We present a viable circulating tumor cell (CTC) isolation method based on hypo-osmotic swelling, which is applicable to various size-based CTC isolation devices. The previous CTC filtration devices suffered from the size overlap between CTCs and large leukocytes. Affinity-based size enhancement has been employed to separate CTCs and leukocytes with similar sizes, but the size enhancement was confined to the CTCs expressing specific surface proteins and the cell loss or viability reduction was inevitable when detaching the antibody-conjugated beads from the captured CTCs. In contrast, hypo-osmotic swelling is applicable regardless of the cancer cell types. The size increments of both epithelial-and mesenchymallike cancer cells were larger than that of leukocytes, with less than 10% of cell death at the osmolality of 190 mOsm kg
À1. Consequently, cancer cell isolation was 1.2-fold enhanced with negligible reduction in specificity or cell viability, when using one of the conventional CTC filters. We further explored the improvements in CTC isolation using patients' blood samples and confirmed that the CTC detection rate was enhanced when the samples were processed under hypotonic conditions. Our label-free cell size increment technique can be widely applied to the various CTC filters, for enhancing the isolation of heterogeneous CTCs.
IntroductionMetastasis is the leading cause of death among cancer patients, since over 90% of human deaths due to cancer are strongly associated with metastasis.
1Tumour metastasis involves a series of processes, including invasion of a proliferative tumour into the surrounding blood vessels, intravasation of the tumour cells into the blood stream, and the secondary tumour formation aer extravasation of the detached tumour cells.
2Circulating tumour cells (CTCs) are the cells that have been detached from the primary tumour and circulate through the peripheral blood during the metastasis. It has been reported that the number and the characteristic of CTCs highly match with the malignancy of a tumor. 3,4 In this regard, CTCs have huge potential as novel biomarkers that not only allow early diagnosis of a tumour but also provide evaluation of treatment effectiveness.
5A number of CTC isolation methods have been developed by the advance in microuidics. Two of the most widely accepted CTC isolation methods are the method based on markerspecic binding and the method utilizing the difference in size or other physical properties between CTCs and other blood cells.6 The affinity-based CTC isolation method relies on the binding force between antibody and specic antigen, which is widely expressed on the surface of CTCs. The only FDA-approved CTC detection system, CellSearch®, also enumerates CTCs using the antibody against epithelial cell adhesion molecule (EpCAM). A number of devices, following CellSearch® system, have immobilized anti-EpCAM antibodies on the surface of various microuidic devices and successfully isolated cancer cells that show high-EpCAM expressions.7-12 However, conside...