Mice orthotopically implanted with patient-derived cancer cells were monitored weekly by µCT scanning. At the end of the experiment, the animals were euthanized. Intestines, ceca (Figure 1A,B), livers, lungs, and any other possible lesion were collected, included in a cassette, and fixed with 4% formalin overnight. Intestine tissue from a mouse without a tumor in the cecum was used as a control (Figure 1C). Finally, cassettes were changed to 70% ethanol for at least 3 h and paraffin embedded. Hematoxylin and eosin (H&E) staining from ceca, livers, and lungs were performed using histopathology facility standard protocols to identify tumor cells (Figure 2, Figure 3, and Figure 4).
In another experiment, mice bearing orthotopic tumors were monitored weekly. When a tumor µCT scan signal was detected in most of the mice (around 2-4 weeks, depending on the PDX model), the animals were randomized in four groups and treated with either the vehicle, the testing drug (20 mg/kg), the standard of care chemotherapy irinotecan (50 mg/kg), or the testing drug with irinotecan. The drugs were administered intraperitoneally once a week until the end of the experiment. Tumor growth was monitored weekly by µCT scanning throughout the course of the experiment. The results indicated that the testing drug induced a reduction of the tumor volume, calculated by the µCT scan images, and that was enhanced in combination with irinotecan treatment (Figure 5 and Figure 6).
Previous studies in our lab have shown that the metastatic potential (carcinomatosis, lung and liver metastasis) of the orthotopic CRC-PDX models depends on the PDX model used (Table 3)2. In the present study, the therapeutic efficacy on metastasis formation was also evaluated. The results indicated that the testing drug, irinotecan, and the combination eradicated the formation of lung and liver metastasis in treated mice (Table 4)11.

Figure 1: Macroscopic images of the intestine of mice bearing orthotopic CRC-PDX tumors. Macroscopic intestine images from two mice bearing an orthotopic PDX tumor (A,B) at the end of the experiment. Cecum tumors are defined in red in the images. (C) An intestine image of a mouse without a tumor in the cecum as a control. Scale bars = 5 mm (A,B); 1 cm (C). Please click here to view a larger version of this figure.

Figure 2: Histological images of orthotopic CRC-PDX tumors. H&E staining of a PDX tumor model in the cecum at the end of the experiment at low (A) and high (a) magnification. Cecum tumors are defined in red in the images. Scale bars = 2.5 mm (A); 100 mm (a). Please click here to view a larger version of this figure.

Figure 3: Histological images of lung metastasis derived from orthotopic CRC-PDX tumor H&E staining of a lung from a mouse bearing an orthotopic PDX tumor. Lung metastasis can be observed at low (A) and high (a) magnification. Lung metastases are defined in red in the images. Scale bars = 250 mm (A); 100 mm (a). Please click here to view a larger version of this figure.

Figure 4: Histological images of liver metastasis derived from orthotopic CRC-PDX tumors. H&E staining of a liver from a mouse bearing an orthotopic PDX tumor. Liver metastasis can be observed at low (A) and high (a) magnification. Liver metastases are defined in red in the images. Scale bars are indicated in the images. Scale bars = 500 mm (A); 50 mm (a). Please click here to view a larger version of this figure.

Figure 5: Therapeutic efficacy of a testing drug in an orthotopic CRC-PDX model. Example of an experiment with four groups (vehicle, testing drug, irinotecan, and testing drug with irinotecan)11. Tumor volume obtained from the µCT scan images is represented over time (A) and at the end of the experiment (day 42) (B). Bars, ± SE (n = 15-30) and *p < 0.05, ***p < 0.001, ****p < 0.0001 versus vehicle (t-test, two-sided). Please click here to view a larger version of this figure.

Figure 6: µCT images from mice bearing orthotopic CRC-PDX tumors under treatment. Representative µCT images of mice bearing orthotopic tumors treated with a therapeutic drug. The cecum (red) and tumor mass (blue) are defined in the images. Please click here to view a larger version of this figure.
Table 1: Establishment of the subcutaneous PDX. Example of three PDX models established in the lab (P1, P2, and P3) from our biobank2 of more than 350 PDX models with the number of cells inoculated, the incidence of PDX establishment, and the passages in mice. Please click here to download this Table.
Table 2: Reagents to prepare the growth factors (GF) MIX 10X, the CoCSCM 6Ab without EGF, FGF2, and growth factors, the CoCSCM 6Ab complete medium, and the digestion medium. Please click here to download this Table.
Table 3: Metastatic potential of orthotopic CRC-PDX models. Example of three orthotopic CRC-PDX models established in the lab (P1, P2, and P3) from our biobank2. Here, the number of cells inoculated, the incidence of cecum tumor formation, and the incidence to generate carcinomatosis, lung metastasis, or liver metastasis are indicated. Please click here to download this Table.
Table 4: Therapeutic metastatic efficacy of a testing drug in an orthotopic CRC-PDX model. Example of an experiment with four groups (vehicle, testing drug, irinotecan, and testing drug with irinotecan)11. Here, the number of mice in each group and which of them developed carcinomatosis, lung metastasis, or liver metastasis at the end of the experiment are indicated. Please click here to download this Table.