Showing posts with label deformability. Show all posts
Showing posts with label deformability. Show all posts

Thursday, May 2, 2013

PLOS publication comparing the performance of various types of filters for CTC recovery


Filter Characteristics Influencing Circulating Tumor Cell Enrichment from Whole Blood


This is great! I have been wanting to do this myself for quite sometime. There are tons of CTC technologies based on using a filter of one type of another to recover CTCs. In fact this probably is the most crowded sub-segment of commercial CTC platforms. This is mainly due to low technical threshold needed to get to market. Thus attracting lots of market entrants.

However, not many have attempted a broader study of exactly what the correlation is between the porosity, shape and size of pores to the precisely measured cellular dimensions from cell lines as well as patient samples. This study has attempted to do it. Thanks to the authors.

Key findings:

Cell Enumeration is Easiest on a Stiff Filter with Low Porosity

>> The authors point out that there is difficulty in imaging a flexible substrate, which is intuitive, hence rigid substrates are preferred.

>> "The high porosity and low number of pores of the microsieves and the TEM grids resulted in a cell density too high to reliably distinguish adjacent cells when imaged with a 4x/NA0.13 objective" ==> this is a bit confusing. my understanding is that high porosity = high number of pores per cm2. the paper seems to suggest otherwise. Share your thoughts

>> "he ideal filter should maintain its planar form during filtration, it should not react with the sample and pores should be sufficiently separated to facilitate discrimination of cells"

Increasing Pore Size Leads to Lower Recovery and Higher Sample Purity
>> This is also intuitive as larger pores deplete WBCs better than smaller pores but also lose more CTCs

>> recoveries vary for different cell lines at different pore sizes, indicating that the filter method is not one size fits all, which also intuitive, given the vast heterogeneity among tumor cells

>> "As long as there are sufficient pores to pass the sample, recovery seems to be insensitive to the number of pores. There is almost no difference between the microsieves with 115,000 pores and the one with 26,000 pores in terms of spiked cell recovery or pressure across the filter, but the number of leukocytes retained is 3.1 fold higher on the filter with 4.4 fold more pores"

Recovery is Constant Until Approximately 2% of Pores are Occupied

The Volume that can be Filtered is Limited by the Contaminant Concentration
>> that is smaller volumes lead to better recovery rates than larger volumes of sample

Monocytes are Retained More than Other Leukocytes

EpCAM+CK+CD45− CTC (from patient samples) are Smaller than Typical Cells Derived from Tumor Cell Lines

Cell Lines with Size of CTC Typically have Low Recovery

Summary:
This paper is a highly recommended read as it clarifies several aspects of membrane-based CTC filtration devices. The key points are, a) one size does not fit all, b) there is always a recovery purity trade-off in this method, and c) CTC recovery using this method is subject to a number of factors such as geometry, number of pores, rigidity, flow rate, sample volume etc.

The authors summarize it in the manuscript "In summary, the ideal filter for CTC enrichment from 10 ml of whole blood has a pore size of about 5 µm, thickness of at least 10 µm, at least 100,000 regularly spaced pores, a porosity of 10% or less and is constructed of a stiff, flat material, which does not interact with blood cells. While cell size is an important factor in determining recovery, other factors must be involved in determining whether a cell can pass as well. To evaluate a filtration procedure, cell lines with a median size of 11–13 µm should be used to challenge the system, such as Colo-320, SW-480 and not cell lines significantly larger than CTC."


Limitations:
though the authors used a polycarbonate track etched membrane, they did not use a patterned parylene membrane or other deformable membrane, so arrive at the conclusion that a hard surface is necessary may require additional experimentaiton  comparing the track etched polycarbonate versus parylene or other patterned substrate (this study may already exist, I will have to look it up)

the spiked cells used in the experiments were pre-stained. this is not the case for patient samples. typically, if staining were to be done on filter post recovery, a certain amount of cell loss can be expected due to this process

I wrote another post some time ago
The Problem with using size and deformability as the criteria to isolate Circulating tumor cells (CTC)

I found another good reference below
Pore design and engineering for filters and membranes

Saturday, December 29, 2012

Microfluidics separation reveals the stem-cell–like deformability of tumor-initiating cells

Microfluidics separation reveals the stem-cell–like deformability of tumor-initiating cells

Key findings:
Here we report a microfluidics method to enrich physically deformable cells by mechanical manipulation through artificial microbarriers. Driven by hydrodynamic forces, flexible cells or cells with high metastatic propensity change shape to pass through the microbarriers and exit the separation device, whereas stiff cells remain trapped. We demonstrate the separation of (i) a mixture of two breast cancer cell types (MDA-MB-436 and MCF-7) with distinct deformabilities and metastatic potentials, and (ii) a heterogeneous breast cancer cell line (SUM149), into enriched flexible and stiff subpopulations. We show that the flexible phenotype is associated with overexpression of multiple genes involved in cancer cell motility and metastasis, and greater mammosphere formation efficiency. Our observations support the relationship between tumor-initiating capacity and cell deformability, and demonstrate that tumor-initiating cells are less differentiated in terms of cell biomechanics.

Significance: This is a key finding, which raises the following question; are technologies that use size and deformability as a criteria to enrich Circulating Tumor Cells (CTCs) are inherently biased towards missing cells with high metastatic propensity?


Thursday, December 13, 2012

The Grand Challenge in Circulating Tumor Cell Isolation: The need for a Gold Standard Platform


The urgent need for a Standardized Technology for Tumor Cell Isolation
In recent years, a number of technologies have claimed the ability to isolate tumor cells for clinical cancer management. These technologies can be broadly classified as falling into the following categories with regards to their value proposition,
a)      Using specific antibodies (either single-EpCAM or combination) in a conventional magnetic isolation assay or a microfluidics assay (Eg., Veridex, Biocept, OnQity, Biofluidica, Adnagen)
b)      Using size and biomechanical properties as a differentiator between tumor cells and normal blood cells (Eg., Clearbridge, CellSeivo, Rare cells, Screen Cell, Creative Microtech, Filtini, Parsortix)
c)       Technologies whose value proposition is in automated enumeration and identification such as automated microscopy  (Eg., Bioview, Ikonisys, eDAR, Epic Sciences)
d)      Technologies that use electrical properties (Silicon biosystems, Apocell)
The advantages and disadvantages of various techniques are tabulated extensively in various reviews [1 -8]. It’s also widely noted that most of these technologies remain to be independently validated and not considered optimal for tumor cell isolation [9-15]. Some criterion were recently (2012) suggested by a group of KOLs, titled “Considerations in the development of circulating tumor cell technology for clinical use” [16]. A list of technological requirements of an ideal CTC platform were previously suggested in a Lab on a chip paper in 2011 titled “Circulating Tumor Cells: The Grand Challenge” [17].
The pain due to lack of robust and standardized tumor cell isolation technology:
So far CTCs have only been FDA approved for cancer prognosis, which is of limited clinical utility. The real clinical impact of CTCs will be realized when their relevance is shown for personalized therapy & monitoring and early diagnosis. The clinical community is now investigating this relevance. However, the present technology platforms are inherently biased and may lead to poor clinical interest. For example, “A recent study revealed that “normal-like” breast cancer cells, which usually display an aggressive phenotype, express low expression of EpCAM and are not detected by the CellSearch® test [65]. Moreover, a retrospective study that involved 292 patients with metastatic breast cancer has shown that 36% of them showed an undetectable CTC status, which could be due, at least in part, to an underestimation of CTCs by the Cell-Search® test due to CTC undergoing epithelial-mesenchymal transition (EMT) ” [1]
Another paper noted that, “ The challenge of CTC detection is related to the requirement of both high sensitivity and specificity. A wrong labeling of ‘‘non-tumor cells’’ (epithelial non tumor cells or normal hepatocytes, for instance) as ‘‘tumor cells’ could generate poor clinical interest” [8]
This problem is well summarized by the following passage in recent literature “The true potential of CTCs has yet to be realized because of limits in technology used to capture these cells and our lack of a complete understanding of metastasis. This is complicated by the fact that our understanding of CTCs is subject to the techniques available to identify and isolate CTCs, and the biases inherent to them.” [6]
From the above passage it is very clear that what is urgently needed now in CTC field is not “cheap” or “fast” technology but the “most reliable” platform to accurately reflect the patient physiology. 
The problem with existing technologies:
“Despite the recent technological advances, the development of a single device capable of simultaneously achieving high throughput, high target cancer cell recovery, high purity, and high cell viability remains challenging.” [5]
As pointed out by the numerous review papers, all technology platforms existing today suffer from one trade-off or another. For example, antibody-based technologies are limited by the expression of specific antibodies. A universal CTC marker is yet unknown and given the heterogeneity of cancer [18], it is doubtful that a single universal cancer marker will be found.
The problem with Size and biomechanical properties based isolation  “The size range of different tumor cells is highly variable and does overlap with that of normal blood cells” [19]. Also, “CTC may not be always .8 mm making the sensitivity of these assays questionable.” [20]. Moreover, “ these methods suffer from low cell viability resulting from potential damage incurred as the cells pass through narrow filter pores, which renders the use of microfilters less compatible for live cell interrogations (e.g., cell suspensions were partially fixed before being passed through a membrane micro-filter)” [4]
The assessment of technologies based on size is well summed up in this review “Unfortunately, large leukocytes can be trapped by the filter as well, therefore contaminating the CTC fraction or small CTC can pass through the pores therefore depleting the CTC population. This is why this technique is generally considered not highly sensitive and poorly specific” [8]
There are several companies based on the principle of size and biomechanical properties and this is the most crowded sub-space within CTC. A reason for this is because of low technological barrier to entry and wide availability of hole making technology in various materials such as polycarbonate, silicon nitride and other polymers. As it can be readily inferred by-passability is easy and patentability is low for technologies operating on this principle. 
The Solution:
The clinical need and technology requirements are well documented [16, 17]. Briefly, the assay must be highly sensitive, well characterized with analytical and clinical samples, standardized for cross reference studies at various clinical sites, should be free of operator bias, should use standard blood collection and processing techniques and should be time stable over a period to allow for stable sample transportability. Above all, the assay should isolate viable, pure tumor cells with high efficiency in a simple and cost effective manner. 
Neegative depletion approach has been recommended over the positive selection method [2, 21]. In negative depletion approach, all normal cells are eliminated, leaving behind “abnormal cells”. These cells are then identified by immunohistochemical staining or molecular methods.
Conclusion: Despite the presence of several technologies, the need for a gold standard tumor cell isolation platform remains unmet. 

References:
1.       Am. J Cancer Res 2011;1(6):740-751
2.       Nature reviews, clinical oncology, December, 2010
3.       Clinical Chemistry 58:5 (2012)
4.       Lab Chip, 2012, 12, 1753–1767
5.       Review article, Frontiers in oncology, vol 2, article 69, july 2012
6.       J Cancer Res Clin Oncol DOI 10.1007/s00432-011-0988-y
7.       International Journal of Hepatology, Volume 2012 (2012),
8.       Methods 50 (2010) 289–297
9.       Circulating tumor cells: approaches to isolation, and characterization, JCB review, 2011
10.   New technologies for the detection of circulating tumour cells, British Medical Bulletin 2010; 1–16
11.   Let Me Do More Than Count the Ways: What Circulating Tumor Cells Can Tell Us about the Biology of Cancer  VOL. 6, NO. 5, 1307–1310 MOLECULAR PHARMACEUTICS, 2009
12.   Disseminated Tumor Cells in Bone Marrow and Circulating Tumor Cells in Blood of Breast Cancer Patients: Current State of Detection and Characterization
 Pathobiology 2008;75:140–148
13.   Circulating tumor cells (CTC) detection: Clinical impact and future directions Patrizia Paterlini-Brechot *, Naoual Linda Benali  Cancer Letters 253 (2007) 180–204
14.   Clin Cancer Res; 16(20) October 15, 2010
15.   Cancer Letters 253 (2007) 180–204
16.   Journal of Translational Medicine 2012, 10:138 
17.   Lab Chip, 2011,11, 375-377
18.   PLoS ONE 7(5): e33788
19.   Current Opinion in Genetics & Development 2010, 20:96–99
20.   British Medical Bulletin 2010; 1–16
21.   Cancer Res; 71(18), 2011

Paper Commentary: SSA-MOA: a novel CTC isolation platform using selective size amplification (SSA) and a multi-obstacle architecture (MOA) filter - Lab on a Chip (RSC Publishing)

SSA-MOA: a novel CTC isolation platform using selective size amplification (SSA) and a multi-obstacle architecture (MOA) filter - Lab on a Chip (RSC Publishing)

============================================================
Update (10 Feb, 2013): A follow up improvement of this technology has been published here
performance: 95% isolation efficiency, 59% purity from 3 ml of blood (total isolation time ~ 30 mins)
no results from clinical samples were reported.

another recent publication from Samsung in Biomicrofluidics 
an older publication from Samsung advanced Institute of Technology can be found here
=============================================================
Summary:
This paper presents a novel method of enriching CTCs by combining EpCAM based bead tagging followed by size filtration. The basic premise of this paper is that purely size-based techniques suffer from size overlap between CTCs and WBCs. To overcome this, CTCs are selectively tagged with 3 micron polymer beads to enhance their size, followed by filtration through a lateral filter surface. recoveries of upto 99.1% are reported in spiked cells.

Advantages:
  • Results show that the size enhancement seems to work in appropriately discriminating between WBCs and MCF-7 cells
Limitations:
  • Fundamentally, this is an antigen dependent technology, hence belongs to positive enrichment family of techniques. Its inherently limited by antigen expression and its variability as well as the efficiency of binding interaction.
  • There are other known cancer cell lines which are smaller than the MCF-7 cells, how does this technique work with smaller cancer cells? smaller cells will require larger beads for effective differentiation, however, steric hindrance will become a factor between adjoining binding sites
  • silicon manufacturing technology is expensive as it is. it is unclear how expensive is the silicon on glass technology
  • throughput is 20ul/min, which is considerably lower than size filtration systems, which have reported as fast as 2 mls in 5 minutes. the overall assay time is also increased due to the need to pre-conjugate beads to cells
  • the effect of occupancy of antigen binding sites by microbeads on downstream molecular characterization of tumor cells
  • lack of clinical data
  • lateral flow filtration is inherently limited by the requirement of scaling for higher throughput versus large area staining and imaging requirement

other considerations:
  1. http://www.clearbridgebiomedics.com/ --> has a platform for size and deformability based CTC isolation
  2. cell size enhancement product is available here  http://pluriselect.com/home.html
  3. how is the performance of this paper in comparison to item 2 above, which should be relatively inexpensive and has a higher thorughput

The Problem with using size and deformability as the criteria to isolate Circulating tumor cells (CTC)



  • “The size range of different tumor cells is highly variable and does overlap with that of normal blood cells” [1]
  • However, CTC may not be always .8 mm making the sensitivity of this assay questionable. [2]
  • However, these methods suffer from low cell viability resulting from potential damage incurred as the cells pass through narrow filter pores, which renders the use of microfilters less compatible for live cell interrogations (e.g., cell suspensions were partially fixed before being passed through a membrane micro-filter72) [3]
  • Due to the force (centrifugation or pumping) many of the cells are destroyed (viability decreased upto 70% of CTCs). Many CTCs will pass through the narrow passage due to EMT as they become more flexible and bendable. Many blood cells still remain that produce contamination and noiseHence it is not considered to be the best method[4]
  • isolation of circulating tumor cells (CTCs) by size exclusion can yield poor purity and low recovery rates, due to large variations in size of CTCs, which may overlap with leukocytes and render size-based filtration methods unreliable [5].
  • Physical size separations could potentially undercount a small portion of CTCs  [6]
  • Our observations support the relationship between tumor-initiating capacity and cell deformability, and demonstrate that tumor-initiating cells are less differentiated in terms of cell biomechanics (from normal cells). Thus deformability-based techniques may miss tumor initiating cells. [7]
  • Metastatic cells are more deformable and pass through capillaries faster than non metastatic cells [8]



[1] Current Opinion in Genetics & Development 2010, 20:96–99
[2] British Medical Bulletin 2010; 1–16
[3] Lab Chip, 2012, 12, 1753
[5] Anal Chem. 2012 Sep 4;84(17):7400-7
[6] Lab Chip, 2012,12, 4388-4396
[7] PNAS November 13, 2012 vol. 109no. 46 18707-18712
[8] http://www.pnas.org/content/early/2013/04/19/1218806110