Ye / Genetic and epigenetic alterations significantly contribute to development of human cancer. Genotyping tumour tissue in search for these actionable genetic and epigenetic changes has become routine practice in oncology. However, sampling tumour tissue has significant inherent limitations. It provides only a single snapshot in time, prone to selection bias due to intra-tumour heterogeneity, and cannot always be performed owing to its invasive nature. Circulating tumour DNA (ctDNA) based liquid biopsy provides an effective alternative to invasive tissue sampling and have emerged as a minimally invasive, real-time biomarker. Recent advancements in DNA sequencing technologies have revealed enormous potential of ctDNA to improve tumour detection and stratification. In this review, we critically appraise the role of ctDNA as a liquid biopsy for cancer and evaluate the role of circulating tumour DNA as a diagnostic, prognostic and predictive biomarker. We also highlight some technical challenges and constraints associated with circulating DNA analysis.

Yes / This work evaluates the efficiency of the aqueous mixture of Methyl Diethanolamine (MDEA) and Diethanolamine (DEA) at various mass concentrations to remove CO2 and H2S from natural gas in an industrial sweetening unit in Fajr Jam Gas Refining Company located in the south of Iran and gives recommendations for modifying the process. The sweetening unit includes absorber and desorption towers, flash drum, lean and rich amine exchanger, kettle type reboiler and a reflux drum. The considered process is simulated by Promax simulator (version 3.2) taking into account operational constraints and sustainability of the environment. The validity of simulation has been evaluated by comparison between simulation results and the plant data. The main objective of this work is the modification of natural gas sweetening unit to achieve lower energy consumption. Thus, the effect of amine circulating rate and MDEA to DEA ratio on steam consumption in the regeneration tower, CO2 and H2S concentration in the treated gas, and the acid gas loadings have been investigated. Therefore, substitution of DEA solvent in the unit with the aqueous mixture of DEA and MDEA is proposed. In the examined cases, the mass concentration of MDEA and DEA lies between 15 and 45 wt% and 0–30 wt%, respectively, with the reference cases having MDEA 0 wt% and DEA 31.6 wt%. The results show that in the proposed cases of alternative mixtures including cases 1 (MDEA15 wt% and DEA 30 wt%), 2 (MDEA 20 wt% and DEA 25 wt%), and 3 (MDEA 25 wt% and DEA 20 wt%) the amount of reduction in amine circulation rate are between 11.1%v/v and 19.4%v/v compared to the original amine circulation rate. Likewise, steam consumption decreases between 24.4 %wt/wt and 27 %wt/wt. Influence of anti-foam injection for the different cases were also studied and it was found that anti-foam with the concentration of 5000 ppmv is more suitable for the optimum operation and is a more cost effective.

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

Les biomarqueurs sanguins peuvent être utilisés pour définir le pronostic des patients ou permettre de déterminer les altérations moléculaires des cancers, et peut-être pouvoir guider les traitements de thérapies ciblées.Les cellules tumorales circulantes sont le reflet de la cascade métastatique et de la progression tumorale. La détection et la caractérisation des CTC est un domaine clé de la recherche dans le cancer. Cependant, il n’existe pas de méthode standard pour la détection des CTC, et le premier objectif de notre étude a été de comparer deux systèmes de détection des CTC basé sur l’expression de l’antigène EpCAM (CellSearch), ou la taille des cellules (ISET). Nos résultats montrent qu’il existe une bonne corrélation pour la détection des CTC dans les cancers du sein ou de la prostate, mais pas dans les cancers bronchiques. Ces résultats suggèrent qu’il est nécessaire de développer d’autres techniques de détection des CTC pour l’énumération et la caractérisation pour permettre une médecine de précision.A ce jour il n’existe aucun marqueur validé pour prédire l’efficacité des antiangiogéniques. Les CEC et CEP sont des marqueurs prometteurs. Dans notre étude, nous avons fait l’hypothèse que les CEC et les CEP pouvaient être pronostic de la survie des patients inclus dans les études de phases précoces. Nos résultats montrent qu’un taux élevé de CEP est associé à un mauvais pronostic, et que les CEP pourraient permettre de mieux sélectionner les patients. En conclusion, les marqueurs sanguins comme les CTC, les CEC ou les CEP peuvent être utilisés comme des facteurs pronostiques ou permettre une caractérisation moléculaire, et être une partie intégrante des programmes de médecine de précision. / Non-inasive biomarkers detected in the blood could be use for risk) stratification or molecular classification in advanced cancer patients, and could be a guide for molecular targeted therapies. Circulating tumor cells reflect the metastatic cascade and the cancer progression. The detection and molecular characterization of circulating tumor cells (CTCs) are a key area of translational cancer research. However, there is no universal method to detect CTC, and the primary objective of our study was to compare CTC detection systems based on the expression of the EpCAM antigen (CellSearch assay) or on cell size (ISET assay). Our results showed concordant results in CTC detection in breast and prosatet cancer patients, but not in lung cancer patients. These results suggest that we need to develop other CTC-detection techniques CTC for enumeration and characterization in order to to contribute to guiding specific targeted.To date, no biomarker has been validated for the prediction of efficacy of antiangiogenic agents in patients with advanced cancer. CEC and CEP counts have recently emerged as a potential candidate. In our study, we hypothesised that CEC and CEP are prognostic in patients enrolled in phase I. Our results showed that High CEP levels are associated with poor prognostics and could provide a new tool for patient selection in early anticancer drug trials.In conclusion, non invasive biomarkers such as CTC or CEC, CEP detectable in the blood could be used in the clinic as prognostic factors or surrogates for traditional tumor biopsies, and be a major component of precision medicine.

L’endothélium joue un rôle primordial dans le développement et le maintien des multiples fonctions vasculaires. Il est ainsi largement impliqué dans des situations pathologiques comme les maladies cardio-vasculaires. La description de marqueurs endothéliaux circulants a permis une exploration non invasive de l'endothélium. Notre équipe s’est intéressée principalement aux cellules endothéliales circulantes (CEC), dont le taux reflète la lésion ou l’activation de l’endothélium, et aux progéniteurs endothéliaux circulants (PEC), marqueurs de régénération endothéliale. La découverte en 1997 par Asahara de la présence chez l’adulte de ces PEC, participant à la formation de nouveaux vaisseaux par vasculogenèse, a ouvert de nouvelles perspectives, notamment pour la thérapie cellulaire des pathologies ischémiques. Ce travail a consisté à développer les méthodes d’étude de ces cellules dans plusieurs contextes. Tout d’abord, nous avons exploré l’utilité de ces marqueurs dans la physiopathologie de l’hypertension artérielle pulmonaire (HTAP). Puis nous avons analysé le potentiel de mobilisation des progéniteurs endothéliaux à partir de la paroi vasculaire lors d’une ischémie locale chez des volontaires sains dans le cadre du développement d’un produit de thérapie cellulaire autologue. Une partie de ce projet a été de mettre en place et d’optimiser les techniques d’étude de ces marqueurs. Les CEC ont été quantifiées par immunoséparation magnétique (IMS), technique mise au point en 1992 (Dignat-George 1992) et transférée dans notre laboratoire. La quantification des PEC a été réalisée par cytométrie en flux et par culture cellulaire. En culture, deux types de PEC sont décrits : les PEC précoces, dont l’origine est monocytaire et pour lesquels la culture est déjà standardisée, et les « Endothelial Colony Forming Cells » (ECFC), seules cellules présentant des caractéristiques de cellules endothéliales progénitrices et pouvant être proposées comme produit de thérapie cellulaire. Nous avons optimisé la quantification des ECFC en culture en étudiant l’effet de diverses matrices et de la densité d’ensemencement des cellules mononucléées issues du sang total sur l’obtention de ces cellules et leurs propriétés angiogènes. La dysfonction endothéliale a été décrite comme un élément central dans le développement de l’HTAP dont le diagnostic repose sur la mesure de la pression artérielle pulmonaire par cathétérisme cardiaque droit. En l’absence de marqueur biologique non invasif dans cette maladie, nous avons quantifié les CEC et les progéniteurs circulants dans deux études. Une étude réalisée chez des patients adultes a montré une augmentation spécifique des CEC dans l’HTAP et non dans l’hypertension pulmonaire thromboembolique chronique. Ainsi les CEC semblent être le reflet des lésions endothéliales pulmonaires et non de la sévérité clinique des patients. L’autre étude a montré l’intérêt de la quantification des CEC dans la prise en charge thérapeutique des enfants souffrant d’HTAP secondaire à une cardiopathie congénitale, dont les formes irréversibles présentaient des taux élevés de CEC. Nous avons ainsi défini un nouveau marqueur non invasif à utilité diagnostique et pronostique. Les PEC sont des cellules rares dans le sang circulant, difficiles à expandre, et dont les essais de mobilisation médullaire se sont révélés insuffisants. L’hypothèse récente d’une réserve vasculaire des progéniteurs endothéliaux nous a conduits à étudier l’effet d’un processus d’ischémie locale sur la mobilisation de ces cellules chez des volontaires sains. Deux groupes d'âge ont été inclus afin d'évaluer l'impact du vieillissement sur la méthode de mobilisation étudiée. Malgré un effet de cette ischémie sur la dilatation endothéliale cette méthode n’a pas permis de mobiliser significativement les PEC issus de la paroi endothéliale, quel que soit l'âge des sujets. A l’inverse, l’hypoxie a eu un effet délétère sur les capacités angiogènes des ECFC. / The endothelium plays a key role in the development and the homeostasis of vascular functions. It is also well involved in pathological situations like cardiovascular diseases. Thanks to the description of circulating endothelial markers, non invasive study of the endothelium is now possible. Our group was particularly interested in circulating endothelial cells (CECs), the level of which reflects an endothelial activation or lesion, and to circulating endothelial progenitors cells (EPCs), markers of endothelial repair. EPC description by Asahara in 1997 in adult blood, involved in new blood vessel formation by vasculogenesis, offered new perspectives, specially for cell therapy in ischemic diseases. This work consisted in the development of methods to study these markers in different contexts. First, we explored the interest of these markers in the physiopathology of pulmonary arterial hypertension (PAH). Then we evaluated endothelial progenitors mobilization from the vascular wall by a local ischemia process in healthy volunteers, in the perspective of an autologous cell therapy product development. One part of this project was the implementation and optimization of the methods to study CEC and EPC. CEC were quantified by magnetic immunoseparation. This technique was developped in 1992 by F. Dignat-George's group and transferred in our laboratory. EPC were quantified by flow cytometry and cell culture. Two types of EPC are described in culture: the early EPC, which originate from monocyte lineage and which culture is standardized, and the « Endothelial Colony Forming Cells » (ECFC), the only cells presenting endothelial progenitor cell properties and which use as a cell therapy product can be considered. ECFC quantification by culture was optimized by assessment of the impact of diverse matrices and seeding concentrations of mononuclear cells isolated from whole blood, on ECFC commitment and their angiogenic properties. Endothelial dysfunction was described as a central element in the development of PAH, which diagnosis is based on the use of right heart catheterization. Due to the lack of noninvasive marker for this disease, CEC and circulating progenitors were quantified in two studies. One of them realized in adult patients showed a specific increase of CEC in PAH and not in post-embolic PH. CEC would then reflect the presence of specific endothelial lesions and not the clinical state of the patients. The other study demonstrated the interest of CEC quantification in the therapeutic care of children with PAH secondary to congenital heart disease, for whom patients in irreversible state had a higher level of CEC. We then defined a new noninvasive biomarker.that can be used for the diagnosis and prognosis of PAH. EPC are rare events in whole blood, difficult to expand and for which, mobilization protocols revealed insufficient. The recent hypothesis of a vascular reservoir for endothelial progenitor led us to study the effect of a local ischemia procedure on the mobilization of these cells in healthy volunteers. Two age groups were included to assess the impact of aging on this procedure. Despite a significant endothelial dilation with the local ischemia, no EPC were mobilized, whatever the age group. Ischemia even altered ECFC angiogenic properties.

Malgré l’efficacité thérapeutique avérée des agents anti-angiogéniques et des agents anti-vasculaires (VDA), le mécanisme d’action précis des stratégies ciblant les vaisseaux sanguins tumoraux, les raisons de leur efficacité ainsi que les mécanismes de résistance à ces drogues sont encore mal compris. Il est rapidement apparu essentiel d’identifier des biomarqueurs capables de refléter l’angiogénèse tumorale ou les effets sur la vascularisation tumorale de ces traitements. Compte tenu de leur importance dans des pathologies vasculaires, les cellules endothéliales matures circulantes (CEC) et les progéniteurs endothéliaux circulants (CEP) ont d’emblée été pressenties comme des candidats intéressants pour être des biomarqueurs de réponse aux stratégies ciblant la vascularisation tumorale. Nous avons exploré l’intérêt de ces cellules en tant que biomarqueurs de l’angiogénèse dans des tumeurs pédiatriques, et leur rôle en tant que biomarqueurs de traitement par des agents anti-angiogéniques chez des sujets adultes atteints de cancer. Ces travaux ont mis en lumière l’intérêt des CEP et ont été à la source d’un travail plus « mécanistique » où nous avons étudié dans différents modèles murins le rôle des CEC et CEP dans le mécanisme d’action des agents anti-vasculaires et plus particulièrement le rôle fonctionnel des CEP dans la résistance à ces molécules. Par des stratégies d’association d’agents anti-angiogéniques aux VDA destinées à inhiber les CEP, nous montrons l’augmentation de l’activité anti-tumorale des VDA et offrons un rationnel mécanistique pour optimiser les schémas thérapeutiques actuels des traitements anti-vasculaires. Nos données apportent des arguments en faveur du rôle potentiel de ces cellules en tant que biomarqueurs de l’angiogénèse, des traitements anti-angiogéniques et de la résistance aux traitements anti-vasculaires. / Despite their therapeutic impact and clinical benefit, the mecanisms of action of anti-angiogenic agents and vascular disrupting agents (VDA), the reasons for their efficacy as well as the mechanisms underlying resistance to these drugs are not fully understood. Thus, identifying surrogate biomarkers of tumor angiogenesis and of the effects of these new therapeutic agents targeting tumor blood vessels has become a crucial objective. Because of their importance in vascular diseases, mature circulating endothelial cells (CEC) and circulating endothelial progenitor cells (CEP) were suggested to be potential candidate biomarkers of disease response and relapse to vascular targeting strategies. We investigated the role of these cells as biomarkers of tumor angiogenesis in pediatric solid tumors, as well as biomarkers of response to anti-angiogenic therapies in adult cancer patients. By revealing the particularly important role of CEP, these initial studies led to a more “mechanistic” study in which the cellular and molecular effects of a VDA were evaluated with regard to CEC and CEP in different mouse models; in particular, the “catalytic” role of CEP was explored as a mechanism of resistance to VDA. By combining anti-angiogenic agents aimed to inhibit CEP mobilized by the VDA, we demonstrate an increase in the anti-tumor activity of the VDA and offer a mechanistic rational to optimize VDA-based therapeutic strategies. Our data support the role of CEC and CEP as biomarkers of angiogenesis, of anti-angiogenic strategies and of resistance to vascular-disrupting therapies.

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.

This work focuses on the integration of microfluidics and dielectrophoresis(DEP) with the principles of field flow fractionation (FFF) to create a continuous-flow isolator for rare and viable circulating tumor cells (CTCs) from peripheral blood mononuclear cells (PBMNs) drawn from cancer patients. The method exploits differences in the plasma membrane capacitances of tumor and blood cells, which correspond to differences in the membrane surface areas of these cell types. DEP-FFF was first adapted to measure cell membrane capacitance, cell density and deformability profiles of cell populations. These properties of the NCI-60 panel of cancer cell types, which represents the wide functional diversity of cancers from 9 organs and leukemia, were compared with the normal cell subpopulations of peripheral blood. In every case, the NCI-60 cells exhibited membrane capacitance characteristics that were distinct from blood and, as a result, they could be isolated from blood by DEP. The heightened cancer cell membrane capacitances correlated strongly with membrane-rich morphological characteristics at their growth sites, including cell flattening, dendritic projections, and surface wrinkling. Following harvest from culture and maintenance in suspension, cancer cells were found to shed cytoplasm and membrane area over time and the suspended cell populations developed considerable morphological diversity. The shedding changed the cancer cell DEP properties but they could still be isolated from blood cells. A similar shedding process in the peripheral blood could account for the surprisingly wide morphological diversity seen among circulating cells isolated from clinical specimens. A continuous flow DEP-FFF method was devised to exploit these findings by allowing CTCs to be isolated from the nucleated cells of 10 mL clinical blood specimens in 40 minutes, an extremely high throughput rate for a microfluidic-based method. Cultured cancer cells could be isolated at 70-80% efficiency using this approach and the isolation of CTCs from clinical specimens was demonstrated. The results showed that the continuous DEP-FFF method delivers unmodified, viable CTCs for analysis, is perhaps universally applicable to isolation of CTCs from different cancer types and is independent of surface antigens - making it suitable for cells lacking the epithelial markers used in currently accepted CTC isolation methods. / text

Telomerase, discovered in 1985, is considered a near-universal marker of malignancy and therefore has a potential use in cancer therapeutics and diagnostics. In this study, I used several approaches to gain a better understanding of telomerase and its potential applications in the canine context, for both cancer therapeutics and diagnosis. Having already developed an effective siRNA viral vector in vitro, the challenge still remained to deliver it efficiently in vivo. Thus, I initially investigated two possible approaches for in vivo delivery. First, I investigated a cell-based system for direct delivery to the tumours. Specifically I optimised a system for efficient gene-transfer to endothelial cells using a green fluorescent protein plasmid vector, and monitored systemic delivery by ex vivo imaging of dye-labelled cells in a canine xenograft tumour mouse model. In parallel, in vitro I investigated the gene transfer mediated by a novel dendrimer vector that can form nanoparticles with DNA and accumulate in tumour sites in vivo after i.v. administration. In order to utilize these delivery systems, I developed a DNA plasmid-based siRNA vector and tested its efficacy on canine tumour cells. To investigate telomerase as a cancer biomarker, I conducted a study that aimed to detect circulating telomerase reverse transcriptase (TERT) mRNA in serum taken from canine cancer patients. For this I developed several systems for effective RNA isolation from serum and used both conventional and quantitative PCR assays to detect TERT expression. Although for the first time I can confirm the existence of mRNA in serum of canine cancer patients, in this clinical study, I could only detect telomerase transcripts in a very small proportion of canine cancer patients. In a final pilot study to investigate anti-ageing technologies, I looked at the potential for drug-dependant telomerase induction rather than inhibition. For this I investigated the ability of three candidate drugs to induce TERT mRNA activation in canine embryonic fibroblasts. In this study, telomerase induction was measured using the quantitative PCR method that I had developed for serum detection. In summary, I have demonstrated that a cell-based delivery vehicle has a potential application in cancer therapy, but that more development is required before it can be applied clinically. I have also reported here that PPIG3 dendrimer-based gene transfer in vitro is low in canine cancer cells and thus require more optimisation and development before it can be utilised as an efficient systemic delivery vehicle. For the siRNA experiment, unfortunately, I did not observe any telomerase genesilencing in canine cancer cells using the plasmid-based siRNA expression vector, and therefore the gene sequence of cTR that we were targeting as well as the siRNA plasmid-vector that we used needs further validation in canine cells. I also suggest that TERT mRNA may not be a good serum biomarker for canine cancer diagnostics as I did not find TERT transcript in most of our serum samples from canine cancer patients, although circulating mRNA of a housekeeping gene was detected. Finally, in a pilot study, I have demonstrated that telomerase can be induced in normal canine somatic cells using small molecules. However, the long-term effects of telomerase induction on ageing must be determined in future studies.

Attachment of circulating tumor cells in microfluidic devices functionalized with proper antibodies was studied. Under static experimental conditions, microchambers were utilized to study the parameters such as cell suspension concentration, incubation time or ambient temperature that may affect the binding of cell to the functionalized surfaces. Specific capture of cells from suspensions increases exponentially with incubation time and linearly with concentration within the tested range. Functionalizing a surface with counter-receptors enables capture of almost 100% of cells within 15 minutes incubation time at ambient temperature higher than 25°C. Suspending cells with different receptors, changing the counter receptors immobilized on the surface, or incubation the cell suspension at low ambient temperature result in a poor capture ratio. To illustrate the specific binding of target cells, various binary mixtures of target cancer and blood cells were incubated in the microchambers. The microsystem sensitivity, specificity and accuracy were determined as a function of the incubated cell concentrations. In general, the system specificity increases while the sensitivity decreases with increasing cell concentration; the accuracy of the system depends weakly on cell concentration within the tested range. The cell attachment dynamics in shear flow was studied by driving the MDA-MB- 231 or BT-20 cells through microchannels functionalized with EpCAM antibodies. The cell attachment ratio was experimentally determined at different flow rates. A modeling system based on Stokesian as well as cell-adhesive dynamics is adopted to analyze the cell motion. The cell motion is modeled as a rigid sphere, with receptors on its surface, moving under shear flow above a surface immobilized with ligands. The system is described mathematically by the Langevin equation, in which the receptor-ligand bonds are modeled as linear springs. Primarily depending on the applied flow rate, three distinct dynamic states of cell motion have been observed: free motion, rolling adhesion, and firm adhesion. The fraction of cells captured due to firm adhesion, defined as attachment ratio, depends on the applied flow rate with a characteristic value that increases with either cellreceptor or surface-ligand density. Utilizing this characteristic flow rate as a scaling parameter, all measured and calculated attachment ratios for different receptor and ligand densities collapse onto a single exponential curve. Binary mixtures of target MDA-MB-231 cells and non-target BT-20 cells were driven through anti-cadherin-11 functionalized microchannels to study the selective isoaltion of target cells from binary mixtures. The system sensitivity is very high, above 0.95, while the specificity is only moderately high, about 0.85, essentially independent of the relative concentration of the target and non-target cells in the binary mixture. An attachment/detachment flow field pattern is proposed to enhance the system specificity. Utilizing this flow pattern with a 1:1,000 MDA-MB-231:BT-20 binary cell mixture, the microfluidic system specificity increased to about 0.95 while the sensitivity remained above 0.95. In order to obtain high experimental throughput allowing lower relative concentration of target cells, a microchannel array which enables processing samples containing about 510⁵ cells with a minimum target cell concentration ratio of 1/100,000 was designed and fabricated. To demonstrate selective isolation of target cells, binary mixtures of BT-20 cells and MIA PaCa-2 cells were driven through microchannel arrays functionalized with EpCAM antibodies; the EpCAM positive BT-20 cells served as target cells and the EpCAM negative MIA PaCa-2 cells as non-target cells. The relative concentration ratio of target/non-target cells varied from 1:1 to 1:100,000. The sensitivity was close to 1.0 while the specificity was also high, about 0.95. The additional detachment step, with a faster flow rate, enhanced the specificity to about 0.985. Initial results of two sets of experiments are reported as preliminary studies for future work. In the first set of experiments, whole blood samples from healthy donors were spiked with a known number of BT-20 cells at a concentration of 500 CTCs per milliliter blood or 50 CTCs per milliliter blood. After a pretreatment to enrich the CTCs, the samples were driven through microchannel arrays functionalized with anti-EpCAM. For both samples, around 55% of the target CTCs were captured in the microchannel arrays. The second set of experiments was dedicated to characterization of target cells exposed to applied shear stress. BT-20 or MDA-MB-231 cells were driven through microchannels functionalized with EpCAM antibodies to allow target cell attachment; then, a high flow rate was applied to detach the captured cells. The detached cells were collected and cultured in an incubator to test their viability. For both cell lines, the majority of the captured CTCs collected from the microchannels were viable. The images taken after three and seven days of culture demonstrate continuous cell growth and division.