Aim: To develop an immunomagnetic assay for the isolation of circulating tumor cells (CTCs) followed by the analysis of a multimarker panel, which will enable the characterization of these malignant cells with high accuracy. Patients and Methods: Peripheral blood (PB) was collected from 32 metastatic breast cancer patients and 42 negative controls. The antibodies BM7 and VU1D9 were used for immunomagnetic tumor cell enrichment. A real-time reverse transcription-polymerase chain reaction (RT-PCR) approach for the markers KRT19, SCGB2A2, MUC1, EPCAM, BIRC5 and ERBB2 was used for CTC detection and characterization. Results: The positivity rates for each marker were as follows: 46.9% for KRT19, 25.0% for SCGB2A2, 28.1% for MUC1, 28.1% for EPCAM, 21.9% for BIRC5, and 15.6% for ERBB2. After the creation of individualized cutoffs, the sensitivity and specificity of the combined marker gene panel increased to 56.3% and 100%, respectively. Interestingly, 27.0% of the HER2-negative tumor patients showed ERBB2 mRNA-positive CTCs. Conclusions: The described technique can be used to measure CTCs with great accuracy. The use of a multimarker panel for the characterization of CTCs may provide real-time information and be of great value in therapy monitoring. / Ziel: Entwicklung eines immunomagnetischen Verfahrens zur Isolierung zirkulierender Tumorzellen (CTCs) in Kombination mit einer molekularen Multimarkeranalyse für die hochspezifische Identifizierung maligner Zellen. Patientinnen und Methoden: Peripheres Blut (PB) von 32 Patientinnen mit metastasiertem Mammakarzinom und von 42 gesunden Kontrollen wurde für die immunomagnetische Tumorzellanreicherung mit den Antikörpern BM7 und VU1D9 genutzt. Eine Real-Time Reverse Transkription Polymerase-Kettenreaktion (RT-PCR)-Methodik mit den Markern KRT19, SCGB2A2, MUC1, EPCAM, BIRC5 und ERBB2 wurde für den CTC-Nachweis und die Tumorzellcharakterisierung entwickelt. Ergebnisse: Für die einzelnen Marker wurden die folgenden Positivitätsraten ermittelt: 46,9% für KRT19, 25,0% für SCGB2A2, 28,1% für MUC1, 28,1% für EPCAM, 21,9% für BIRC5 und 15,6% für ERBB2. Nach der Bestimmung individualisierter Cut-off-Werte ergab sich für den kombinierten Multimarkernachweis eine Sensitivität und Spezifität von 56,3% bzw. 100%. Bemerkenswert war der Befund, dass 27,0% der HER2-tumornegativen Patientinnen ERBB2-mRNA-positive CTCs aufwiesen. Schlussfolgerung: Die hier beschriebene Methodik bestimmt CTCs mit hoher Spezifität. Die molekulare Multimarkeranalyse liefert wertvolle Real-Time-Informationen für personalisierte Behandlungsmodalitäten. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Esta pesquisa avaliou o uso de ozônio para inativar cistos de Giardia spp. e oocistos de Cryptosporidium parvum presentes na água filtrada obtida após a utilização da tecnologia de ciclo completo com flotação (coagulação, floculação, flotação e filtração) em escala de bancada, empregando o cloreto de polialumínio – PAC – como coagulante. O método de floculação em carbonato de cálcio – FCCa, sem e com a etapa de separação imunomagnética – IMS – foi utilizado na quantificação dos protozoários. A recuperação nos ensaios de qualidade utilizando o kit Easyseed® de Giardia spp. foi de 8,4% ± 97,4% sem IMS e com IMS, com duas dissociações, o valor foi de 7,4% ± 39,7% e, com três dissociações, a recuperação alcançou 9,6% ± 34,7%, portanto, somente o ensaio com IMS e duas dissociações, não atendeu os padrões do Método 1623.1. A recuperação de Cryptosporidium parvum, obteve valor de 3,4% ± 100% em ensaio sem IMS e com IMS, o valor obtido foi de 1,0% ± 70,0% com duas dissociações e 1,8% ± 44,4% com três dissociações e nos três métodos apresentados, não houve conformidade com os critérios do Método 1623.1. Na etapa de desinfecção com ozônio, os ensaios realizados na Etapa 1, que se utilizou 5 mgO3L-1 e tempo de contato de 1 min sem IMS, as maiores inativações atingidas foram de 2,52 e 2,22 log para cistos de Giardia spp. e oocistos de Cryptosporidium parvum, respectivamente. Com o tempo de contato de 5 min, as maiores inativações foram de 2,52 e 2,92 log de cistos de Giardia spp. e oocistos de Cryptosporidium parvum, respectivamente. Na Etapa 2, com IMS, utilizando a mesma dosagem e tempo de contato de 1 min, obteve-se 2,27 e 0,21 log de inativação para cistos e oocistos, respectivamente. Comparando-se com o tempo de contato de 5 min, foram obtidos 2,9 e 2,3 log de inativação para cistos e oocistos, respectivamente. Na avaliação de custo, o método de FCCa sem IMS demonstrou ser o mais econômico em relação ao procedimento com IMS. A influência da inclusão da terceira dissociação ácida no método com IMS também foi analisada e este procedimento não resultou em diferenças estatísticas significativas nos resultados. / This research evaluated the use of ozone to inactivate Giardia spp. cysts and Cryptosporidium parvum oocysts present in the filtered water obtained after the use of the complete cycle of flotation technology (coagulation, flocculation, flotation and filtration) on a bench scale employing polyaluminium chloride - PAC as coagulant. The calcium carbonate flocculation method - FCCa, without and with immunomagnetic separation step - IMS has been used in the quantification of protozoa. The recovery in quality test using the kit Easyseed® for Giardia spp. was 8.4% ± 97.4% non-IMS and IMS with two dissociations, the value was 7.4% ±39.7% and with three dissociations, the recovery reached 9.6% ± 34,7%, so only the test with IMS and two dissociations, did not meet the standards of method 1623.1. Recovery of Cryptosporidium parvum obtained value of 3.4% ± 100% in non-IMS and IMS testing, the value obtained was 1.0% ± 70.0% with two dissociations and 1.8% ± 44.4% with three dissociations and the three methods presented, there was non-compliance with the criteria of Method 1623.1. In step disinfection with ozone, tests performed in Step 1 was used 5 mgO3L-1 and contact time of 1 min without IMS, the major inactivation achieved were 2.52 and 2.22 log for Giardia spp. cysts and Cryptosporidium parvum oocysts, respectively. With 5 minutes of contact time, the greater inactivation were 2.52 and 2.92 log for Giardia spp. cysts and Cryptosporidium parvum oocysts, respectively. In Step 2, with IMS, using the same dose and 1 min contact time, there was obtained 2.27 and 0.21 log inactivation for cysts and oocysts, respectively. Compared with the 5 min of contact time, were obtained 2.9 and 2.3 log inactivation for cysts and oocysts, respectively. In evaluating cost, the FCCa method without IMS proved to be the most economical in relation to the procedure with IMS. The influence of inclusion of the third acid dissociation method in IMS was also analyzed and this procedure did not result in statistically significant differences in the results.

Este trabalho teve como objetivo avaliar diversos métodos de detecção e recuperação de cistos de Giardia spp. e de oocistos de Cryptosporidium parvum em resíduos gerados no tratamento de águas de abastecimento com turbidez elevada tendo como padrão o Método 1623.1 da USEPA (2012 ). Para tanto, ensaios utilizando aparelho Jarteste (coagulação, floculação, decantação e filtração ) foram realizados utilizando o coagulante cloreto de polialumínio - PAC. Em todos os métodos avaliados foi utilizada a técnica de purificação por separação imunomagnética - IMS. A adaptação do método floculação em carbonato de cálcio FCCa elaborado por Vesey et al. (1993) e adaptado por Feng et al. (2011), repercutiu nos melhores resultados para a amostra de resíduo sedimentado, com recuperações de 68 ± 17 % para oocisto de C. parvum e de 42 ± 7 % para cisto de Giardia spp. Entretanto, as recuperações para a amostra de água de lavagem dos filtros - ALF foram inferiores à 1 %, não sendo possível determinar um método adequado. A presença dos patógenos indica que o reuso da ALF em ETA convencionais ou o descarte em mananciais sem um tratamento prévio, pode representar problemas de contaminação. A adaptação dos métodos de Boni de Oliveira (2012) e Keegan et al. (2008), também repercutiram em porcentagens de recuperação expressivas para a amostra de resíduo sedimentado, sendo de: 41 ± 35 % para oocisto de C. parvum e 11 ± 70 % para cisto de Giardia spp., e 38 ± 26 % para oocisto de C. parvum e 26 ± 13 % para cisto de Giardia spp., respectivamente. A análise estatística não resultou em diferença significativa entre estes dois métodos, entretanto, as elevadas recuperações indicam que estes métodos podem ser melhor avaliados em pesquisas futuras. / This dissertation addresses the evaluation of several methods for the detection of Giardia spp. cysts and Cryptosporidium parvum oocysts in wastes produced after a high-turbidity water treatment, according to Method 1623.1 from USEPA (2012). Coagulant polyaluminium chloride - PACl was used in jar test experiments (coagulation/flocculation, sedimentation and filtration ). The Immunomagnetic Separation - IMS technique was applied to all methods. The calcium carbonate flocculation (CCF) method, developed by Vesey et al. (1993) and adapted by Feng et al. (2011 ), was applied to sludge samples in this research and was the best method tested, with 68% ± 17 % and 42 % ± 7,00 % recoveries for C. parvum oocysts and Giardia spp. cysts, respectively. On the other hand, the percentage recovery of (oo)cysts for filter backwash water samples was lower than 1 % and no suitable method could be detected. The presence of pathogens represents contamination risks for water sources and the reuse of filter backwash water may be a problem to conventional water treatment plants. The application of Boni de Oliveira (2012) and Keegan et al. (2008) methods, adjusted to this study, also resulted in significant percentage recoveries for the sludge samples, with 41 ± 35 % for C. parvum oocyst and 11 ± 70% for cyst Giardia spp., and 38 ± 26% for oocyst C. parvum and 26 ± 13% for cyst Giardia spp., respectively. The statistical analysis showed no significant differences between the two methods, however, such high recoveries indicate they should be better evaluated in future research.

O objetivo deste trabalho foi avaliar o desempenho da remoção de cistos deGiardia spp. e oocistos de Cryptosporidium parvum, em águas de abastecimento com turbidez elevada, em experimentos em escala de bancada (coagulação, floculação, decantação e filtração). Para tanto, empregou-se o coagulante cloreto de polialumínio – PAC. O método de filtração em membranas foi adotado para a concentração de protozoários, seguido ou não da etapa de purificação por separação imunomagnética – IMS. Os métodos foram avaliados em experimentos de controle de qualidade analítica e o método sem IMS apresentou as seguintes porcentagens de recuperação, 80% ±16,32% para cistos de Giardia spp. e 5% ±10,00% para oocistos de C. parvum. O método com IMS apresentou 31,5%±7,55% de recuperação para cistos de Giardia spp. e 5,75%±3,20% de recuperação para oocistos de C. parvum. Os experimentos demonstraram que não houve melhora na remoção de ambos os protozoários na condição de maior dosagem de coagulante (65 mg.L-1 de PAC e pH 7,29). A condição de menor dosagem de coagulante (25 mg.L-1 de PAC e pH 6,76) apresentou um desempenho melhor, ao contrário de uma expectativa de que a maior dosagem de coagulante pudesse favorecer a remoção destes microrganismos. A condição de menor dosagem apresentou, na água filtrada, 50 e 75% de ausência de identificação de cistos de Giardia e oocistos de C. parvum, respectivamente. A condição de maior dosagem apresentou (oo)cistos na água filtrada de todas amostras analisadas. Estes resultados indicam a importância do controle da coagulação na remoção de protozoários. / The aim of this study was to evaluate the performance of Giardia spp. cysts and Cryptosporidium parvum oocysts removal in a bench scale experiment. The coagulant polyaluminium chloride – PACl was used in this research. The protozoa concentration tests were performed by applying the Membrane Filtration method, with and without Immunomagnetic Separation assay-IMS. The methods were evaluated using control experiments and the method without IMS had the following percentage recovery, 80% ± 16.32% and 5% ±10.00% for Giardia cysts and C. parvum oocysts, respectively. The method with IMS presented 31.5% ± 7.55% and 5.75% ± 3.20% of percentage recovery for Giardia cysts and C. parvum oocysts, respectively. Bench scale experimental results have clearly shown that there was no improvement in protozoa removal using the superior dosage of coagulant. The inferior dosage condition (25 mg.L-1 of PACl and pH 6,76) performed better, which was contrary to what was expected in which a superior dosage of coagulant could favour when removing microorganisms. The inferior dosage condition presented 50% and 75% of absence of Giardia cysts and C. parvum oocysts in the final water, respectively. The second coagulation condition (65 mg.L-1 of PACl and pH 7,29) presented protozoa (oo)cysts in the final water of all the samples examined. These results indicate the importance of coagulation control in protozoa removal.

Este trabalho teve como objetivo avaliar diversos métodos de detecção e recuperação de cistos de Giardia spp. e de oocistos de Cryptosporidium parvum em resíduos gerados no tratamento de águas de abastecimento com turbidez elevada tendo como padrão o Método 1623.1 da USEPA (2012 ). Para tanto, ensaios utilizando aparelho Jarteste (coagulação, floculação, decantação e filtração ) foram realizados utilizando o coagulante cloreto de polialumínio - PAC. Em todos os métodos avaliados foi utilizada a técnica de purificação por separação imunomagnética - IMS. A adaptação do método floculação em carbonato de cálcio FCCa elaborado por Vesey et al. (1993) e adaptado por Feng et al. (2011), repercutiu nos melhores resultados para a amostra de resíduo sedimentado, com recuperações de 68 ± 17 % para oocisto de C. parvum e de 42 ± 7 % para cisto de Giardia spp. Entretanto, as recuperações para a amostra de água de lavagem dos filtros - ALF foram inferiores à 1 %, não sendo possível determinar um método adequado. A presença dos patógenos indica que o reuso da ALF em ETA convencionais ou o descarte em mananciais sem um tratamento prévio, pode representar problemas de contaminação. A adaptação dos métodos de Boni de Oliveira (2012) e Keegan et al. (2008), também repercutiram em porcentagens de recuperação expressivas para a amostra de resíduo sedimentado, sendo de: 41 ± 35 % para oocisto de C. parvum e 11 ± 70 % para cisto de Giardia spp., e 38 ± 26 % para oocisto de C. parvum e 26 ± 13 % para cisto de Giardia spp., respectivamente. A análise estatística não resultou em diferença significativa entre estes dois métodos, entretanto, as elevadas recuperações indicam que estes métodos podem ser melhor avaliados em pesquisas futuras. / This dissertation addresses the evaluation of several methods for the detection of Giardia spp. cysts and Cryptosporidium parvum oocysts in wastes produced after a high-turbidity water treatment, according to Method 1623.1 from USEPA (2012). Coagulant polyaluminium chloride - PACl was used in jar test experiments (coagulation/flocculation, sedimentation and filtration ). The Immunomagnetic Separation - IMS technique was applied to all methods. The calcium carbonate flocculation (CCF) method, developed by Vesey et al. (1993) and adapted by Feng et al. (2011 ), was applied to sludge samples in this research and was the best method tested, with 68% ± 17 % and 42 % ± 7,00 % recoveries for C. parvum oocysts and Giardia spp. cysts, respectively. On the other hand, the percentage recovery of (oo)cysts for filter backwash water samples was lower than 1 % and no suitable method could be detected. The presence of pathogens represents contamination risks for water sources and the reuse of filter backwash water may be a problem to conventional water treatment plants. The application of Boni de Oliveira (2012) and Keegan et al. (2008) methods, adjusted to this study, also resulted in significant percentage recoveries for the sludge samples, with 41 ± 35 % for C. parvum oocyst and 11 ± 70% for cyst Giardia spp., and 38 ± 26% for oocyst C. parvum and 26 ± 13% for cyst Giardia spp., respectively. The statistical analysis showed no significant differences between the two methods, however, such high recoveries indicate they should be better evaluated in future research.

Esta pesquisa avaliou o uso de ozônio para inativar cistos de Giardia spp. e oocistos de Cryptosporidium parvum presentes na água filtrada obtida após a utilização da tecnologia de ciclo completo com flotação (coagulação, floculação, flotação e filtração) em escala de bancada, empregando o cloreto de polialumínio – PAC – como coagulante. O método de floculação em carbonato de cálcio – FCCa, sem e com a etapa de separação imunomagnética – IMS – foi utilizado na quantificação dos protozoários. A recuperação nos ensaios de qualidade utilizando o kit Easyseed® de Giardia spp. foi de 8,4% ± 97,4% sem IMS e com IMS, com duas dissociações, o valor foi de 7,4% ± 39,7% e, com três dissociações, a recuperação alcançou 9,6% ± 34,7%, portanto, somente o ensaio com IMS e duas dissociações, não atendeu os padrões do Método 1623.1. A recuperação de Cryptosporidium parvum, obteve valor de 3,4% ± 100% em ensaio sem IMS e com IMS, o valor obtido foi de 1,0% ± 70,0% com duas dissociações e 1,8% ± 44,4% com três dissociações e nos três métodos apresentados, não houve conformidade com os critérios do Método 1623.1. Na etapa de desinfecção com ozônio, os ensaios realizados na Etapa 1, que se utilizou 5 mgO3L-1 e tempo de contato de 1 min sem IMS, as maiores inativações atingidas foram de 2,52 e 2,22 log para cistos de Giardia spp. e oocistos de Cryptosporidium parvum, respectivamente. Com o tempo de contato de 5 min, as maiores inativações foram de 2,52 e 2,92 log de cistos de Giardia spp. e oocistos de Cryptosporidium parvum, respectivamente. Na Etapa 2, com IMS, utilizando a mesma dosagem e tempo de contato de 1 min, obteve-se 2,27 e 0,21 log de inativação para cistos e oocistos, respectivamente. Comparando-se com o tempo de contato de 5 min, foram obtidos 2,9 e 2,3 log de inativação para cistos e oocistos, respectivamente. Na avaliação de custo, o método de FCCa sem IMS demonstrou ser o mais econômico em relação ao procedimento com IMS. A influência da inclusão da terceira dissociação ácida no método com IMS também foi analisada e este procedimento não resultou em diferenças estatísticas significativas nos resultados. / This research evaluated the use of ozone to inactivate Giardia spp. cysts and Cryptosporidium parvum oocysts present in the filtered water obtained after the use of the complete cycle of flotation technology (coagulation, flocculation, flotation and filtration) on a bench scale employing polyaluminium chloride - PAC as coagulant. The calcium carbonate flocculation method - FCCa, without and with immunomagnetic separation step - IMS has been used in the quantification of protozoa. The recovery in quality test using the kit Easyseed® for Giardia spp. was 8.4% ± 97.4% non-IMS and IMS with two dissociations, the value was 7.4% ±39.7% and with three dissociations, the recovery reached 9.6% ± 34,7%, so only the test with IMS and two dissociations, did not meet the standards of method 1623.1. Recovery of Cryptosporidium parvum obtained value of 3.4% ± 100% in non-IMS and IMS testing, the value obtained was 1.0% ± 70.0% with two dissociations and 1.8% ± 44.4% with three dissociations and the three methods presented, there was non-compliance with the criteria of Method 1623.1. In step disinfection with ozone, tests performed in Step 1 was used 5 mgO3L-1 and contact time of 1 min without IMS, the major inactivation achieved were 2.52 and 2.22 log for Giardia spp. cysts and Cryptosporidium parvum oocysts, respectively. With 5 minutes of contact time, the greater inactivation were 2.52 and 2.92 log for Giardia spp. cysts and Cryptosporidium parvum oocysts, respectively. In Step 2, with IMS, using the same dose and 1 min contact time, there was obtained 2.27 and 0.21 log inactivation for cysts and oocysts, respectively. Compared with the 5 min of contact time, were obtained 2.9 and 2.3 log inactivation for cysts and oocysts, respectively. In evaluating cost, the FCCa method without IMS proved to be the most economical in relation to the procedure with IMS. The influence of inclusion of the third acid dissociation method in IMS was also analyzed and this procedure did not result in statistically significant differences in the results.

O objetivo deste trabalho foi avaliar o desempenho da remoção de cistos deGiardia spp. e oocistos de Cryptosporidium parvum, em águas de abastecimento com turbidez elevada, em experimentos em escala de bancada (coagulação, floculação, decantação e filtração). Para tanto, empregou-se o coagulante cloreto de polialumínio – PAC. O método de filtração em membranas foi adotado para a concentração de protozoários, seguido ou não da etapa de purificação por separação imunomagnética – IMS. Os métodos foram avaliados em experimentos de controle de qualidade analítica e o método sem IMS apresentou as seguintes porcentagens de recuperação, 80% ±16,32% para cistos de Giardia spp. e 5% ±10,00% para oocistos de C. parvum. O método com IMS apresentou 31,5%±7,55% de recuperação para cistos de Giardia spp. e 5,75%±3,20% de recuperação para oocistos de C. parvum. Os experimentos demonstraram que não houve melhora na remoção de ambos os protozoários na condição de maior dosagem de coagulante (65 mg.L-1 de PAC e pH 7,29). A condição de menor dosagem de coagulante (25 mg.L-1 de PAC e pH 6,76) apresentou um desempenho melhor, ao contrário de uma expectativa de que a maior dosagem de coagulante pudesse favorecer a remoção destes microrganismos. A condição de menor dosagem apresentou, na água filtrada, 50 e 75% de ausência de identificação de cistos de Giardia e oocistos de C. parvum, respectivamente. A condição de maior dosagem apresentou (oo)cistos na água filtrada de todas amostras analisadas. Estes resultados indicam a importância do controle da coagulação na remoção de protozoários. / The aim of this study was to evaluate the performance of Giardia spp. cysts and Cryptosporidium parvum oocysts removal in a bench scale experiment. The coagulant polyaluminium chloride – PACl was used in this research. The protozoa concentration tests were performed by applying the Membrane Filtration method, with and without Immunomagnetic Separation assay-IMS. The methods were evaluated using control experiments and the method without IMS had the following percentage recovery, 80% ± 16.32% and 5% ±10.00% for Giardia cysts and C. parvum oocysts, respectively. The method with IMS presented 31.5% ± 7.55% and 5.75% ± 3.20% of percentage recovery for Giardia cysts and C. parvum oocysts, respectively. Bench scale experimental results have clearly shown that there was no improvement in protozoa removal using the superior dosage of coagulant. The inferior dosage condition (25 mg.L-1 of PACl and pH 6,76) performed better, which was contrary to what was expected in which a superior dosage of coagulant could favour when removing microorganisms. The inferior dosage condition presented 50% and 75% of absence of Giardia cysts and C. parvum oocysts in the final water, respectively. The second coagulation condition (65 mg.L-1 of PACl and pH 7,29) presented protozoa (oo)cysts in the final water of all the samples examined. These results indicate the importance of coagulation control in protozoa removal.

Introduction: The presence of circulating tumor cells (CTC) in the peripheral blood has been associated with worse prognosis and early relapse in breast cancer patients. CTC determination in the peripheral blood has been considered as a liquid biopsy. The aim of this project was to analyze the presence of CTC followed by their molecular characterization with the potential use not only as a new biomarker for real-time monitoring of therapy efficacy but also as a suitable tool for patient's stratification and individualization of treatment for breast cancer. Methods: A total of 54 patients with diagnosed early breast cancer were enrolled into a prospective study. Ten millilitres of peripheral blood were sequentially collected to test for the presence and characterization of CTC during the follow-up of patients. CTC isolation and detection was performed by AdnaTest BreastCancer™ (AdnaGen AG, Germany), which is based on the detection of EpCAM, HER2 and MUC1 specific transcripts in enriched CTC- lysates. cDNA from isolated CTC has been further used for newly optimized qPCR assays for breast tumor and therapy resistance associated genes: TOP1, TOP2A, CSTD, ST6GAL, KRT19 and reference gene actin. qPCR results have been analyzed by Genex software (MultiD Analysis). Results: 195 blood samples have been...

Aim: To develop an immunomagnetic assay for the isolation of circulating tumor cells (CTCs) followed by the analysis of a multimarker panel, which will enable the characterization of these malignant cells with high accuracy. Patients and Methods: Peripheral blood (PB) was collected from 32 metastatic breast cancer patients and 42 negative controls. The antibodies BM7 and VU1D9 were used for immunomagnetic tumor cell enrichment. A real-time reverse transcription-polymerase chain reaction (RT-PCR) approach for the markers KRT19, SCGB2A2, MUC1, EPCAM, BIRC5 and ERBB2 was used for CTC detection and characterization. Results: The positivity rates for each marker were as follows: 46.9% for KRT19, 25.0% for SCGB2A2, 28.1% for MUC1, 28.1% for EPCAM, 21.9% for BIRC5, and 15.6% for ERBB2. After the creation of individualized cutoffs, the sensitivity and specificity of the combined marker gene panel increased to 56.3% and 100%, respectively. Interestingly, 27.0% of the HER2-negative tumor patients showed ERBB2 mRNA-positive CTCs. Conclusions: The described technique can be used to measure CTCs with great accuracy. The use of a multimarker panel for the characterization of CTCs may provide real-time information and be of great value in therapy monitoring. / Ziel: Entwicklung eines immunomagnetischen Verfahrens zur Isolierung zirkulierender Tumorzellen (CTCs) in Kombination mit einer molekularen Multimarkeranalyse für die hochspezifische Identifizierung maligner Zellen. Patientinnen und Methoden: Peripheres Blut (PB) von 32 Patientinnen mit metastasiertem Mammakarzinom und von 42 gesunden Kontrollen wurde für die immunomagnetische Tumorzellanreicherung mit den Antikörpern BM7 und VU1D9 genutzt. Eine Real-Time Reverse Transkription Polymerase-Kettenreaktion (RT-PCR)-Methodik mit den Markern KRT19, SCGB2A2, MUC1, EPCAM, BIRC5 und ERBB2 wurde für den CTC-Nachweis und die Tumorzellcharakterisierung entwickelt. Ergebnisse: Für die einzelnen Marker wurden die folgenden Positivitätsraten ermittelt: 46,9% für KRT19, 25,0% für SCGB2A2, 28,1% für MUC1, 28,1% für EPCAM, 21,9% für BIRC5 und 15,6% für ERBB2. Nach der Bestimmung individualisierter Cut-off-Werte ergab sich für den kombinierten Multimarkernachweis eine Sensitivität und Spezifität von 56,3% bzw. 100%. Bemerkenswert war der Befund, dass 27,0% der HER2-tumornegativen Patientinnen ERBB2-mRNA-positive CTCs aufwiesen. Schlussfolgerung: Die hier beschriebene Methodik bestimmt CTCs mit hoher Spezifität. Die molekulare Multimarkeranalyse liefert wertvolle Real-Time-Informationen für personalisierte Behandlungsmodalitäten. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Introduction: The presence of circulating tumor cells (CTC) in the peripheral blood has been associated with worse prognosis and early relapse in breast cancer patients. CTC determination in the peripheral blood has been considered as a liquid biopsy. The aim of this project was to analyze the presence of CTC followed by their molecular characterization with the potential use not only as a new biomarker for real-time monitoring of therapy efficacy but also as a suitable tool for patient's stratification and individualization of treatment for breast cancer. Methods: A total of 54 patients with diagnosed early breast cancer were enrolled into a prospective study. Ten millilitres of peripheral blood were sequentially collected to test for the presence and characterization of CTC during the follow-up of patients. CTC isolation and detection was performed by AdnaTest BreastCancer™ (AdnaGen AG, Germany), which is based on the detection of EpCAM, HER2 and MUC1 specific transcripts in enriched CTC- lysates. cDNA from isolated CTC has been further used for newly optimized qPCR assays for breast tumor and therapy resistance associated genes: TOP1, TOP2A, CSTD, ST6GAL, KRT19 and reference gene actin. qPCR results have been analyzed by Genex software (MultiD Analysis). Results: 195 blood samples have been...