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Espejo-Cruz ML, González-Rubio S, Espejo JJ, Zamora-Olaya JM, Alejandre-Altamirano RM, Prieto-Torre M, Linares CI, Guerrero-Misas M, Barrera-Baena P, Poyato-González A, Sánchez-Frías M, Ayllón MD, Rodríguez-Perálvarez ML, de la Mata M, Ferrín G. Enumeration and Characterization of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Int J Mol Sci 2023; 24:ijms24032558. [PMID: 36768881 PMCID: PMC9916725 DOI: 10.3390/ijms24032558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Circulating tumor cells (CTCs), and particularly circulating cancer stem cells (cCSC), are prognostic biomarkers for different malignancies and may be detected using liquid biopsies. The ex vivo culture of cCSCs would provide valuable information regarding biological aggressiveness and would allow monitoring the adaptive changes acquired by the tumor in real time. In this prospective pilot study, we analyzed the presence of EpCAM+ CTCs using the IsoFlux system in the peripheral blood of 37 patients with hepatocellular carcinoma undergoing transarterial chemoembolization (TACE). The average patient age was 63.5 ± 7.9 years and 91.9% of the patients were men. All patients had detectable CTCs at baseline and 20 patients (54.1%) showed CTC aggregates or clusters in their peripheral blood. The increased total tumor diameter (OR: 2.5 (95% CI: 1.3-4.8), p = 0.006) and the absence of clusters of CTCs at baseline (OR: 0.2 (95% CI: 0.0-1.0), p = 0.049) were independent predictors of a diminished response to TACE. Culture of cCSC was successful in five out of thirty-three patients, mostly using negative enrichment of CD45- cells, ultra-low adherence, high glucose, and a short period of hypoxia followed by normoxia. In conclusion, the identification of clusters of CTCs before TACE and the implementation of standardized approaches for cCSC culture could aid to predict outcomes and to define the optimal adjuvant therapeutic strategy for a true personalized medicine in hepatocellular carcinoma.
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Affiliation(s)
- María L. Espejo-Cruz
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
| | - Sandra González-Rubio
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
| | - Juan J. Espejo
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Interventional Radiology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Javier M. Zamora-Olaya
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Rafael M. Alejandre-Altamirano
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María Prieto-Torre
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Clara I. Linares
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
| | - Marta Guerrero-Misas
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Pilar Barrera-Baena
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Antonio Poyato-González
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Marina Sánchez-Frías
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Pathology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María D. Ayllón
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Manuel L. Rodríguez-Perálvarez
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Correspondence:
| | - Manuel de la Mata
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Gustavo Ferrín
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
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Espejo-Cruz ML, González-Rubio S, Zamora-Olaya J, Amado-Torres V, Alejandre R, Sánchez-Frías M, Ciria R, De la Mata M, Rodríguez-Perálvarez M, Ferrín G. Circulating Tumor Cells in Hepatocellular Carcinoma: A Comprehensive Review and Critical Appraisal. Int J Mol Sci 2021; 22:ijms222313073. [PMID: 34884878 PMCID: PMC8657934 DOI: 10.3390/ijms222313073] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm and a major cause of cancer-related death worldwide. There is no ideal biomarker allowing early diagnosis of HCC and tumor surveillance in patients receiving therapy. Liquid biopsy, and particularly circulating tumor cells (CTCs), have emerged as a useful tool for diagnosis and monitoring therapeutic responses in different tumors. In the present manuscript, we evaluate the current evidence supporting the quantitative and qualitative assessment of CTCs as potential biomarkers of HCC, as well as technical aspects related to isolation, identification, and classification of CTCs. Although the dynamic assessment of CTCs in patients with HCC may aid the decision-making process, there are still many uncertainties and technical caveats to be solved before this methodology has a true impact on clinical practice guidelines. More studies are needed to identify the optimal combination of surface markers, to increase the efficiency of ex-vivo expansion of CTCs, or even to target CTCs as a potential therapeutic strategy to prevent HCC recurrence after surgery or to hamper tumor progression and extrahepatic spreading.
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Affiliation(s)
- María Lola Espejo-Cruz
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
| | - Sandra González-Rubio
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
| | - Javier Zamora-Olaya
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Víctor Amado-Torres
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Rafael Alejandre
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Marina Sánchez-Frías
- Department of Pathology, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain;
| | - Rubén Ciria
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Manuel De la Mata
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Manuel Rodríguez-Perálvarez
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence:
| | - Gustavo Ferrín
- Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; (M.L.E.-C.); (S.G.-R.); (J.Z.-O.); (V.A.-T.); (R.A.); (R.C.); (M.D.l.M.); (G.F.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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