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Sensitive and easy screening for circulating tumor cells by flow cytometry
Alexia Lopresti, Fabrice Malergue, François Bertucci, Maria Lucia Liberatoscioli, Severine Garnier, Quentin DaCosta, Pascal Finetti, Marine Gilabert, Jean Luc Raoul, Daniel Birnbaum, Claire Acquaviva, Emilie Mamessier
Alexia Lopresti, Fabrice Malergue, François Bertucci, Maria Lucia Liberatoscioli, Severine Garnier, Quentin DaCosta, Pascal Finetti, Marine Gilabert, Jean Luc Raoul, Daniel Birnbaum, Claire Acquaviva, Emilie Mamessier
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Resource and Technical Advance Oncology

Sensitive and easy screening for circulating tumor cells by flow cytometry

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Abstract

Circulating tumor cells (CTCs) provide easy, repeatable, and representative access to information regarding solid tumors. However, their detection remains difficult because of their paucity, their short half-life, and the lack of reliable surface biomarkers. Flow cytometry (FC) is a fast, sensitive, and affordable technique, ideal for rare-cell detection. Adapted to CTC detection (i.e., extremely rare cells), most FC-based techniques require a time-consuming pre-enrichment step, followed by a 2-hour staining procedure, impeding the efficiency of CTC detection. We overcame these caveats and reduced the procedure to less than 1 hour, with minimal manipulation. First, cells were simultaneously fixed, permeabilized, and then stained. Second, using low-speed FC acquisition conditions and 2 discriminators (cell size and pan-cytokeratin expression), we suppressed the pre-enrichment step. Applied to blood from donors with or without known malignant diseases, this protocol ensures a high recovery of the cells of interest independently of their epithelial-mesenchymal plasticity and can predict which samples are derived from cancer donors. This proof-of-concept study lays the bases of a sensitive tool to detect CTCs from a small amount of blood upstream of in-depth analyses.

Authors

Alexia Lopresti, Fabrice Malergue, François Bertucci, Maria Lucia Liberatoscioli, Severine Garnier, Quentin DaCosta, Pascal Finetti, Marine Gilabert, Jean Luc Raoul, Daniel Birnbaum, Claire Acquaviva, Emilie Mamessier

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Figure 6

CTC detection in regard to clinical evolution of the malignant disease.

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CTC detection in regard to clinical evolution of the malignant disease.
...
(A) Impact of treatment on the amount of CTCs detected. Detection of CTCs in 7 donors with malignant disease (metastatic colon cancer, mColon) responding to treatment, before and after chemotherapy. The number of CTCs, on the y axis, is per milliliter of blood; it decreases when subjects are responding to treatment, from 14.4 to 3.2 CTCs/mL. Comparison of the numbers of CTCs before and after treatment was done using the nonparametric Wilcoxon’s matched-pairs signed-rank test (2-tailed, confidence interval of 95%). (B) Survival curve based on CTC counts of advanced metastatic breast cancer (mBC) patients (patients included in the study less than 4 years after the initial diagnosis of metastases). A threshold of 10 CTCs/mL was set (median value of CTC counts in the mBC cohort). The survival curves from the entire cohort (blue line, n = 28), from patients with >10 CTCs/mL (purple line, n = 11) or from patients with less than 10 CTCs/mL (gray line, n = 17) were calculated using the Kaplan-Meier method and were compared using the log-rank test. (C) Survival curve based on CTC’s epithelial or mesenchymal status of advanced mBC patients (patients included in the study less than 4 years after the initial diagnosis of metastases). The epithelial or mesenchymal status of CTCs was determined based on the expression of EPCAM+VIMlo/dim (epithelial CTCs, green line, n = 10) or mesenchymal EPCAM–VIM+ (mesenchymal CTCs, magenta line, n = 18). Based on this grouping, survivals were calculated using the Kaplan-Meier method and were compared using the log-rank test. For all analyses, only P values < 0.05 were considered statistically significant.

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