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Segeren HA, Andree KC, Oomens L, Westendorp B. Collection of cells for single-cell RNA sequencing using high-resolution fluorescence microscopy. STAR Protoc 2021; 2:100718. [PMID: 34401784 PMCID: PMC8353340 DOI: 10.1016/j.xpro.2021.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
FACS sorting followed by single-cell RNA-sequencing (SORT-Seq) is a popular procedure to select cells of interest for single-cell transcriptomics. However, FACS is not suitable for measurement of subcellular distribution of fluorescence or for small samples (<1,000 cells). The VYCAP puncher system overcomes these limitations. Here, we describe a workflow to capture, image, and collect fluorescent human retina pigment epithelium cells for SORT-Seq using this system. The workflow can be used for any cell type with a diameter of ∼5-50 μm. For complete details on the use and execution of this protocol, please refer to Segeren et al. (2020).
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Affiliation(s)
- Hendrika A Segeren
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | | | | | - Bart Westendorp
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
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2
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Neves RPL, Ammerlaan W, Andree KC, Bender S, Cayrefourcq L, Driemel C, Koch C, Luetke-Eversloh MV, Oulhen M, Rossi E, Alix-Panabières C, Betsou F, Farace F, Riethdorf S, Schlange T, Wikman H, Zamarchi R, Pantel K, Terstappen LWMM, Stoecklein NH. Proficiency Testing to Assess Technical Performance for CTC-Processing and Detection Methods in CANCER-ID. Clin Chem 2021; 67:631-641. [PMID: 33491069 DOI: 10.1093/clinchem/hvaa322] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Multiple technologies are available for detection of circulating tumor cells (CTCs), but standards to evaluate their technical performance are still lacking. This limits the applicability of CTC analysis in clinic routine. Therefore, in the context of the CANCER-ID consortium, we established a platform to assess technical validity of CTC detection methods in a European multi-center setting using non-small cell lung cancer (NSCLC) as a model. METHODS We characterized multiple NSCLC cell lines to define cellular models distinct in their phenotype and molecular characteristics. Standardized tumor-cell-bearing blood samples were prepared at a central laboratory and sent to multiple European laboratories for processing according to standard operating procedures. The data were submitted via an online tool and centrally evaluated. Five CTC-enrichment technologies were tested. RESULTS We could identify 2 cytokeratin expressing cell lines with distinct levels of EpCAM expression: NCI-H441 (EpCAMhigh, CKpos) and NCI-H1563 (EpCAMlow, CKpos). Both spiked tumor cell lines were detected by all technologies except for the CellSearch system that failed to enrich EpCAMlow NCI-H1563 cells. Mean recovery rates ranged between 49% and 75% for NCI-H411 and 32% and 76% for NCI-H1563 and significant differences were observed between the tested methods. CONCLUSIONS This multi-national proficiency testing of CTC-enrichment technologies has importance in the establishment of guidelines for clinically applicable (pre)analytical workflows and the definition of minimal performance qualification requirements prior to clinical validation of technologies. It will remain in operation beyond the funding period of CANCER-ID in the context of the European Liquid Biopsy Society (ELBS).
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Affiliation(s)
- Rui P L Neves
- Department of General, Visceral and Paediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Wim Ammerlaan
- Integrated BioBank of Luxembourg, Dudelange, Luxembourg
| | - Kiki C Andree
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | | | - Laure Cayrefourcq
- Laboratory of Rare Human Circulating Cells, University Medical Centre of Montpellier, Montpellier, France
| | - Christiane Driemel
- Department of General, Visceral and Paediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Claudia Koch
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Marianne Oulhen
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, Villejuif, France
| | - Elisabetta Rossi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.,Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells, University Medical Centre of Montpellier, Montpellier, France
| | - Fay Betsou
- Integrated BioBank of Luxembourg, Dudelange, Luxembourg
| | - Françoise Farace
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, Villejuif, France
| | - Sabine Riethdorf
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Harriet Wikman
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rita Zamarchi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Klaus Pantel
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Nikolas H Stoecklein
- Department of General, Visceral and Paediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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3
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Tamminga M, Oomens L, Hiltermann TJN, Andree KC, Tibbe A, Broekmaat J, Schuuring E, Terstappen LWMM, Groen HJM. Microsieves for the detection of circulating tumor cells in leukapheresis product in non-small cell lung cancer patients. Transl Lung Cancer Res 2020; 9:1093-1100. [PMID: 32953488 PMCID: PMC7481649 DOI: 10.21037/tlcr-19-413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Circulating tumor cells (CTC) in non-small cell lung cancer (NSCLC) patients are a prognostic and possible therapeutic marker, but have a low frequency of appearance. Diagnostic leukapheresis (DLA) concentrates CTC and mononuclear cells from the blood. We evaluated a protocol using two VyCAP microsieves to filter DLA product of NSCLC patients and enumerate CTC, compared with CellSearch as a gold standard. Methods DLA was performed in NSCLC patients before starting treatment. DLA product equaling 2×108 leukocytes was diluted to 9 mL with CellSearch dilution buffer in a Transfix CTC tube. Within 72 hours the sample was filtered with a 7 µm pore microsieve and subsequently over a 5µm pore microsieve. CTC were defined as nucleated cells which stained for cytokeratin, but lacked CD45 and CD16. CellSearch detected CTC in the same volume of DLA. Results Of 29 patients a median of 1.4 mL DLA product (range, 0.5–4.1) was filtered (2% of total product) successfully in 93% and 45% of patients using 7 and 5 µm pores, respectively. Two DLA products were unevaluable for CTC detection. Clogging of the 5 µm but not 7 µm microsieves was positively correlated with fixation time (ρ=0.51, P<0.01). VyCAP detected CTC in 44% (12/27) of DLA products. Median CTC count per mL DLA was 0 [interquartile range (IQR): 0–1]. CellSearch detected CTC in 63% of DLA products (median =0.9 CTC per mL DLA, IQR: 0–2.1). CTC counts detected by CellSearch were significantly higher compared with VyCAP (P=0.05). Conclusions VyCAP microsieves can identify CTC in DLA product, but workflows need to be optimized.
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Affiliation(s)
- Menno Tamminga
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - T Jeroen N Hiltermann
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kiki C Andree
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, Groningen, The Netherlands
| | | | | | - Ed Schuuring
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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Faugeroux V, Pailler E, Oulhen M, Deas O, Brulle-Soumare L, Hervieu C, Marty V, Alexandrova K, Andree KC, Stoecklein NH, Tramalloni D, Cairo S, NgoCamus M, Nicotra C, Terstappen LWMM, Manaresi N, Lapierre V, Fizazi K, Scoazec JY, Loriot Y, Judde JG, Farace F. Genetic characterization of a unique neuroendocrine transdifferentiation prostate circulating tumor cell-derived eXplant model. Nat Commun 2020; 11:1884. [PMID: 32313004 PMCID: PMC7171138 DOI: 10.1038/s41467-020-15426-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
Transformation of castration-resistant prostate cancer (CRPC) into an aggressive neuroendocrine disease (CRPC-NE) represents a major clinical challenge and experimental models are lacking. A CTC-derived eXplant (CDX) and a CDX-derived cell line are established using circulating tumor cells (CTCs) obtained by diagnostic leukapheresis from a CRPC patient resistant to enzalutamide. The CDX and the derived-cell line conserve 16% of primary tumor (PT) and 56% of CTC mutations, as well as 83% of PT copy-number aberrations including clonal TMPRSS2-ERG fusion and NKX3.1 loss. Both harbor an androgen receptor-null neuroendocrine phenotype, TP53, PTEN and RB1 loss. While PTEN and RB1 loss are acquired in CTCs, evolutionary analysis suggest that a PT subclone harboring TP53 loss is the driver of the metastatic event leading to the CDX. This CDX model provides insights on the sequential acquisition of key drivers of neuroendocrine transdifferentiation and offers a unique tool for effective drug screening in CRPC-NE management.
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MESH Headings
- Animals
- Benzamides
- Carcinoma, Neuroendocrine/genetics
- Carcinoma, Neuroendocrine/metabolism
- Cell Line, Tumor
- Cell Transdifferentiation/genetics
- Disease Models, Animal
- Drug Resistance, Neoplasm
- Gene Expression Regulation, Neoplastic
- Homeodomain Proteins/metabolism
- Humans
- Male
- Mice
- Mice, Inbred NOD
- Neoplastic Cells, Circulating/drug effects
- Neoplastic Cells, Circulating/metabolism
- Nitriles
- Phenylthiohydantoin/analogs & derivatives
- Phenylthiohydantoin/pharmacology
- Phylogeny
- Prostate/metabolism
- Prostate/pathology
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/metabolism
- Receptors, Androgen/genetics
- Sequence Alignment
- Serine Endopeptidases/metabolism
- Transcription Factors/metabolism
- Transcriptome
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Vincent Faugeroux
- INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", 94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | - Emma Pailler
- INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", 94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | - Marianne Oulhen
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | | | | | - Céline Hervieu
- INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", 94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | - Virginie Marty
- Gustave Roussy, Université Paris-Saclay, Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | - Kamelia Alexandrova
- Gustave Roussy, Université Paris-Saclay, Department of Cell Therapy, 94805, Villejuif, France
| | - Kiki C Andree
- Medical Cell Biophysics Group, Technical Medical Centre, Faculty of Science and Technology, University of Twente, 7522 NB, Enschede, The Netherlands
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Dominique Tramalloni
- Gustave Roussy, Université Paris-Saclay, Department of Cell Therapy, 94805, Villejuif, France
| | | | - Maud NgoCamus
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, 94805, Villejuif, France
| | - Claudio Nicotra
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, 94805, Villejuif, France
| | - Leon W M M Terstappen
- Medical Cell Biophysics Group, Technical Medical Centre, Faculty of Science and Technology, University of Twente, 7522 NB, Enschede, The Netherlands
| | | | - Valérie Lapierre
- Gustave Roussy, Université Paris-Saclay, Department of Cell Therapy, 94805, Villejuif, France
| | - Karim Fizazi
- INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", 94805, Villejuif, France
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, 94805, Villejuif, France
| | - Jean-Yves Scoazec
- Gustave Roussy, Université Paris-Saclay, Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, 94805, Villejuif, France.
| | | | - Françoise Farace
- INSERM, U981 "Identification of Molecular Predictors and new Targets for Cancer Treatment", 94805, Villejuif, France.
- Gustave Roussy, Université Paris-Saclay, "Circulating Tumor Cells" Translational Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805, Villejuif, France.
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Tamminga M, Andree KC, Hiltermann TJN, Jayat M, Schuuring E, van den Bos H, Spierings DCJ, Lansdorp PM, Timens W, Terstappen LWMM, Groen HJM. Detection of Circulating Tumor Cells in the Diagnostic Leukapheresis Product of Non-Small-Cell Lung Cancer Patients Comparing CellSearch ® and ISET. Cancers (Basel) 2020; 12:E896. [PMID: 32272669 PMCID: PMC7226321 DOI: 10.3390/cancers12040896] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 01/04/2023] Open
Abstract
Circulating tumor cells (CTCs) detected by CellSearch are prognostic in non-small-cell lung cancer (NSCLC), but rarely found. CTCs can be extracted from the blood together with mononuclear cell populations by diagnostic leukapheresis (DLA), therefore concentrating them. However, CellSearch can only process limited DLA volumes (≈2 mL). Therefore, we established a protocol to enumerate CTCs in DLA products with Isolation by SizE of Tumor cells (ISET), and compared CTC counts between CellSearch® and ISET. DLA was performed in NSCLC patients who started a new therapy. With an adapted protocol, ISET could process 10 mL of DLA. CellSearch detected CTCs in a volume equaling 2 × 108 leukocytes (mean 2 mL). CTC counts per mL were compared. Furthermore, the live cell protocol of ISET was tested in eight patients. ISET successfully processed all DLA products-16 with the fixed cell protocol and 8 with the live cell protocol. In total, 10-20 mL of DLA was processed. ISET detected CTCs in 88% (14/16), compared to 69% (11/16, p < 0.05) with CellSearch. ISET also detected higher number of CTCs (ISET median CTC/mL = 4, interquartile range [IQR] = 2-6, CellSearch median CTC/mL = 0.9, IQR = 0-1.8, p < 0.01). Cells positive for the epithelial cell adhesion molecule (EpCAM+) per mL were detected in similar counts by both methods. Eight patients were processed with the live cell protocol. All had EpCAM+, CD45-, CD235- cells isolated by fluorescence-activated cell sorting (FACS). Overall, ISET processed larger volumes and detected higher CTC counts compared to CellSearch. EpCAM+ CTCs were detected in comparable rates.
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Affiliation(s)
- Menno Tamminga
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.T.); (T.J.N.H.)
| | - Kiki C. Andree
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, 7522 NB Enschede, The Netherlands; (K.C.A.); (L.W.M.M.T.)
| | - T. Jeroen N. Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.T.); (T.J.N.H.)
| | | | - Ed Schuuring
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.S.); (W.T.)
| | - Hilda van den Bos
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands; (H.v.d.B.); (D.C.J.S.); (P.M.L.)
| | - Diana C. J. Spierings
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands; (H.v.d.B.); (D.C.J.S.); (P.M.L.)
| | - Peter M. Lansdorp
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands; (H.v.d.B.); (D.C.J.S.); (P.M.L.)
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Wim Timens
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.S.); (W.T.)
| | - Leon W. M. M. Terstappen
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, 7522 NB Enschede, The Netherlands; (K.C.A.); (L.W.M.M.T.)
| | - Harry J. M. Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.T.); (T.J.N.H.)
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6
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Zeune LL, Boink YE, van Dalum G, Nanou A, de Wit S, Andree KC, Swennenhuis JF, van Gils SA, Terstappen LW, Brune C. Deep learning of circulating tumour cells. NAT MACH INTELL 2020. [DOI: 10.1038/s42256-020-0153-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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7
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Tamminga M, de Wit S, van de Wauwer C, van den Bos H, Swennenhuis JF, Klinkenberg TJ, Hiltermann TJN, Andree KC, Spierings DCJ, Lansdorp PM, van den Berg A, Timens W, Terstappen LWMM, Groen HJM. Analysis of Released Circulating Tumor Cells During Surgery for Non-Small Cell Lung Cancer. Clin Cancer Res 2019; 26:1656-1666. [PMID: 31772122 DOI: 10.1158/1078-0432.ccr-19-2541] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/17/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor cells from patients with lung cancer are expelled from the primary tumor into the blood, but difficult to detect in the peripheral circulation. We studied the release of circulating tumor cells (CTCs) during surgery to test the hypothesis that CTC counts are influenced by hemodynamic changes (caused by surgical approach) and manipulation. EXPERIMENTAL DESIGN Patients undergoing video-assisted thoracic surgery (VATS) or open surgery for (suspected) primary lung cancer were included. Blood samples were taken before surgery (T0) from the radial artery (RA), from both the RA and pulmonary vein (PV) when the PV was located (T1) and when either the pulmonary artery (T2 open) or the PV (T2 VATS) was dissected. The CTCs were enumerated using the CellSearch system. Single-cell whole-genome sequencing was performed on isolated CTCs for aneuploidy. RESULTS CTCs were detected in 58 of 138 samples (42%) of 31 patients. CTCs were more often detected in the PV (70%) compared with the RA (22%, P < 0.01) and in higher counts (P < 0.01). After surgery, the RA but not the PV showed less often CTCs (P = 0.02). Type of surgery did not influence CTC release. Only six of 496 isolated CTCs showed aneuploidy, despite matched primary tumor tissue being aneuploid. Euploid so-called CTCs had a different morphology than aneuploid. CONCLUSIONS CTCs defined by CellSearch were identified more often and in higher numbers in the PV compared with the RA, suggesting central clearance. The majority of cells in the PV were normal epithelial cells and outnumbered CTCs. Release of CTCs was not influenced by surgical approach.
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Affiliation(s)
- Menno Tamminga
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Sanne de Wit
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, the Netherlands
| | - Caroline van de Wauwer
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hilda van den Bos
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joost F Swennenhuis
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, the Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kiki C Andree
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, the Netherlands
| | - Diana C J Spierings
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter M Lansdorp
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anke van den Berg
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, the Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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8
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Andree KC, Mentink A, Nguyen AT, Goldsteen P, van Dalum G, Broekmaat JJ, van Rijn CJM, Terstappen LWMM. Tumor cell capture from blood by flowing across antibody-coated surfaces. Lab Chip 2019; 19:1006-1012. [PMID: 30762848 DOI: 10.1039/c8lc01158c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The load of circulating tumor cells (CTC) is related to poor outcomes in cancer patients. A sufficient number of these cells would enable a full characterization of the cancer. An approach to probe larger blood volumes, allowing for the detection of more of these very rare CTC, is the use of leukapheresis. Currently available techniques allow only the analysis of a small portion of leukapheresis products. Here, we present a method that uses flow rather than static conditions which allows processing of larger volumes. We evaluated the conditions needed to isolate tumor cells from blood while passing antibody coated surfaces. Results show that our set-up efficiently captures cancer cells from whole blood. Results show that the optimal velocity at which cells are captured from blood is 0.6 mm s-1. Also, it can be concluded that the VU1D9 antibody targeting the EpCAM antigen has very high capture efficiency. When using an antibody that does not capture 100% of all cells, combining multiple antibodies on the capture surface is very beneficial leading to an increase in cell capture and is therefore worthwhile considering in any cancer cell capture methodology.
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Affiliation(s)
- K C Andree
- Medical Cell Biophysics Group, Technical Medical Centre, Faculty of Science and Technology, University of Twente, The Netherlands.
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9
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Andree KC, Mentink A, Zeune LL, Terstappen LWMM, Stoecklein NH, Neves RP, Driemel C, Lampignano R, Yang L, Neubauer H, Fehm T, Fischer JC, Rossi E, Manicone M, Basso U, Marson P, Zamarchi R, Loriot Y, Lapierre V, Faugeroux V, Oulhen M, Farace F, Fowler G, Sousa Fontes M, Ebbs B, Lambros M, Crespo M, Flohr P, de Bono JS. Toward a real liquid biopsy in metastatic breast and prostate cancer: Diagnostic LeukApheresis increases CTC yields in a European prospective multicenter study (CTCTrap). Int J Cancer 2018; 143:2584-2591. [PMID: 30006930 PMCID: PMC6637919 DOI: 10.1002/ijc.31752] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023]
Abstract
Frequently, the number of circulating tumor cells (CTC) isolated in 7.5 mL of blood is too small to reliably determine tumor heterogeneity and to be representative as a “liquid biopsy”. In the EU FP7 program CTCTrap, we aimed to validate and optimize the recently introduced Diagnostic LeukApheresis (DLA) to screen liters of blood. Here we present the results obtained from 34 metastatic cancer patients subjected to DLA in the participating institutions. About 7.5 mL blood processed with CellSearch® was used as “gold standard” reference. DLAs were obtained from 22 metastatic prostate and 12 metastatic breast cancer patients at four different institutions without any noticeable side effects. DLA samples were prepared and processed with different analysis techniques. Processing DLA using CellSearch resulted in a 0–32 fold increase in CTC yield compared to processing 7.5 mL blood. Filtration of DLA through 5 μm pores microsieves was accompanied by large CTC losses. Leukocyte depletion of 18 mL followed by CellSearch yielded an increase of the number of CTC but a relative decrease in yield (37%) versus CellSearch DLA. In four out of seven patients with 0 CTC detected in 7.5 mL of blood, CTC were detected in DLA (range 1–4 CTC). The CTC obtained through DLA enables molecular characterization of the tumor. CTC enrichment technologies however still need to be improved to isolate all the CTC present in the DLA. What's new? Circulating tumor cells (CTC) can mirror tumor heterogeneity but a standard blood sample (7.5 mL) is too small to truly represent the tumor. To increase the yield of CTC, the authors used Diagnostic LeukApheresis in which liters of blood are screened for the presence of CTC in metastatic cancer patients. They report a significant increase in CTC yield and consequently, a better molecular characterization of the tumor, encouraging further research into the use of leukapheresis as “liquid biopsy” in cancer patients.
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Affiliation(s)
- Kiki C Andree
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Anouk Mentink
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Leonie L Zeune
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, The Netherlands
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rui P Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christiane Driemel
- Department of General, Visceral and Pediatric Surgery, University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rita Lampignano
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Liwen Yang
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Neubauer
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Elisabetta Rossi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.,DiSCOG, University of Padova, Padova, Italy
| | | | - Umberto Basso
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Piero Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova, Italy
| | - Rita Zamarchi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Yohann Loriot
- Department of Medicine, Université Paris-Saclay, Gustave Roussy, Villejuif, France.,INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment", Gustave Roussy, Villejuif, France
| | - Valerie Lapierre
- Department of Medicine, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Vincent Faugeroux
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment", Gustave Roussy, Villejuif, France.,"Circulating Tumor Cells" Translational Platform, CNRS UMS3655 - INSERM US23 Ammica, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Marianne Oulhen
- "Circulating Tumor Cells" Translational Platform, CNRS UMS3655 - INSERM US23 Ammica, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Françoise Farace
- INSERM U981 "Identification of Molecular Predictors and New Targets for Cancer Treatment", Gustave Roussy, Villejuif, France.,"Circulating Tumor Cells" Translational Platform, CNRS UMS3655 - INSERM US23 Ammica, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Gemma Fowler
- Cancer Biomarkers, Institute of Cancer Research, Sutton, UK
| | - Mariane Sousa Fontes
- Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Berni Ebbs
- Cancer Biomarkers, Institute of Cancer Research, Sutton, UK
| | - Maryou Lambros
- Cancer Biomarkers, Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Cancer Biomarkers, Institute of Cancer Research, Sutton, UK
| | - Penny Flohr
- Cancer Biomarkers, Institute of Cancer Research, Sutton, UK
| | - Johann S de Bono
- Prostate Cancer Targeted Therapies Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
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Andree KC, Tamminga M, Mentink A, Hilterman TJ, Groen HJ, Terstappen LW. Abstract 5584: Circulating tumor cells in the peripheral blood and leukapheresis product of non-small cell lung cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction The number of circulating tumor cells (CTC) isolated by the FDA approved CellSearch (CS) system in 7.5 mL of blood of metastatic and non-metastatic non-small cell lung cancer (NSCLC) patients is low or absent. Processing a larger blood volume could yield a greater amount of CTC from these patients. An approach to probe larger volumes is using diagnostic leukapheresis (DLA) where the blood can be split into its components after which selective harvesting of mononuclear cells (MNC) including CTC can take place.
Methods Patients with histologically proven NSCLC who either have been recently diagnosed or are eligible for new therapy can participate in this ongoing study. Patients had DLA for MNC collection derived from one total body blood volume. Before and after DLA, whole blood was drawn in a CellSave blood collection tube and analyzed by CS. The obtained DLA product was divided for analysis. 2x108 cells (on average 2mL of DLA product, representing ~100mL of blood) was diluted in 7.5 mL buffer, and analyzed by CS. 9 mL of the DLA product (on average 1x109 cells) was fixed and depleted of leukocytes using the RosetteSep CD45 depletion kit (Stemcell Technologies), allowing processing of a larger volume, followed by CS analysis. Results of molecular characterization of the detected CTC is pending.
Results So far, a total of 8 DLA's were performed in 7 stage 4 NSCLC patients. Sample collection took place before (t=0) and/or after (t=1) treatment. Patients underwent DLA in about 110 minutes, at this time an average of 4860 mL of blood was processed. No complications occurred, no post-procedure complaints were recorded. Similar DLA products with an average of 95 mL were obtained. CTC counts for these patient samples are shown in the table below.
CTC counts blood and DLAPatientt=#CTC pre blood#CTC post blood#CTC DLA (~2mL, 200x106 cells)#CTC depleted DLA (~9mL, 900x106 cells)101n/a114113020203514602031000040n/a04495000166000029020114
Conclusion DLA is a novel method to collect CTC from the blood. DLA can result in the detection of CTC where the use of 7.5mL of blood is not sufficient. Additionally, DLA shows an increase of CTC yield in patients with CTC detected in 7.5 mL of blood.
Citation Format: Kiki C. Andree, Menno Tamminga, Anouk Mentink, T Jeroen Hilterman, Harry J. Groen, Leon W. Terstappen. Circulating tumor cells in the peripheral blood and leukapheresis product of non-small cell lung cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5584.
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Affiliation(s)
| | - Menno Tamminga
- 2University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Harry J. Groen
- 2University Medical Center Groningen, Groningen, Netherlands
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Andree KC, Mentink A, Swennenhuis JF, Terstappen LW, Stoecklein NH, Neves RP, Lampignano R, Neubauer H, Fehm T, Fischer JC, Rossi E, Manicone M, Basso U, Marson P, Zamarchi R, Loriot Y, Lapierre V, Faugeroux V, Oulhen M, Farace F, Fowler G, Fontes MS, Ebbs B, Lambros M, Crespo M, Flohr P, Bono JSD. Abstract 1723: Diagnostic leukapheresis results in a significant increase in CTC yield in metastatic breast and prostate cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction Frequently the number of CTC isolated in 7.5 mL of blood is too small to reliably determine tumor heterogeneity and to be representative as a ‘liquid biopsy’. In the EU FP7 program CTCTrap we aimed to validate and optimize the recently introduced Diagnostic LeukApheresis (DLA; doi: 10.1073/pnas.1313594110) approach to screen liters of blood and thereby substantially increasing the number of CTC available for further characterization. Here we present the results obtained from 32 metastatic cancer patients subjected to DLA in the participating institutions.
Methods Before the DLA procedure, whole blood was drawn in a CellSave blood collection tube and a 7.5 ml aliquot was processed with the ‘gold standard’ reference CellSearch® (Janssen Diagnostics, USA). DLAs from metastatic cancer patients were performed for ≈90 minutes to obtain 40 mL of product containing ≈4x109 mononuclear cells (MNC) representing ≈1 liter of blood. The obtained DLA samples were then divided, fixed with CellSave preservative, prepared and processed with each of the analysis techniques as described in the Standard Operating Procedures developed for DLA in the CTCTrap consortium (https://www.utwente.nl/tnw/mcbp/protocolsandtools/).
Results DLAs were obtained from 20 metastatic prostate cancer patients and 12 metastatic breast cancer patients at four different European academic medical institutions. Using a SOP for the DLA procedure, similar DLA products (MNC concentration: 64x106/mL, SD = 38x106) could be generated without any noticeable side effects. CTC in 7.5 mL of blood ranged from 0 to 324 (mean = 61, median = 18). DLA processed with CellSearch represented 7 to 212 mL of blood (mean = 100, median = 97), CTC ranged from 0 to 2913 (mean = 330, median = 105). Resulting in a significant increase in CTC yield (p = 0.004) ranging from 0x to 40x (mean = 13, median = 9) when comparing 1mL of whole blood to 1mL of DLA. Filtration of 50x106 WBC of DLA, through 5um microsieves yielded only 0 to 12 CTC (mean = 2, median = 0, n = 16). Leukocyte depletion of 18 mL of DLA followed by filtration yielded 0 to 178 CTC (mean = 37, median = 4, n = 22) not yielding a relative increase versus CellSearch DLA. Leukocyte depletion followed by CellSearch yielded 271 to 1620 CTC (mean = 792, median = 484, n = 3) also not yielding a relative increase versus CellSearch DLA. In 7 patients 0 CTC were detected in 7.5mL of blood, in 4 out of these 7 patients CTC were detected in DLA.
Conclusion The yield of CTC can be significantly increased by the use of DLA in patients with CTC detected in 7.5 mL of blood. Technology to select CTC from DLAs will need to be further improved before one can make optimal use of the large processed blood volumes.
Citation Format: Kiki C. Andree, Anouk Mentink, Joost F. Swennenhuis, Leon W. Terstappen, Nikolas H. Stoecklein, Rui P. Neves, Rita Lampignano, Hans Neubauer, Tanja Fehm, Johannes C. Fischer, Elisabetta Rossi, Mariangela Manicone, Umberto Basso, Piero Marson, Rita Zamarchi, Yohann Loriot, Valérie Lapierre, Vincent Faugeroux, Marianne Oulhen, Francoise Farace, Gemma Fowler, Mariane Sousa Fontes, Berni Ebbs, Maryou Lambros, Mateus Crespo, Penelope Flohr, Johann S. de Bono. Diagnostic leukapheresis results in a significant increase in CTC yield in metastatic breast and prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1723. doi:10.1158/1538-7445.AM2017-1723
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Affiliation(s)
| | | | | | | | - Nikolas H. Stoecklein
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rui P. Neves
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rita Lampignano
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Neubauer
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tanja Fehm
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes C. Fischer
- 2University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | - Yohann Loriot
- 6Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | | | - Gemma Fowler
- 8Institute of Cancer Research, Sutton, United Kingdom
| | - Mariane Sousa Fontes
- 9The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Berni Ebbs
- 8Institute of Cancer Research, Sutton, United Kingdom
| | | | - Mateus Crespo
- 8Institute of Cancer Research, Sutton, United Kingdom
| | | | - Johann S. de Bono
- 9The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Wit SD, Andree KC, Swennenhuis JF, Rossi E, Manicone M, Vidotto R, Zamarchi R, Alunni-Fabbroni M, Trapp EK, Tzschaschel M, Rack B, Lampignano R, Neubauer H, Fehm T, Oulhen M, Colomba E, Farace F, Crespo M, Flohr P, Fowler G, Fontes MS, Bono JSD, Terstappen LWMM. Abstract 3787: EpCAM- and EpCAM+ circulating tumor cells in metastatic prostate and breast cancer patients: a multicenter study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The presence of circulating tumor cells (CTC) enumerated by the CellSearch system in blood of patients with cancers of epithelial origin is strongly associated with a poor prognosis of these patients. CTC are enriched by targeting the EpCAM antigen, raising the question which EpCAM subtypes are present as well in patients. In the EU-FP7 CTCTrap program, we investigated the presence of EpCAM- CTC in blood samples after depletion of EpCAM+ CTC by CellSearch. Studies were performed and validated at the participating laboratories by distribution and analysis of blood samples spiked with cancer cells and by testing blood from 73 metastatic prostate and 22 metastatic breast cancer patients. Methods: Blood samples were processed according to the standard operating procedures and tools developed in the program (https://www.utwente.nl/tnw/mcbp/protocolsandtools/). First, CellSearch was performed for EpCAM+ CTC, followed by filtration and fluorescent labeling of the blood discarded by CellSearch for EpCAM- CTC. To validate the procedures across the 6 participating clinical sites, 3x 3 tubes with aliquots of healthy donor blood, spiked with either PC3, MDA-MB-231 or no cells, were prepared at one site and shipped to all other sites for simultaneous processing. Metastatic prostate and breast cancer patients were processed with the same procedures. Results: 27% of PC3 cells were recovered by CellSearch and 21% by filtration, leaving 52% unaccounted for. For MDA, 26% were recovered by CellSearch and 18% by filtration, leaving 56% accounted for. Differences in recovery between sites were not significant. In patients both EpCAM+ and EpCAM- CTC were detected (see table). Conclusion: In a multicenter study EpCAM+ and EpCAM- CTC were present in blood of metastatic prostate and breast cancer patients. Spiking experiments showed that the developed methods can be further improved to increase the CTC yield. Molecular characterization of the CTC subtypes and relation with clinical outcome is ongoing.
% metastatic cancer patients with EpCAM+ and EpCAM- CTC% prostate cancer patients (n=73)% breast cancer patients (n=22)CellSearch CTC EpCAM+CellSearch CTC EpCAM+# CTC01-4>4Total01-4>4TotalMicrosieve CTC EpCAM-011819381859321-4671629991432>48619331414936Total252154412732
Citation Format: Sanne de Wit, Kiki C. Andree, Joost F. Swennenhuis, Elisabetta Rossi, Mariangela Manicone, Riccardo Vidotto, Rita Zamarchi, Marianna Alunni-Fabbroni, Elisabeth K. Trapp, Marie Tzschaschel, Brigitte Rack, Rita Lampignano, Hans Neubauer, Tanja Fehm, Marianne Oulhen, Emeline Colomba, Françoise Farace, Mateus Crespo, Penelope Flohr, Gemma Fowler, Mariane Sousa Fontes, Johann S. de Bono, Leon WMM Terstappen. EpCAM- and EpCAM+ circulating tumor cells in metastatic prostate and breast cancer patients: a multicenter study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3787. doi:10.1158/1538-7445.AM2017-3787
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tanja Fehm
- 6Heinrich-Heine University, Duesseldorf, Germany
| | | | | | | | - Mateus Crespo
- 8Institute of Cancer Research, Sutton, United Kingdom
| | | | - Gemma Fowler
- 8Institute of Cancer Research, Sutton, United Kingdom
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Lambros MB, Gil VS, Crespo M, Fontes MS, Neves RN, Mahra N, Fowler G, Ebbs B, Flohr P, Seed G, Yuan W, Hunt J, Moloney D, Ayanda D, Swennenhuis JF, Andree KC, Sumanasuriya S, Clarke M, Rescigno P, Zafeiriou Z, Mateo J, Bianchini D, Stoecklein NH, Terstappen LW, Boysen G, Bono JSD. Abstract 993: Diagnostic leukapheresis (DLA): Molecular characterisation and organoid culture of circulating tumor cells (CTC) from metastatic castration resistant prostate cancer (mCRPC). Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: CTC count is an independent predictor of overall survival in mCRPC. Isolation of CTC from peripheral blood (PB) for genomic and functional analysis is challenging, especially in patients (pts) with low CTC count. It has been shown that DLA increases CTC yield. However, it has yet to be proven whether CTC isolation from DLA can be used in complementary studies such as molecular characterization and growth of organoid culture for drug sensitivity studies. Here we present preliminary data of an on-going study, which evaluates DLA in mCRPC pts, focusing on safety, CTC enrichment, molecular characterization and feasibility for organoid culture. Methods: mCRPC pts considered for clinical trials were selected according to performance status (ECOG 0-1) and number of CTC found in 7.5ml PB (>20 cells/7.5mL). DLA products (200x106 cells) were processed using the CellSearch CTC kit (Janssen Diagnostics, LLC) according to manufacturer procedures. The contents of CellSearch cartridges were sorted into single cell by fluorescence activated cell sorting (FACS) and subsequently assessed by array comparative genomic hybridization (aCGH) for copy number aberrations (CNA). Enrichment of CTC for organoid culture was performed by density gradient of mononuclear cells followed by positive selection using magnetic beads. Results: Overall 12 mCRPC patients underwent DLA without any complication or toxicity. The mean CTC count was 90 CTC/7.5 ml peripheral blood (median = 31) and ranged from 20 to 324. CellSearch CTC count in the DLA yielded a mean of 466 (median=203) and ranged from 60 to 2496 with an up to 40-fold increase (mean = 13, median = 6) in CTC count separation when comparing 1mL of PB to 1mL of DLA. Molecular analyses of FACS single CTC from the DLA by aCGH showed that these CTC genomic profiles had the typical hallmarks of mCRPC with CNAs including AR and MYC locus (8q) amplification, and PTEN, RB1, TP53, CHD1 loss. Additionally, ex vivo culture of CTC-derived organoids was successfully achieved. aCGH of these organoids matched the genomic profile that of the CTC from the same patient. Conclusion: DLA from mCRPC pts was well tolerated and yields higher CTC capture than PB and may provide an alternative to tissue biopsy and routine blood volumes. Our strategy allowed us to isolate genomic DNA with good quality for molecular characterization and viable CTC for organoid culture and functional studies.
Citation Format: Maryou B. Lambros, Veronica S. Gil, Mateus Crespo, Mariane S. Fontes, Rui N. Neves, Niven Mahra, Gemma Fowler, Berni Ebbs, Penny Flohr, George Seed, Wei Yuan, Joanne Hunt, Deirdre Moloney, Dionne Ayanda, Joost F. Swennenhuis, Kiki C. Andree, Semini Sumanasuriya, Matthew Clarke, Pasquale Rescigno, Zafeiris Zafeiriou, Joaquin Mateo, Diletta Bianchini, Nikolas H. Stoecklein, Leon W. Terstappen, Gunther Boysen, Johann S. De Bono. Diagnostic leukapheresis (DLA): Molecular characterisation and organoid culture of circulating tumor cells (CTC) from metastatic castration resistant prostate cancer (mCRPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 993. doi:10.1158/1538-7445.AM2017-993
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Affiliation(s)
| | | | - Mateus Crespo
- 1The Institute of Cancer Research, London, United Kingdom
| | | | - Rui N. Neves
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Niven Mahra
- 1The Institute of Cancer Research, London, United Kingdom
| | - Gemma Fowler
- 1The Institute of Cancer Research, London, United Kingdom
| | - Berni Ebbs
- 1The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- 1The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- 1The Institute of Cancer Research, London, United Kingdom
| | - Wei Yuan
- 1The Institute of Cancer Research, London, United Kingdom
| | - Joanne Hunt
- 2The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Deirdre Moloney
- 2The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Dionne Ayanda
- 2The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Matthew Clarke
- 1The Institute of Cancer Research, London, United Kingdom
| | | | | | - Joaquin Mateo
- 2The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Nikolas H. Stoecklein
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Gunther Boysen
- 1The Institute of Cancer Research, London, United Kingdom
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Swennenhuis JF, Andree KC, Abali F, Stevens M, Broekmaat J, Passanha FF, Rijn CJV, Terstappen LW. Abstract 3785: Self-sorting microwells to isolate and expand single circulating tumor cells. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Circulating tumor cells (CTCs) can be isolated from blood and serve as a source of tumor material. Expansions of CTCs may permit functional treatment-efficacy tests in combination with genetics, epigenetics and proteomics screening. We present a fast workflow to isolate, capture, grow and image cells inside a self-sorting microwell chip using the VyCAP single cell isolation platform. After seeding single cells in a microwell chip, they can grow inside the chip or can be transferred to a tissue culture plate for clonal expansion or downstream analysis.
Materials and methods:
The Rosette-Sep™ Human CD45 depletion cocktail (Stem Cell Technologies) was used to enrich spiked cells from 1 ml of fresh EDTA blood. Cells were stained with CellTrace™ violet for tracking spiked cells, calcein for live cells, ethidium bromide for dead cells, α-CD45-PERCP as negative marker and α-EpCAM-AF647 as positive marker. After density gradient separation using Ficoll-Paque™, the cell suspension was measured and quantified using flow cytometry for Rosette-Sep™ efficiency. Cell suspensions were seeded in the self-sorting microwell chips using a negative pressure of 40-70 mbar using the VyCAP Filtration system. After seeding single cells in the microwells, the chips were imaged with the VyCAP Puncher system and either placed immediately into culture medium for cell expansion or selected cells were transferred into a 96 well tissue culture plate. Cell expansion in microwell chips and plates was followed up to 14 days.
Results:
Cultured MDA-MB-231 and MCF-7 cells were single-cell-trapped in the microwells with an efficiency of 82% ± 9% and 74% ± 15% respectively, after direct filtration without enrichment. Immediately after capturing in microwells 93% of the MCF7 cells were viable. Rosette-Sep™ enriched MDA-MB-231 and MCF-7 cells with an efficiency of 73% ± 6% and 74% ± 7% respectively, when measured with flow cytometry. The Rosette-Sep™ procedure followed by capture of the MDA-MB-231 and MCF-7 cells in the microwells resulted in an efficiency of 50% ± 11% and 52% ± 11% respectively. 92% of the cells were found back in a culture plate after punching of single cells from the chip, and of these cells, 80% were alive 4 hours after punching. 82% of these cells were alive and still growing after 14 days. In total 53% of cells spiked in blood, could be found back in the cups of which after punching into individual wells, 77% were alive and growing.
Conclusion:
We present a single cell capture and isolation method for clonal expansion of viable tumor cells. The VyCAP single cell isolation platform used for these experiments provides an easy separation of the single cells from a CTC enriched cell suspension and allows on-chip expansion as well as immediate separation of the CTCs into culture plates. About 50% of spiked cells could be retrieved inside the microwell chip and of these 77% were alive after punching into individual wells of a culture plate.
Citation Format: Joost F. Swennenhuis, Kiki C. Andree, Fikri Abali, Michiel Stevens, Joska Broekmaat, Fiona F. Passanha, Cees J. van Rijn, Leon W. Terstappen. Self-sorting microwells to isolate and expand single circulating tumor cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3785. doi:10.1158/1538-7445.AM2017-3785
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van der Meer LT, Terry SYA, van Ingen Schenau DS, Andree KC, Franssen GM, Roeleveld DM, Metselaar JM, Reinheckel T, Hoogerbrugge PM, Boerman OC, van Leeuwen FN. In Vivo Imaging of Antileukemic Drug Asparaginase Reveals a Rapid Macrophage-Mediated Clearance from the Bone Marrow. J Nucl Med 2016; 58:214-220. [PMID: 27493268 DOI: 10.2967/jnumed.116.177741] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
The antileukemic drug asparaginase, a key component in the treatment of acute lymphoblastic leukemia, acts by depleting asparagine from the blood. However, little is known about its pharmacokinetics, and mechanisms of therapy resistance are poorly understood. Here, we explored the in vivo biodistribution of radiolabeled asparaginase, using a combination of imaging and biochemical techniques, and provide evidence for tissue-specific clearance mechanisms, which could reduce the effectiveness of the drug at these specific sites. METHODS In vivo localization of 111In-labeled Escherichia coli asparaginase was performed in C57BL/6 mice by both small-animal SPECT/CT and ex vivo biodistribution studies. Mice were treated with liposomal clodronate to investigate the effect of macrophage depletion on tracer localization and drug clearance in vivo. Moreover, macrophage cell line models RAW264.7 and THP-1, as well as knockout mice, were used to identify the cellular and molecular components controlling asparaginase pharmacokinetics. RESULTS In vivo imaging and biodistribution studies showed a rapid accumulation of asparaginase in macrophage-rich tissues such as the liver, spleen, and in particular bone marrow. Clodronate-mediated depletion of phagocytic cells markedly prolonged the serum half-life of asparaginase in vivo and decreased drug uptake in these macrophage-rich organs. Immunohistochemistry and in vitro binding assays confirmed the involvement of macrophagelike cells in the uptake of asparaginase. We identified the activity of the lysosomal protease cathepsin B in macrophages as a rate-limiting factor in degrading asparaginase both in vitro and in vivo. CONCLUSION We showed that asparaginase is rapidly cleared from the serum by liver-, spleen-, and bone marrow-resident phagocytic cells. As a consequence of this efficient uptake and protease-mediated degradation, particularly bone marrow-resident macrophages may provide a protective niche to leukemic cells.
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Affiliation(s)
- Laurens T van der Meer
- Laboratory of Pediatric Oncology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Samantha Y A Terry
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Imaging Sciences and Biomedical Engineering, Department of Imaging Chemistry and Biology, King's College London, London, United Kingdom
| | - Dorette S van Ingen Schenau
- Laboratory of Pediatric Oncology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kiki C Andree
- Laboratory of Pediatric Oncology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerben M Franssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debbie M Roeleveld
- Laboratory of Pediatric Oncology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Experimental Rheumatology, Radboud Insititute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josbert M Metselaar
- Department of Experimental Molecular Imaging, University Clinic and Helmholtz Institute for Biomedical Engineering, RWTH-Aachen University, Aachen, Germany
| | - Thomas Reinheckel
- Institute of Molecular Medicine and Cell Research, Albert-Ludwigs-University, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, Albert-Ludwigs-University, Freiburg, Germany; and
| | | | - Otto C Boerman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank N van Leeuwen
- Laboratory of Pediatric Oncology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Andree KC, Mentink A, Scholz M, Kirchner R, Neves RP, Driemel C, Lampignano R, Neubauer H, Niederacher D, Fehm T, Knoefel WT, Fischer JC, Stoecklein NH, Terstappen LWMM. Abstract 1532: The isolation of CTC from diagnostic leukapheresis. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
At present, the CellSearch system is the only validated method for the detection of circulating tumor cells (CTC) that has been cleared by the U.S. Food and Drug Administration. This system, designed for the enumeration of CTC in 7.5 mL of blood, detects CTC based on their expression of EpCAM and cytokeratins and negativity for CD45. However, the number of CTC that are detected in patients with metastatic carcinomas is in most cases too small to reliably determine tumor heterogeneity and to be representative as a ‘liquid biopsy’. Our aim is to identify and isolate a sufficient number of circulating tumor cells in virtually all metastatic cancer patients to enable their characterization and to represent a real-time liquid biopsy. For this purpose we used Diagnostic LeukApheresis (DLA) to increase the blood volume to be analyzed. We developed several techniques to isolate CTC from DLA to enable a multicenter comparison of CTC detection in DLA products.
Methods
DLAs were performed for ∼1 hour to obtain 40 mL of product containing ∼4 x10⁁9 mononuclear cells representing ∼1 liter of blood. Using CellSearch a maximum of 2 mL of DLA could be processed for EpCAM+ CTC (Fisher et al. doi: 10.1073/pnas.1313594110) and EpCAM- CTC (de Wit et al doi: 10.1038/srep12270). Using filtration through microsieves with 5 μm pores a maximum of 1.0 mL of DLA could be processed. To process 18 mL DLA product protocols were developed for leukocyte depletion using RosetteSep™ (StemCell Technologies, USA) and for EpCAM selection using an anti-EpCAM coated column (Leukocare AG). All enriched cell fractions were stained using CD45 PerCP, Cytokeratins PE and the nuclear dye DAPI, followed by fluorescence microscopy scanning and analysis.
Results
Leukocyte depletion using the RosetteSep™ CTC Enrichment cocktail was first optimized using small sample volumes (1 mL) spiked with cells from cancer cell lines. Depletion of leukocytes ranged from 3.1 to 3.9 logs with an average recovery of spiked cancer cells of 50-60%. Isolation of CTC expressing EpCAM was pursued using anti-EpCAM coated columns and optimized for selection and release of EpCAM expressing cells by passage of cells from cancer cell lines through the column resulting in 34-100% recovery. Both procedures were scaled up to enable processing of 18 mL of DLA. Leukocytes were depleted using RosetteSepTM by 3.1 - 3.9 logs whereas with anti-EpCAM columns only 1.7 - 1.8 logs depletion were reached. Using RosetteSepTM 21% and with the anti-EpCAM coated columns 2% of the tumor cells spiked into 18ml DLA were recovered.
Conclusion
Standard operating procedures were developed to isolate CTC in DLA's from breast, prostate cancer and lung cancer patients for evaluation and comparison in the EU sponsored consortiums CTCTrap (www.utwente.nl/tnw/ctctrap/) and CANCER-ID (www.CANCER-ID.eu). Isolation of EpCAM expressing CTC using the anti-EpCAM coated columns will need further optimization before it can proceed to multicenter comparison.
Citation Format: Kiki C. Andree, Anouk Mentink, Martin Scholz, Roland Kirchner, Rui P. Neves, Christiane Driemel, Rita Lampignano, Hans Neubauer, Dieter Niederacher, Tanja Fehm, Wolfram T. Knoefel, Johannes C. Fischer, Nikolas H. Stoecklein, Leon WMM Terstappen. The isolation of CTC from diagnostic leukapheresis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1532.
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Affiliation(s)
| | | | | | | | - Rui P. Neves
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christiane Driemel
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rita Lampignano
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Neubauer
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Dieter Niederacher
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tanja Fehm
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfram T. Knoefel
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes C. Fischer
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nikolas H. Stoecklein
- 3University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Andree KC, Barradas AMC, Nguyen AT, Mentink A, Stojanovic I, Baggerman J, van Dalum J, van Rijn CJM, Terstappen LWMM. Capture of Tumor Cells on Anti-EpCAM-Functionalized Poly(acrylic acid)-Coated Surfaces. ACS Appl Mater Interfaces 2016; 8:14349-56. [PMID: 27187784 DOI: 10.1021/acsami.6b01241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The presence of tumor cells in blood is predictive of short survival in several cancers and their isolation and characterization can guide toward the use of more effective treatments. These circulating tumor cells (CTC) are, however, extremely rare and require a technology that is sufficiently sensitive and specific to identify CTC against a background of billions of blood cells. Immuno-capture of cells expressing the epithelial cell adhesion molecule (EpCAM) are frequently used to enrich CTC from blood. The choice of bio conjugation strategy and antibody clone is crucial for adequate cell capture but is poorly understood. In this study, we determined the binding affinity constants and epitope binding of the EpCAM antibodies VU1D-9, HO-3, EpAb3-5, and MJ-37 by surface plasmon resonance imaging (SPRi). Glass surfaces were coated using a poly(acrylic acid) based coating and functionalized with anti-EpCAM antibodies. Binding of cells from the breast carcinoma cell line (SKBR-3) to the functionalized surfaces were compared. Although EpAb3-5 displayed the highest binding affinity HO-3 captured the highest amount of cells. Hence we report differences in the performance of the different antibodies and more importantly that the choice of antibody to capture CTC should be based on multiple assays.
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Affiliation(s)
- Kiki C Andree
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
| | - Ana M C Barradas
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
| | - Ai T Nguyen
- Aquamarijn Micro Filtration BV , IJsselkade 7, 7201 HB Zutphen, The Netherlands
| | - Anouk Mentink
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
| | - Ivan Stojanovic
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
| | - Jacob Baggerman
- Aquamarijn Micro Filtration BV , IJsselkade 7, 7201 HB Zutphen, The Netherlands
| | - Joost van Dalum
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
| | - Cees J M van Rijn
- Laboratory of Organic Chemistry, Wageningen University , Dreijenplein 8, 6703 HB Wageningen, The Netherlands
| | - Leon W M M Terstappen
- Medical Cell Biophysics Group, MIRA Institute for Biomedical Engineering and Technical Medicine, Faculty of Science and Technology, University of Twente , 7522 NB Enschede, The Netherlands
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Schasfoort RB, Andree KC, van der Velde N, van der Kooi A, Stojanović I, Terstappen LW. Interpolation method for accurate affinity ranking of arrayed ligand–analyte interactions. Anal Biochem 2016; 500:21-3. [DOI: 10.1016/j.ab.2016.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 11/16/2022]
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Andree KC, van Dalum G, Terstappen LWMM. Challenges in circulating tumor cell detection by the CellSearch system. Mol Oncol 2015; 10:395-407. [PMID: 26795350 DOI: 10.1016/j.molonc.2015.12.002] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022] Open
Abstract
Enumeration and characterization of circulating tumor cells (CTC) hold the promise of a real time liquid biopsy. They are however present in a large background of hematopoietic cells making their isolation technically challenging. In 2004, the CellSearch system was introduced as the first and only FDA cleared method designed for the enumeration of circulating tumor cells in 7.5 mL of blood. Presence of CTC detected by CellSearch is associated with poor prognosis in metastatic carcinomas. CTC remaining in patients after the first cycles of therapy indicates a futile therapy. Here we review challenges faced during the development of the CellSearch system and the difficulties in assigning objects as CTC. The large heterogeneity of CTC and the different approaches introduced in recent years to isolate, enumerate and characterize CTC results in a large variation of the number of CTC reported urging the need for uniform definitions and at least a clear definition of what the criteria are for assigning an object as a CTC.
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Affiliation(s)
- Kiki C Andree
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands
| | - Guus van Dalum
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Hallenweg 23, 7522 NH Enschede, The Netherlands.
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