Name: capture and release of viable circulating tumor cells from blood
Uploaded: 2016-10-28T14:00:00
Description: Watch this Scientific Journal Video about Capture and Release of Viable Circulating Tumor Cells from Blood at JoVE.com

We thank all the patients who have donated blood samples to support this work. We thank Drs. Guiseppe Giaconne, Ritesh Parajuli, and Marc E. Lippman for their assistance in clinical sample acquirement, and Drs. Carmen Gomez, Ralf Landgraf, Stephan Z&#252;chner, Toumy Guettouche, Diana Lopez for their insightful discussions. Zheng Ao thanks partial support and assistance from the Sheila and David Fuente Graduate Program in Cancer Biology, Sylvester Comprehensive Cancer Center.

Ethics Statement: To protect the rights of human subjects, blood samples were obtained following an informed consent under protocols approved by the University of Miami institutional review boards under IRB 20150020. 
NOTE: Blood to be filtered for CTC capture should be collected in an EDTA tube to prevent coagulation.
1. Coating the Microfilter with Poly (N-iso-propylacrylamide) (PIPAAm)
<ol>
	<li>Weigh out PIPAAm to prepare a 10% w/v solution in butanol. Mix using a vortex until the solution is clear.</li...

<ol>
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The process of capturing viable CTC from whole blood and releasing them from the microfilter is relatively straightforward; however a few critical points are worth mentioning. It is imperative, as with all cell culture that a sterile condition is maintained through the whole process. The initial step of coating the filter with PIPAAm is critical, as the basis for the technique of releasing the cells from the filter is based on exploiting PIPAAm&#39;s temperature responsive interfacial properties. To ensure the filter has...

Metastatic disease is responsible for most cancer deaths. Developing prognostic and companion diagnostic biomarker for metastasis is crucial in cancer management and treatment. Circulating tumor cells (CTC) play a central role in tumor dissemination and metastasis. Furthermore, being easily accessible as a &#39;liquid biopsy&#39; biomarker, CTC in cancer patients&#39; peripheral blood has been rising as a &#39;hotbed&#39; for cancer biomarker research. CTC have been well validated as a prognostic biomarker in various cancer settings, including breast, prostate and colorectal cancer1-3. However, recent advances in CTC field has indicated that the mere enumeration of these rare cells has limited clinical utility, as shown in interventional clinical trials4. Thus, there is an emerging need for technologies that allow for molecular and functional characterization of CTC. Currently, only few technologies exist that allow for non-antigen biased, viable capture and release of CTC, enabling robust downstream molecular and functional analysis5,6. Majority of these microfabricated devices are coupled to microfluidic platforms and thus have a limiting factor in the amount of blood that that can be processed, which ranges from 2-4 ml7-10 . CTC are rare events in a single tube of blood draw (7.5 ml), therefore further reducing the amount of blood that can be processed, greatly hinders the chances of capturing and isolating these cells of interest.
We have developed two types of Parylene C membrane microfilter devices for the capture of CTC which exploit the size differences between larger tumor cells and the smaller normal blood cells11,12. We have previously reported on the round pore enumeration filter and compared it with a FDA-approved platform, where the microfilter was shown to be superior in CTC capture efficiency for cancer patient blood samples13,14. However, a limitation of the round filter is the necessity to use a formaldehyde-based fixative prior to filtration. This process preserves the cells morphology while allowing them to withstand the shear stress and pressure during the filtration process. While enumeration and molecular studies can be performed on-chip13, the fixative impairs the ability to perform functional characterization. To address this limitation, we developed a slot pore filter that negates the necessity to fix cells prior to filtration (Figure 1). The slot pore geometry (6 &#181;m width x 40 &#181;m length slot pores) allows the tumor cells to be captured while only partially occluding a pore and thus still permitting free passage for other blood cells and alleviating the rise in pressure that would lead to cell damage and eventual bursting15,16 The slot pore cartridge is composed of 2 acrylic pieces which sandwich the slot pore filter between the top and bottom piece with Polydimethylsiloxane (PDMS) acting as a gasket to provide a leak proof seal14,15 (Figure 1).
While the capture efficiency of the slot pore filter is high, (Table 1), the captured CTC are bound to the Parylene C membrane by strong non-specific electrostatic interactions instead of extracellular matrix (ECM) mediated adhesion15. Methods such as reverse flow or the use of cell scrapers fail to effectively release the cells from the filter, or result in cell damage and cell death. We explored an unconventional use of PIPAAm to formulate a release strategy15. PIPAAm is a polymer that undergoes a reversible lower critical solution temperature (LCST) phase transition at a solution temperature of 32 &#176;C17. Traditionally, this property of PIPAAm has been widely explored for tissue engineering applications. Typically, cells are cultured on PIPAAm coated surfaces at 37 &#176;C when PIPAAm is hydrophobic. The cells can then be detached as a sheet when the culture temperature is shifted to below 32 &#176;C, where the PIPAAm coated surface becomes hydrated17,18. We exploited this thermal property by performing the filtration process at room temperature (below 32 &#176;C) and then enabling cell release by placing the filter in culture media maintained at 37 &#176;C. At this temperature, the PIPAAm polymer layer becomes hydrophobic, thereby releasing the electrostatically bound cells15 (Figure 1).
Although the temperature responsive method as well as other methods have been successfully implemented to achieve viable CTC capture and release19-21, one key potential drawback shared by these technologies reported is that they all employ an antigen-dependent principle for CTC capture. Antigen based CTC capture, as shown previously, may lead to biased CTC analysis11,14. For example, many affinity-based technologies employ antibody that binds EpCAM for CTC capture. However, CTC has been shown to express various levels of EpCAM, leading to omission of EpCAM low and EpCAM negative CTC by these technologies. Also, limitations may occur when CTC from non-epithelial origin is of interest, such as CTC in melanoma and sarcoma settings. Thus, a technology that allows for viable CTC capture and release without potential bias introduced by antigen based capture is highly desirable.
Importantly, the microfilter capture device is purely sized based and the release strategy is agnostic to the presence of certain surface markers. We believe that the employment of the PIPAAm coated microfilter will help to expand our understanding of the metastatic process, through providing the ability to effectively and efficiently capture and release CTC for downstream analyses. This may potentially expose new molecules for which novel targeted systemic therapies might be directed as well as provide a biomarker that can be monitored easily and aid in cancer patient management.

<table border="0" cellpadding="0" cellspacing="0" width="603">
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	<tbody>
		<tr height="106">
			<td height="106" style="height:107px;width:216px;">Slot Filter</td>
			<td style="width:101px;">Circulogix Inc.</td>
			<td style="width:119px;">MSF-01</td>
			<td style="width:167px;">Different size filters available based for filtration for CTC from blood or urine (www.circulogixinc.com)</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">poly(N-iso-propylacrylamide) (PIPAAm)&#160;</td>
			<td style="width:101px;">Ploysciences Inc.</td>
			<td style="width:119px;">21458</td>
			<td style="width:167px;">Non-Hazardous. Store at room temp.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">1-Butanol</td>
			<td style="width:101px;">Sigma Aldrich</td>
			<td style="width:119px;">B7906</td>
			<td style="width:167px;">Use in well ventilated area</td>
		</tr>
		<tr height="118">
			<td height="118" style="height:119px;width:216px;">Plastic Microscope Slides</td>
			<td style="width:101px;">Cole-Parmer</td>
			<td style="width:119px;">48510-30</td>
			<td style="width:167px;">Any plastic slides or alternatively any sort of square (Metal, Acrylic etc.) can be used if it will be bale to hold the 8mmx8mm filter square</td>
		</tr>
		<tr height="59">
			<td height="59" style="height:59px;width:216px;">Spin Coater</td>
			<td style="width:101px;">Specialty Coating Systems</td>
			<td style="width:119px;">SCS G3 Spin Coater</td>
			<td>Instrument</td>
		</tr>
		<tr height="62">
			<td height="62" style="height:63px;width:216px;">Polyimide Tape</td>
			<td style="width:101px;">Uline</td>
			<td style="width:119px;">S-7595</td>
			<td style="width:167px;">Polyimide is the generic name for Kapton Tape which can be purchased form multiple vendors (Amazon, Kaptontape.com)</td>
		</tr>
		<tr height="47">
			<td height="47" style="height:47px;width:216px;">HBSS- Hank&#39;s Balanced Salt Solution</td>
			<td style="width:101px;">Gibco</td>
			<td style="width:119px;">14025-092</td>
			<td></td>
		</tr>
		<tr height="50">
			<td height="50" style="height:50px;width:216px;">1XPBS</td>
			<td style="width:101px;">Gibco</td>
			<td style="width:119px;">10010-023</td>
			<td></td>
		</tr>
		<tr height="189">
			<td height="189" style="height:189px;width:216px;">McCoy&#39;s</td>
			<td style="width:101px;">Gibco</td>
			<td style="width:119px;">16600-082</td>
			<td style="width:167px;">Warm in 37 &#8304;C water bath before use. McCoys was used for SKBr3 cells, if you use different cell lines or patient blood, please use media that would be optimal for that particular case</td>
		</tr>
		<tr height="74">
			<td height="74" style="height:74px;width:216px;">Falcon Petri dishes 35x10 mm</td>
			<td style="width:101px;">VWR</td>
			<td style="width:119px;">25373-041</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="87">
			<td height="87" style="height:87px;width:216px;">Microfilter Cassette</td>
			<td style="width:101px;">Circulogix Inc.</td>
			<td style="width:119px;">FC-01</td>
			<td style="width:167px;">Custom catridges are avilable based on filtration for CTC from blood or urine&#160;</td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Syringe 20mL</td>
			<td style="width:101px;">BD Scientific</td>
			<td style="width:119px;">302830</td>
			<td></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:216px;">Syringe Pump</td>
			<td style="width:101px;">KD scientific&#160;</td>
			<td style="width:119px;">78-0100V</td>
			<td style="width:167px;">Any syringe pump capable of holding a 25mL syringe may be used</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cellstar 50mL Centrifuge tube</td>
			<td style="width:101px;">VWR</td>
			<td style="width:119px;">82050-322</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">Greiner Bio One 6 well plate</td>
			<td style="width:101px;">VWR</td>
			<td style="width:119px;">89131-688</td>
			<td style="width:167px;">Any brand can be used, as long as the surface is compatiable for cell adesion and not repellant</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">SKBR3 Cells</td>
			<td style="width:101px;">ATCC</td>
			<td style="width:119px;">HTB-30</td>
			<td></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:216px;">Live Dead Assay</td>
			<td style="width:101px;">Life Technologies</td>
			<td style="width:119px;">L3224</td>
			<td style="width:167px;">Any assay that can provide a reasonable analysis to evaluate live cells will work</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:216px;">Cell Culture Incubator</td>
			<td style="width:101px;">VWR</td>
			<td style="width:119px;">98000-368</td>
			<td style="width:167px;">Any incubator that can be used for cell culture will suffice</td>
		</tr>
	</tbody>
</table>

capture and release of viable circulating tumor cells from blood

We demonstrate a method for size based capture of viable circulating tumor cell (CTC) from whole blood, along with the release of these cells from chip for downstream analysis and/or culture. The strategy employs the use of a novel Parylene C membrane slot pore microfilter to capture CTC and a coating of poly (N-iso-propylacrylamide) (PIPAAm) for thermoresponsive viable release of the captured CTC. The capture of live cells is enabled by leveraging the design of a slot pore geometry with specific dimensions to reduce the shear stress typically associated with the filtration process. While the microfilter exhibits a high capture efficiency, the release of these cells is non-trivial. Typically, only a small percentage of cells are released when techniques such as reverse flow or cell scraping are used. The strong adhesion of these epithelial cancer cells to the Parylene C membrane is attributable to non-specific electrostatic interaction. To counteract this effect, we employed the use of PIPAAm coating and exploited its thermal responsive interfacial properties to release the cells from the filter. Blood is first filtered at room temperature. Below 32 &#176;C, PIPAAm is hydrophilic. Thereafter, the filter is placed in either culture media or a buffer maintained at 37 &#176;C, which results in the PIPAAm turning hydrophobic, and subsequently releasing the electrostatically bound cells.

Using healthy donors&#39; blood (obtained under a protocol approved by the University of Miami IRB 20150020 following an informed consent) spiked with cultured cancer cells, the thermoresponsive technique for release of viable circulating tumor cells (CTC),achieved capture, release and retrieval efficiency of 94% &#177; 9%, 82% &#177; 5% and 77% &#177; 5% respectively (Table 1)15. By comparison, the release and retrieval efficiency of uncoated filters were sign...

Watch this Scientific Journal Video about Capture and Release of Viable Circulating Tumor Cells from Blood at JoVE.com

Capture and Release of Viable Circulating Tumor Cells from Blood

A protocol to utilize a poly(N-iso-propylacrylamide) (PIPAAm) coated microfilter for effective capture and thermoresponsive release of viable circulating tumor cells (CTC) is presented. This method allows capture of CTC from patients&#39; blood and subsequent release of viable CTC for downstream off-chip culture, analyses and characterization.

We demonstrate a method for size based capture of viable circulating tumor cell (CTC) from whole blood, along with the release of these cells from chip ...

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