Abstract
BackgroundMalignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies. Hence, the aim of the study was to investigate the features of 2D and 3D MSE culture systems as well as their feasibilities for in vitro drug screening.MethodsPleural and peritoneal effusions from 8 patients were collected and processed for 2D monolayer and 3D hanging drop cell culture into GravityPLUS™ plates. Representative markers for cell components, proliferation rate and tumour classification were investigated by immunohistochemistry, followed by absolute quantification using a digitalised image analysis approach. Further, we implemented another 3D cell culture model based on a low attachment method for in vitro drug sensitivity testing of carboplatin, pemetrexed and pembrolizumab for 5 patients.ResultsMonolayer cell culture was favourable for the growth of mesothelial cells, while hanging drop culture in GravityPLUS™ plates showed better ability for preserving cancer cells, inducing positive diagnostic markers expression and restraining the growth of mesothelial cells. For in vitro drug testing, MSE from five patients presented various drug sensitivities, and one case showed strong response to PD-1 checkpoint inhibition (pembrolizumab). For some patients, the application of combinatorial drugs had better therapeutic responses compared to monotherapy.ConclusionsDigitalised quantification of data offers a better understanding of different MSE culture models. More importantly, the proposed platforms are practical and amenable for performing in vitro chemo-/immunotherapeutic drug testing by using routine cytologic MSE in a personalised manner. Next to cell blocks, our work demonstrates the prognostic and predictive value of cytologic effusion samples.
Highlights
Malignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies
The conventional smear (CS) and cell block (CB) methods are commonly used for cytologic diagnosis of exudative serous effusions [2], and
We have previously shown that patients bearing malignant pleural effusions were characterised by heterogeneous expression of immune cells and immunomodulators in their effusion liquids, which resulted in different prognosis [9]
Summary
Malignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies. The conventional smear (CS) and cell block (CB) methods are commonly used for cytologic diagnosis of exudative serous effusions [2], and. Thanks to the abundant access to ligands and growth factors, malignant cells in MSE can spread and metastasise to adjacent sites [7]. These cells are usually creating a pro-inflammatory environment enriched in cytokines and growth factors promoting a permissive local microenvironment for metastatic processes. We have previously shown that patients bearing malignant pleural effusions were characterised by heterogeneous expression of immune cells and immunomodulators in their effusion liquids, which resulted in different prognosis [9]
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