Circulating tumor microemboli: Progress in molecular understanding and enrichment technologies

Muhammad Umer, Ramanathan Vaidyanathan, Nam-Trung Nguyen, Muhammad J.A. Shiddiky

Research output: Contribution to journalReview articlepeer-review

54 Citations (Scopus)


Circulating tumor cells (CTCs) and their clusters, also known as circulating tumor microemboli (CTM), have emerged as valuable tool that can provide mechanistic insights into the tumor heterogeneity, clonal evolution, and stochastic events within the metastatic cascade. However, recent investigations have hinted that CTM may not be mere aggregates of tumor cells but cells comprising CTM exhibit distinct phenotypic and molecular characteristics in comparison to single CTCs. Moreover, in many cases CTM demonstrated higher metastatic potential and resistance to apoptosis as compared to their single cell counterparts. Thus, their evaluation and enumeration may provide a new dimension to our understanding of cancer biology and metastatic cancer spread as well as offer novel theranostic biomarkers. Most of the existing technologies for isolation of hematogenous tumor cells largely favor single CTCs, hence there is a need to devise new approaches, or re-configure the existing ones, for specific and efficient CTM isolation. Here we review existing knowledge and insights on CTM biology. Furthermore, a critical commentary on current and emerging trends in CTM enrichment and characterization along with recently developed ex-vivo CTC expansion methodologies is presented with the aim to facilitate researchers to identify further avenues of research and development.
Original languageEnglish
Pages (from-to)1367-1389
Number of pages23
JournalBiotechnology Advances
Issue number4
Early online dateMay 2018
Publication statusPublished - 01 Jul 2018


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