Abstract
(1) Background: Circulating tumor cell (CTC) clusters are emerging as clinically significant harbingers of metastases in solid organ cancers. Prior to engaging these CTC clusters in animal models of metastases, it is imperative for technology to identify them with high sensitivity. These clusters often present heterogeneous surface markers and current methods for isolation of clusters may fall short. (2) Methods: We applied an inertial microfluidic Labyrinth device for high-throughput, biomarker-independent, size-based isolation of CTCs/CTC clusters from patients with metastatic non-small-cell lung cancer (NSCLC). (3) Results: Using Labyrinth, CTCs (PanCK+/DAPI+/CD45−) were isolated from patients (n = 25). Heterogeneous CTC populations, including CTCs expressing epithelial (EpCAM), mesenchymal (Vimentin) or both markers were detected. CTCs were isolated from 100% of patients (417 ± 1023 CTCs/mL). EpCAM− CTCs were significantly greater than EpCAM+ CTCs. Cell clusters of ≥2 CTCs were observed in 96% of patients—of which, 75% were EpCAM−. CTCs revealed identical genetic aberrations as the primary tumor for RET, ROS1 , and ALK genes using fluorescence in situ hybridization (FISH) analysis. (4) Conclusions: The Labyrinth device recovered heterogeneous CTCs in 100% and CTC clusters in 96% of patients with metastatic NSCLC. The majority of recovered CTCs/clusters were EpCAM−, suggesting that these would have been missed using traditional antibody-based capture methods.
Highlights
Cancer metastasis is the cause of cancer death in the vast majority of patients with solid organ cancers, including lung cancer [1]
We have previously demonstrated the presence of Circulating tumor cell (CTC) clusters in patients with early-stage lung cancer [4]
Products were collected after flow stabilization (1.5 min) and the percentage of CTC recovery and white blood cells (WBCs) depletion were determined by cell counting
Summary
Cancer metastasis is the cause of cancer death in the vast majority of patients with solid organ cancers, including lung cancer [1]. Therapies to reduce and prevent metastases have mostly been elusive. CTC clusters are defined as groups of two or more aggregated CTCs, often consists of other non-tumor cells including endothelial cells, erythrocytes, stromal cells, leukocytes, platelets, and cancer associated fibroblasts found in the blood of patients with solid tumors [6]. This cocktail of cells provides a local microenvironment for protection from death in the circulation by minimizing shear stress, immune system attack and through facilitating colonization [7]. More recently technological advances have allowed researchers to capture
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