Detection of Cell-Free DNA in Blood Plasma Samples of Cancer Patients

Liquid biopsy using cell-free DNA may identify tumor mutations and fusions to potentially diagnose the tumor type and its drug response. In contrast to tissue biopsy, cell-free DNA based liquid biopsy offers a non-invasive approach that can be performed multiple times to monitor cancer disease progression. To isolate circulating cell-free DNA from a patient plasma sample, add 100 microliters of Proteinase K and 800 microliters of lysis buffer supplemented with one microgram of carrier RNA to one milliliter of patient plasma.

Thoroughly pulse vortex the solution for 30 seconds before incubating for 30 minutes at 60 degrees Celsius. At the end of the incubation, add 1.8 milliliters of binding buffer to the tube and thoroughly mix with 15 to 30 seconds of pulse vortexing. After a five minute incubation on ice, insert a silica membrane column into a vacuum apparatus connected to a vacuum pump and firmly insert a 20 milliliter tube extender into the open column to prevent sample leakage.

At the end of the incubation, carefully pour the mixture into the tube extender and switch on the vacuum pump. When all of the lysate has completely run through the columns, switch off the vacuum pump, release the pressure to zero millibars and carefully discard the tube extender without contaminating the adjacent columns. Transfer the column into a collection tube for centrifugation to remove any residual lysate.

After discarding the flow-through, add 600 microliters of wash buffer 1 to the column for a second centrifugation. After discarding the flow-through, centrifuge the column again with 750 microliters of wash buffer 2. After discarding the flow-through, add 750 microliters of 96 to 100%ethanol to the column for an additional centrifugation.

Transfer the column into a new two milliliter collection tube for another centrifugation before placing the membrane column assembly into a new two milliliter collection tube at 56 degrees Celsius for 10 minutes. At the end of the incubation, transfer the column into a new 1.5 milliliter elution tube and add 50 microliters of elution buffer to the column for a three minute incubation at room temperature. Then, centrifuge the recovered solution for one minute at 20, 000 times G to elute the nucleic acids.

To analyze the size of the DNA fragments, first secure the base plate to the chip priming station and adjust the clip at the lowest position. Place a new high sensitivity DNA chip onto the chip priming station and add nine microliters of gel dye mix to the bottom of the G chip well. Position the plunger at one milliliter and close the chip priming station.

Close the lock of the latch until it clicks, set the timer to 60 seconds, and press down the plunger until it is held by the clip. After exactly 60 seconds, use the clip release mechanism to release the plunger. When the plunger retreats to at least the 300 microliter mark, wait for five seconds before slowly retracting the plunger to the one milliliter position.

Open the chip priming station to remove nine microliters of the gel dye mix and transfer the gel to the bottom of the high sensitivity DNA chip G well. To load the DNA marker, dispense five microliters of DNA marker into the ladder well and to the 11 sample wells. To load the ladder and samples, add one microliter of the DNA ladder to the DNA ladder well, one microliter of sample to the used sample wells and one microliter of marker to the unused sample wells.

Place the high sensitivity DNA chip horizontally in the adapter for 60 seconds of vortexing at 2, 400 revolutions per minute, taking care that the bulge that fixes the high sensitivity DNA chip is not damaged. After vortexing, confirm that the electrode cartridge is properly inserted and that the chip selector is positioned to double stranded high sensitivity DNA. Carefully mount the high sensitivity DNA chip into the receptacle and confirm that the electrode cartridge is fit exactly into the wells of the chip before closing the lid.

The fragment analyzer software screen will display a chip icon to indicate that the chip has been inserted and the lid has been closed. To initiate the analysis, open the assay menu and select the double stranded DNA high sensitivity assay. Enter the sample names into the table and click start to initiate the chip run.

At the end of the run, immediately remove and discard the chip according to good laboratory practice. Here are the expected cell-free DNA bioanalyzer graph from a representative glioma patient in which cell-free DNA fragments are enriched at 166 base pairs and there is no genomic DNA contamination in the sample can be observed. Here, the same fragment enrichment graph can be observed after next generation sequencing library preparation of the cell-free DNA.

Note the fragment enrichment shift from 166 to 291 base pairs due to the attachment of 125 base pair indexes and adapters. For this second representative patient, a very slight enrichment of the cell-free DNA fragments can be observed. Despite the low cell-free DNA concentration, the addition of next generation sequencing adapters to the cell-free DNA and PCR amplification leads to a visible cell-free DNA library peak on the fragment enrichment graph, indicating that the library was prepared successfully from this low concentration cell-free DNA sample.

For this third representative patient, the cell-free DNA fragments peaked near 166 base pairs, but genomic DNA contamination was also apparent near the 10, 380 base pair reference ladder peak. Plasma sample lysis is a crucial step in this protocol, as incomplete lysis will affect the cell-free DNA yield and the entire downstream process.