Master of Science / Department of Chemistry / Christopher T. Culbertson / Circulating tumor cells (CTCs) have become a key component in the identification and treatment of cancer. Once dislodged from the main tumor, CTCs travel through the bloodstream and cause metastasis. Early detection and identification of these cells can help in the evaluation and prognosis of various types of cancer, as well as assisting in patient treatments by determining the spread of the disease. Here, a high-throughput microfluidic analysis technique is described that can efficiently detect and identify cells, with the specific identification of CTCs as a future application through fluorescent labeling in mind. As proof of principle, the device has been shown to detect and characterize individual human Jurkat (T-lymphocyte) cells at a rate of 100 cells/minute. The device employs micro-scale flow focusing to isolate individual cells. The cells are detected using both light scattering and laser-induced fluorescence to evaluate cell size and surface functionality.

Circulating tumor cells (CTCs) are known to escape from the primary tumor site and may settle down at the distant organ to grow a second tumor. CTCs are one of causes initiating carcinoma metastasis. Detection of CTCs has been considered to be valuable for cancer management, including diagnosis, prognosis, and clinical treatment management. However, efficient isolation, enumeration, characterization, and genetic analysis of CTCs in whole-blood samples from cancer patients are very challenging due to their extremely low concentration and rare nature (per CTC in blood cells is 1:106–109). With the increasing worldwide death rate associated with cancer, there is a desperate demand for a high-sensitivity, high-throughput, and low-cost detection and separation system. My doctoral research focused on the design and fabrications of the screening system for the detection of CTCs with further analysis of captured CTCs, such as immunofluoresce staining and fluorescence in-situ hybridization (FISH). The distinct significance of this research is that the development of the computer-controlled rotational holder with a series of six inverted microfluidic chips reduced the cost by significantly reducing the consumption of magnetic carriers (25% of the consumed amount used in the commercial CellSearch® system), increasing the capture efficiency by manipulating the blood sedimentation in the microchannel, enhancing the system stability by integrating the micromagnets on the plain glass slide substrate, and achieving high throughput because of the high flow rate (2.5 mL/hr) and large screening volume (screening up to six chips in parallel with each containing 2.5 mL of blood). Immunofluorescence staining and the FISH method have been performed to prove the capability of the system. In addition, the system has been successfully applied for patient samples screening. The incorporation of micromagnets has demonstrated that micromagnets provide localized magnetic forces to scatter the target cancer cells and free nanoparticles throughout the whole channel substrate to increase the channel space usage by 13%. Four cancer cell lines, including COLO 205 (colorectal cancer), SK-BR-3 (breast cancer), MCF-7 (breast cancer), and PC3 (prostate cancer), were spiked in blood samples from healthy donors to verify high capture efficiency of the developed system. On average, over a 97% capture rate was demonstrated for all cell lines. Moreover, the developed screening system has been successfully screened over 40 patient samples, including metastatic lung cancer, breast cancer, prostate cancer, and colorectal cancer. After capture of CTCs, immunofluorescence staining was used to identified the captured cancer cells and the FISH method was performed to characterize the isolated cancer cells by studying the gene expression of CTCs from breast cancer. The proposed automated immunomagnetic microchip-based screening system shows high capture efficiency (average 97% for three spiked cell lines), high throughput (15 mL of blood sample per screening), high sensitivity, high specificity, and low nanoparticle consumption (75% less than CellSearch® system). The screening system provides great promise as a clinical tool for early cancer diagnosis, diagnosis, personalized therapy, and treatment monitoring. / text

Colorectal cancer (CRC) is the third most common cancer worldwide; it is responsible for nearly 10% of all newly diagnosed cancers and is the second most cause of cancer related death in Europe. Biomarkers for therapy guidance, targeted therapy and survival prognosis are still limited. As CRC is a heterogeneous disease, different parts of the tumor might have varying molecular characteristics which may change during therapy or disease progression. Through solid biopsies and screenings, these local or temporal differences are impossible to monitor. To facilitate detection of these possible temporal changes, a regularly and non-invasively accessible biomarker is required for disease monitoring. Circulating tumor cells (CTCs) might represent such a biomarker as they have been shown to be fluid surrogates of the solid tumor. EpCAM positive CTCs have shown to be prognostic in CRC for survival, but their full potential has not yet been evaluated further. By using the High Definition Single Cell Analysis (HD-SCA) workflow, we were able to analyze the entire spectrum of CTCs and categorize them as the regular CTCs (HD-CTC), CTCs with a smaller nuclear area (CTC-Small), CTCs with low expression of epithelial marker cytokeratin (CTC-LowCK) and CTCs undergoing apoptosis and therefore releasing cell free DNA...

Colorectal cancer (CRC) is the third most common cancer worldwide; it is responsible for nearly 10% of all newly diagnosed cancers and is the second most cause of cancer related death in Europe. Biomarkers for therapy guidance, targeted therapy and survival prognosis are still limited. As CRC is a heterogeneous disease, different parts of the tumor might have varying molecular characteristics which may change during therapy or disease progression. Through solid biopsies and screenings, these local or temporal differences are impossible to monitor. To facilitate detection of these possible temporal changes, a regularly and non-invasively accessible biomarker is required for disease monitoring. Circulating tumor cells (CTCs) might represent such a biomarker as they have been shown to be fluid surrogates of the solid tumor. EpCAM positive CTCs have shown to be prognostic in CRC for survival, but their full potential has not yet been evaluated further. By using the High Definition Single Cell Analysis (HD-SCA) workflow, we were able to analyze the entire spectrum of CTCs and categorize them as the regular CTCs (HD-CTC), CTCs with a smaller nuclear area (CTC-Small), CTCs with low expression of epithelial marker cytokeratin (CTC-LowCK) and CTCs undergoing apoptosis and therefore releasing cell free DNA...

L’apparition de la technique CellSearch® a permis d’obtenir la sensibilité et la spécificité suffisantes et de détecter les CTCs en ciblant les marqueurs spécifiques dans le sang périphérique. Elle permet la numération et l’étude morphologique des CTCs qui est largement utilisée et validée. Nous décrivons une adaptation de la méthode CellSearch® pour détecter les cellules tumorale chez les LM (métastases leptoméningées) patients atteints de cancers du sein, du poumon et mélanomes, qui semble atteindre une sensibilité améliorée en comparaison avec la cytologie conventionnelle. Nous présentons également un cas clinique pour la détection de cellules tumorales dans l’ascite et du sang chez un patient avec le cancer de l’oesophage métastatique. De plus, la détection des cellules tumorales dans le redon chez les patients subis une chirurgie de la tête et du cou a été également réalisée. En utilisant cette méthode, les résultats sont non seulement quatitatifs, mais aussi quantitatifs avec des images numériques de chaque cellule, et des résultats séquentiels ont été étudiés chez certains patients atteints de cancer du sein, de cancer du poumon et de mélanome. Les données ont montré des changements dynamiques des nombres de cellules tumorales détectées dans le LCR, mais leurs corrélations avec la réponse au traitement ou la progression de la maladie ont besoin des études supplémentaires plus contrôlées avec une grande cohorte de patients. La mise en évidence de cette application serait importante en clinique pour le diagnostic, le pronostic et le traitement des patients atteints de cancer avec des métastases aux niveaux du SNC, du péritoine / The introduction of CellSearch® technology allows to give sufficient sensitivity and specificity and to detect CTCs targeting specific markers in peripheral blood. The enumeration and morphological study of CTCs are widely used and validated. We described an adaptation of the CellSearch® method to detect tumor cells in LM (leptomeningeal metastases) patients with breast cancer, lung cancer and melanoma, which appeared to achieve an improved sensitivity in comparison with conventional cytology. We also presented a case report for the detection of tumor cells in the ascites and blood of a patient with metastatic oesophageal cancer. Furthermore, the detection of tumor cells in aspirative drains after neck dissectionin from the patients undergoing surgery for head and neck cancer was also performed. Using this method, the results were not only quatitative but also quantitative with digital images of each cell, and sequential results were studied in some patients with breast cancer, lung cancer and melanoma. The data showed dynamic changes of the numbers of tumor cells detected in CSF, but their correlation with the response to treatment or disease progression need additional more controlled studies with a large cohort of patients. The application would be important for the clinical diagnosis, prognosis and treatment of cancer patients with CNS metastases and peritoneal metastases

Contexte : Le mélanome est un cancer agressif chez l’homme, développé aux dépens des mélanocytes. L’identification de la mutation BRAF conditionne la prescription d’une thérapie ciblée. L’objectif de ce travail a été de mettre au point dans les tissus tumoraux et dans le sang (cellules tumorales circulantes, ADN libre tumoral plasmatique) des approches technologiques de biologie moléculaire et d’immunohistochimie (IHC) pour identifier des biomarqueurs prédictifs d’une réponse ou de résistance thérapeutique. Nous montrons que l’IHC BRAF (clone VE1, Roche, Ventana) pourrait remplacer l’analyse en biologie moléculaire dans certaines indications, notamment sur un matériel tumoral de petite taille. Parallèlement, nous montrons que la présence de cellules mélanocytaires circulantes [détectées par cytomorphologie (Technique ISET)] chez des patients atteints de mélanome métastatique est un facteur prédictif indépendant de mauvais pronostic de la survie globale. Enfin, nous montrons que le système Biocartis Idylla™ (processus automatisé couplant l’extraction, le séquençage et l’analyse de l’ADN) est sensible et spécifique pour la détection plasmatique des mutations BRAF et NRAS et que cette technique pourrait être indiquée dans le suivi de la maladie résiduelle (apparition de résistance) après traitement des patients atteints de mélanomes métastatiques. Conclusion : L’identification des biomarqueurs tissulaires et sanguins (BRAF, NRAS et CTC) permettent : 1- Une optimisation des délais diagnostiques de la mutation BRAF/NRAS – 2) L’identification de facteurs de mauvais pronostic – 3) De détecter une récidive précoce et de suivre la maladie résiduelle après traitement / Background: Knowledge of the BRAFV600E status is mandatory in metastatic melanoma patients (MMP). Molecular biology is currently the gold standard method for status assessment. The aim of this work was to assess and compare several methods of molecular biology and immunohistochemistry (IHC) in tissue and blood (cell-free circulating tumor DNA, circulating tumor cell (CTC)) to identify predictive biomarkers of response or resistance to targeted treatment. Results: We showed that BRAFV600 IHC could be a substitute for molecular biology in the initial assessment of the BRAFV600E status in MPP. We also found that the presence of circulating tumor cell detetcted by a cytomorphological approach ISET (Isolation by Size of Epithelial Tumor Cell – Rarecells Diagnostics, Paris, France) in MMP is an independent predictor of shorter survival. Then, in a monocentric study conducted at the University of Nice Hospital, we evaluated a novel and fully automated CE-IVD PCR-based system (IdyllaTM, Biocartis, Mechelen, Belgium) for plasmatic BRAF and NRAS mutation detection. We showed that this technology is highly sensitive and specific and provide promising potential to assess tumor progression, identify targets for therapy, and evaluate clinical response to treatment. In conclusion, identification of tissue and blood biomarkers with these technologies allow a quick turnaround-time to BRAF/NRAS diagnosis and improve monitoring of treatment response and development of resistance in metastatic melanoma patients

Epigenetic modifications, such as DNA methylation and histone modifications, play important roles in gene expression and regulation, and are highly involved in cellular processes such as stem cell pluripotency/differentiation and tumorigenesis. Chromatin immunoprecipitation (ChIP) is the technique of choice for examining in vivo DNA-protein interactions and has been a great tool for studying epigenetic mechanisms. However, conventional ChIP assays require millions of cells for tests and are not practical for examination of samples from lab animals and patients. Automated microfluidic chips offer the advantage to handle small sample sizes and facilitate rapid reaction. They also eliminate cumbersome manual handling. In this report, I will talk about three different projects that utilized microfluidic immunoprecipitation followed by next genereation sequencing technologies to enable low input and high through epigenomics profiling. First, I examined RNA polymerase II transcriptional regulation with microfluidic chromatin immunoprecipitation followed by next generation sequencing (ChIP-seq) assays. Second, I probed the temporal dynamics in the DNA methylome during cancer development using a transgenic mouse model with microfluidic methylated DNA immunoprecipitation followed by next generation sequencing (MeDIP-seq) assays. Third, I explored negative enrichment of circulating tumor cells (CTCs) followed by microfluidic ChIP-seq technology for studying temporal dynamic histone modification (H3K4me3) of patient-derived tumor xenograft on an immunodeficient mouse model during the course of cancer metastasis. In the first study, I adapted microfluidic ChIP-seq devices to achieve ultrahigh sensitivity to study Pol2 transcriptional regulation from scarce cell samples. I dramatically increased the assay sensitivity to an unprecedented level (~50 K cells for pol2 ChIP-seq). Importantly, this is three orders of magnitude more sensitive than the prevailing pol2 ChIP-seq assays. I showed that MNase digestion provided better ChIP-seq signal than sonication, and two-steps fixation with MNase digestion provided the best ChIP-seq quality followed by one-step fixation with MNase digestion, and lastly, no fixation with MNase digestion. In the second study, I probed dynamic epigenomic changes during tumorigenesis using mice often require profiling epigenomes using a tiny quantity of tissue samples. Conventional epigenomic tests do not support such analysis due to the large amount of materials required by these assays. In this study, I developed an ultrasensitive microfluidics-based methylated DNA immunoprecipitation followed by next-generation sequencing (MeDIP-seq) technology for profiling methylomes using as little as 0.5 ng DNA (or ~100 cells) with 1.5 h on-chip process for immunoprecipitation. This technology enabled me to examine genome-wide DNA methylation in a C3(1)/SV40 T-antigen transgenic mouse model during different stages of mammary cancer development. Using this data, I identified differentially methylated regions and their associated genes in different periods of cancer development. Interestingly, the results showed that methylomic features are dynamic and change with tumor developmental stage. In the last study, I developed a negative enrichment of CTCs followed by ultrasensitive microfluidic ChIP-seq technology for profiling histone modification (H3K4Me3) of CTCs to resolve the technical challenges associated with CTC isolation and difficulties related with tools for profiling whole genome histone modification on tiny cell samples. / Ph. D.

Nous proposons, dans cette thèse, d'utiliser les techniques de modélisation en pharmacométrie selon l'approche de population afin de décrire les cinétiques de plusieurs marqueurs tumoraux sériques, et d'analyser leurs potentielles applications. Dans un premier temps, nous avons construit un modèle reliant les cinétiques de taille tumorale et de CA-125 dans le cancer de l'ovaire. Nous avons ensuite évalué son application pour : i) la prévision de la réponse tumorale au niveau individuel ; ii) la prédiction précoce de la survie au niveau d'une population dans le développement du médicament. Dans un second temps, nous avons réalisé un travail plus méthodologique sur la modélisation des cinétiques conjointes de PSA et d'un nouveau marqueur, le nombre de cellules tumorales circulantes (CTCs), dans le cancer de la prostate. Un modèle atypique combinant plusieurs innovations en pharmacométrie a été développé. En perspective, un lien va être établi avec la survie. En conclusion, la modélisation mathématique est un outil efficace pour l'évaluation précoce de l'efficacité des traitements / Our thesis project aimed at building mathematical models, using population approach, for different serum tumor markers, in order to describe their kinetics and to assess their potential applications. In a first intent, we built a semi-mechanistic model linking tumor size changes and CA-125 kinetics induced by chemotherapy in ovarian cancer patients. This model allowed assessment of CA-125 as: i) a biomarker for tumor size dynamics and treatment efficacy for clinical purposes; ii) an early predictor of clinical benefit during drug development. Then, we realized a more fundamental work by developing a semi-mechanistic model for characterizing the relationships between PSA kinetics and circulating tumor cell count dynamics during treatment in metastatic prostate cancer patients. This is an atypical model combining several advanced features in pharmacometrics. We have planned to assess a link with survival. In conclusion, mathematical modeling could be an efficient tool for the early prediction of treatment efficacy

L'émergence des thérapies ciblées dans le traitement des cancers a rendu indispensable la mise au point de marqueurs plus spécifiques et sensibles pour la surveillance des patients. Dès le stade invasif, des cellules tumorales peuvent passer dans le sang où elles constituent les Cellules Tumorales Circulantes (CTC). Les CTC sont accessibles par une simple prise de sang, évitant les biopsies invasives. De plus, elles représentent le seul matériel tumoral résiduel après traitement. C'est la raison pour laquelle les CTC constituent un axe de recherche très actif avec plus de 400 essais cliniques incluant ces cellules comme biomarqueurs. Ces essais apportent des renseignements importants sur le risque de récidive ou de progression métastatique, et ont pour objectif de pouvoir gérer en temps réel la conduite thérapeutique. Cependant, les CTC potentiellement métastatiques ne représentent qu'une fraction très minoritaire de ces cellules circulantes. Les technologies existantes, essentiellement basées sur une simple numération, ne suffisent pas pour guider efficacement la stratégie thérapeutique. Ce projet a évalué un ensemble de critères pouvant être utile pour la prise de décisions thérapeutiques pertinentes, adaptées à chaque patient, et la mesure de l'efficacité des traitements. Ce projet sera centre sur le mélanome. Les stades d'évolution de ce cancer sont bien définis, et dans les stades avances, le risque de développer des métastases est très élevé et la détection précoce de celles-ci est un enjeu important. Par ailleurs, ce cancer bénéficie de rapides progrès thérapeutiques, les CTC constituent donc un outil intéressant pour tester l'efficacité de ces nouveaux traitements. / The emergence of targeted therapies in cancer treatment has made essential the development of more specific and sensitive markers for monitoring patients. At the invasive stage, tumor cells can pass to blood. These cells are called Circulating Tumor Cells (CTC). CTCs are accessible through a simple blood test, avoiding invasive biopsies. Moreover, they represent the only residual tumor after treatment. It is why CTCs are a very active center of research with more than 400 clinical trials involving these cells as biomarkers. These tests provide important information on the risk of recurrence or metastatic progression and aim to manage in real time the therapeutic conduct. But the CTC potentially metastatic represents only a fraction very minority of these circulating cells. Existing technologies, mainly based on simple enumeration, are not enough to effectively guide therapeutic strategy. This project has evaluated a set of criteria to make appropriate therapeutic decisions, adapted to each patient, and able to measure the effectiveness of treatments. This project will focus on melanoma. Evolution stages of this cancer are well defined, and in advanced stages, the risk of developing metastases is very high and the early detection is an important issue. Moreover, CTC could be is an interesting tool to test the effectiveness of these new treatments.

Les métastases sont la principale cause de décès chez les patients atteints d’un cancer. Lors du développement métastatique, les cellules tumorales disséminées (CTD) doivent franchir certaines étapes clés avant de coloniser des organes distants de la tumeur primaire. Notre hypothèse est que la TNC pourrait jouer différents rôles dans la migration des cellules cancéreuses et par conséquent dans le développement métastatique. Considérant l’actine comme un réservoir de facteurs de croissance, la TNC pourrait induire la TEM ainsi que la survie et l’extravasation des cellules tumorales. Cependant, des cellules cancéreuses individualisées localement pourraient répondre à la TNC en initiant des changements rapides menant à un phénotype migratoire de type amiboïde. L’objectif de cette thèse a été d’étudier comment la TNC stimule le développement métastatique dans le cancer du sein au niveau cellulaire et moléculaire en utilisant des modèles tumoraux et cellulaires. / A high TNC expression correlates with lung metastagenicity and was shown to promote experimental lung metastasis, but the underlying mechanisms are poorly understood. The results of my thesis have provided insight into the roles of TNC in metastasis suggesting that TNC contributes to extravasation by impacting on survival, endothelialization, EMT and migration. Moreover, I have identified TGF-β signaling and integrin α9β1 as important pathway and molecule, respectively to be employed by TNC. Whether both molecule/pathway play a similar role in the investigated models of breast cancer, osteosarcoma and glioblastoma remains to be seen.