrate that the liquid MLAs possess a powerful reconfigurability with long-term stability and sharp imaging that can conveniently switch between the on and off state and can dynamically magnify by simply adjusting the acoustic amplitude. Moreover, the high biocompatibility inherited from liquids accompanied by the acoustic treatment allows cells to be within working distance of the MLAs without immersion, as would be required for a solid lens. This innovative liquid MLA is inexpensive to manufacture and possesses continuous focus, fast response, and satisfactory bioaffinity, and thus offers promising potential for microfluidic adaptive imaging and biomedical sensing, especially for live cell imaging.

Recent Progress on Optical Micro/Nanomanipulations: Structured Forces, Structured Particles, and Synergetic Applications

Optical manipulation has achieved great success in the fields of biology, micro/nano robotics and physical sciences in the past few decades. To date, the optical manipulation is still witnessing substantial progress powered by the growing accessibility of the complex light field, advanced nanofabrication and developed understandings of light-matter interactions. In this perspective, we highlight recent advancements of optical micro/nanomanipulations in cutting-edge applications, which can be fostered by structured optical forces enabled with diverse auxiliary multiphysical field/forces and structured particles. We conclude with our vision of ongoing and futuristic directions, including heat-avoided and heat-utilized manipulation, nonlinearity-mediated trapping and manipulation, metasurface/two-dimensional material based optical manipulation, as well as interface-based optical manipulation.

Efficient bioparticle extraction using a miniaturized inertial microfluidic centrifuge

Conventional bioparticle extraction requires labor-intensive operation, and expensive and bulky centrifuges. Herein, we report a miniaturized centrifuge by cascading four paralleled inertial spiral channels with a two-stage serpentine channel, allowing for the efficient washing and acquisition of concentrated bioparticles from background fluids. First, the effects of channel size and flow rate on particle focusing dynamics and solution exchange performances are explored to enable the optimization and wide application of our device. Then, the integrated device is fabricated and tested experimentally. The results indicate that 10-20 μm particles can be washed from the original samples with increased concentrations and with recovery efficiencies of >93%. Finally, to verify its versatility, we use our miniaturized centrifuge to successfully change the culture medium for cultured MCF-7 breast cancer cells, extract A549 lung cancer cells from a calcein-AM staining solution, purify white blood cells (WBCs) from lysed whole blood, and extract target cells from an unbonded magnetic microbead background. Compared with conventional centrifuges, our device has the advantages of simple fabrication, easy operation, and small footprint. More importantly, it offers outstanding capability for extracting bioparticles from various background fluids, and avoids bioparticle damage that may be caused by high-speed centrifugation. Therefore, we envision that our miniaturized centrifuge could be a promising alternative to traditional centrifuges in many applications.

Smart acoustic 3D cell construct assembly with high-resolution

Precise and flexible three-dimensional (3D) cell construct assembly using external forces or fields can produce micro-scale cellular architectures with intercellular connections, which is an important prerequisite to reproducing the structures and functions of biological systems. Currently, it is also a substantial challenge in the bioengineering field. Here, we propose a smart acoustic 3D cell assembly strategy that utilizes a 3D printed module and hydrogel sheets. Digitally controlled six wave beams offer a high degree of freedom (including wave vector combination, frequency, phase, and amplitude) that enables versatile biomimetic micro cellular patterns in hydrogel sheets. Further, replaceable frames can be used to fix the acoustic-built micro-scale cellular structures in these sheets, enabling user-defined hierarchical or heterogeneous constructs through layer-by-layer assembly. This strategy can be employed to construct vasculature with different diameters and lengths, composed of human umbilical vein endothelial cells and smooth muscle cells. These constructs can also induce controllable vascular network formation. Overall, the findings of this work extend the capabilities of acoustic cell assembly into 3D space, offering advantages including innovative, flexible, and precise patterning, and displaying great potential for the manufacture of various artificial tissue structures that duplicate in vivo functions.

Application of Microfluidics in Detection of Circulating Tumor Cells

Tumor metastasis is one of the main causes of cancer incidence and death worldwide. In the process of tumor metastasis, the isolation and analysis of circulating tumor cells (CTCs) plays a crucial role in the early diagnosis and prognosis of cancer patients. Due to the rarity and inherent heterogeneity of CTCs, there is an urgent need for reliable CTCs separation and detection methods in order to obtain valuable information on tumor metastasis and progression from CTCs. Microfluidic technology is increasingly used in various studies of CTCs separation, identification and characterization because of its unique advantages, such as low cost, simple operation, less reagent consumption, miniaturization of the system, rapid detection and accurate control. This paper reviews the research progress of microfluidic technology in CTCs separation and detection in recent years, as well as the potential clinical application of CTCs, looks forward to the application prospect of microfluidic technology in the treatment of tumor metastasis, and briefly discusses the development prospect of microfluidic biosensor.

Noninvasive Optical Isolation and Identification of Circulating Tumor Cells Engineered by Fluorescent Microspheres

Circulating tumor cells (CTCs) are rare, meaning that current isolation strategies can hardly satisfy efficiency and cell biocompatibility requirements, which hinders clinical applications. In addition, the selected cells require immunofluorescence identification, which is a time-consuming and expensive process. Here, we developed a method to simultaneously separate and identify CTCs by the integration of optical force and fluorescent microspheres. Our method achieved high-purity separation of CTCs without damage through light manipulation and avoided additional immunofluorescence staining procedures, thus achieving rapid identification of sorted cells. White blood cells (WBCs) and CTCs are similar in size and density, which creates difficulties in distinguishing them optically. Therefore, fluorescent PS microspheres with high refractive index (RI) are designed here to capture the CTCs (PS-CTCs) and increase the average index of refraction of PS-CTCs. In optofluidic chips, PS-CTCs were propelled to the collection channel from the sample mixture, under the radiation of light force. Cells from the collection outlet were easily identified under a fluorescence microscope due to the fluorescence signals of PS microspheres. This method provides an approach for the sorting and identification of CTCs, which holds great potential for clinical applications in early diagnosis of disease.

Recent Advances in Microfluidic Platform for Physical and Immunological Detection and Capture of Circulating Tumor Cells

CTCs (circulating tumor cells) are well-known for their use in clinical trials for tumor diagnosis. Capturing and isolating these CTCs from whole blood samples has enormous benefits in cancer diagnosis and treatment. In general, various approaches are being used to separate malignant cells, including immunomagnets, macroscale filters, centrifuges, dielectrophoresis, and immunological approaches. These procedures, on the other hand, are time-consuming and necessitate multiple high-level operational protocols. In addition, considering their low efficiency and throughput, the processes of capturing and isolating CTCs face tremendous challenges. Meanwhile, recent advances in microfluidic devices promise unprecedented advantages for capturing and isolating CTCs with greater efficiency, sensitivity, selectivity and accuracy. In this regard, this review article focuses primarily on the various fabrication methodologies involved in microfluidic devices and techniques specifically used to capture and isolate CTCs using various physical and biological methods as well as their conceptual ideas, advantages and disadvantages.

Application of Microfluidic Systems for Breast Cancer Research

Cancer is a disease in which cells in the body grow out of control; breast cancer is the most common cancer in women in the United States. Due to early screening and advancements in therapeutic interventions, deaths from breast cancer have declined over time, although breast cancer remains the second leading cause of cancer death among women. Most deaths are due to metastasis, as cancer cells from the primary tumor in the breast form secondary tumors in remote sites in distant organs. Over many years, the basic biological mechanisms of breast cancer initiation and progression, as well as the subsequent metastatic cascade, have been studied using cell cultures and animal models. These models, although extremely useful for delineating cellular mechanisms, are poor predictors of physiological responses, primarily due to lack of proper microenvironments. In the last decade, microfluidics has emerged as a technology that could lead to a paradigm shift in breast cancer research. With the introduction of the organ-on-a-chip concept, microfluidic-based systems have been developed to reconstitute the dominant functions of several organs. These systems enable the construction of 3D cellular co-cultures mimicking in vivo tissue-level microenvironments, including that of breast cancer. Several reviews have been presented focusing on breast cancer formation, growth and metastasis, including invasion, intravasation, and extravasation. In this review, realizing that breast cancer can recur decades following post-treatment disease-free survival, we expand the discussion to account for microfluidic applications in the important areas of breast cancer detection, dormancy, and therapeutic development. It appears that, in the future, the role of microfluidics will only increase in the effort to eradicate breast cancer.

Rapid and efficient capturing of circulating tumor cells from breast cancer Patient's whole blood via the antibody functionalized microfluidic (AFM) chip

Accurate enumeration of circulating tumor cells (CTCs) in cancer patient's blood functions as a form of "liquid biopsy", which is pivotal for cancer screening, prognosis, and diagnosis. Herein, we demonstrate a novel antibody functionalized microfluidic (AFM) chip that rapidly and accurately qualifies CTCs from breast cancer patient's whole blood. The AFM chip consists of three buffering zones, and four main capturing zones filled with equilateral triangular pillars and periodically distributed obstacles. We validate the AFM chip with three Epithelial cell adhesion molecule (EpCAM) positive cancer cell lines, including breast (MCF-7), prostate (PC3), and lung cancer cell lines (A549), achieving capture efficiencies of 99.5%, 98.5%, and 96.72%, respectively, at a flow rate of 0.6 mL/hour. We further confirm the efficacy of the AFM chip with five advanced breast cancer patients' whole blood to capture EpCAM+/CK19+/CD45-/DAPI + CTCs. Interestingly, high number of CTCs were identified from each patient's 1 mL whole blood (595-2270), The AFM chip is highly efficient at rapidly capturing CTCs from cancer patients' whole blood without requiring extra equipment, which is critically beneficial for clinical application.

Digital optofluidic compound eyes with natural structures and zooming capability for large-area fluorescence sensing

Compound eyes are ubiquitous natural biosensors that possess high temporal resolution and large fields of view (FOVs). While for solid materials based artificial imaging systems, flexible zooming ability while keeping the constant FOV is still challenging, as well as the low-cost fabrication. Herein, liquid compound eyes with natural structures are presented that synthesize optofluidics and bionics in a non-trivial manner, which enables the deformation-free zooming and flexible cell fluorescence sensing. Experimental results indicate that the innovatively manufactured bionic template possesses low roughness and uniform lens configuration with more than two thousands units, which endows the eyes with high-quality and low aberration imaging ability. Besides, digital controlled miscible liquids switching enables the focus of ommatidia simultaneously be adjusted from 150 μm to 5 mm with 100° view angle, and without bending the microlens curvature, to avoid FOV changing and image aberration. Due to large FOV and tunable ability, large-area cell fluorescence signal arrays and dynamic cell motion are imaged using this liquid compound eyes. This work presents novel strategy for compound lens manufacture at low-cost, and proposes deformation-free and continuous focus-tuning strategy, offering potentials for numerous applications, including biomedical sensing and adaptive imaging with large FOV.

Specific capture and intact release of breast cancer cells using a twin-layer vein-shaped microchip with a self-assembled surface

Breast cancer is the most fatal disease among female cancers yet its detection still relies on needle biopsy. The unique physical and immune characteristics of breast cancer cells different from blood cells make them suitable to be employed as excellent biomarkers in liquid biopsy, through which breast cancer cells are collected from peripheral blood for further cancer diagnosis, medical treatment monitoring, and drug screening. Although the separation and enrichment of breast cancer cells from peripheral blood have been studied for years, there are still two problems to be solved in these methods: the low efficiency of on-chip immunologic capture in the flow state and the influence of the conjugated antibodies for the following analyses during cell release. In this paper, a vein-shaped microchip with self-assembled surface was developed for the specific and robust capture (91.2%) of breast cancer cells in the flow state. A protein-recovery process was proposed, in which trypsin served as a mild release reagent, releasing 92% of cells with high viability (96%), normal adherent proliferation, and complete proteins on the cell membrane, avoiding disturbance of the conjugated chemical molecules in the following clinical study. The excellent performance demonstrated in isolating free breast cancer cells from real peripheral blood sample, originating from the orthotopic 4T1 breast cancer metastatic models, suggest the microchip could be utilized as a multiple circulating tumor cell capture and release platform that could allow providing more reliable information in liquid biopsies.

Ultradense Erythrocyte Bionic Layer Used to Capture Circulating Tumor Cells and Plasma-Assisted High-Purity Release

The isolation and detection of rare circulating tumor cells (CTCs) from patient peripheral blood can help early diagnosis of cancer and evaluation of therapeutic outcomes. At present, most of the available strategies for enriching CTCs face serious problems with purity due to the nonspecific interactions between the capture medium and leukocytes. Inspired by the immune evasion ability of homologous red blood cells (RBCs), we modified the tumor-targeting molecule folic acid (FA) on the surface of RBCs by hydrophobic interactions. Under the treatment of polybrene, the charges on the surface of RBCs are neutralized, which reduces the mutual repulsion force. Furthermore, RBCs treated with polyethylene also have excellent deformability, thereby enabling engineered RBCs to form a dense bionic layer on the adhesive glass slide, which can greatly inhibit the nonspecific adhesion of leukocytes. The bionic layer can achieve high-purity enrichment of tumor cells in phosphate-buffered saline (PBS), and we can achieve high-activity release in plasma. The cell count showed over 80% capture efficiency and over 70% release rate, and the purity of CTCs obtained in the artificial blood sample after release was higher than 90%. The RBC bionic surface coating is notably cost-effective and highly applicable for CTC isolation in clinic practice, and thus provides new prospects for designing cell-material interfaces for advanced cell-based biomedical studies in the future.

Efficient method for the calculation of the optical force of a single nanoparticle based on the quasinormal mode expansion

An efficient method for the calculation of the optical force of a single nanoparticle is proposed based on the expansion of quasinormal modes (QNMs), which are eigensolutions of source-free Maxwell's equations with complex eigenfrequencies. In this method, the optical force is calculated by integrating the Maxwell stress tensor (MST) over a closed surface encompassing the nanoparticle. The electromagnetic (EM) field required for evaluating the MST is computed by a rigorous modal analysis, in which the EM field is expanded onto a small set of QNMs. Once the QNMs of the nanoparticle are solved, their excitation coefficients are obtained analytically. This means that additional full-wave computations are not required if the nanoparticle's location and the wavelength or distribution of the excitation field vary. Comparisons with full-wave numerical calculations of optical force evidence the high efficiency and accuracy of our formalism.

Rapid isolation of circulating cancer associated fibroblasts by acoustic microstreaming for assessing metastatic propensity of breast cancer patients

We demonstrate a label free and high-throughput microbubble-based acoustic microstreaming technique to isolate rare circulating cells such as circulating cancer associated fibroblasts (cCAFs) in addition to circulating tumor cells (CTCs) and immune cells (i.e. leukocytes) from clinically diagnosed patients with a capture efficiency of 94% while preserving cell functional integrity within 8 minutes. The microfluidic device is self-pumping and was optimized to increase flow rate and achieve near perfect capturing of rare cells enabled by having a trapping capacity above the acoustic vortex saturation concentration threshold. Our approach enables rapid isolation of CTCs, cCAFs and their associated clusters from blood samples of cancer patients at different stages. By examining the combined role of cCAFs and CTCs in early cancer onset and metastasis progression, the device accurately diagnoses both cancer and the metastatic propensity of breast cancer patients. This was confirmed by flow cytometry where we observed that metastatic breast cancer blood samples had significantly higher percentage of exhausted CD8+ T cells expressing programmed cell death protein 1 (PD1), higher number of CD4+ T regulatory cells and T helper cells. We show for the first time that our lateral cavity acoustic transducers (LCATs)-based approach can thus be developed into a metastatic propensity assay for clinical usage by elucidating cancer immunological responses and the complex relationships between CTCs and its companion tumor microenvironment.

Research Progress for the Clinical Application of Circulating Tumor Cells in Prostate Cancer Diagnosis and Treatment

Prostate cancer is a life-threatening and highly heterogeneous malignancy. In the past decade, circulating tumor cells (CTCs) have been suggested to play a critical role in the occurrence and progression of prostate cancer. In particular, as the “seed” of the cancer metastasis cascade, CTCs determine numerous biological behaviors, such as tumor invasion into adjacent tissues and migration to distant organs. Many studies have shown that CTCs are necessary in the processes of tumor progression, including tumorigenesis, invasion, metastasis, and colonization. Furthermore, CTCs express various biomarkers relevant to prostate cancer and thus can be applied clinically in noninvasive tests. Moreover, CTCs can serve as potential prognostic targets in prostate cancer due to their roles in regulating many processes associated with cancer metastasis. In this review, we discuss the isolation and detection of CTCs as predictive markers of prostate cancer, and we discuss their clinical application in the diagnosis and prognosis of prostate cancer and in monitoring the response to treatment and the prediction of metastasis.

Label-free Separation of Circulating Tumor Cells Using a Self-Amplified Inertial Focusing (SAIF) Microfluidic Chip

Circulating tumor cells (CTCs) are rare cells existing in the bloodstream with a relatively low number, which facilitate as a predictor of cancer progress. However, it is difficult to obtain highly purified intact CTCs with desired viability due to the low percentage of CTCs among blood cells. In this work, we demonstrate a novel self-amplified inertial focused (SAIF) microfluidic chip that enables size-based, high-throughput, label-free separation of CTCs from a patient's blood. The SAIF chip introduced in this study demonstrated the feasibility of an extremely narrow zigzag channel (with 40 μm channel width) connected with two expansion regions to effectively separate different-sized cells with amplified separation distance. The chip performance was optimized with different-sized polystyrene (PS) particles and blood cells spiked with three different types of cancer cells. The separation efficiencies for blood cells and spiked cancer cells are higher than 80%. Recovery rates of cancer cells were tested by spiking 1500 lung cancer cells (A549), breast cancer cells (MCF-7), and cervical cancer cells (HeLa) separately to 3 mL 0.09% saline with 3 × 10⁶ white blood cells (WBCs). The recovery rates for larger cells (MCF-7 and HeLa) were 79.1 and 85.4%, respectively. Viabilities of the cells harvested from outlets were all higher than 97% after culturing for 24, 48, and 72 h. The SAIF chip performance was further confirmed using the real clinical patient blood samples from four lung cancer patients. Theoretical force balance analysis in physics, computational simulations, and experimental observations indicate that the SAIF chip is simple but effective, and high-throughput separation CTCs can be readily achieved without complex structures.

Recent advances in microfluidic technologies for circulating tumor cells: enrichment, single-cell analysis, and liquid biopsy for clinical applications

Circulating tumor cells (CTCs) detach from primary or metastatic lesions and circulate in the peripheral blood, which is considered to be the cause of distant metastases. CTC analysis in the form of liquid biopsy, enumeration and molecular analysis provide significant clinical information for cancer diagnosis, prognosis and therapeutic strategies. Despite the great clinical value, CTC analysis has not yet entered routine clinical practice due to lack of efficient technologies to perform CTC isolation and single-cell analysis. Taking the rarity and inherent heterogeneity of CTCs into account, reliable methods for CTC isolation and detection are in urgent demand for obtaining valuable information on cancer metastasis and progression from CTCs. Microfluidic technology, featuring microfabricated structures, can precisely control fluids and cells at the micrometer scale, thus making itself a particularly suitable method for rare CTC manipulation. Besides the enrichment function, microfluidic chips can also realize the analysis function by integrating multiple detection technologies. In this review, we have summarized the recent progress in CTC isolation and detection using microfluidic technologies, with special attention to emerging direct enrichment and enumeration in vivo. Further, few insights into single CTC molecular analysis are also demonstrated. We have provided a review of potential clinical applications of CTCs, ranging from early screening and diagnosis, tumor progression and prognosis, treatment and resistance monitoring, to therapeutic evaluation. Through this review, we conclude that the clinical utility of CTCs will be expanded as the isolation and analysis techniques are constantly improving.

Versatile biomimetic array assembly by phase modulation of coherent acoustic waves

A high-throughput cell-assembly method, with the advantages of adjustability, ease of operation, and good precision, is remarkable for artificial tissue engineering. Here, we present a scientific solution by introducing high rotational symmetrical coherent acoustic waves, in order to enable the shape and arrangement of the acoustic potential wells to be flexibly modulated, and therefore to assemble on a large area diverse biomimetic arrays on a microfluidic platform. Ring arrays, honeycomb, and many other biomimetic arrays are achieved by real-time modulation of the wave vectors and phase relation of acoustic beams from six directions. In the experiments, human umbilical vein endothelial cells (HUVECs), arranged in ring structures, tend to connect with the adjacent cells and reach confluency, thus directing the in vitro two-dimensional vascular network formation. Higher rotational symmetry of the six coherent acoustic waves provides much more flexibility and diversity for acoustic cell assembly. With the advantages of efficiency, diversity and adjustability, this acoustic chip is expected to fulfill many applications, such as in biochemistry, bioprinting and tissue engineering related research.

Optical Sorting at the Single-Particle Level with Single-Nanometer Precision Using Coordinated Intensity and Phase Gradient Forces

Position-controlled sorting of colloidal nanoparticles (NPs) at the single-particle level is a challenge in nanoscience. Optofluidic potential wells can partially address this challenge, but they have limited flexibility, reconfigurability, and precision. Here we introduce a strategy by feedback-controlled manipulation of NPs using reconfigurable optical traps with designed intensity and phase gradient. Spatiotemporal patterns of these optical traps coordinatively manipulate the NPs based on machine vision of their positions and differentiated scattering intensities. The NPs are always kept inside the optical field during the manipulation and stably trapped once the sorting is accomplished. To substantiate the key advantages of our approach, we present position-controlled optical sorting of single Ag and Au NPs of the same size (150 nm diameter) and ordering of monodisperse Au NPs (80 ± 9 nm diameter) according to their sub-10 nm radius variation, which can hardly be done via other approaches.

On-chip hydrogel arrays individually encapsulating acoustic formed multicellular aggregates for high throughput drug testing

Multicellular aggregates in three-dimensional (3D) environments provide novel solid tumor models that can provide insight into in vivo drug resistance. Such models are therefore essential for developing new drugs and preventing the failure of clinical treatments. However, high-throughput cell cluster assembly and fabricating individual 3D environments that mimic the extracellular matrix (ECM) remain significant challenges. To rapidly produce mini 3D multicellular aggregate units, acoustic force assembly combined with ECM mimic hydrogel array encapsulation is developed and then integrated into a diffusion-based microfluidic device for high-throughput drug testing. The active acoustic force gathers human mononuclear leukemia cells (THP-1) into hundreds of multicellular clusters with a controllable size. Instead of continuous bulk materials, photosensitive gelatin methacryloyl (GelMA) hydrogel pillar arrays containing cell clusters at drug concentration gradients are obtained through selective area exposure. Ten azelaic acid (AZA) concentration gradient series are applied to 100 units to simultaneously test the multicellular cluster drug resistance to multiple drug conditions. Real-time green fluorescent protein (GFP) fluorescence is analyzed to monitor cell viability. The results show that cell aggregate activity is inversely related to the drug concentration in the hydrogel pillars, and shows lower sensitivity to drug toxicity than the activity of monolayer cultured cells. The 3D multicellular arrays provide numerous in vitro tumor models and can be directly used for downstream drug testing. This technology inherits the advantages of acoustic assembly, while being more flexible, practical, and high-throughput, and shows significant potential for use in further tumor related research and clinical practice.

A Portable and Accurate Phosphate Sensor Using a Gradient Fabry-Pérot Array

Here, a portable and accurate phosphate sensor using a gradient Fabry-Pérot array (FPA) is proposed. It can form a bidirectional gradient concentration (absorbance) distribution in the gradient FPA, simplifying the complex operations to get a standard curve and saving time. The gradient FPA can effectively filter out the interference (bubbles, light intensity, and salinity) while improving the absorbance, achieving a highly accurate and stable detection. Besides, the smartphone simplifies data processing and makes sensors more portable. In this work, the detection errors of standard solutions (100, 50, and 30 μM) are 0.39, 1.48, and 1.84%, respectively, and it has also been demonstrated with errors of 2.46 (sample 1, seawater), 2.08 (sample 2, lake water), and 1.83% (sample 3, sewage) for natural samples detection, which is more accurate than a traditional analyzer. The sensor has a good performance when affected by bubbles, light intensity, and salinity. In addition, the detection time is shortened to 80 s, which is more time saving compared with traditional devices, and the limit of detection (LOD) is 0.4 μM. It can be predicted that the novel optofluidic sensor is conducive to build a smart nutrient monitoring system and will be applied in the field of biochemistry and environmental chemistry.

Detection of Circulating Tumor Cells by Fluorescence Microspheres-Mediated Amplification

Here we describe a fluorescent microspheres-based separation and analysis that enables the isolation of circulating tumor cells (CTCs) from whole blood of patients with metastatic cancer and the identification of isolated CTCs in situ without immunostaining. This approach uses antibody-functionalized fluorescent polystyrene (PS) microspheres that can selectively bind to CTCs. The binding of CTCs and fluorescent PS microspheres leads to the formation of complexes of CTCs and fluorescent PS microspheres, thereby the CTCs are size-amplified and labeled simultaneously. A pyramidal microcavity array (PMCA) is fabricated using microfabrication technology to create a precise microfilter structure with a high aspect ratio. The PMCA filter device can effectively isolate microspheres-labeled CTCs, while allow hematologic cells to deform and pass through. Using this approach, CTCs are isolated and identified in 15 of 18 patients with metastatic colorectal cancer. This approach will open new possibilities for CTCs isolation and identification and can serve a versatile platform to facilitate CTCs analysis in diverse biomedical applications.

Mass production of thin-walled hollow optical fibers enables disposable optofluidic laser immunosensors

Disposable biosensors are of great importance in disease diagnosis due to their inherent merits of no cross-contamination and ease of use. Optofluidic laser (OFL) sensors are a new category of sensitive biosensors; however, it is challenging to cost-effectively mass-produce them to achieve disposability. Here, we report a disposable optofluidic laser immunosensor based on thin-walled hollow optical fibers (HOFs). Using a fiber draw tower, the fabrication parameters, including drawing speed and gas flow rate, are explored, and the HOF geometry is precisely controlled, which allows identical laser microring resonators to be distributed along the fibers. The disposable OFL immunosensor detects the protein concentration in the HOF through a wash-free immunoassay. Enabled by the disposable sensors, the statistical characteristics of 80 tests for each concentration greatly reduces the bioassay uncertainty. A low coefficient of variation (CV) of 3.3% confirms the high reproducibility of the disposable HOF-OFL sensors, and the mean of the normal distribution of the logarithmic OFL intensity serves as the sensing output. A limit of detection of 11 nM within a short assay time of 15 min is achieved. These disposable immunosensors possess the advantages of low cost, high reproducibility, fast assay, and low-volume consumption of sample and reagents. We believe that this work will inspire disposable optofluidics through the mass production of multifunctional microstructured optical fibers.

Microfluidics for label-free sorting of rare circulating tumor cells

A review discussing the working principles and performances of label-free CTC sorting methods.