This study outlines an efficient and non-surgical approach for the orthotopic implantation of patient-derived breast cancer xenografts in mice. Breast tumor tissue was dissociated using human-specific enzymes and mechanical agitation, resuspended in a 1:1 v/v ratio of Matrigel: RPMI 1640, and injected orthotopically into the inguinal mammary fat pads of NSG mice (Figure 1 and Figure 2). To ensure the fidelity of the PDX models, the concordance of the original patient tumor sample with the passaged tumors was validated with established histopathological and genomic techniques. Receptor expression was profiled using immunohistochemistry (IHC) staining of standard breast cancer receptors, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) (Figure 3). Cellular morphology was assessed using hematoxylin and eosin (H&E) staining of sectioned tumor slices and expert pathologist interpretation of the stained sections. Preservation of the genetic landscape and retention of human cells was validated using bulk RNA-sequencing and short tandem repeat (STR) authentication (Figure 4 and Table 1). Additionally, pathogen testing identified no contamination of the patient or passaged tumor samples, which is an essential verification step given the use of immunodeficient mice.

Figure 1: Overview of the protocol. Representation of tumor dissociation and injection workflow. Please click here to view a larger version of this figure.
NSG mice were prepared for injection using a depilatory cream applied in alternating clockwise and counterclockwise motions to thoroughly remove fur from the inguinal mammary fat pad area (Figure 2A). Excess depilatory cream was wiped from exposed abdominal skin using sterile gauze, and the area was disinfected with an alcohol pad (Figure 2B). A sterile needle loaded with dissociated tumor cells was positioned at approximately a 45-degree angle 0.5-1 mm caudal to the fourth inguinal nipple mammary fat pads (Figure 2C). Tumor cells were injected in a controlled manner into the fourth inguinal nipple mammary fat pads (Figure 2D). Tumor growth was initially detected by digital palpation of the fat pads. Subsequently, tumor volume progression was quantitatively tracked using magnetic resonance imaging (MRI) (Figure 2E). Both body weight (Figure 2F) and tumor volumes (Figure 2G) were measured weekly to monitor for fluctuations in weight and progression of tumor volumes. Tumors were visually inspected to monitor for wounds such as ulceration that would necessitate premature termination. Successful bilateral engraftment of the PDX in the inguinal mammary fat pads is shown in Figure 2H, and the fat pads following the excision of the tumors are shown in Figure 2I.

Figure 2: Preparation of mice, PDX injection, and monitoring of tumor progression. (A) Mammary fat pads were thoroughly depilated. (B) Presentation of the injection site with clear visibility of the target injection areas. (C) Position of the syringe on the fat pad, typically 0.5-1 mm caudal to fat pad depending on needle length. The white arrow indicates the target area for the needle when inserting. (D) Depiction of dissociated cell injection into the left fourth inguinal nipple mammary fat pad. The needle should be held at an approximately 45-degree angle as shown for injection. (E) Representative MRI image of bilaterally engrafted tumors at injection site. Tumors are highlighted in green. (F) Representative progression of body weights in grams following tumor cell injection (n = 5). The dark blue line represents simple linear regression, which is significantly non-zero (p < 0.0001); mice gained, on average, 22 mg.day-1. Dark blue shading is a 95% confidence interval, light blue shading is a 95% prediction interval, and orange lines are longitudinal body weight measurements. (G) Representative progression of individual tumor volumes in mm3 following tumor cell injection (n = 10). The dark blue line represents exponential regression; tumor volume doubling time was 19.08 days. Dark blue shading is a 95% confidence interval, light blue shading is a 95% prediction interval, and orange lines are longitudinal tumor volumes. (H) Successful bilateral engraftment of PDX cells into the inguinal mammary fat pads. Note that vascularization can be seen supplying each tumor. The white arrows identify the tumors. (I) The inguinal mammary fat pad area following the excision of tumors. (H,I) Units on the ruler are in cm. Please click here to view a larger version of this figure.
The representative PDX (PEN_056) originated from a 31-year-old Caucasian female with stage 3A invasive mammary carcinoma. The primary tumor, collected from the right breast, had a receptor status of ER and PR negative, HER2 positive (ER-PR-HER2+). IHC staining for ER, PR, and HER2 receptors showed concordance between the patient and PDX tumors (Figure 3). However, the PDX does show a greater expression of HER2, which may be due to a selective growth of HER2+ cells. Pathologist evaluation of H&E stained sections confirmed poorly differentiated carcinoma with consistent morphology and cytology in both the patient and PDX samples (Figure 3).

Figure 3: IHC receptor and H&E staining. (Left column) IHC staining of ER, PR, and HER2 receptors and H&E staining in the patient tumor. ER and PR stains show no evident positive staining, as expected. HER2 stains display positivity for HER2 (brown). (Right column) IHC staining of ER, PR, and HER2 receptors and H&E staining in the passaged PDX sample. Receptor staining closely resembles that seen in the patient sample, although HER2 shows greater expression after passaging. Scale bar: 50 µm; magnification: 20x. Please click here to view a larger version of this figure.
Short tandem repeat (STR) genotyping confirmed >80% similarity across the 13 autosomal loci defined by the American Type Cell Culture Collection (ATCC) ASN-0002-2022 consensus guidelines plus 3 additional loci (Table 1). Bulk RNA-sequencing (RNA-seq) of the patient tumor sample and PDX confirmed equivalent levels of alignment to the latest human reference genome (T2T CHM13v2.0), with 82.3% and 79.1% of reads aligning, respectively. Furthermore, the patient tumor and PDX showed a strong positive correlation with a Pearson r value of 0.9559 (Figure 4A). Gene set enrichment analysis comparing PDX vs patient tumor revealed that the top 10 significantly enriched pathways from gene ontology biological processes were predominantly immunologic gene sets, suggesting that the majority of the transcriptional variance between PDX and patient tumor derives from the lack of immune cells in the PDX sample (Figure 4B).
| D5S818 | D13S317 | D7S820 | VWA | TH01 | AM | TPOX | CSF1PO | D3S1358 | D21S11 | D18S51 | Penta_E | Penta_D | D8S1179 | FGA |
| Patient tumor | 12
13 | 8
8 | 8
9 | 17
17 | 9
9.3 | X
X | 8
10 | | 15
16 | 29
31.2 | 16
19 | 12
13 | 14
14 | 10
14 | 21
25 |
| PDX tumor | 13
14 | 8
8 | 8
9 | 17
17 | 9
9.3 | X
X | 10
10 | | 15
15 | 29
29 | 16
19 | 12
13 | 14
14 | 10
14 | 21
25 |
Table 1: Short tandem repeat (STR) authentication.

Figure 4: RNA-sequencing correlation and gene set enrichment. (A) Scatter plot visualizing the log2 normalized counts per million (CPM) for all genes from the patient tumor (x-axis) and PDX (y-axis). A strong positive correlation was found, with a Pearson r value of 0.9559. (B) Ridge plots for the top 10 enriched gene ontology biological process gene sets when comparing PDX vs. patient tumor. Curves depict the enrichment score distribution for each gene set; color represents the FDR q-value for each gene set. Please click here to view a larger version of this figure.