We acknowledge the technical assistance of the Translational Research Institute Histology core and Biological Resource Facility. This research was supported by funding from a Princess Alexandra Research Foundation award (I.V., E.D.W.), and the Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program (Centre for Personalised Analysis of Cancers (CPAC; E.D.W., I.V.). The Translational Research Institute receives support from the Australian Government.

Patients have consented to this study following their admission under the Urology team at the Princess Alexandra Hospital, Brisbane, Australia. This study was performed in accordance with the principles of the Declaration of Helsinki and within ethical and institutional guidelines (ethics number HREC/05/QPAH/95, QUT 1000001165).
NOTE: As eligibility criteria, patients were aged &#8805; 18 with cancer, and able to understand and provide consent. Those who were not able to give informed consent were excluded. Those having a primary language other than English were excluded as the provision of interpreters was not possible due to logistical and budgetary considerations. Also excluded were patients whose tumors were not accessible to biopsy or unlikely to be available in adequate amount after routine pathology.
1. Organoid Medium Preparation
NOTE: Human bladder cancer organoid medium requires growth factors that aid in the survival, growth, and continuous expansion of organoids derived from dissociated clinical material (Table 1). For complete details of each supplement used in this procedure, please refer to the Table of Materials.
<ol>
	<li>Thaw frozen ingredients on ice or in a refrigerator at 2-8 &#176;C. Avoid repeated freeze/thaw cycles and work from frozen aliquots (stored at -20 &#176;C).</li>
	<li>Basal medium: Prepare basal medium by supplementing advanced Dulbecco&#39;s Modified Eagle Medium/Ham&#39;s F-12 (adDMEM/F12) with HEPES (10 mM) and glutamine (2 mM). This is also used as a transport medium, and during organoid washing steps. 
	NOTE: Advanced DMEM/F-12 is used as the basal medium to aid in the expansion of organoids in the presence of limited serum; however, it requires supplementation with HEPES and L-glutamine.</li>
	<li>Briefly centrifuge fibroblast growth factor 10 (FGF-10), fibroblast growth factor 2 (FGF-2), epithelial growth factor (EGF), SB202190, prostaglandin E2 (PGE2), and A 83-01 before opening to ensure components are at the bottom of the vial.</li>
	<li>Complete organoid medium: Supplement basal medium with human noggin- and R-spondin 1-conditioned media at a final concentration of 5% v/v, human EGF (50 ng/mL), human FGF-2 (5 ng/mL), human FGF-10 (20 ng/mL), A 83-01 (500 nM), SB202190 (10 &#181;M), B27 (1x), nicotinamide (10 mM), N-acetylcysteine (1.25 mM), Y-27632 (10 &#181;M), PGE2 (1 &#181;M) and a broad-spectrum antibiotic formation at the concentration indicated by the manufacturer.</li>
	<li>Store organoid media at 4 &#176;C in the dark and use it within 2 weeks (1 month at most). Do not freeze. Avoid extended exposure to light sources. 
	NOTE: The organoid medium is prepared serum-free; however, serum and penicillin/streptomycin could be supplemented on a user-to-user basis as required.</li>
</ol>
2. A day before procedure outlined in 3
<ol>
	<li>Thaw growth factor reduced basement membrane (BME; see Table of Materials) overnight for at least 12 h before use in a 4 &#176;C refrigerator or cold room. If required, dispense BME into 1 mL aliquots in a 1.5 mL polypropylene single-use tube to avoid freeze-thaw cycles.</li>
	<li>Place filtered pipette tips into a 4 &#176;C refrigerator or cold room. 
	NOTE: This section refers to pipette tips that will be used when handling BME to prevent premature polymerization and reduce the coating of BME on the surface of the tips.</li>
	<li>Sterilize all surgical equipment required for the procedure.</li>
</ol>
3. Generation of bladder tumor organoids
NOTE: This is an initial step for PDO establishment from primary patient tumors. This procedure is adapted for bladder cancer tissues from methods established by Gao et al.24.
<ol>
	<li>Use a class II biohazard hood to prepare the specimen. Retrieve dry and wet ice and print Patient Specimen Processing Sheet (Supplemental File).</li>
	<li>Call research personnel to the operating room when surgical resection is near complete. 
	NOTE: Confirm that the patient meets the eligibility criteria and has signed the participant consent form. Tissue is provided for research only if surplus to requirements for clinical histopathologic assessment.</li>
	<li>Collect a fresh macroscopically viable tumor specimen from surgery. Ensure that the sample is submerged in transport medium (either 1x adDMEM/F12 or 1x Dulbecco&#39;s phosphate-buffered saline (DPBS)) in a sterile 50 mL conical tube or urine specimen jar during transit. 
	NOTE: At some clinical centers, tissue may need to be transported to a pathology laboratory for to be allocated for research. Under these circumstances, it is recommended that antibiotics and antimycotics be added to the transport medium. Tissue can be stored at 4 &#176;C in basal medium for up to 24 h post-surgery and still generate viable organoid cultures.</li>
	<li>Record specimen details, including tissue weight (g or mg), sample description, and details regarding any blood and urine samples on the Patient Specimen Processing Sheet (Supplemental File).</li>
	<li>Carefully remove the transport medium and replace it with 10 mL of basal media. Allow the tumor tissue to settle by gravity. 
	NOTE: Transport medium is considered as clinical waste and must be collected in an appropriately labeled waste container in an appropriate amount of decontamination solution. Once the liquid has been chemically decontaminated, it can be disposed of according to institutional guidelines for hazardous waste.</li>
	<li>Remove the tumor tissue with forceps and place it in a sterile 90 mm Petri dish (Figure 2A). Record the weight of the tissue in mg or g on the clinical specimen processing sheet and dissection grid (Figure 2B).</li>
	<li>Remove non-cancerous tissue (including adipose tissue) and macroscopically visible necrotic regions using sterile forceps and disposable scalpel blade mounted to scalpel handle (Figure 2C). Wash tumor pieces 1-2 times with cold 1x DPBS. Collect the tumor pieces and transfer them to a new sterile 90 mm Petri Dish. 
	NOTE: As scalpel blades are sharp, take caution when manually slicing. Tumor-adjacent adipose tissue can be identified by distinctly soft, gelatinous, pale areas immediately adjacent to the visual tumor perimeter. Macroscopic adipose tissue, and focally dark regions representing areas of necrosis will require personal judgment when dissecting from an excisional bladder tumor biopsy.</li>
	<li>Take a photograph, draw a diagram of tissue, and plan tissue dissection on a clinical processing grid (Figure 2B and Figure 2C). 
	NOTE: It is important to keep a visual record and rough sketch of the individual macroscopic tumor characteristics and dissection for each specific case.</li>
	<li>Dissect tumor tissue pieces and allocate for histopathological (Figure 2D) and molecular analyses (Figure 2E).
	<ol>
		<li>For histological analyses: Place approximately 50 mg of tumor tissue into a labeled disposable plastic histology cassette (Figure 2D). Submerge histology cassette into a container with 5x to 10x volume of 10% neutral buffered formalin (NBF). Incubate overnight at RT.</li>
		<li>Remove 10% NBF and replace with 70% (w/w) ethanol the next day for storage at 4 &#176;C until tissue can be processed using routine tissue processing protocol</li>
		<li>For molecular analyses: Snap freeze at least one 1-3 mm3 tumor piece in an RNase/DNase-free 1.5 mL cryovial using liquid nitrogen and store at -80 &#176;C (Figure 2E).</li>
	</ol>
	</li>
	<li>Dispense 5 mL of organoid medium (Table 1) in the 90 mm Petri dish containing the remaining tumor piece(s).</li>
	<li>Mechanically mince tissue as finely as possible (0.5-1 mm3 pieces or smaller) with a sterile #10 scalpel blade. 
	NOTE: Larger fragments or whole chunks of tissue (&#62;3 mm3) will take considerably longer to digest and will decrease the viability of the specimen. Omit the above step if the tissue is disaggregated and fragments are small enough to pipette with a 5 mL serological pipette tip.</li>
	<li>Transfer finely minced tissue to a 50 mL conical tube and add 4 mL of organoid medium, 1 mL of 10x collagenase/hyaluronidase, and 0.1 mg/mL deoxyribonuclease 1 (DNase 1) to avoid cell clumping. 
	NOTE: Enzyme solution should be freshly prepared each time. Increase the volume of the medium to be approximately 10x the visible amount of the tumor fragments for large samples.</li>
	<li>Incubate the minced tumor tissue and enzyme solution for 1-2 h on an orbital shaker or rotator (150 rpm) in an incubator (37 &#176;C, 5% CO2) to dissociate fragments into a cell suspension and break down collagens. This can be checked with histological analysis (Figure 3A). 
	NOTE: If the amount of tissue is large or no obvious dissociation is observed after 1-1.5 h, increase the incubation time checking the level of dissociation every 30 min. Timing for this step depends on the sample and must be determined empirically each time. A noticeably clearer solution with tissue fragments indiscernible to the eye (or very few fragments) indicates successful digestion.</li>
	<li>Terminate the digestion with the addition of 2x volume (20 mL) of basal medium to the sample.</li>
	<li>Centrifuge the sample at 261 x g for 5 min at room temperature (RT), aspirate, and discard the supernatant.</li>
	<li>To lyse contaminating red blood cells (RBCs), resuspend the pellet obtained from the above step in 5 mL of ammonium-chloride-potassium (ACK) buffer. Incubate the tube at RT for 3 min or until the complete lysis of the RBCs is seen (suspension becomes clear). 
	NOTE: If RBCs are not observed as a small red clump in the pellet, this step may be omitted.</li>
	<li>Add 20 mL of the basal medium into the tube. Centrifuge the tube at 261 x g for 5 min at RT and aspirate the supernatant.</li>
	<li>At this step, place a 10 mL aliquot of 2x and 1x organoid medium in a 37 &#176;C water bath to warm.</li>
	<li>Filter the sample through a pre-wet reversible 100 &#181;m strainer into a new 50 mL tube to remove large insoluble material. 
	NOTE: Large undigested material (&#62;100 &#181;m) collected by the filter may contain cells of interest and can be cultured in 90 mm Petri dish or 6-well cell culture plate in organoid medium to derive 2D cultures (Figure 1 (step 5) and Figure 3B).</li>
	<li>Filter the eluate through a pre-wet reversible 37 &#181;m strainer to collect single cells and small clusters for single-cell and immune cell isolation (Tube 37-1; Figure 1 (step 6) and Figure 3B). 
	NOTE: The yield of tumor cells during this step may be increased by passing the filtered cell suspension through the strainer again.</li>
	<li>Reverse the 37 &#181;m strainer and use 10 mL of basal media to collect small and moderate-sized clusters (37-100 &#181;m) (tube 70-1; Figure 3B).</li>
	<li>Top up each of the new 50 mL tubes (tubes 70-1 and 37-1) with DPBS to 40 mL. Centrifuge the suspension at 261 x g for 5 min at RT. Aspirate and discard the supernatant.</li>
	<li>Add 10 mL of basal media to tube 37-1 and count the cells using trypan blue exclusion dye and an automated cell counter (as per the manufacturer&#39;s specifications). Determine the cell number and viability of cells.</li>
	<li>Centrifuge the remainder of the sample at 261 x g for 5 min at RT. Aspirate the medium and replace it with cell freezing solution or basal media containing 10% fetal bovine serum (FBS), 1% penicillin/streptomycin, and 10% dimethyl sulfoxide (DMSO).</li>
	<li>Place samples in 1.5 mL cryovials and store them in a cell-freezing container. Immediately transfer the container to a -80 &#176;C freezer for optimal rate of cooling. Following overnight freezer storage at -80 &#176;C, transfer the cryovials into cryogenic liquid or air phase storage (-196 &#176;C) for long-term storage.</li>
	<li>Resuspend cells from tube 70-1 with 500 &#181;L of pre-warmed 2x organoid medium. 
	NOTE: Seeding density must be high for successful organoid propagation. The volume of the organoid medium and, subsequently, BME should be altered empirically on the number of cells isolated from the filtration step. This step provides a relevant starting point based on studies in our laboratory.</li>
	<li>Add BME to cells (at a 1:1 ratio with 2x organoid medium) with ice-cold P1000 sterile filter pipette tips and mix gently to suspend cells. Quickly and carefully pipette 100 &#181;L of reconstituted cells/ BME mixture to wells of an ultra-low attachment flat-bottom 96-well plate. Place the 96-well plate in an incubator (37 &#176;C, 5% CO2) for 20-30 min to solidify.</li>
	<li>Add 1:2 ratio of 1x organoid medium on top of BME cell suspension depending on the empirically assessed volume. In the relevant starting point, add 50 &#181;L of 1x organoid medium media on top of 100 &#181;L of reconstituted cells/ BME mixture.</li>
	<li>Place the 96-well plate in an incubator (37 &#176;C, 5% CO2) for 20 min to equilibrate.</li>
	<li>Take the cell culture plate out of the incubator and assemble it on a specimen holder on the stage of a microscope. Assess organoids visually under phase contrast or brightfield settings. 
	NOTE: Images are best acquired by an inverted phase-contrast microscope equipped with differential interference (DIC) optics, digital camera, and associated software to observe the formation of spherical PDOs in preparation for endpoint analysis.
	<ol>
		<li>If distinct clusters are visible, place the cell culture plate into an onstage electronically heated microscope chamber (37 &#176;C, 5% CO2) for live-cell imaging over the first 24-72 h.</li>
		<li>Ensure the flexible heated collar is attached to the lens to reduce thermal drift and the humidifier is filled with dH2O.</li>
		<li>Perform the initial imaging using a 4x or 10x objective lens (N.A. 0.30, W.D. 15.2 mm). Time-lapse every 5-10 min on the phase-contrast setting.</li>
		<li>Check for the successful isolation as characterized by the appearance of &#62;10 self-organizing organoids per well after a 24-72 h period.</li>
		<li>Allow cultures to continue for up to two weeks if organoid numbers are low (Figure 3C).</li>
	</ol>
	</li>
	<li>Top up the medium every 2-3 days using 50 &#181;L of pre-warmed organoid medium to replenish depleted growth factors and overall volume.</li>
	<li>Acquire images (as described in step 3.30) on days 1, 2, and 3 (time-lapse series), and on days 5, 7, and 10 before passaging (if applicable). 
	NOTE: Organoids (observed as generally round structures where you cannot see the edges of individual cells) are typically passaged 7-10 days following setup, depending on the success of the isolation. Before or following passaging, organoids can be treated with cytotoxics or therapeutic agents for up to 6 days and drug response measured using cell viability and cytotoxicity assays. Alternatively, organoids can be retrieved from BME (using 1 mg/mL dispase) and cryopreserved (bio banked), prepared for molecular testing, or embedded and assessed histologically (Figure 4).</li>
</ol>

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(155), e60364 (2020).</li><li>Pleguezuelos-Manzano, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishment+and+culture+of+human+intestinal+organoids+derived+from+adult+stem+cells.">Establishment and culture of human intestinal organoids derived from adult stem cells.</a> Current Protocols in Immunology. 130 (1), 106 (2020).</li><li>Fusco, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-derived+organoids+(PDOs)+as+a+novel+in+vitro+model+for+neuroblastoma+tumours.">Patient-derived organoids (PDOs) as a novel in vitro model for neuroblastoma tumours.</a> BMC Cancer. 19 (1), 970 (2019).</li><li>Mullenders, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+and+human+urothelial+cancer+organoids:+A+tool+for+bladder+cancer+research.">Mouse and human urothelial cancer organoids: A tool for bladder cancer research.</a> Proceedings of the National Academy of Sciences. 116 (10), 4567-4574 (2019).</li><li>Vasyutinv, I., Zerihun, L., Ivan, C., Atala, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bladder+organoids+and+spheroids:+potential+tools+for+normal+and+diseased+tissue+modelling.">Bladder organoids and spheroids: potential tools for normal and diseased tissue modelling.</a> Anticancer Research. 39 (3), 1105-1118 (2019).</li><li>Santos, C. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Urothelial+organoids+originating+from+Cd49fhigh+mouse+stem+cells+display+Notch-dependent+differentiation+capacity.">Urothelial organoids originating from Cd49fhigh mouse stem cells display Notch-dependent differentiation capacity.</a> Nature Communications. 10 (1), 4407 (2019).</li><li>Whyard, T., Liu, J., Darras, F. S., Waltzer, W. C., Romanov, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Organoid+model+of+urothelial+cancer:+establishment+and+applications+for+bladder+cancer+research.">Organoid model of urothelial cancer: establishment and applications for bladder cancer research.</a> Biotechniques. 69 (3), 193-199 (2020).</li></ol>

The authors have no conflicts of interest.

While 3D organoid protocols derived from bladder cancer tissue are still in their infancy, they are an area of active research and clinical investigation. Here, an optimized protocol to successfully establish bladder cancer PDOs that are suitable for both NMIBC and MIBC specimens is detailed. This workflow integrates parallelly into hospital-based clinical trials and considers biobank sample accrual, including histological sample processing and fresh frozen tissue banking, which is an important consideration for clinical...

Bladder cancer is the most prevalent urinary tract cancer and the tenth most common human malignancy worldwide1. It encompasses a genetically diverse and phenotypically complex spectrum of disease2. Urothelial non-muscle-invasive forms of bladder cancer (NMIBC) are the most common bladder cancer diagnoses (70%-80%), and these cancers display considerable biological heterogeneity and variable clinical outcomes2,3,4. Patients with NMIBC typically experience a high risk of disease recurrence (50-70%) and one-third of cancers will progress and develop into significantly more aggressive muscle-invasive bladder cancer (MIBC)2. Although 5-year survival rates for NMIBC are high (&#62;90%), these patients must undergo long-term clinical management5. On the other hand, locally advanced (unresectable) or metastatic MIBC is generally considered incurable6. Consequently, bladder cancer has one of the highest lifetime treatment costs within cancer care and is a significant burden for both the individual and the healthcare system3,7. The underlying genetic aberrations in advanced disease renders therapeutic management of bladder cancer a clinical challenge, and therapeutic options for invasive urothelial tumors have only recently improved since the approval of immunotherapies for both advanced and high-risk NMIBC8,9. Currently, clinical decision-making has been guided by conventional clinical and histopathological features, despite individual bladder cancer tumors showing large differences in disease aggressiveness and response to therapy10. There is an urgent need to accelerate research into clinically useful models to improve the prediction of individual patient prognosis and identification of effective treatments.
Three-dimensional (3D) organoids show great potential as tumor models due to their ability to self-organize and recapitulate the original tumor&#39;s intrinsic in vivo architecture and pharmacogenomic profile, and their capability to mirror the native cellular functionality of the original tissue from which they were derived11,12,13. Although established bladder cancer cell lines are readily available, relatively cost-effective, scalable, and simple to manipulate, the in vitro cell lines largely fail to mimic the spectrum of diverse genetic and epigenetic alterations observed in clinical bladder cancers12,14 and were all established and maintained under 2D, adherent culture conditions. Additionally, cell lines derived from primary and metastatic bladder tumors harbor significant genetic divergence from the original tumor material. 8,15.
An alternative approach is to use genetically engineered and carcinogen-induced mouse models. However, while these models recapitulate some of the natural oncogenic cascades involved in human neoplasia (reviewed in refs16,17,18), they lack tumor heterogeneity, are expensive, poorly represent invasive and metastatic bladder cancer, and are not viable for rapid term drug testing as tumors can take many months to develop14,19. Patient-derived models of cancer (including organoids, conditionally reprogrammed primary cell culture, and xenografts) provide invaluable opportunities to understand the effects of drug treatment before clinical treatment20. Despite this, few groups routinely use these patient-proximal models due to limited access to fresh primary patient tissue and the extensive optimization required to reproducibly generate patient-derived organoid (PDO) culture conditions. In an in vivo setting, oncogenic cells can interact and communicate with various compositions of the surrounding constituents, including stromal cells, tissue infiltrating immune cells, and matrix12. Similarly, for PDOs grown in a 3D format, cellular/matrix complexity can be customized to include other relevant components. PDOs can be rapidly generated and are often able to be passaged extensively or cryopreserved for later use, despite having a finite lifespan21,22,23. Pharmacodynamics (i.e., response to a drug) can be evaluated using multiple read-outs, including organoid viability and morphology, and characterization of immunohistochemistry targets or transcriptional changes.
Here, the procedures for the establishment of bladder cancer organoids from patient material collected from transurethral resection of bladder tumor (TURBT) or surgical removal of the bladder (radical cystectomy) are described. The method to generate PDOs is illustrated, using readily available wet laboratory materials and tools. Endpoints include changes in cell morphological characteristics and viability. These were measured using fluorescence microscopy, in vitro viability (metabolic and cell membrane integrity) assays, and histopathological analysis. Figure 1 shows the workflow for establishing human bladder cancer PDOs from clinical material obtained during elective surgery.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1.2 mL cryogenic vial</td>
			<td>Corning</td>
			<td>430487</td>
			<td></td>
		</tr>
		<tr>
			<td>1.5 mL Eppendorf tubes</td>
			<td>Sigma-Aldrich</td>
			<td>T9661-500EA</td>
			<td>polypropylene single-use tube</td>
		</tr>
		<tr>
			<td>100 &#181;M reversible strainer</td>
			<td>STEMCELL Technologies</td>
			<td>#27270</td>
			<td></td>
		</tr>
		<tr>
			<td>100 mm petri dish</td>
			<td>Corning</td>
			<td>430167</td>
			<td></td>
		</tr>
		<tr>
			<td>10x Collagenase/ Hyaluronidase</td>
			<td>STEMCELL Technologies</td>
			<td>#07912</td>
			<td></td>
		</tr>
		<tr>
			<td>37 &#181;M reversible strainer</td>
			<td>STEMCELL Technologies</td>
			<td>#27250</td>
			<td></td>
		</tr>
		<tr>
			<td>37&#176;C incubator</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>37&#176;C water bath</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>50 mL falcon tube</td>
			<td>Corning</td>
			<td>CLS430829-500EA</td>
			<td></td>
		</tr>
		<tr>
			<td>6-well plate</td>
			<td>Corning</td>
			<td>CLS3516</td>
			<td></td>
		</tr>
		<tr>
			<td>70% (w/w) ethanol</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>-80&#176;C freezer</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>96 well ultra low attachment plate (Black)</td>
			<td>Sigma-Aldrich</td>
			<td>CLS3474-24EA</td>
			<td></td>
		</tr>
		<tr>
			<td>A 83-01</td>
			<td>BioScientific</td>
			<td>2939</td>
			<td>Prevents the growth-inhibitory effects of TGF-&#946;</td>
		</tr>
		<tr>
			<td>ACK lysis buffer</td>
			<td>STEMCELL Technologies</td>
			<td>#07850</td>
			<td></td>
		</tr>
		<tr>
			<td>adDMEM/F-12</td>
			<td>Thermo Fisher Scientific</td>
			<td>12634028</td>
			<td>Base medium</td>
		</tr>
		<tr>
			<td>Animal-free recombinant EGF</td>
			<td>Sigma</td>
			<td>518179</td>
			<td>Growth factor</td>
		</tr>
		<tr>
			<td>Automated cell counter (TC20)</td>
			<td>Bio-rad</td>
			<td>1450102</td>
			<td></td>
		</tr>
		<tr>
			<td>B27 additive</td>
			<td>Gibco</td>
			<td>17504044</td>
			<td>Increases sphere-forming efficiency</td>
		</tr>
		<tr>
			<td>Cell Counting Slides</td>
			<td>Bio-rad</td>
			<td>1450015</td>
			<td></td>
		</tr>
		<tr>
			<td>Centrifuge</td>
			<td>Eppendorf</td>
			<td>EP022628188</td>
			<td></td>
		</tr>
		<tr>
			<td>Computer system</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>CryoStor CS10</td>
			<td>STEMCELL Technologies</td>
			<td>#07930</td>
			<td>Cell freezing solution</td>
		</tr>
		<tr>
			<td>Dispase II, powder</td>
			<td>Thermofisher</td>
			<td>17105041</td>
			<td>To enzymatically disrupt Matrigel</td>
		</tr>
		<tr>
			<td>DNAse 1</td>
			<td>STEMCELL Technologies</td>
			<td>#07900</td>
			<td></td>
		</tr>
		<tr>
			<td>DPBS</td>
			<td>Thermofisher</td>
			<td>14190144</td>
			<td></td>
		</tr>
		<tr>
			<td>Dry and wet ice</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Esky</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Farmdyne (Iodine 16g/L)</td>
			<td>Ecolab</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Formalin solution, neutral buffered, 10%</td>
			<td>Sigma</td>
			<td>HT501128</td>
			<td>Histological tissue fixative</td>
		</tr>
		<tr>
			<td>Glutamax (L-alanine-L-glutamine)</td>
			<td>Invitrogen</td>
			<td>35050061</td>
			<td>Source of nitrogen for the synthesis of proteins, nucleic acids</td>
		</tr>
		<tr>
			<td>HEPES</td>
			<td>Gibco</td>
			<td>15630-080</td>
			<td>All-purpose buffer</td>
		</tr>
		<tr>
			<td>Histology cassette</td>
			<td>ProSciTech</td>
			<td>RCH44-W</td>
			<td></td>
		</tr>
		<tr>
			<td>Human FGF-10</td>
			<td>Peprotech</td>
			<td>100-26-25</td>
			<td>Growth factor</td>
		</tr>
		<tr>
			<td>Human FGF-2</td>
			<td>Peprotech</td>
			<td>100-18B-50</td>
			<td>Growth factor</td>
		</tr>
		<tr>
			<td>Liquid nitrogen</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Matrigel (Growth Factor Reduced (GFR), phenol red-free, LDEV free)</td>
			<td>In Vitro Technologies</td>
			<td>356231</td>
			<td>Basement membrane extract (BME)</td>
		</tr>
		<tr>
			<td>Mr. Frosty freezing container</td>
			<td>ThermoFisher</td>
			<td>5100-0001</td>
			<td>cell freezing container</td>
		</tr>
		<tr>
			<td>N-acetyl-L-cysteine (NAC)</td>
			<td>Sigma</td>
			<td>A7250</td>
			<td>Anti-oxidant required to protect against ROS-induced cytotoxicity</td>
		</tr>
		<tr>
			<td>Nicotinamide</td>
			<td>Sigma</td>
			<td>N0636-100G</td>
			<td>SIRT-1 inhibitor</td>
		</tr>
		<tr>
			<td>NikonTs2U inverted microscope</td>
			<td>Nikon</td>
			<td>MFA510BB</td>
			<td></td>
		</tr>
		<tr>
			<td>NIS-Elements Advanced Research</td>
			<td>Nikon</td>
			<td>MQS31000</td>
			<td></td>
		</tr>
		<tr>
			<td>Noggin conditioned media</td>
			<td>In-house</td>
			<td></td>
			<td>BMP inhibitor</td>
		</tr>
		<tr>
			<td>Pipetboy acu 2</td>
			<td>Integra</td>
			<td>155000</td>
			<td></td>
		</tr>
		<tr>
			<td>Pipettes (p20, p100, p1000) with tips</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Primocin</td>
			<td>Jomar Bioscience</td>
			<td>ant-pm2</td>
			<td>Combination of antibacterial and antifungal compounds to protect cell cultures from contaminations</td>
		</tr>
		<tr>
			<td>Prostaglandin E2 (PGE2)</td>
			<td>Tocris</td>
			<td>2296</td>
			<td>support proliferation of cells</td>
		</tr>
		<tr>
			<td>Rotary tube mixer</td>
			<td>Ratek</td>
			<td>RSM7DC</td>
			<td></td>
		</tr>
		<tr>
			<td>R-spondin 1 conditioned media</td>
			<td>In-house</td>
			<td></td>
			<td>WNT signalling regulator</td>
		</tr>
		<tr>
			<td>SB202190</td>
			<td>Jomar Bioscience</td>
			<td>s1077-25mg</td>
			<td>Selective p38 MAP kinase inhibitor</td>
		</tr>
		<tr>
			<td>Scale</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel handle</td>
			<td>Livingstone</td>
			<td>WBLDHDL03</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpels, #11 blade</td>
			<td>Medical and Surgical Requisites</td>
			<td>EU-211-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Serological pipettes (5, 10, 25 mL)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Specimen Waste Bags</td>
			<td>Medical Search</td>
			<td>SU09125X16</td>
			<td></td>
		</tr>
		<tr>
			<td>Urine specimen jar</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Y27632</td>
			<td>Jomar Bioscience</td>
			<td>s1049-10mg</td>
			<td>Selective ROCK inhibitor. Increases survival of dissociated epithelial cells</td>
		</tr>
	</tbody>
</table>

culture of bladder cancer organoids as precision medicine tools

Current in vitro therapeutic testing platforms lack relevance to tumor pathophysiology, typically employing cancer cell lines established as two-dimensional (2D) cultures on tissue culture plastic. There is a critical need for more representative models of tumor complexity that can accurately predict therapeutic response and sensitivity. The development of three-dimensional (3D) ex vivo culture of patient-derived organoids (PDOs), derived from fresh tumor tissues, aims to address these shortcomings. Organoid cultures can be used as tumor surrogates in parallel to routine clinical management to inform therapeutic decisions by identifying potential effective interventions and indicating therapies that may be futile. Here, this procedure aims to describe strategies and a detailed step-by-step protocol to establish bladder cancer PDOs from fresh, viable clinical tissue. Our well-established, optimized protocols are practical to set up 3D cultures for experiments using limited and diverse starting material directly from patients or patient-derived xenograft (PDX) tumor material. This procedure can also be employed by most laboratories equipped with standard tissue culture equipment. The organoids generated using this protocol can be used as ex vivo surrogates to understand both the molecular mechanisms underpinning urological cancer pathology and to evaluate treatments to inform clinical management.

3D organoids were successfully established from human bladder cancer patient TURBT and cystectomy tissues. Briefly, this technique highlights a rapid formation of 3D multicellular structures that are both viable and suitable for other endpoint analyses such as histological evaluation, molecular characterization (by immunohistochemistry or quantitative real-time PCR), and drug screening. During the procedure (Figure 1), the various eluates during our filtration phases (Fi...

Watch this Scientific Journal Video about Culture of Bladder Cancer Organoids as Precision Medicine Tools at JoVE.com

Culture of Bladder Cancer Organoids as Precision Medicine Tools

Patient-derived organoids (PDOs) are a powerful tool in translational cancer research, reflecting both the genetic and phenotypic heterogeneity of the disease and response to personalized anti-cancer therapies. Here, a consolidated protocol to generate human primary bladder cancer PDOs in preparation for the evaluation of phenotypic analyses and drug responses is detailed.

Current in vitro therapeutic testing platforms lack relevance to tumor pathophysiology, typically employing cancer cell lines established as ...

culture-of-bladder-cancer-organoids-as-precision-medicine-tools

Research

JoVE Journal

Cancer Research

4.3K Views.  Queensland University of Technology (QUT) at Translational Research Institute. Patient-derived organoids (PDOs) are a powerful tool in translational cancer research, reflecting both the genetic and phenotypic heterogeneity of the disease and response to personalized anti-cancer therapies. Here, a consolidated protocol to generate human primary bladder cancer PDOs in preparation for the evaluation of phenotypic analyses and drug responses is detailed. 

Video: Culture of Bladder Cancer Organoids as Precision Medicine Tools

A Murine Orthotopic Bladder Tumor Model and Tumor Detection System

This protocol describes the generation of bladder tumors in female C57BL/6J mice using the murine bladder cancer cell line MB49, which has been modified to secrete human Prostate Specific Antigen (PSA), and the procedure for the confirmation of tumor implantation. In brief, mice are anesthetized using injectable drugs and are made to lay in the dorsal position. Urine is vacated from the bladder and 50 &#181;L of poly-L-lysine (PLL) is slowly instilled at a rate of 10 &#181;L/20 s using a 24 G IV catheter. It is left in the bladder for 20 min by stoppering the catheter. The catheter is removed and PLL is vacated by gentle pressure on the bladder. This is followed by instillation of the murine bladder cancer cell line (1 x 105 cells/50 &#181;L) at a rate of 10 &#181;L/20 s. The catheter is stoppered to prevent premature evacuation. After 1 h, the mice are revived with a reversal drug, and the bladder is vacated. The slow instillation rate is important, as it reduces vesico-ureteral reflux, which can cause tumors to occur in the upper urinary tract and in the kidneys. The cell line should be well re-suspended to reduce clumping of cells, as this can lead to uneven tumor sizes after implantation.
This technique induces tumors with high efficiency. Tumor growth is monitored by urinary PSA secretion. PSA marker monitoring is more reliable than ultrasound or fluorescence imaging for the detection of the presence of tumors in the bladder. Tumors in mice generally reach a maximum size that negatively impacts health by about 3 - 4 weeks if left untreated. By monitoring tumor growth, it is possible to differentiate mice that were cured from those that were not successfully implanted with tumors. With only end-point analysis, the latter may be mistakenly assumed to have been cured by therapy.

This protocol describes the generation of murine orthotopic bladder tumors in female C57BL/6J mice and the monitoring of tumor growth.

This protocol describes the generation of bladder tumors in female C57BL/6J mice using the murine bladder cancer cell line MB49, which has been modified ...

3-D Cell Culture System for Studying Invasion and Evaluating Therapeutics in Bladder Cancer

Bladder cancer is a significant health problem. It is estimated that more than 16,000 people will die this year in the United States from bladder cancer. While 75% of bladder cancers are non-invasive and unlikely to metastasize, about 25% progress to an invasive growth pattern. Up to half of the patients with invasive cancers will develop lethal metastatic relapse. Thus, understanding the mechanism of invasive progression in bladder cancer is crucial to predict patient outcomes and prevent lethal metastases. In this article, we present a three-dimensional cancer invasion model which allows incorporation of tumor cells and stromal components to mimic in vivo conditions occurring in the bladder tumor microenvironment. This model provides the opportunity to observe the invasive process in real time using time-lapse imaging, interrogate the molecular pathways involved using confocal immunofluorescent imaging and screen compounds with the potential to block invasion. While this protocol focuses on bladder cancer, it is likely that similar methods could be used to examine invasion and motility in other tumor types as well.

The processes governing bladder cancer invasion represent opportunities for biomarker and therapeutic development. Here we present a bladder cancer invasion model which incorporates 3-D culture of tumor spheroids, time-lapse imaging and confocal microscopy. This technique is useful for defining the features of the invasive process and for screening therapeutic agents.

Bladder cancer is a significant health problem. It is estimated that more than 16,000 people will die this year in the United States from bladder cancer. ...

Magnetic Resonance Imaging Assessment of Carcinogen-induced Murine Bladder Tumors

Murine bladder tumor models are critical for the evaluation of new therapeutic options. Bladder tumors induced with the N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) carcinogen are advantageous over cell line-based models because they closely replicate the genomic profiles of human tumors, and, unlike cell models and xenografts, they provide a good opportunity for the study of immunotherapies. However, bladder tumor generation is heterogeneous; therefore, an accurate assessment of tumor burden is needed before randomization to experimental treatment. Described here is a BBN mouse model and protocol to evaluate bladder cancer tumor burden in vivo using a fast and reliable magnetic resonance (MR) sequence (true FISP). This method is simple and reliable because, unlike ultrasound, MR is operator-independent and allows for the straightforward post-acquisition image processing and review. Using axial images of the bladder, analysis of regions of interest along the bladder wall and tumor allow for the calculation of bladder wall and tumor area. This measurement correlates with ex vivo bladder weight (rs= 0.37, p = 0.009) and tumor stage (p = 0.0003). In conclusion, BBN generates heterogeneous tumors that are ideal for evaluation of immunotherapies, and MRI can quickly and reliably assess tumor burden prior to randomization to experimental treatment arms.

Murine bladder tumors are induced with the N-butyl-N-(4-hydroxybutyl) nitrosamine carcinogen (BBN). Bladder tumor generation is heterogeneous; therefore, an accurate assessment of tumor burden is needed before randomization to experimental treatment. Here we present a fast, reliable MRI protocol to assess tumor size and stage.

Murine bladder tumor models are critical for the evaluation of new therapeutic options. Bladder tumors induced with the N-butyl-N-(4-hydroxybutyl) ...

Prostate Organoid Cultures as Tools to Translate Genotypes and Mutational Profiles to Pharmacological Responses

Presented here is a protocol to study pharmacodynamics, stem cell potential, and cancer differentiation in prostate epithelial organoids. Prostate organoids are androgen responsive, three-dimensional (3D) cultures grown in a defined medium that resembles the prostatic epithelium. Prostate organoids can be established from wild-type and genetically engineered mouse models, benign human tissue, and advanced prostate cancer. Importantly, patient derived organoids closely resemble tumors in genetics and in vivo tumor biology. Moreover, organoids can be genetically manipulated using CRISPR/Cas9 and shRNA systems. These controlled genetics make the organoid culture attractive as a platform for rapidly testing the effects of genotypes and mutational profiles on pharmacological responses. However, experimental protocols must be specifically adapted to the 3D nature of organoid cultures to obtain reproducible results. Described here are detailed protocols for performing seeding assays to determine organoid formation capacity. Subsequently, this report shows how to perform drug treatments and analyze pharmacological response via viability measurements, protein isolation, and RNA isolation. Finally, the protocol describes how to prepare organoids for xenografting and subsequent in vivo growth assays using subcutaneous grafting. These protocols yield highly reproducible data and are widely applicable to 3D culture systems.

Presented here is a protocol to study pharmacological responses in prostate epithelial organoids. Organoids closely resemble in vivo biology and recapitulate patient genetics, making them attractive model systems. Prostate organoids can be established from wildtype prostates, genetically engineered mouse models, benign human tissue, and advanced prostate cancer.

Presented here is a protocol to study pharmacodynamics, stem cell potential, and cancer differentiation in prostate epithelial organoids. Prostate ...

Culture, Manipulation, and Orthotopic Transplantation of Mouse Bladder Tumor Organoids

The development of advanced tumor models has long been encouraged because current cancer models have shown limitations such as lack of three-dimensional (3D) tumor architecture and low relevance to human cancer. Researchers have recently developed a 3D in vitro cancer model referred to as tumor organoids that can mimic the characteristics of a native tumor in a culture dish. Here, experimental procedures are described in detail for the establishment of bladder tumor organoids from a carcinogen-induced murine bladder tumor, including culture, passage, and maintenance of the resulting 3D tumor organoids in vitro. In addition, protocols to manipulate the established bladder tumor organoid lines for genetic engineering using lentivirus-mediated transduction are described, including optimized conditions for the efficient introduction of new genetic elements into tumor organoids. Finally, the procedure for orthotopic transplantation of bladder tumor organoids into the wall of the murine bladder for further analysis is laid out. The methods described in this article can facilitate the establishment of an in vitro model for bladder cancer for the development of better therapeutic options.

This protocol provides detailed experimental steps to establish a three-dimensional in vitro culture of bladder tumor organoids derived from carcinogen-induced murine bladder cancer. Culture methods including passaging, genetic engineering, and orthotopic transplantation of tumor organoids are described.

The development of advanced tumor models has long been encouraged because current cancer models have shown limitations such as lack of three-dimensional ...

Modeling Oral-Esophageal Squamous Cell Carcinoma in 3D Organoids

Esophageal squamous cell carcinoma (ESCC) is prevalent worldwide, accounting for 90% of all esophageal cancer cases each year, and is the deadliest of all human squamous cell carcinomas. Despite recent progress in defining the molecular changes accompanying ESCC initiation and development, patient prognosis remains poor. The functional annotation of these molecular changes is the necessary next step and requires models that both capture the molecular features of ESCC and can be readily and inexpensively manipulated for functional annotation. Mice treated with the tobacco smoke mimetic 4-nitroquinoline 1-oxide (4NQO) predictably form ESCC and esophageal preneoplasia. Of note, 4NQO lesions also arise in the oral cavity, most commonly in the tongue, as well as the forestomach, which all share the stratified squamous epithelium. However, these mice cannot be simply manipulated for functional hypothesis testing, as generating isogenic mouse models is time- and resource-intensive. Herein, we overcome this limitation by generating single cell-derived three-dimensional (3D) organoids from mice treated with 4NQO to characterize murine ESCC or preneoplastic cells ex vivo. These organoids capture the salient features of ESCC and esophageal preneoplasia, can be cheaply and quickly leveraged to form isogenic models, and can be utilized for syngeneic transplantation experiments. We demonstrate how to generate 3D organoids from normal, preneoplastic, and SCC murine esophageal tissue and maintain and cryopreserve these organoids. The applications of these versatile organoids are broad and include the utilization of genetically engineered mice and further characterization by flow cytometry or immunohistochemistry, the generation of isogeneic organoid lines using CRISPR technologies, and drug screening or syngeneic transplantation. We believe that the widespread adoption of the techniques demonstrated in this protocol will accelerate progress in this field to combat the severe burden of ESCC.

This protocol describes the key steps to generate and characterize murine oral-esophageal 3D organoids that represent normal, preneoplastic, and squamous cell carcinoma lesions induced via chemical carcinogenesis.

Esophageal squamous cell carcinoma (ESCC) is prevalent worldwide, accounting for 90% of all esophageal cancer cases each year, and is the deadliest of all ...

Establishment and Culture of Patient-Derived Breast Organoids

Breast cancer is a complex disease that has been classified into several different histological and molecular subtypes. Patient-derived breast tumor organoids developed in our laboratory consist of a mix of multiple tumor-derived cell populations, and thus represent a better approximation of tumor cell diversity and milieu than the established 2D cancer cell lines. Organoids serve as an ideal in vitro model, allowing for cell-extracellular matrix interactions, known to play an important role in cell-cell interactions and cancer progression. Patient-derived organoids also have advantages over mouse models as they are of human origin. Furthermore, they have been shown to recapitulate the genomic, transcriptomic as well as metabolic heterogeneity of patient tumors; thus, they are capable of representing tumor complexity as well as patient diversity. As a result, they are poised to provide more accurate insights into target discovery and validation and drug sensitivity assays. In this protocol, we provide a detailed demonstration of how patient-derived breast organoids are established from resected breast tumors (cancer organoids) or reductive mammoplasty-derived breast tissue (normal organoids). This is followed by a comprehensive account of 3D organoid culture, expansion, passaging, freezing, as well as thawing of patient-derived breast organoid cultures.

A detailed protocol is provided here for establishing human breast organoids from patient-derived breast tumor resections or normal breast tissue. The protocol provides comprehensive step-by-step instructions for culturing, freezing, and thawing human patient-derived breast organoids.

Breast cancer is a complex disease that has been classified into several different histological and molecular subtypes. Patient-derived breast tumor ...

Establishment and Characterization of Patient-Derived Xenograft Models of Anaplastic Thyroid Carcinoma and Head and Neck Squamous Cell Carcinoma

Patient-derived xenograft (PDX) models faithfully preserve the histological and genetic characteristics of the primary tumor and maintain its heterogeneity. Pharmacodynamic results based on PDX models are highly correlated with clinical practice. Anaplastic thyroid carcinoma (ATC) is the most malignant subtype of thyroid cancer, with strong invasiveness, poor prognosis, and limited treatment. Although the incidence rate of ATC accounts for only 2%-5% of thyroid cancer, its mortality rate is as high as 15%-50%. Head and neck squamous cell carcinoma (HNSCC) is one of the most common head and neck malignancies, with over 600,000 new cases worldwide each year. Herein, detailed protocols are presented to establish PDX models of ATC and HNSCC. In this work, the key factors influencing the success rate of model construction were analyzed, and the histopathological features were compared between the PDX model and the primary tumor. Furthermore, the clinical relevance of the model was validated by evaluating the in vivo therapeutic efficacy of representative clinically used drugs in the successfully constructed PDX models.

The present protocol establishes and characterizes a patient-derived xenograft (PDX) model of anaplastic thyroid carcinoma (ATC) and head and neck squamous cell carcinoma (HNSCC), as PDX models are rapidly becoming the standard in the field of translational oncology.

Patient-derived xenograft (PDX) models faithfully preserve the histological and genetic characteristics of the primary tumor and maintain its ...

Optimizing HCC Organoid Formation for Target Identification and Drug Development

Development and Optimization of A Human Hepatocellular Carcinoma Patient-Derived Organoid Model for Potential Target Identification and Drug Discovery

Hepatocellular carcinoma (HCC) is a highly prevalent and lethal tumor worldwide and its late discovery and lack of effective specific therapeutic agents necessitate further research into its pathogenesis and treatment. Organoids, a novel model that closely resembles native tumor tissue and can be cultured in vitro, have garnered significant interest in recent years, with numerous reports on the development of organoid models for liver cancer. In this study, we have successfully optimized the procedure and established a culture protocol that enables the formation of larger-sized HCC organoids with stable passaging and culture conditions. We have comprehensively outlined each step of the procedure, covering the entire process of HCC tissue dissociation, organoid plating, culture, passaging, cryopreservation, and resuscitation, and provided detailed precautions in this paper. These organoids exhibit genetic similarity to the original HCC tissues and can be utilized for diverse applications, including the identification of potential therapeutic targets for tumors and subsequent drug development.

Author Spotlight: Investigating Liver Cancer Pathogenesis Using Patient-Derived Organoids 

We provide a comprehensive overview and refinement of existing protocols for hepatocellular carcinoma (HCC) organoid formation, encompassing all stages of organoid cultivation. This system serves as a valuable model for the identification of potential therapeutic targets and the assessment of drug candidate effectiveness.

Hepatocellular carcinoma (HCC) is a highly prevalent and lethal tumor worldwide and its late discovery and lack of effective specific therapeutic agents ...

Evaluating Quantitative Tumor Cell Killing by CAR-Expressing Jurkat Cells

Rapid In Vitro Cytotoxicity Evaluation of Jurkat Expressing Chimeric Antigen Receptor using Fluorescent Imaging

Chimeric antigen receptor (CAR) T cells are at the forefront of oncology. A CAR is constructed of a targeting domain (usually a single chain variable fragment, scFv), with an accompanying intra-chain linker, followed by a hinge, transmembrane, and costimulatory domain. Modification of the intra-chain linker and hinge domain can have a significant effect on CAR-mediated killing. Considering the many different options for each part of a CAR construct, there are large numbers of permutations. Making CAR-T cells is a time-consuming and expensive process, and making and testing many constructs is a heavy time and material investment. This protocol describes a platform to rapidly evaluate hinge-optimized CAR constructs in Jurkat cells (CAR-J). Jurkat cells are an immortalized T cell line with high lentivirus uptake, allowing for efficient CAR transduction. Here, we present a platform to rapidly evaluate CAR-J using a fluorescent imager, followed by confirmation of cytolysis in PBMC-derived T cells.

Author Spotlight: High-Throughput Screening of CAR T-Cell Constructs for Enhanced Cytotoxicity and Immunologic Memory 

A protocol to evaluate quantitative tumor cell killing by Jurkat cells expressing chimeric antigen receptor (CAR) targeting single tumor antigen. This protocol can be used as a screening platform for rapid optimization of CAR hinge constructs prior to confirmation in peripheral blood-derived T cells.

Chimeric antigen receptor (CAR) T cells are at the forefront of oncology. A CAR is constructed of a targeting domain (usually a single chain variable ...