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Analysis of white blood cells (WBCs) composition is among the most frequently requested laboratory tests in hematological diagnostics. Differential leukocyte count serves as an indicator for a spectrum of diseases including infection, inflammation, anemia, and leukemia, and is under investigation as an early prognostic biomarker for several other conditions as well. Gold standard in WBC subtyping involves immunostaining and/or flow cytometry both of which require costly, instability-prone fluorescent antibodies and are often highly dependent on operator proficiency in sample preparation. Moreover, this method is applicable to fresh blood samples only, such that the samples cannot be frozen for shipment or later analysis.
Epigenetic markers have recently emerged as powerful analytical tools for the study of phenotypic variations. Subsequently, human leukocyte populations have been shown to have cell-lineage DNA methylation patterns that allow for the precise characterization of WBC subsets. Subtyping based on epigenetic markers provides a promising alternative that does not depend on fresh blood sample collection or expensive antibodies and can be exploited as a biomarker for disease onset and susceptibility1,2,3,4,5.
Genome-wide studies have been performed for extensive mapping of methylated specific CG-rich regions in the genome (CpG islands) in leukocyte subtypes to identify candidate epigenetic markers specific to leukocyte subtypes. PCR protocols have been developed because of this reason for methylated gene regions, e.g., CD3Z and FOXP3, corresponding to CD3+ T-Cells and CD4+ CD25+ Regulatory T-Cells (T-Regs), respectively. Wiencke et al. have demonstrated the utility of duplex droplet PCR for epigenetic subtyping of T-Cells, yielding results that highly correlate with flow activated cell sorting (FACS) analysis6. This quantitative genetic analysis method relies on partitioning the template nucleic acid molecules and PCR reagents into thousands of discrete, volumetrically defined, sub-nanoliter sized droplets containing zero, one or more target nucleic acid copies, using water-in-oil emulsions enabled by microfluidics7,8. The PCR amplification is performed within each individual droplet and the endpoint fluorescence intensity of each droplet is measured, allowing absolute quantification of targets present in the sample. Droplet PCR has been established to be more precise, accurate, and technically simpler than standard qPCR, making it a more favorable DNA methylation-based method for clinical evaluation of T-Cells. Although a rapidly emerging subtyping methodology, multiplexed epigenetic analysis to probe for various methylated CpG regions simultaneously is lacking. This is necessary for routine leukocyte differential counts.
Herein, a thermoplastic elastomer (TPE) droplet microfluidic device is presented and employed for methylation-specific multiplex droplet PCR (mdPCR). The technology has been used to delineate specific leukocyte subtypes, CD3+ T-Cells and CD4+ CD25+ T-Regs, based on cell-lineage DNA methylation patterns, i.e., epigenetic variation of CD3Z and FOXP3 CpG regions, respectively. A detailed protocol for DNA extraction, bisulfite conversion and mdPCR is described in concert with a fabrication method for a TPE droplet generation device. Representative results of the method are compared to those of immunofluorescence staining highlighting the utility of the proposed approach.