Metastasis being the main cause of breast cancer (BC) mortality represents the complex and multistage process. The entrance of tumor cells into the blood vessels and the appearance of circulating tumor cells (CTCs) seeding and colonizing distant tissues and organs are one of the key stages in the metastatic cascade. Like the primary tumor, CTCs are extremely heterogeneous and presented by clusters and individual cells which consist of phenotypically and genetically distinct subpopulations. However, among this diversity, only a small number of CTCs is able to survive in the bloodstream and to form metastases. The identification of the metastasis-initiating CTCs is believed to be a critical issue in developing therapeutic strategies against metastatic disease. In this review, we summarize the available literature addressing morphological, phenotypic and genetic heterogeneity of CTCs and the molecular makeup of specific subpopulations associated with BC metastasis. Special attention is paid to the need for in vitro and in vivo studies to confirm the tumorigenic and metastatic potential of metastasis-associating CTCs. Finally, we consider treatment approaches that could be effective to eradicate metastatic CTCs and to prevent metastasis.

The spread of tumor cells throughout the body by traveling through the bloodstream is a critical step in metastasis, which continues to be the main cause of cancer-related death. The detection and analysis of circulating tumor cells (CTCs) is important for understanding the biology of metastasis and the development of antimetastatic therapy. However, the isolation of CTCs is challenging due to their high heterogeneity and low representation in the bloodstream. Different isolation methods have been suggested, but most of them lead to CTC damage. However, viable CTCs are an effective source for developing preclinical models to perform drug screening and model the metastatic cascade. In this review, we summarize the available literature on methods for isolating viable CTCs based on different properties of cells. Particular attention is paid to the importance of in vitro and in vivo models obtained from CTCs. Finally, we emphasize the current limitations in CTC isolation and suggest potential solutions to overcome them.

The problem of finding more precise stratification criteria for identifying the cohort of patients who would obtain the maximum benefit from immunotherapy is acute in modern times. In our study were enrolled 18 triple-negative breast cancer patients. The Ventana SP142 test was used for PD-L1 detection. Spatial transcriptomic analysis by 10x Genomics was used to compare PD-L1-positive and PD-L1-negative tumors. The seven-color multiplex immunofluorescence (by Akoya) was used for the detection of the type of cells that carried the PD1 receptor and the PD-L1 ligand. Using pathway analysis, we showed that PD-L1-positive tumors demonstrate signatures of a cell response to cytokines, among others, and PD-L1-negative tumors demonstrate signatures of antigen presentation. PD-L1-positive and PD-L1-negative tumors have different tumor microenvironment (TME) compositions according to CIBERSORT analysis. Multiplex immunohistochemistry (IHC) confirmed the prevalence of PD1-negative M2 macrophages and PD1-negative T lymphocytes in PD-L1-positive tumors. PD-L1-positive tumors are not characterized by direct contact between cells carrying the PD1 receptor and the PD-L1 ligand. So, the absence of specific immune reactions against the tumor, predominance of pro-tumor microenvironment, and rare contact between PDL1 and PD1-positive cells may be the potential reasons for the lack of an immune checkpoint inhibitor (ICI) effect in triple-negative breast cancer patients.

We studied direct effects of erythropoietin (Epo) on functional properties of human monocytes/macrophages (Mc/Mphs) in vitro. Cells expressing CD14 marker (a co-receptor for bacterial LPS) were isolated from human peripheral blood mononuclear cells (PBMCs) by positive magnetic separation. We showed that Epo treatment reduce the percentages of CD14+ cells, CD124 (alpha subunit of IL-4 receptor)+ cells and CD197 (CCR7) + cells in non-activated Mph cultures without affecting the levels of CD16 (low-affinity Fc-receptor)+ and CD119 (interferon-γ (IFN-γ) receptor)+ cells. Epo also markedly reduced percentages of CD197+ cells in LPS-activated Mc/Mphs, without significantly affecting the expression of all other molecular markers studied. In addition, Epo caused moderate up-regulation of interleukin-1β (IL-1β) and IL-6 production in resting Mc/Mph cultures, as compared to the down-regulation of IL-1β and IL-6 production in LPS-activated cells. No Epo-mediated effects on tumor necrosis factor-α (TNF-α) and IL-10 production were observed. Our data suggests that Epo effects on Mph functionality are largely dependent on the baseline activation status of these cells, and that Epo exerts no distinct direct effects on the particular Mph polarization pathway. This data contributes to better understanding of mechanisms underlying Mph-mediated, anti-inflammatory effects of Epo, which are an important immunotherapeutic target in autoimmune diseases.