Liquid Biopsy as Novel Tool in Precision Medicine: Origins, Properties, Identification and Clinical Perspective of Cancer’s Biomarkers

Producción CientíficaIn recent years, there has been an increase in knowledge of cancer, accompanied by a technological development that gives rise to medical oncology. An instrument that allows the implementation of individualized therapeutic strategies is the liquid biopsy. Currently, it is the most innovative methodology in medical oncology. Its high potential as a tool for screening and early detection, the possibility of assessing the patient’s condition after diagnosis and relapse, as well as the effectiveness of real-time treatments in different types of cancer. Liquid biopsy is capable of overcoming the limitations of tissue biopsies. The elements that compose the liquid biopsy are circulating tumor cells, circulating tumor nucleic acids, free of cells or contained in exosomes, microvesicle and platelets. Liquid biopsy studies are performed on various biofluids extracted in a non-invasive way, and they can be performed both from the blood and in urine, saliva or cerebrospinal fluid. The development of genotyping techniques, using the elements that make up liquid biopsy, make it possible to detect mutations, intertumoral and intratumoral heterogeneity, and provide molecular information on cancer for application in medical oncology in an individualized way in different types of tumors. Therefore, liquid biopsy has the potential to change the way medical oncology could predict the course of the disease

Investigating the Clinical Utility of Circulating Tumor Cells Via Nanomaterial Based Microfluidic Platforms

To realize personalized treatment for cancer patients, it is crucial to identify and monitor the molecular drivers of tumors. Currently, the molecular analysis of tumors is mostly performed on tissue biopsies. However, due to the invasiveness of the procedure, biopsies typically cannot be obtained repeatedly during the course of treatment and thus cannot reveal the dynamic evolution of tumors on both the genetic and epigenetic levels. There is a pressing need to monitor tumor evolution and to predict the treatment response to guide the clinical decision-making in the practice of personalized therapy. Circulating tumor cells (CTCs) shed from the primary tumor, travel through the blood, and have the potential to cause metastases. As CTCs can be frequently sampled from peripheral blood, CTC isolation and analysis hold great potential as a biomarker in real-time monitoring of tumor status. This work highlights the clinical utility of CTCs for providing prognostic and predictive information for specific treatments in cancer patients. First, dynamic changes of PD-L1(+) CTCs during radio(chemo)therapy were investigated in NSCLC. The real-time monitoring of PD-L1 expression in tumor microenvironment is crucial in guiding the therapeutic management of anti-PD-1/PD-L1 immunotherapy. CTCs were isolated using a nanomaterial based microfluidic device, the GO chip. PD-L1 (+) CTCs were detected in 25 out of 36 (69%) samples from 12 NSCLC patients undergoing radiation or radiochemotherapy. After the initiation of radiation, the proportion of PD-L1 (+) CTCs in total CTCs increased significantly (median 4% vs 24%, P=0.018). Furthermore, patients who were PD-L1 positive (5% of CTCs stained with PD-L1) at baseline had shorter PFS, suggesting the prognostic value of PD-L1 (+) CTCs (6.7 months vs 14.75 months, P = 0.017) Secondly, CTC number and the molecular features of CTCs were monitored at different time points during the course of treatment for locally advanced pancreatic patients. The reduction of CTC numbers after chemotherapy correlated with shorter progressed free survival (PFS), indicating that changes of CTC numbers may be an early indicator for treatment failure (6.5 months vs 13.5 months, P value= 0.002). Furthermore, in the mRNA profiling of CTCs, the expression levels of three genes that have been shown to play a role in drug resistance, BAX, CHK1 and EZH2, are associated with poor prognosis, which could act as makers to predict and monitor the treatment response. Thirdly, this work presents two technical advances of CTC technologies. A highly sensitive microfluidic device to capture and release circulating tumor cells from whole blood of cancer patients is developed. Graphene oxide is embeded into a thermoresponsive polymer film to serve as the first step of an antibody functionalization chemistry. As the temperature decreases to around 5 °C, the polymer film dissolves and detaches from the device and captured cells are released. Over 90% capture efficiency and release efficiency have been achieved. Released CTCs were viable and structurally intact, enabling subsequent analysis such as standard clinical cytopathological and genetic testing. Finally, to develop a high throughput CTC isolation technology, a herringbone mixer is incorporated into the previously developed GO chip and optimized the structure of the herringbone mixer and the channel geometry to maximize the throughput while achieving high capture efficiency (> 80%) and cell viability (> 90%). The time required to process a 1-mL blood sample is reduced to 10 minutes, 6 times faster than in the previous design.PHDChemical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/138765/1/wyangela_1.pd

Benign Breast Tumours - Diagnosis and Management

With improvements in breast imaging, mammography, ultrasound and minimally invasive interventions, the detection of early breast cancer, non-invasive cancers, lesions of uncertain malignant potential, and benign lesions has increased. However, with the improved diagnostic capabilities comes a substantial risk of false-positive benign lesions and vice versa false-negative malignant lesions. A statement is provided on the manifestation, imaging, and diagnostic verification of isolated benign breast tumours that have a frequent manifestation, in addition to general therapy management recommendations. Histological evaluation of benign breast tumours is the most reliable diagnostic method. According to the S3 guideline and information gained from analysis of the literature, preference is to be given to core biopsy for each type of tumour as the preferred diagnostic method. An indication for open biopsy is also to be established should the tumour increase in size in the follow-up interval, after recurring discrepancies in the vacuum biopsy results, or at the request of the patient. As an alternative, minimally invasive procedures such as therapeutic vacuum biopsy, cryoablation or high-intensity focused ultrasound are also becoming possible alternatives in definitive surgical management. The newer minimally invasive methods show an adequate degree of accuracy and hardly any restrictions in terms of post-interventional cosmetics so that current requirements of extensive breast imaging can be thoroughly met

Application of artificial vision algorithms to images of microscopy and spectroscopy for the improvement of cancer diagnosis

El diagnóstico final de la mayoría de tipos de cáncer lo realiza un médico experto en anatomía patológica que examina muestras tisulares o celulares sospechosas extraídas del paciente. Actualmente, esta evaluación depende en gran medida de la experiencia del médico y se lleva a cabo de forma cualitativa mediante técnicas de imagen tradicionales como la microscopía óptica. Esta tarea tediosa está sujeta a altos grados de subjetividad y da lugar a niveles de discordancia inadecuados entre diferentes patólogos, especialmente en las primeras etapas de desarrollo del cáncer. La espectroscopía infrarroja por Transformada de Fourier (siglas FTIR en inglés) es una tecnología ampliamente utilizada en la industria que recientemente ha demostrado una capacidad creciente para mejorar el diagnóstico de diferentes tipos de cáncer. Esta técnica aprovecha las propiedades del infrarrojo medio para excitar los modos vibratorios de los enlaces químicos que forman las muestras biológicas. La principal señal generada consiste en un espectro de absorción que informa sobre la composición química de la muestra iluminada. Los microespectrómetros FTIR modernos, compuestos por complejos componentes ópticos y detectores matriciales de alta sensibilidad, permiten capturar en un laboratorio de investigación común imágenes hiperespectrales de alta calidad que aúnan información química y espacial. Las imágenes FTIR son estructuras de datos ricas en información que se pueden analizar individualmente o junto con otras modalidades de imagen para realizar diagnósticos patológicos objetivos. Por lo tanto, esta técnica de imagen emergente alberga un alto potencial para mejorar la detección y la graduación del riesgo del paciente en el cribado y vigilancia de cáncer. Esta tesis estudia e implementa diferentes metodologías y algoritmos de los campos interrelacionados de procesamiento de imagen, visión por ordenador, aprendizaje automático, reconocimiento de patrones, análisis multivariante y quimiometría para el procesamiento y análisis de imágenes hiperespectrales FTIR. Estas imágenes se capturaron con un moderno microscopio FTIR de laboratorio a partir de muestras de tejidos y células afectadas por cáncer colorrectal y de piel, las cuales se prepararon siguiendo protocolos alineados con la práctica clínica actual. Los conceptos más relevantes de la espectroscopía FTIR se investigan profundamente, ya que deben ser comprendidos y tenidos en cuenta para llevar a cabo una correcta interpretación y tratamiento de sus señales especiales. En particular, se revisan y analizan diferentes factores fisicoquímicos que influyen en las mediciones espectroscópicas en el caso particular de muestras biológicas y pueden afectar críticamente su análisis posterior. Todos estos conceptos y estudios preliminares entran en juego en dos aplicaciones principales. La primera aplicación aborda el problema del registro o alineación de imágenes hiperespectrales FTIR con imágenes en color adquiridas con microscopios tradicionales. El objetivo es fusionar la información espacial de distintas muestras de tejido medidas con esas dos modalidades de imagen y centrar la discriminación en las regiones seleccionadas por los patólogos, las cuales se consideran más relevantes para el diagnóstico de cáncer colorrectal. En la segunda aplicación, la espectroscopía FTIR se lleva a sus límites de detección para el estudio de las entidades biomédicas más pequeñas. El objetivo es evaluar las capacidades de las señales FTIR para discriminar de manera fiable diferentes tipos de células de piel que contienen fenotipos malignos. Los estudios desarrollados contribuyen a la mejora de métodos de decisión objetivos que ayuden al patólogo en el diagnóstico final del cáncer. Además, revelan las limitaciones de los protocolos actuales y los problemas intrínsecos de la tecnología FTIR moderna, que deberían abordarse para permitThe final diagnosis of most types of cancers is performed by an expert clinician in anatomical pathology who examines suspicious tissue or cell samples extracted from the patient. Currently, this assessment largely relies on the experience of the clinician and is accomplished in a qualitative manner by means of traditional imaging techniques, such as optical microscopy. This tedious task is subject to high degrees of subjectivity and gives rise to suboptimal levels of discordance between different pathologists, especially in early stages of cancer development. Fourier Transform infrared (FTIR) spectroscopy is a technology widely used in industry that has recently shown an increasing capability to improve the diagnosis of different types of cancer. This technique takes advantage of the ability of mid-infrared light to excite the vibrational modes of the chemical bonds that form the biological samples. The main generated signal consists of an absorption spectrum that informs of the chemical composition of the illuminated specimen. Modern FTIR microspectrometers, composed of complex optical components and high-sensitive array detectors, allow the acquisition of high-quality hyperspectral images with spatially-resolved chemical information in a common research laboratory. FTIR images are information-rich data structures that can be analysed alone or together with other imaging modalities to provide objective pathological diagnoses. Hence, this emerging imaging technique presents a high potential to improve the detection and risk stratification in cancer screening and surveillance. This thesis studies and implements different methodologies and algorithms from the related fields of image processing, computer vision, machine learning, pattern recognition, multivariate analysis and chemometrics for the processing and analysis of FTIR hyperspectral images. Those images were acquired with a modern benchtop FTIR microspectrometer from tissue and cell samples affected by colorectal and skin cancer, which were prepared by following protocols close to the current clinical practise. The most relevant concepts of FTIR spectroscopy are thoroughly investigated, which ought to be understood and considered to perform a correct interpretation and treatment of its special signals. In particular, different physicochemical factors are reviewed and analysed, which influence the spectroscopic measurements for the particular case of biological samples and can critically affect their later analysis. All these knowledge and preliminary studies come into play in two main applications. The first application tackles the problem of registration or alignment of FTIR hyperspectral images with colour images acquired with traditional microscopes. The aim is to fuse the spatial information of distinct tissue samples measured by those two imaging modalities and focus the discrimination on regions selected by the pathologists, which are meant to be the most relevant areas for the diagnosis of colorectal cancer. In the second application, FTIR spectroscopy is pushed to their limits of detection for the study of the smallest biomedical entities. The aim is to assess the capabilities of FTIR signals to reliably discriminate different types of skin cells containing malignant phenotypes. The developed studies contribute to the improvement of objective decision methods to support the pathologist in the final diagnosis of cancer. In addition, they reveal the limitations of current protocols and intrinsic problems of modern FTIR technology, which should be tackled in order to enable its transference to anatomical pathology laboratories in the future.El diagnòstic final de la majoria de tipus de càncer ho realitza un metge expert en anatomia patològica que examina mostres tissulars o cel¿lulars sospitoses extretes del pacient. Actualment, aquesta avaluació depèn en gran part de l'experiència del metge i es porta a terme de forma qualitativa mitjançant tècniques d'imatge tradicionals com la microscòpia òptica. Aquesta tasca tediosa està subjecta a alts graus de subjectivitat i dóna lloc a nivells de discordança inadequats entre diferents patòlegs, especialment en les primeres etapes de desenvolupament del càncer. L'espectroscòpia infraroja per Transformada de Fourier (sigles FTIR en anglès) és una tecnologia àmpliament utilitzada en la indústria que recentment ha demostrat una capacitat creixent per millorar el diagnòstic de diferents tipus de càncer. Aquesta tècnica aprofita les propietats de l'infraroig mitjà per excitar els modes vibratoris dels enllaços químics que formen les mostres biològiques. El principal senyal generat consisteix en un espectre d'absorció que informa sobre la composició química de la mostra il¿luminada. Els microespectrómetres FTIR moderns, compostos per complexos components òptics i detectors matricials d'alta sensibilitat, permeten capturar en un laboratori d'investigació comú imatges hiperespectrals d'alta qualitat que uneixen informació química i espacial. Les imatges FTIR són estructures de dades riques en informació que es poden analitzar individualment o juntament amb altres modalitats d'imatge per a realitzar diagnòstics patològics objectius. Per tant, aquesta tècnica d'imatge emergent té un alt potencial per a millorar la detecció i la graduació del risc del pacient en el cribratge i vigilància de càncer. Aquesta tesi estudia i implementa diferents metodologies i algoritmes dels camps interrelacionats de processament d'imatge, visió per ordinador, aprenentatge automàtic, reconeixement de patrons, anàlisi multivariant i quimiometria per al processament i anàlisi d'imatges hiperespectrals FTIR. Aquestes imatges es van capturar amb un modern microscopi FTIR de laboratori a partir de mostres de teixits i cèl¿lules afectades per càncer colorectal i de pell, les quals es van preparar seguint protocols alineats amb la pràctica clínica actual. Els conceptes més rellevants de l'espectroscòpia FTIR s'investiguen profundament, ja que han de ser compresos i tinguts en compte per dur a terme una correcta interpretació i tractament dels seus senyals especials. En particular, es revisen i analitzen diferents factors fisicoquímics que influeixen en els mesuraments espectroscòpiques en el cas particular de mostres biològiques i poden afectar críticament la seua anàlisi posterior. Tots aquests conceptes i estudis preliminars entren en joc en dues aplicacions principals. La primera aplicació aborda el problema del registre o alineació d'imatges hiperespectrals FTIR amb imatges en color adquirides amb microscopis tradicionals. L'objectiu és fusionar la informació espacial de diferents mostres de teixit mesurades amb aquestes dues modalitats d'imatge i centrar la discriminació en les regions seleccionades pels patòlegs, les quals es consideren més rellevants per al diagnòstic de càncer colorectal. En la segona aplicació, l'espectroscòpia FTIR es porta als seus límits de detecció per a l'estudi de les entitats biomèdiques més xicotetes. L'objectiu és avaluar les capacitats dels senyals FTIR per discriminar de manera fiable diferents tipus de cèl¿lules de pell que contenen fenotips malignes. Els estudis desenvolupats contribueixen a la millora de mètodes de decisió objectius que ajuden el patòleg en el diagnòstic final del càncer. A més, revelen les limitacions dels protocols actuals i els problemes intrínsecs de la tecnologia FTIR moderna, que haurien d'abordar per permetre la seva transferència als laboratoris d'anatomia patològica en el futur.Peñaranda Gómez, FJ. (2018). Application of artificial vision algorithms to images of microscopy and spectroscopy for the improvement of cancer diagnosis [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/99748TESI

Advances in Concepts, Ideas, and Methods Relevant to Fine Needle Aspiration Biopsy of Thyroid and Cervical Lymph Node

With the increasingly used semi-thyroidectomy and rapid progress in ultrasound-guided thermal ablation therapy for treatment of papillary thyroid carcinoma (PTC) and cervical lymph node metastasis from PTC, ultrasound-guided fine needle aspiration biopsy (FNAB) has got the mainstream position in pre-treatment cytopathologic diagnosis of PTC. How to acquire adequate and qualified cellular specimen for cytological examination has been described in several published expert consensus and practice guidelines. However, new issues continue to emerge in the real world of thyroid FNAB practice, and most of them are rooted in the perception and skills of the physician or technician who conduct FNAB. In this chapter, a series of new concept, idea, and technical methods are to be introduced and discussed. We believe that properly addressing these issues will facilitate the better implementation of FNAB and promote the new therapeutic modalities such as the thermal ablation to better progress

Comparative study between fine needle aspiration cytology and tru-cut biopsy in the diagnostic accuracy of breast cancer in Coimbatore Medical College Hospital.

A method of definitive diagnosis is essential for the patients who present with palpable breast lump at the outpatient department. The method must be accurate, easy to perform and acceptable to the patient, safe, can be carried out in a busy clinic setting and must not require too much preparation or expensive equipment.1,2 A study, to compare the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) and Tru-cut Biopsy, was conducted to differentiate between benign & malignant lesions of palpable lump in breast and to evaluate the validity of FNAC in arriving at a diagnosis with histopathological correlation The diagnostic efficacy, sensitivity and specificity observed in this study by FNAC were comparable to that observed in Tru-cut biopsy and those given in other texts. Hence FNAC stands as an effective and valid tool as the first line diagnostic modality in the preoperative diagnosis of both benign and malignant lesions. A positive correlation was also observed between Robinson cytological grading system and Scarff Bloom Richardson histological grading system. Discordance between cytologic grading and histologic grading was seen only in few cases

The Malignant Pleural Effusion as a Model to Investigate Intratumoral Heterogeneity in Lung Cancer

Malignant Pleural Effusions (MPE) may be useful as a model to study hierarchical progression of cancer and/or intratumoral heterogeneity. To strengthen the rationale for developing the MPE-model for these purposes, we set out to find evidence for the presence of cancer stem cells (CSC) in MPE and demonstrate an ability to sustain intratumoral heterogeneity in MPE-primary cultures. Our studies show that candidate lung CSC-expression signatures (PTEN, OCT4, hTERT, Bmi1, EZH2 and SUZ12) are evident in cell pellets isolated from MPE, and MPE-cytopathology also labels candidate-CSC (CD44, cMET, MDR-1, ALDH) subpopulations. Moreover, in primary cultures that use MPE as the source of both tumor cells and the tumor microenvironment (TME), candidate CSC are maintained over time. This allows us to live-sort candidate CSC-fractions from the MPE-tumor mix on the basis of surface markers (CD44, c-MET, uPAR, MDR-1) or differences in xenobiotic metabolism (ALDH). Thus, MPE-primary cultures provide an avenue to extract candidate CSC populations from individual (isogenic) MPE-tumors. This will allow us to test whether these cells can be discriminated in functional bioassays. Tumor heterogeneity in MPE-primary cultures is evidenced by variable immunolabeling, differences in colony-morphology, and differences in proliferation rates of cell subpopulations. Collectively, these data justify the ongoing development of the MPE-model for the investigation of intratumoral heterogeneity, tumor-TME interactions, and phenotypic validation of candidate lung CSC, in addition to providing direction for the pre-clinical development of rational therapeutics

The peroxisome: an update on mysteries 2.0

This is the final version of the article. Available from Springer Verlag via the DOI in this record.Peroxisomes are key metabolic organelles, which contribute to cellular lipid metabolism, e.g. the β-oxidation of fatty acids and the synthesis of myelin sheath lipids, as well as cellular redox balance. Peroxisomal dysfunction has been linked to severe metabolic disorders in man, but peroxisomes are now also recognised as protective organelles with a wider significance in human health and potential impact on a large number of globally important human diseases such as neurodegeneration, obesity, cancer, and age-related disorders. Therefore, the interest in peroxisomes and their physiological functions has significantly increased in recent years. In this review, we intend to highlight recent discoveries, advancements and trends in peroxisome research, and present an update as well as a continuation of two former review articles addressing the unsolved mysteries of this astonishing organelle. We summarise novel findings on the biological functions of peroxisomes, their biogenesis, formation, membrane dynamics and division, as well as on peroxisome-organelle contacts and cooperation. Furthermore, novel peroxisomal proteins and machineries at the peroxisomal membrane are discussed. Finally, we address recent findings on the role of peroxisomes in the brain, in neurological disorders, and in the development of cancer.This work was supported by the Biotechnology and Biological Sciences Research Council (BB/K006231/1, BB/N01541X/1) and MRC CiC 08135, University of Exeter (to M.S.). M.I. is supported by the German Research Foundation (DFG grant 397476530) and MEAMEDMA Anschubförderung, Medical Faculty Mannheim, University of Heidelberg

A Single-Molecule Bioelectronic Portable Array for Early Diagnosis of Pancreatic Cancer Precursors

A cohort of 47 patients is screened for pancreatic cancer precursors with a portable 96-well bioelectronic sensing-array for single-molecule assay in cysts fluid and blood plasma, deployable at point-of-care (POC). Pancreatic cancer precursors are mucinous cysts diagnosed with a sensitivity of at most 80% by state-of-the-art cytopathological molecular analyses (e.g., KRASmut DNA). Adding the simultaneous assay of proteins related to malignant transformation (e.g., MUC1 and CD55) is deemed essential to enhance diagnostic accuracy. The bioelectronic array proposed here, based on single-molecule-with-a-large-transistor (SiMoT) technology, can assay both nucleic acids and proteins at the single-molecule limit-of-identification (LOI) (1% of false-positives and false-negatives). It comprises an enzyme-linked immunosorbent assay (ELISA)-like 8 × 12-array organic-electronics disposable cartridge with an electrolyte-gated organic transistor sensor array, and a reusable reader, integrating a custom Si-IC chip, operating via software installed on a USB-connected smart device. The cartridge is complemented by a 3D-printed sensing gate cover plate. KRASmut, MUC1, and CD55 biomarkers either in plasma or cysts-fluid from 5 to 6 patients at a time, are multiplexed at single-molecule LOI in 1.5 h. The pancreatic cancer precursors are classified via a machine-learning analysis resulting in at least 96% diagnostic-sensitivity and 100% diagnostic-specificity. This preliminary study opens the way to POC liquid-biopsy-based early diagnosis of pancreatic-cancer precursors in plasma