Microfluidic-based immunohistochemistry for breast cancer diagnosis: a comparative clinical study

Breast cancer is a highly heterogeneous disease. The efficacy of tailored therapeutic strategies relies on the precise detection of diagnostic biomarkers by immunohistochemistry (IHC). Therefore, considering the increasing incidence of breast cancer cases, a concomitantly time-efficient and accurate diagnosis is clinically highly relevant. Microfluidics is a promising innovative technology in the field of tissue diagnostic, enabling for rapid, reliable, and automated immunostaining. We previously reported the microfluidic-based HER2 (human epidermal growth factor receptor 2) detection in breast carcinomas to greatly correlate with the HER2 gene amplification level. Here, we aimed to develop a panel of microfluidic-based IHC protocols for prognostic and therapeutic markers routinely assessed for breast cancer diagnosis, namely HER2, estrogen/progesterone receptor (ER/PR), and Ki67 proliferation factor. The microfluidic IHC protocol for each marker was optimized to reach high staining quality comparable to the standard procedure, while concomitantly shortening the staining time to 16 min-excluding deparaffinization and antigen retrieval step-with a turnaround time reduction up to 7 folds. Comparison of the diagnostic score on 50 formaldehyde-fixed paraffin-embedded breast tumor resections by microfluidic versus standard staining showed high concordance (overall agreement: HER2 94%, ER 95.9%, PR 93.6%, Ki67 93.7%) and strong correlation (rho coefficient: ER 0.89, PR 0.88, Ki67 0.87; p < 0.0001) for all the analyzed markers. Importantly, HER2 genetic reflex test for all discordant cases confirmed the scores obtained by the microfluidic technique. Overall, the microfluidic-based IHC represents a clinically validated equivalent approach to the standard chromogenic staining for rapid, accurate, and automated breast cancer diagnosis.

Continuous quantification of HER2 expression by microfluidic precision immunofluorescence estimates HER2 gene amplification in breast cancer

Ata Tuna Ciftlik, Diego Gabriel Dupouy, Maryse Fiche, Martinus Gijs, Déborah Heintze

Chromogenic immunohistochemistry (IHC) is omnipresent in cancer diagnosis, but has also been criticized for its technical limit in quantifying the level of protein expression on tissue sections, thus potentially masking clinically relevant data. Shifting from qualitative to quantitative, immunofluorescence (IF) has recently gained attention, yet the question of how precisely IF can quantify antigen expression remains unanswered, regarding in particular its technical limitations and applicability to multiple markers. Here we introduce microfluidic precision IF, which accurately quantifies the target expression level in a continuous scale based on microfluidic IF staining of standard tissue sections and low-complexity automated image analysis. We show that the level of HER2 protein expression, as continuously quantified using microfluidic precision IF in 25 breast cancer cases, including several cases with equivocal IHC result, can predict the number of HER2 gene copies as assessed by fluorescence in situ hybridization (FISH). Finally, we demonstrate that the working principle of this technology is not restricted to HER2 but can be extended to other biomarkers. We anticipate that our method has the potential of providing automated, fast and high-quality quantitative in situ biomarker data using low-cost immunofluorescence assays, as increasingly required in the era of individually tailored cancer therapy.

Nature Publishing Group2016

Mechanisms underlying cell-fate determination in the mammary gland development

Duje Buric

Notch signaling pathway is an important developmental pathway and has been implicated in both mammary gland development and tumorigenesis. Several studies investigating Notch signaling in mouse mammary gland implied that Notch signaling is an important factor in the determination of the luminal cell type. Clinical studies on breast tumors as well as studies in transgenic mouse models overexpressing active Notch receptors suggested an oncogenic function of Notch in the mammary gland connecting it to the poor breast cancer prognosis. However the physiological role of Notch signaling and its downstream mechanisms remain unclear. Analysis of Transgenic-EGFP Notch reporter mouse mammary epithelium revealed that Notch signaling is active specifically in a subset of hormone receptor positive cells. More sensitive FACS analysis consistently shows EGFP expression in HR+ luminal cells and reveals a weaker signal in a subset of basal (CD24lo) cells. Additionally mRNA analysis revealed that Notch active luminal cells are expressing Wnt4 ligand. To unveil the role of the Notch signaling in the Wnt4 expressing HR+ cells, we conditionally deleted RBP-Jκ, Notch signaling mediator, in Wnt4 expressing subpopulation of hormone receptor positive cells via Wnt4Cre. Abrogation of RBP-Jκ resulted in loss of progesterone receptor expression in 90% of cells bearing the RBP-Jκ deletion while estrogen receptor expression remained intact, implicating RBP-Jκ in regulation of progesterone receptor expression. To test whether Notch signaling regulates PR expression in the entire HR+ population, we analyzed mammary epithelium in which RBP-Jκ has been conditionally deleted via MMTV-Cre in progenitor cells revealing the presence of a subpopulation of luminal hormone receptor positive cells that differentiate independently of Notch signaling. Time directed deletion of RBP-Jκ via intraductally injected Adeno-Cre virus into the adult mouse mammary ductal system through the nipple additionally confirmed that RBP-Jκ is required for progesterone receptor expression. Chromatin immunoprecipitation assay showed that RBP-Jκ binds two out of four putative RBPJκ binding sites in the progesterone receptor promoter. Inhibition of Notch signaling in vivo via intraductal injection of γ-secretase inhibitor, DAPT, resulted in reduced progesterone receptor expression strongly suggesting that Notch-related RBP-Jκ signaling is responsible for PR expression. In this project we are proposing that there are two different populations of HR+ cells: one defined as Wnt4 expressing subpopulation of HR+ cells in which PR expression is dependent of Notch signaling, and another one defined as Wnt4 non expressing subpopulation of HR+ cells which is independent of Notch signaling. Since Notch signaling is able to replace ER signaling and activate ER target genes in the endocrine therapy resistant cell lines, Wnt4 expressing population of HR+ luminal cells might play a crucial role in the acquiring of the resistance.

EPFL2015

Microfluidics-assisted fluorescence in situ hybridization for advantageous human epidermal growth factor receptor 2 assessment in breast cancer

Maryse Fiche, Martinus Gijs, Seiya Matsuoka, Huu Tuan Nguyen, Raphaël Etienne Jean Trouillon

Fluorescence in situ hybridization (FISH) is one of the recommended techniques for human epidermal growth factor receptor 2 (HER2) status assessment on cancer tissues. Here we develop microfluidics-assisted FISH (MA-FISH), in which hybridization of the FISH probes with their target DNA strands is obtained by applying square-wave oscillatory flows of diluted probe solutions in a thin microfluidic chamber of 5 mu l volume. By optimizing the experimental parameters, MA-FISH decreases the consumption of the expensive probe solution by a factor 5 with respect to the standard technique, and reduces the hybridization time to 4 h, which is four times faster than in the standard protocol. To validate the method, we blindly conducted HER2 MA-FISH on 51 formalin-fixed paraffin-embedded tissue slides of 17 breast cancer samples, and compared the results with standard HER2 FISH testing. HER2 status classification was determined according to published guidelines, based on average number of HER2 copies per cell and average HER2/CEP17 ratio. Excellent agreement was observed between the two methods, supporting the validity of MA-FISH and further promoting its short hybridization time and reduced reagent consumption.

Nature Publishing Group2017

Mechanisms underlying cell-fate determination in the mammary gland development

Duje Buric

EPFL2015