Circulating tumor cells (CTC)

Circulating tumor cells are full of information for the fight against cancer.
Dive into the world of microfluidics applied to their study.

Microfluidic capture of circulating tumor cells

Circulating tumor cells (CTCs) are of great interest, no doubt because of the disease to which they refer. Cells detached from the primary tumor and circulating in the bloodstream – hence their name – they offer unhoped-for prospects for progress in our understanding of cancer.

Nevertheless, their rarity compared to normal blood cells makes their capture, isolation and characterization particularly delicate.

Circulating tumor cells capture, CTC

It is precisely to meet this challenge that microfluidics is being increasingly mobilized by various research teams. Thanks to its versatility, it promises not only easier, but also highly specific CTC capture.

Thanks to its contribution, access to an in-depth analysis of the genetic profile of these cells, their properties and their evolution is now more concrete. The development of personalized medicine for patient treatment and follow-up is also becoming more tangible.

Characteristics of circulating tumor cells

The cells that cause metastases

More mobile than normal cells, circulating tumor cells leave the primary tumor and enter the bloodstream. As they are then able to establish themselves in sites distinct from the first, they continue to grow, becoming the breeding ground for metastases and, by extension, the formation of new tumors.

Cellular diversity equivalent to the variety of cancers

Given the number of cancers that can affect human beings, it’s easy to understand why these cells can be so varied. Some are skin cells, others are muscle cells, and so can vary considerably in size. But there’s one point on which they all agree, and that’s their origin. Since they originate from the primary tumor, they also possess characteristics similar to those of the primary tumor, providing essential new information for cancer monitoring, diagnosis and treatment.

Why are they so valuable?

By their very nature circulating tumor cells offer exceptional potential for understanding and treating the disease. Among the main reasons for their in-depth study:

  • Metastatic spread.
    In other words, the ability of cancer cells to colonize other parts of the body.
  • A representative sample.
    They provide a reliable representative sample of the tumor cells active in the body, as well as information on the genetic and biological diversity of the disease.
  • Early detection of metastases,
    It can also help identify metastases at an early stage, an essential step in intervening before the disease becomes more difficult to treat.
  • Assessment of response to treatment.
    Changes in their number or characteristics can provide clues as to the efficacy of a given therapy, and thus lead to more rapid adaptation of treatment strategies in the event of non-response by the organism.
  • Better disease surveillance.
    It can help anticipate possible relapses or the emergence of resistance to treatment, enabling proactive disease management.

Microfluidic devices for capturing circulating tumor cells

A few examples

As research in this field is constantly evolving, it is possible to count several tumor cell capture devices using microfluidics, including those based on CTC size or affinity. Among the most popular are:

  • Integrated Ferrohydrodynamic Cell Separation (iFCS). Based on affinity, it can capture all CTC subtypes, and determine which are the best markers of disease progression or relapse.
  • The EPHESIA system, also based on affinity. It consists of a microplate – a kind of cellular sieve – made up of a network of columns of magnetic microbeads carrying antibodies directed against a tumor cell-specific surface protein.
  • The size-based Clearcell® system separates CTCs from white blood cells.

Limits already being improved

Microfluidic devices for capturing circulating tumor cells naturally have certain limitations. We could also talk about capture efficiency, which in terms of percentage of recovery, purity and total absence of contaminants in the CTCs captured, can be debatable. Performance variability is also a recurring problem that changes according to various factors, such as the physical properties of CTCs, the complexity of blood samples and the operating conditions of microfluidic devices.

Nevertheless, when we summarize all the research efforts made over the last decade to develop robust methods for capturing CTCs, we can only imagine the progress that will be made in the future to overcome these weaknesses.

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