Enumeration of circulating tumor cells (CTCs) predicts overall survival
and treatment response in metastatic cancer, but as many commercialized assays
isolate CTCs positive for epithelial cell markers alone, CTCs with little or no
EpCAM expression stay undetected. Therefore, CTC enrichment and isolation by
label-free methods based on biophysical rather than biochemical properties could
provide a more representative spectrum of CTCs. Here, we report on a clinical
scale automated acoustic microfluidic platform processing 5 mL erythrocyte
depleted paraformaldehyde (PFA) fixed blood (diluted 1:2) at a flow rate of 75
>L/min, recovering 43/50 (87±2.3%) breast cancer cell line
cells (MCF7), with 0.11% cancer cell purity and 162-fold enrichment in
close to 2 hours based on intrinsic biophysical cell properties. Adjustments of
the voltage-settings aimed at higher cancer cell purity in the central outlet
provided 0.72% cancer cell purity and 1445-fold enrichment that resulted
in 62±8.7% cancer cell recovery. Similar rates of cancer cell
recovery, cancer-cell purity and fold-enrichment were seen with both prostate
cancer (DU145, PC3) and breast cancer (MCF7) cell line cells. We identified
eosinophil granulocytes as the predominant WBC contaminant (85%) in the
enriched cancer cell fraction. Processing of viable cancer cells in erythrocyte
depleted blood provided slightly reduced results as to fixed cells, (77%
cancer cells in the enriched cancer cell fraction, with 0.2% WBC
contamination). We demonstrate feasibility of enriching either PFA-fixed or
viable cancer cells with a clinical scale acoustic microfluidic platform that
can be adjusted to meet requirements for either high cancer cell recovery or
higher purity, and can process 5 mL blood samples in close to 2 hours.