High‑throughput and continuous flow isolation of rare circulating tumor cells and clusters in gastric cancer from human whole blood samples using electromagnetic vibration‑based filtration

How circulating tumor cluster biology contributes to the metastatic cascade: from invasion to dissemination and dormancy

Circulating tumor cells (CTCs) are known to be prognostic for metastatic relapse and are detected in patients as solitary cells or cell clusters. Circulating tumor cell clusters (CTC clusters) have been observed clinically for decades and are of significantly higher metastatic potential compared to solitary CTCs. Recent studies suggest distinct differences in CTC cluster biology regarding invasion and survival in circulation. However, differences regarding dissemination, dormancy, and reawakening require more investigations compared to solitary CTCs. Here, we review the current state of CTC cluster research and consider their clinical significance. In addition, we discuss the concept of collective invasion by CTC clusters and molecular evidence as to how cluster survival in circulation compares to that of solitary CTCs. Molecular differences between solitary and clustered CTCs during dormancy and reawakening programs will also be discussed. We also highlight future directions to advance our current understanding of CTC cluster biology.

Design of a high-throughput bio-ferrograph for isolation of cancer cells from whole blood

Enumeration and morphological characterization of circulating tumor cells (CTCs) can be useful in diagnosis and prognosis of metastatic cancer patients. The bio-ferrograph (BF) with its five flow channels, which was developed in the late 1990s for magnetic isolation of biological cells and tissue fragments from fluids, is a modification of the analytical ferrograph. Its use for isolation of rare CTCs from human whole blood (HWB) is a novel approach for the detection of cancer at a cellular level. The isolation process is facilitated by the interaction of specifically magnetized cells with a strong external magnetic field, yielding high recovery rates with no morphological alternation of cells that are isolated on a coverslip glass slide, thus allowing complementary microscopic, chemical, biological, and mechanical analyses. Here, a full mechanical and magnetostatic design of a novel high-throughput BF is presented. The system design is based on an optimized procedure for bio-ferrographic isolation of CTCs from HWB. It incorporates a semi-automated CTC separation system consisting of sample preparation, labeling, and staining; magnetic isolation; and system recovery. The design process was optimized based on experimental feasibility tests and finite element analyses. The novel bench-top system consists of 100 flow channels, allowing simultaneous analysis of multiple samples from 20 patients in each run, with the potential to become a decision-making tool for medical doctors when monitoring patients in a hospital setting. It opens a new route for early diagnosis, prognosis, and treatment of cancers, as well as other diseases, such as osteoarthritis.

Detection of circulating tumor cells: Advances and critical concerns

Metastasis is the main cause of cancer-related death and the major challenge in cancer treatment. Cancer cells in circulation are termed circulating tumor cells (CTCs). Primary tumor metastasis is likely due to CTCs released into the bloodstream. These CTCs extravasate and form fatal metastases in different organs. Analyses of CTCs are clarifying the biological understanding of metastatic cancers. These data are also helpful to monitor disease progression and to inform the development of personalized cancer treatment-based liquid biopsy. However, CTCs are a rare cell population with 1-10 CTCs per ml and are difficult to isolate from blood. Numerous approaches to detect CTCs have been developed based on the physical and biological properties of the cells. The present review summarizes the progress made in detecting CTCs.

Sorting Technology for Circulating Tumor Cells Based on Microfluidics

Circulating tumor cells (CTCs) carry reliable clinical information for the diagnosis and treatment of cancer that is a malignant disease with a high mortality rate. However, the amount of CTCs in the blood is quite low. To obtain credible clinical information, an efficient method of extracting CTCs is necessary. Microfluidic technology has proven its effectiveness on CTCs separation in recent years. Here, we present a comprehensive review of CTC sorting methods based on microfluidics. Specifically, we introduce four different microfluidic sorting methods of CTCs and compare their advantages and disadvantages. Finally, we summarize the analysis of CTCs based on microfluidics and present a prospective view of future research.