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494391
research-article2013
Review Article
Abstract
The metastatic dissemination and spread of malignant circulating tumor cells (CTCs) accounts for more than 90% of cancerrelated deaths. CTCs detach from a primary tumor, travel through the circulatory system, and then invade and proliferate
in distant organs. The detection of CTCs from blood has been established for prognostic monitoring and is predictive of
patient outcome. Analysis of CTCs could enable the means for early detection and screening in cancer, as well as provide
diagnostic access to tumor tissues in a minimally invasive way. The fundamental challenge with analyzing CTCs is the fact
that they occur at extremely low concentrations in blood, on the order of one out of a billion cells. Various technologies
have been proposed to isolate CTCs for enrichment. Here we focus on antigen-independent approaches that are not
limited by specific capture antibodies. Intrinsic physical properties of CTCs, including cell size, deformability, and electrical
properties, are reviewed, and technologies developed to exploit them for enrichment from blood are summarized. Physical
enrichment technologies are of particular interest as they have the potential to increase yield and enable the analysis of
rare CTC phenotypes that may not be otherwise obtained.
Keywords
circulating tumor cells, cancer, physical properties, antigen-independent, enrichment
has been long known that the presence of CTCs is indicative of shorter survival times.912 Detecting, isolating, and
analyzing CTCs has the potential to improve diagnosis,
allow prognostic monitoring, and enable targeted treatment
strategies that are based on the metastatic cells most responsible for cancer mortality. CTCs may be sampled repeatedly
in a minimally invasive way to monitor therapeutic efficacy
and to account for constantly evolving tumor phenotypes.
There is currently only one US Food and Drug
Administration (FDA)cleared technology for CTC enrichment, CellSearch (Veridex, LLC, Raritan, NJ). Enumeration of
CTCs enriched with this technology has been established as a
prognostic marker and predictor of patient outcome in metastatic breast,13 prostate,14 and colon cancers.15 CellSearch is
based on immunomagnetic enrichment, employing antibodycoated magnetic beads to isolate cells that express the epithelial cell adhesion molecule (EpCAM). CTC identification
1
456
Figure 1. Overview of the process of metastasis: Progression from a primary epithelial cancer cell to an invasive, metastatic cell
involves several steps. First, cancer cells undergo an epithelial to mesenchymal transition to (1) reduce adhesion to neighboring cells
and (2) dissolve the basement membrane through the secretion of extracellular matrix metalloproteases. (3) Intravasation, or the
entry of a cancer cell into the bloodstream, is achieved by the release of molecules, such as vascular endothelial growth factor, that
stimulate angiogenesis. In the bloodstream, cancer cells can interact with platelets (4), which protect the cancer cell from the immune
system. After reaching the secondary site, cancer cells can exit the bloodstream (5) by inducing endothelial cell retraction or death.
Last, the cancer cells undergo a mesenchymal to epithelial transition (6) and continue to proliferate at the metastatic site.157
criteria include (1) positive expression of monoclonal antibodies targeting cytokeratins (CK), a class of intermediate filaments present in epithelial cells; (2) negative expression of a
leukocyte-specific antibody targeting the leukocyte common
antigen, CD45; and (3) positive expression of a nuclear stain,
DAPI. In addition, a cell must have a diameter of at least four
microns to be identified as a CTC.16 Nagrath et al.17 designed a
microfluidic chip consisting of an array of silicon microposts
coated with EpCAM to improve CTC enrichment. This CTCchip captured CTCs at a high purity of 50%, with a capture
efficiency of 65% and a throughput of 2.5 mL/h. Various other
immunoafinity-based technologies have been developed to
enrich CTCs using capture antibodies that target EpCAM,
including a microvortex-generating herringbone chip,18 a magnetic sweeper device,19 nanostructured silicon substrates,20
selectin-coated microtubes,21 and a surface functionalized
457
Harouaka et al.
transition (EMT) by which epithelial tumors cells overcome
the physical constraints of cell-to-cell adhesions and acquire
the motility and invasive characteristics of mesenchymal cells.
EMT is known to be essential for cell and tissue remodeling
during embryogenesis32 and wound healing.33 During EMT,
the expression of epithelial proteins such as E-cadherin is
downregulated,34 while mesenchymal markers such as
N-cadherin are upregulated.35 Mani et al.35 discovered that
EMT generates cells with many of the properties of selfrenewing stem cells. A reverse process of mesenchymal-toepithelial transition (MET) during extravasation, and
colonization has also been proposed. Currently, the EMT/MET
model is gaining more evidentiary support in cell line studies,
animal models, and clinical investigations. However, it is still
unclear how widely this model applies to all metastatic
diseases.
The recent discovery of the presence of cancer stem cells
(CSCs) is another important concept in cancer metastasis.
This rare subpopulation of cells within a tumor retains the
ability to initiate and drive tumor cell expansion, as well as a
capacity for self-renewal and to produce differentiated progeny.36 The existence of CSCs was first proven in acute
myelogenous leukemia37,38 and later verified in breast39 and
brain tumors.4042 Recently, the identification of CSCs has
also been reported in prostate,43 ovarian,44 and pancreatic45
cancers based on the identification of specific cell surface
markers. Conventional cancer treatments have been developed and tested based on their ability to kill the majority of
the tumor population. However, CSCs can escape conventional therapy and have been shown in several tumor types to
be more resistant to standard chemotherapeutic agents.46
Approaches for CTC enrichment that are independent of
expression of EpCAM or other cell surface antigens have
been developed on the basis of intrinsic physical properties
(e.g., size, deformability, density, and electrical properties).
Expression of cell antigens can vary widely among different
cancer types, and immunoaffinity-based enrichment is further
complicated by the loss of epithelial markers during EMT
and with rare CSC phenotypes. Physical enrichment strategies therefore have the potential for greater CTC yield, and
they enable the analysis and evaluation of clinical relevance
of new CTC subpopulations that do not fit within currently
established definitions. There have been numerous reviews
on biological and clinical studies involving CTCs5,4756 and
technological developments for CTC enrichment and detection.52,5761 Readers are urged to consult those references for
more general information, as we will focus specifically on
CTC enrichment based on physical properties.
458
and 5.2 to 10.1 m using light microscopy of cell suspensions.67 Monocytes are among the largest of leukocytes,
with a diameter of 12 to 20 m in blood smears64,66 and 9.7
to 10.5 m measured with flow cytometry.66
It is generally agreed that cell lines originating from
solid tumors are larger than blood cells. Using optical
microscopy, the average diameter of 15 cancer cell lines
commonly used in our laboratory is between 15 and 25 m,
whereas most leukocytes are less than 12 m (unpublished
results). After partial fixation and filtration through tracketched filters, the cross-sectional area of five tumor cell
lines (MCF-7, Hep3B, HepG2, LNCaP, and Hela) has been
measured to be 396 to 796 m2 using microscopy, which
is significantly larger than that of leukocytes (average of
140 m2) measured under the same conditions.68 In a recent
study, the diameters of all cell lines in the NCI-60 panel
were calculated from dielectrophoretic field-flow fractionation (DEP-FFF) and compared with those of various
subtypes of blood cells.69 Cell size extracted from the DEP
data clearly shows the size difference of leukocytes (6.2
9.4 m), leukemia cells (8.915.3 m), and solid tumor cell
lines (11.723.8 m).
In examinations of routinely fixed and stained pathological tissue samples, viable epithelial cells (e.g., solid tumor
cells) always have been larger than virtually all normal
blood cells, including leukocytes.1,70 Measurement from
38 primary tumor tissue biopsy samples and cell lines
grown in semisolid agar medium has resulted in tumor cell
sizes in the range of 12 to 40 m.71 Measurement of 206
biopsy slides of small cell lung carcinoma (SCLC) and large
cell lung carcinoma (LCLC) showed that these cells are on
average 7.2 to 10 m and 15 m in diameter, respectively.72
CTCs from clinical samples can be smaller than tumor
cell lines. A study of imaging CTCs after erythrocytic lysis
measured the cross-sectional area of CTCs from 10 patients
with stage IV prostate cancer to be 89 m2, whereas that of
the LNCaP cell line was measured to be 142.9 m2 under the
same measurement conditions.73 However, the clinical relevance of CTCs of varying sizes is unclear. One group studied
the cytomorphology of CTCs from patient samples of various cancer types. Erythrocytes were lysed first, and then
nucleated cells were plated on slides and CTCs detected by
immunocytochemistry. A laser scanning imaging system was
applied for high-definition imaging of CTCs.74 In nonsmall
lung cancer, smaller CTCs (4.3 vs. 15 mL1 of normal CTCs)
were not related to clinical features, survival, and treatment
variables.75 In a study of CTC detection on slides after erythrocytic lysis, CTC aggregates were found in 43% of 86 blood
samples of breast, nonsmall cell lung, pancreatic, and prostate metastatic patients.76 Area per cell for both single CTCs
and CTCs in aggregates was twice that of leukocytes in the
same field of view, although the length of CTCs in aggregates was smaller than that of single CTCs. It is interesting to
note that in a CTC study using CellSearch, the average single-imaged CTC area from central venous blood (CVB) was
larger than that measured from peripheral venous blood
(PVB) of the same patient (77.59 vs. 62.28 m2).77
Smaller CTC-positive particles (defined as CK+CD45
DAPI+) were reported after immunological CTC enrichment.18 CellSearch excludes CTC-positive particles smaller
than 4 m and regards them as cell fragments.48 It has been
reported that a high percentage of CTCs are in different
stages of apoptosis and apoptotic cells are expected to have
a smaller size, and thus it is possible that the smaller CTCs in
clinical samples can be attributed to cell death. Mild apoptotic changes (e.g., cytoplasmic blebbing) are observed and
acceptable for the CTC definition, whereas cells with apoptotic indicators in the nucleus are excluded from CTC counts
with the assumption that these cells will not have clinical
significance.70 Another potential cause of CTC size variation
is that CTCs may shift from an active state to a dormant state
(cell cycle G0 like), which may increase their metastatic
potential and thus indicate a poorer prognosis for patients.
459
Harouaka et al.
Table 1. Size (Diameter or Area) of Tumor Cells and Major Blood Cells.
Cell Types
Five tumor cell lines
Leukocytes
Tumor cells in the NCI-60 panel
Solid tumor cell lines
Leukemia cell lines
Leukocytes
Tumor primary culture and cell lines
Cell Size
396796 m
Measurement Methods
2
140 m2
11.723.8 m
8.915.3 m
6.29.4 m
1240 m
Lymphocytes
Monocytes
7.210 m
15 m
89 m2
142.9 m2
2
77.59 m (CVB) 62.28 m2(PVB)
7.08.5 m
1020 m
8.79.9 m
7.313.2 m
618 m
7.110.5 m
5.210.1 m
1220 m
9.710.5 m
Electrical measurement69
CTC, circulating tumor cell; CVB, central venous blood; PVB, peripheral venous blood.
460
Harouaka et al.
461
Centrifugation
Microfiltration
Microfiltration technology has demonstrated the greatest
potential for achieving high-throughput continuous processing of large volumes of blood. Since track-etched polymer
filters were first invented in the 1960s,124,125 they have been
widely used in biological research and clinical practice for cell
enrichment. In 1964, Seal126 once again made a pioneering
contribution to the field when he applied these filters to
attempt to capitalize on his stated observations that CTCs
Microfluidics
Microfluidics allows unparalleled control and ability to
manipulate fluids in miniscule volumes. The past decade
has seen many novel technologies proposed for biological
cell sorting and analysis on microchips. Mohamed et al.91,140
used arrays with pillars of varying geometries to fractionate
cells in blood and capture tumor cells (Fig. 2E). They demonstrated the capture of neuroblastoma and other cancer
cell lines from 1:10 diluted blood samples with a processing
rate of 1 mL/h. Tan et al.141 incorporated crescent-shaped
trap arrays with a fixed 5-m gap width within microfluidic
462
Figure 2. Technologies for circulating tumor cell (CTC) enrichment based on physical properties. (A) Density gradient centrifugation with
OncoQuick (reproduced by courtesy of Grenier Bio-One GmbH, Germany). (B) Track-etch filter for the isolation by size of epithelial tumor
cells technique. Arrows indicate (1) tumor cell, (2) filter pores, and (3) leukocytes (reproduced from Vona et al.68 with permission from
Elsevier). (C) 3D-microfilter device for viable CTC enrichment (reproduced from Zheng et al.137 with permission from Springer).
(D) Crescent-shaped traps in a microfluidic device. Scale bar is 20 m (reproduced from Tan et al.141 with permission from Elsevier).
(E) Array of microfluidic traps with varying geometrical restrictions (reproduced from Mohamed et al.91 with permission from Springer).
(F) Laminar vortices generated on a microfluidic device for size-based CTC enrichment (reproduced from Hur et al.144 with permission from
AIP). (G) Spiral microchannel for CTC isolation using centrifugal forces (reproduced from Hou et al.148 with permission from NPG).
(H) Dielectrophoretic (DEP) separation of CTCs using Apostream (reproduced from Gupta et al.62 with permission from AIP).
Downloaded from jla.sagepub.com by guest on January 25, 2014
463
Harouaka et al.
chambers to enrich CTCs from whole blood without preprocessing, reporting a capture rate of greater than 80% and
a purity of more than 80%. This device was used to successfully detect CTCs in 1- to 3-mL blood samples obtained
from patients with metastatic lung cancer.142 Tumor cell
separation based on size and deformability can also be
achieved through cross-flow filtration within a serpentine
microfluidic channel.136
Inertial flow fractionation enables microfluidic enrichment of tumor cells by exploiting hydrodynamic forces to
select for cells of different sizes. Microfluidic channels incorporating contraction and expansion reservoirs were developed for pinch alignment of tumor cells by Bhagat et al.143
and tumor cell trapping in micro-scale vortices by Hur
et al.144 (Fig. 2F). These devices allow a significantly higher
throughput compared with previous microfluidic approaches,
but with potential reductions to cell recovery rate and enrichment against leukocytes. A similar approach was used to classify cells based on deformability.145 Sun et al.146,147 developed
a double-spiral microfluidic channel to hydrodynamically
separate tumor cells using drag forces, reporting a recovery
rate of 88.5% from diluted blood. Hou and colleagues148
incorporated a spiral microfluidic channel to successfully
enrich CTCs and microclusters in 20 blood samples from
patients with metastatic lung cancer (Fig. 2G).
Carefully applied microfluidic approaches are capable of
achieving excellent purity of greater than 80% and high
capture rates with little disturbance to CTCs. However, this
comes at the expense of throughput, requiring either reduced
sample volumes or several hours to process a full tube of
blood. Recently developed hydrodynamic flow-sorting
approaches can achieve a throughput of up to 3 mL/h for
microfluidic systems, but with a reduction in sample purity
to below 10%.
Dielectrophoresis
The phenomenon of dielectrophoresis has inspired novel
approaches for the separation of cells based on their electrical properties. Becker et al.149 fabricated interdigitated gold
electrodes and used them to separate leukemia and breast
cancer cell lines63 from healthy blood cells. Tumor cells
were attracted toward the electric field generated by the
electrodes by pDEP, while other cells were flushed away.
The electric field was then turned off and the cells were
released for collection with a recovery rate of 95%. Building
on this approach, Huang et al.150 proposed DEP-FFF as a
continuous cell fractionation process that did not require
intermittent activation and deactivation of an electrical
field. Gupta et al.62 presented ApoStream, the first commercial instrument for continuous-flow DEP-FFF enrichment
of CTCs (Fig. 2H). They reported a capture efficiency of
more than 70% and viability greater than 97% from cell
lines spiked in 7.5 mL of whole blood after an initial FicollPaque gradient centrifugation step. Preliminary efforts have
Perspectives
Any enrichment technique applied to CTCs will be biased
according to its principle of enrichment. It is therefore
likely that different approaches will result in the enrichment
of different CTCs. These CTC populations might not completely overlap. There is currently no universal marker that
may be used to enrich or detect all CTCs. There is a need for
comparative studies between technologies to learn more
about the variety of cells being captured with the different
enrichment methods.
It is expected that other proposed CTC enrichment and
detection systems will apply the same criteria used by the
current gold standard, CellSearch, for comparison. However,
this is complicated by the fact that there are no standardized
antibodies for CTC detection. CK consists of many different
types and isoforms, and their expression levels vary widely
among different cancer types.151 Moreover, given the variable expression of markers during EMT and within CSCs, the
current definition of a CTC in terms of immunocytochemistry may not include all clinically relevant tumor cells. For
certain cancer types, there are known tissue- or organ-specific markers, such as prostate-specific antigen for prostate
cancer, carcinoembryonic antigen for colon cancer, cancer
antigen-125 for ovarian cancer, and human epidermal growth
factor receptor 2 for breast cancer. These may be used to
identify CTCs of that specific cancer type.
It is important not to lose sight of the overall clinical
purpose of CTC enrichment. Since the ultimate goal of
CTC analysis is to improve cancer diagnosis and treatment
monitoring, it is important to demonstrate a correlation with
disease progression and patient outcome. Promising new
approaches such as enrichment by acoustophoresis152,153
and other emerging technologies must be evaluated with
patient samples to determine clinical relevance. The clinical
relevance of any enriched CTC subpopulation must eventually be established through large-scale clinical trials. To
date, this has only been achieved with the US FDA clearance of CellSearch in breast, prostate, and colorectal
cancers.
464
Funding
The authors disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
work is partially supported by the Pennsylvania State University
start-up fund and the National Cancer Institute of the National
Institutes of Health under award numbers R21CA161835 and
DP2CA174508. The content is solely the responsibility of the
authors and does not necessarily represent the official views of the
National Institutes of Health.
References
1. Weinberg, R. A. The Biology of Cancer; Garland: New York,
2007.
465
Harouaka et al.
20. Wang, S.; Liu, K.; Liu, J.; et al. Highly Efficient Capture of
Circulating Tumor Cells by Using Nanostructured Silicon
Substrates with Integrated Chaotic Micromixers. Angew.
Chem. Int. Ed. Engl. 2011, 50, 30843088.
21. Hughes, A. D.; Mattison, J.; Western, L. T.; et al. Microtube
Device for Selectin-Mediated Capture of Viable Circulating
Tumor Cells from Blood. Clin. Chem. 2012, 58, 846853.
22. Saucedo-Zeni, N.; Mewes, S.; Niestroj, R.; et al. A Novel
Method for the In Vivo Isolation of Circulating Tumor
Cells from Peripheral Blood of Cancer Patients Using a
Functionalized and Structured Medical Wire. Int. J. Oncol.
2012, 41, 1241.
23. Deng, G.; Herrler, M.; Burgess, D.; et al. Enrichment with
Anti-Cytokeratin Alone or Combined with Anti-EpCAM
Antibodies Significantly Increases the Sensitivity for
Circulating Tumor Cell Detection in Metastatic Breast Cancer
Patients. Breast Cancer Res. 2008, 10, R69.
24. Stott, S. L.; Lee, R. J.; Nagrath, S.; et al. Isolation and
Characterization of Circulating Tumor Cells from Patients
with Localized and Metastatic Prostate Cancer. Sci. Transl.
Med. 2010, 2, 25ra23.
25. Kirby, B. J.; Jodari, M.; Loftus, M. S.; et al. Functional
Characterization of Circulating Tumor Cells with a ProstateCancer-Specific Microfluidic Device. Plos One 2012, 7,
e35976.
26. Yu, M.; Bardia, A.; Wittner, B. S.; et al. Circulating Breast
Tumor Cells Exhibit Dynamic Changes in Epithelial and
Mesenchymal Composition. Science 2013, 339, 580584.
27. Pecot, C. V.; Bischoff, F. Z.; Mayer, J. A.; et al. A Novel
Platform for Detection of CK+ and CK CTCs. Cancer
Discov. 2011, 1, 580586.
28. Lara, O.; Tong, X.; Zborowski, M.; et al. Enrichment of
Rare Cancer Cells through Depletion of Normal Cells
Using Density and Flow-Through, Immunomagnetic Cell
Separation. Exp. Hematol. 2004, 32, 891904.
29. Yang, L.; Lang, J. C.; Balasubramanian, P.; et al. Optimization
of an Enrichment Process for Circulating Tumor Cells
from the Blood of Head and Neck Cancer Patients through
Depletion of Normal Cells. Biotechnol. Bioeng. 2009, 102,
521534.
30. Baccelli, I.; Schneeweiss, A.; Riethdorf, S.; et al. Identification
of a Population of Blood Circulating Tumor Cells from Breast
Cancer Patients That Initiates Metastasis in a Xenograft
Assay. Nat. Biotechnol. 2013, 31, 539544.
31. Riethdorf, S.; Fritsche, H.; Muller, V.; et al. Detection of
Circulating Tumor Cells in Peripheral Blood of Patients
with Metastatic Breast Cancer: A Validation Study of the
CellSearch System. Clin. Cancer Res. 2007, 13, 920928.
32. Burdsal, C. A.; Damsky, C. H.; Pedersen, R. A. The Role of
E-cadherin and Integrins in Mesoderm Differentiation and
Migration at the Mammalian Primitive Streak. Development
1993, 118, 829844.
33. Dvorak, H. F. Tumors: Wounds That Do Not Heal: Similarities
between Tumor Stroma Generation and Wound Healing. N.
Engl. J. Med. 1986, 315, 16501659.
34. Batlle, E.; Sancho, E.; Franc, C.; et al. The Transcription
Factor Snail Is a Repressor of E-cadherin Gene Expression in
Epithelial Tumour Cells. Nat. Cell Biol. 2000, 2, 8489.
35. Mani, S. A.; Guo, W.; Liao, M. J.; et al. The EpithelialMesenchymal Transition Generates Cells with Properties of
Stem Cells. Cell 2008, 133, 704715.
36. Chow, E. K.-H. Implication of Cancer Stem Cells in Cancer
Drug Development and Drug Delivery. J. Lab. Autom. 2013,
18, 611.
37. Bonnet, D.; Dick, J. E. Human Acute Myeloid Leukemia Is
Organized as a Hierarchy That Originates from a Primitive
Hematopoietic Cell. Nat. Med. 1997, 3, 730737.
38. Lapidot, T.; Sirard, C.; Vormoor, J.; et al. A Cell Initiating
Human Acute Myeloid Leukaemia after Transplantation into
SCID Mice. Nature 1994, 367, 645648.
39. Al-Hajj, M.; Wicha, M. S.; Benito-Hernandez, A.; et al.
Prospective Identification of Tumorigenic Breast Cancer
Cells. Proc. Natl. Acad. Sci. U. S. A. 2003, 100, 39833988.
40. Hemmati, H. D.; Nakano, I.; Lazareff, J. A.; et al. Cancerous
Stem Cells Can Arise from Pediatric Brain Tumors. Proc.
Natl. Acad. Sci. U. S. A. 2003, 100, 1517815183.
41. Singh, S. K.; Hawkins, C.; Clarke, I. D.; et al. Identification
of Human Brain Tumour Initiating Cells. Nature 2004, 432,
396401.
42. Galli, R.; Binda, E.; Orfanelli, U.; et al. Isolation and
Characterization of Tumorigenic, Stem-Like Neural Precursors
from Human Glioblastoma. Cancer Res. 2004, 64, 70117021.
43. Patrawala, L.; Calhoun, T.; Schneider-Broussard, R.; et al.
Highly Purified CD44+: Prostate Cancer Cells from Xenograft
Human Tumors Are Enriched in Tumorigenic and Metastatic
Progenitor Cells. Oncogene 2006, 25, 16961708.
44. Szotek, P. P.; Pieretti-Vanmarcke, R.; Masiakos, P. T.; et al.
Ovarian Cancer Side Population Defines Cells with Stem
CellLike Characteristics and Mullerian Inhibiting Substance
Responsiveness. Proc. Natl. Acad. Sci. U. S. A. 2006, 103,
1115411159.
45. Li, C.; Heidt, D. G.; Dalerba, P.; et al. Identification of Pancreatic
Cancer Stem Cells. Cancer Res. 2007, 67, 10301037.
46. Dean, M.; Fojo, T.; Bates, S. Tumour Stem Cells and Drug
Resistance. Nat. Rev. Cancer 2005, 5, 275284.
47.
Alix-Panabires, C.; Schwarzenbach, H.; Pantel, K.
Circulating Tumor Cells and Circulating Tumor DNA. Annu.
Rev. Med. 2012, 63, 199215.
48. Attard, G.; de Bono, J. S. Utilizing Circulating Tumor Cells:
Challenges and Pitfalls. Curr. Opin. Genet. Dev. 2011, 21,
5058.
49. Mocellin, S.; Keilholz, U.; Rossi, C. R.; et al. Circulating
Tumor Cells: The Leukemic Phase of Solid Cancers. Trends
Mol. Med. 2006, 12, 130139.
50. Pantel, K.; Alix-Panabieres, C. The Clinical Significance of
Circulating Tumor Cells. Nat. Clin. Pract. Oncol. 2007, 4,
6263.
51. Hayes, D. F.; Smerage, J. Is There a Role for Circulating
Tumor Cells in the Management of Breast Cancer? Clin.
Cancer Res. 2008, 14, 36463650.
52. Arya, S. K.; Lim, B.; Rahman, A. R. A. Enrichment, Detection
and Clinical Significance of Circulating Tumor Cell. Lab
Chip 2013, 13, 19952027.
53. Bednarz-Knoll, N.; Alix-Panabieres, C.; Pantel, K. Clinical
Relevance and Biology of Circulating Tumor Cells. Breast
Cancer Res. 2011, 13, 228.
466
467
Harouaka et al.
91. Mohamed, H.; Murray, M.; Turner, J. N.; et al. Isolation of
Tumor Cells Using Size and Deformation. J. Chromatogr. A
2009, 1216, 82898295.
92. Li, Q. S.; Lee, G. Y.; Ong, C. N.; et al. AFM Indentation
Study of Breast Cancer Cells. Biochem. Biophys. Res.
Commun. 2008, 374, 609613.
93. Guck, J.; Schinkinger, S.; Lincoln, B.; et al. Optical
Deformability as an Inherent Cell Marker for Testing
Malignant Transformation and Metastatic Competence.
Biophys. J. 2005, 88, 36893698.
94. Lincoln, B.; Erickson, H. M.; Schinkinger, S.; et al.
Deformability-Based Flow Cytometry. Cytometry A 2004,
59, 203209.
95. Zhang, W.; Kai, K.; Choi, D. S.; et al. Microfluidics
Separation Reveals the Stem-CellLike Deformability of
Tumor-Initiating Cells. Proc. Natl. Acad. Sci. U. S. A. 2012,
109, 1870718712.
96. Cross, S. E.; Jin, Y. S.; Rao, J.; et al. Nanomechanical
Analysis of Cells from Cancer Patients. Nat. Nanotechnol.
2007, 2, 780783.
97. Cross, S. E.; Jin, Y.-S.; Rao, J.; et al. Applicability of AFM
in Cancer Detection. Nat. Nano 2009, 4, 7273.
98. Weitz, J.; Kienle, P.; Lacroix, J.; et al. Dissemination of
Tumor Cells in Patients Undergoing Surgery for Colorectal
Cancer. Clin. Cancer Res. 1998, 4, 343348.
99. Gossett, D. R.; Henry, T.; Lee, S. A.; et al. Hydrodynamic
Stretching of Single Cells for Large Population Mechanical
Phenotyping. Proc. Natl. Acad. Sci. U. S. A. 2012, 109,
76307635.
100. Ochalek, T.; Nordt, F. J.; Tullberg, K.; et al. Correlation
between Cell Deformability and Metastatic Potential in B16-F1
Melanoma Cell Variants. Cancer Res. 1988, 48, 51245128.
101. Liu, Z.; Huang, F.; Du, J.; et al. Rapid Isolation of Cancer
Cells Using Microfluidic Deterministic Lateral Displacement
Structure. Biomicrofluidics 2013, 7, 011801.
102. Farace, F.; Massard, C.; Vimond, N.; et al. A Direct
Comparison of CellSearch and ISET for Circulating TumourCell Detection in Patients with Metastatic Carcinomas. Br.
J. Cancer 2011, 105, 847853.
103. Weiss, L.; Zeigel, R. Cell Surface Negativity and the Binding
of Positively Charged Particles. J. Cell Physiol. 1971, 77,
179185.
104. Mehrishi, J. N.; Bauer, J. Electrophoresis of Cells and the
Biological Relevance of Surface Charge. Electrophoresis
2002, 23, 19841994.
105. Pethig, R. Review ArticleDielectrophoresis: Status of the
Theory, Technology, and Applications. Biomicrofluidics
2010, 4, 022811.
106. Asami, K. Characterization of Biological Cells by Dielectric
Spectroscopy. J. Noncryst. Solids 2002, 305, 268277.
107. Cheung, K.; Gawad, S.; Renaud, P. Impedance Spectroscopy
Flow Cytometry: On-Chip Label-Free Cell Differentiation.
Cytometry A 2005, 65, 124132.
108. Gawad, S.; Schild, L.; Renaud, P. Micromachined Impedance
Spectroscopy Flow Cytometer for Cell Analysis and Particle
Sizing. Lab Chip 2001, 1, 7682.
109. Sohn, L. L.; Saleh, O. A.; Facer, G. R.; et al. Capacitance
Cytometry: Measuring Biological Cells One by One. Proc.
Natl. Acad. Sci. U. S. A. 2000, 97, 1068710690.
110. Sun, T.; Holmes, D.; Gawad, S.; et al. High Speed MultiFrequency Impedance Analysis of Single Particles in a
Microfluidic Cytometer Using Maximum Length Sequences.
Lab Chip 2007, 7, 10341040.
111. Jones, T. B. Basic Theory of Dielectrophoresis and
Electrorotation. IEEE Eng. Med. Biol. Mag. 2003, 22, 3342.
112. Chan, K. L.; Morgan, H.; Morgan, E.; et al. Measurements of
the Dielectric Properties of Peripheral Blood Mononuclear
Cells and Trophoblast Cells Using AC Electrokinetic
Techniques. Biochim. Biophys. Acta 2000, 1500, 313322.
113. Borgatti, M.; Bianchi, N.; Mancini, I.; et al. New Trends
in Non-invasive Prenatal Diagnosis: Applications of
Dielectrophoresis-Based Lab-on-a-Chip Platforms to the
Identification and Manipulation of Rare Cells. Int. J. Mol.
Med. 2008, 21, 312.
114. Gagnon, Z. R. Cellular Dielectrophoresis: Applications
to the Characterization, Manipulation, Separation and
Patterning of Cells. Electrophoresis 2011, 32, 24662487.
115. Pethig, R. Dielectrophoresis: Using Inhomogeneous AC
Electrical Fields to Separate and Manipulate Cells. Crit.
Rev. Biotechnol. 1996, 16, 331348.
116. Han, A.; Yang, L.; Frazier, A. B. Quantification of the
Heterogeneity in Breast Cancer Cell Lines Using WholeCell Impedance Spectroscopy. Clin. Cancer Res. 2007, 13,
139143.
117. Han, S.-I.; Joo, Y.-D.; Han, K.-H. An Electrorotation
Technique for Measuring the Dielectric Properties of
Cells with Simultaneous Use of Negative Quadrupolar
Dielectrophoresis and Electrorotation. Analyst 2013, 138,
15291537.
118. Shim, S.; Gascoyne, P.; Noshari, J.; et al. Dynamic Physical
Properties of Dissociated Tumor Cells Revealed by
Dielectrophoretic Field-Flow Fractionation. Integr. Biol.
(Camb). 2011, 3, 850862.
119. Shim, S.; Stemke-Hale, K.; Noshari, J.; et al. Dielectrophoresis
Has Broad Applicability to Marker-Free Isolation of Tumor
Cells from Blood by Microfluidic Systems. Biomicrofluidics
2013, 7, 011808.
120. Seal, S. Silicone Flotation: A Simple Quantitative Method
for the Isolation of Free-Floating Cancer Cells from the
Blood. Cancer 1959, 12, 590595.
121. Rosenberg, R.; Gertler, R.; Friederichs, J.; et al. Comparison
of Two Density Gradient Centrifugation Systems for
the Enrichment of Disseminated Tumor Cells in Blood.
Cytometry 2002, 49, 150158.
122. Mller, V.; Stahmann, N.; Riethdorf, S.; et al. Circulating
Tumor Cells in Breast Cancer: Correlation to Bone Marrow
Micrometastases, Heterogeneous Response to Systemic
Therapy and Low Proliferative Activity. Clin. Cancer Res.
2005, 11, 36783685.
123. Balic, M.; Dandachi, N.; Hofmann, G.; et al. Comparison of
Two Methods for Enumerating Circulating Tumor Cells in
Carcinoma Patients. Cytometry B 2005, 68, 2530.
124. Fleischer, R. L.; Price, P. B.; Symes, E. M. Novel Filter for
Biological Materials. Science 1964, 143, 249250.
125. Fleischer, R. L.; Alter, H. W.; Walker, R. M.; et al. Particle
Track Etching. Science 1972, 178, 255.
126. Seal, S. H. A Sieve for the Isolation of Cancer Cells and Other
Large Cells from the Blood. Cancer 1964, 17, 637642.
468
143. Bhagat, A. A. S.; Hou, H. W.; Li, L. D.; et al. Pinched Flow
Coupled Shear-Modulated Inertial Microfluidics for HighThroughput Rare Blood Cell Separation. Lab Chip 2011, 11,
18701878.
144. Hur, S. C.; Mach, A. J.; Di Carlo, D. High-Throughput SizeBased Rare Cell Enrichment Using Microscale Vortices.
Biomicrofluidics 2011, 5, 022206.
145. Hur, S. C.; Henderson-MacLennan, N. K.; McCabe, E. R.;
et al. Deformability-Based Cell Classification and Enrichment
Using Inertial Microfluidics. Lab Chip 2011, 11, 912920.
146. Sun, J.; Li, M.; Liu, C.; et al. Double Spiral Microchannel
for Label-Free Tumor Cell Separation and Enrichment. Lab
Chip 2012, 12, 39523960.
147. Sun, J.; Liu, C.; Li, M.; et al. Size-Based Hydrodynamic Rare
Tumor Cell Separation in Curved Microfluidic Channels.
Biomicrofluidics 2013, 7, 011802.
148. Hou, H. W.; Warkiani, M. E.; Khoo, B. L.; et al. Isolation
and Retrieval of Circulating Tumor Cells Using Centrifugal
Forces. Sci. Rep. 2013, 3, 1259.
149. Becker, F.; Wang, X.-B.; Huang, Y.; et al. The Removal of
Human Leukaemia Cells from Blood Using Interdigitated
Microelectrodes. J. Phys. D 1994, 27, 2659.
150. Huang, Y.; Wang, X.-B.; Becker, F. F.; et al. Introducing
Dielectrophoresis as a New Force Field for Field-Flow
Fractionation. Biophys. J. 1997, 73, 11181129.
151. Moll, R.; Franke, W. W.; Schiller, D. L.; et al. The Catalog
of Human CytokeratinsPatterns of Expression in Normal
Epithelia, Tumors and Cultured Cells. Cell 1982, 31, 1124.
152. Augustsson, P.; Magnusson, C.; Grenvall, C.; et al. In
Extraction of circulating tumor cells from blood using acoustophoresis, Proceedings of the 14th International Conference
on Miniaturized Systems for Chemistry and Life Sciences,
Groningen, The Netherlands, Oct 3-7 2010, pp. 1592-1594.
2010.
153. Augustsson, P.; Magnusson, C.; Nordin, M.; et al.
Microfluidic, Label-Free Enrichment of Prostate Cancer
Cells in Blood Based on Acoustophoresis. Anal. Chem.
2012, 84, 79547962.
154. Budd, G. T.; Cristofanilli, M.; Ellis, M. J.; et al. Circulating
Tumor Cells versus ImagingPredicting Overall Survival
in Metastatic Breast Cancer. Clin. Cancer Res. 2006, 12,
64036409.
155. Nakagawa, T.; Martinez, S. R.; Goto, Y.; et al. Detection
of Circulating Tumor Cells in Early-Stage Breast Cancer
Metastasis to Axillary Lymph Nodes. Clin. Cancer Res.
2007, 13, 41054110.
156. Wendel, M.; Bazhenova, L.; Boshuizen, R.; et al. Fluid Biopsy
for Circulating Tumor Cell Identification in Patients with Earlyand Late-Stage NonSmall Cell Lung Cancer: A Glimpse into
Lung Cancer Biology. Phys. Biol. 2012, 9, 016005.
157. Kalluri, R.; Weinberg, R. A. The Basics of Epithelial
Mesenchymal Transition. J. Clin. Invest. 2009, 119, 14201428.
158 Lu, B.; Xu, T.; Zheng, S.; et al. Parylene membrane slot filter
for the capture analysis and culture of viable circulating tumor
cells, Proceedings of the 23rd International Conference on
Micro Electro Mechanical Systems, IEEE, Hong Kong, China,
Jan 25-28 2010, pp. 935938.