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      Fast and efficient microfluidic cell filter for isolation of circulating tumor cells from unprocessed whole blood of colorectal cancer patients

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          Abstract

          Liquid biopsy offers unique opportunities for low invasive diagnosis, real-time patient monitoring and treatment selection. The phenotypic and molecular profile of circulating tumor cells (CTCs) can provide key information about the biology of tumor cells, contributing to personalized therapy. CTC isolation is still challenging, mainly due to their heterogeneity and rarity. To overcome this limitation, a microfluidic chip for label-free isolation of CTCs from peripheral blood was developed. This device, the CROSS chip, captures CTCs based on their size and deformability with an efficiency of 70%. Using 2 chips, 7.5 ml of whole blood are processed in 47 minutes with high purity, as compared to similar technologies and assessed by in situ immunofluorescence. The CROSS chip performance was compared to the CellSearch system in a set of metastatic colorectal cancer patients, resulting in higher capture of DAPI+/CK+/CD45− CTCs in all individuals tested. Importantly, CTC enumeration by CROSS chip enabled stratification of patients with different prognosis. Lastly, cells isolated in the CROSS chip were lysed and further subjected to molecular characterization by droplet digital PCR, which revealed a mutation in the APC gene for most patient samples analyzed, confirming their colorectal origin and the versatility of the technology for downstream applications.

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          Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases.

          The purpose of this study was to determine the accuracy, precision, and linearity of the CellSearch system and evaluate the number of circulating tumor cells (CTCs) per 7.5 mL of blood in healthy subjects, patients with nonmalignant diseases, and patients with a variety of metastatic carcinomas. The CellSearch system was used to enumerate CTCs in 7.5 mL of blood. Blood samples spiked with cells from tumor cell lines were used to establish analytical accuracy, reproducibility, and linearity. Prevalence of CTCs was determined in blood from 199 patients with nonmalignant diseases, 964 patients with metastatic carcinomas, and 145 healthy donors. Enumeration of spiked tumor cells was linear over the range of 5 to 1,142 cells, with an average recovery of >/=85% at each spike level. Only 1 of the 344 (0.3%) healthy and nonmalignant disease subjects had >/=2 CTCs per 7.5 mL of blood. In 2,183 blood samples from 964 metastatic carcinoma patients, CTCs ranged from 0 to 23,618 CTCs per 7.5 mL (mean, 60 +/- 693 CTCs per 7.5 mL), and 36% (781 of 2,183) of the specimens had >/=2 CTCs. Detection of >/=2 CTCs occurred at the following rates: 57% (107 of 188) of prostate cancers, 37% (489 of 1,316) of breast cancers, 37% (20 of 53) of ovarian cancers, 30% (99 of 333) of colorectal cancers, 20% (34 of 168) of lung cancers, and 26% (32 of 125) of other cancers. The CellSearch system can be standardized across multiple laboratories and may be used to determine the clinical utility of CTCs. CTCs are extremely rare in healthy subjects and patients with nonmalignant diseases but present in various metastatic carcinomas with a wide range of frequencies.
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            Circulating tumor cells predict survival benefit from treatment in metastatic castration-resistant prostate cancer.

            A method for enumerating circulating tumor cells (CTC) has received regulatory clearance. The primary objective of this prospective study was to establish the relationship between posttreatment CTC count and overall survival (OS) in castration-resistant prostate cancer (CRPC). Secondary objectives included determining the prognostic utility of CTC measurement before initiating therapy, and the relationship of CTC to prostate-specific antigen (PSA) changes and OS at these and other time points. Blood was drawn from CRPC patients with progressive disease starting a new line of chemotherapy before treatment and monthly thereafter. Patients were stratified into predetermined Favorable or Unfavorable groups ( or =5 CTC/7.5mL). Two hundred thirty-one of 276 enrolled patients (84%) were evaluable. Patients with Unfavorable pretreatment CTC (57%) had shorter OS (median OS, 11.5 versus 21.7 months; Cox hazard ratio, 3.3; P 26 to 9.3 months). CTC are the most accurate and independent predictor of OS in CRPC. These data led to Food and Drug Administration clearance of this assay for the evaluation of CRPC.
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              APC mutations occur early during colorectal tumorigenesis.

              Human tumorigenesis is associated with the accumulation of mutations both in oncogenes and in tumour suppressor genes. But in no common adult cancer have the mutations that are critical in the early stages of the tumorigenic process been defined. We have attempted to determine if mutations of the APC gene play such a role in human colorectal tumours, which evolve from small benign tumours (adenomas) to larger malignant tumours (carcinomas) over the course of several decades. Here we report that sequence analysis of 41 colorectal tumours revealed that the majority of colorectal carcinomas (60%) and adenomas (63%) contained a mutated APC gene. Furthermore, the APC gene met two criteria of importance for tumour initiation. First, mutations of this gene were found in the earliest tumours that could be analysed, including adenomas as small as 0.5 cm in diameter. Second, the frequency of such mutations remained constant as tumours progressed from benign to malignant stages. These data provide strong evidence that mutations of the APC gene play a major role in the early development of colorectal neoplasms.
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                Author and article information

                Contributors
                Clotilde.Costa.Nogueira@sergas.es
                lorena.dieguez@inl.int
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                29 May 2019
                29 May 2019
                2019
                : 9
                : 8032
                Affiliations
                [1 ]ISNI 0000 0004 0521 6935, GRID grid.420330.6, Department of Life Sciences, , International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga s/n, ; 4715-330 Braga, Portugal
                [2 ]Roche-CHUS Joint Unit, Oncomet, Health Research Institute of Santiago (IDIS), Complejo Hospitalario de Santiago de Compostela, Trav. Choupana s/n, 15706 Santiago de Compostela, Spain
                [3 ]ISNI 0000 0004 0408 4897, GRID grid.488911.d, Liquid Biopsy Analysis Unit, , Oncomet, Health Research Institute of Santiago (IDIS), Complejo Hospitalario de Santiago de Compostela, Trav. Choupana s/n, ; 15706 Santiago de Compostela, Spain
                [4 ]CIBERONC, Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
                [5 ]ISNI 0000 0004 0521 6935, GRID grid.420330.6, Department of Micro and Nanofabrication, , International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga s/n, ; 4715-330 Braga, Portugal
                [6 ]ISNI 0000 0004 0521 6935, GRID grid.420330.6, Department of Nanoelectronics Engineering, , International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga s/n, ; 4715-330 Braga, Portugal
                Author information
                http://orcid.org/0000-0002-0908-0874
                http://orcid.org/0000-0002-4473-7608
                http://orcid.org/0000-0003-3695-6963
                Article
                44401
                10.1038/s41598-019-44401-1
                6541613
                31142796
                bbf92648-c7c1-4297-b7a6-53ee7ae41db2
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 30 May 2018
                : 7 May 2019
                Funding
                Funded by: This work was supported by the InveNNta Project (Innovation in Nanomedicine), co-financed by the European Union through the Operational Programme for Cross-border Cooperation Spain-Portugal European Regional Development Fund (ERDF) (POCTEP 2007-2013), by the InveNNta2 project funded through the Nanocontest (Galician Agency of Innovation); by the CANCER project (NORTE-01-0145-FEDER-000029) co-funded through the NORTE-45-2015-02 program.
                Funded by: This work was supported by the InveNNta Project (Innovation in Nanomedicine), co-financed by the European Union through the Operational Programme for Cross-border Cooperation Spain-Portugal European Regional Development Fund (ERDF) (POCTEP 2007-2013), by the InveNNta2 project funded through the Nanocontest (Galician Agency of Innovation), and by Roche-Chus Joint Unit (financed by Galician Agency of Innovation and Ministry of Economy and Competitiveness (IN853A2015/10)).
                Funded by: This work was supported by the CANCER project (NORTE-01-0145-FEDER-000029) co-funded through the NORTE-45-2015-02 program.
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                © The Author(s) 2019

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                cancer,biomedical engineering
                Uncategorized
                cancer, biomedical engineering

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