GeTMoR: Simultaneous genomic, transcriptomic, andmorphological profiling of rare single cells

1Circulating tumor cells (CTCs), and circulating tumor related cells, are extremely rare cells that intravasate from the tumor into the circulatory system and can be captured via a liquid biopsy. Although CTCs contribute to the metastatic cascade, and diverse phenotypes of CTCs have been observed - including the cytokeratin expressing CTCs, CTC clusters, large polyploid CTCs, and CTCs undergoing epithelial to mesenchymal transition - little is known about their functionality. By virtue of CTCs being rare, a detection method that maximizes the information obtained per cell would be ideal to understand their biology and for use in diagnostic approaches. The challenge is that rare cell detection necessitates extensive processing steps, during which molecular content, such as RNA and DNA, needs to be preserved for downstream single cell analysis. We developed GEnomic, Transcriptomic, and MOrphological profiling of Rare cells (GeTMoR), a method that extends the High Definition Single Cell Assay for detecting rare cancer related cells to simultaneously image and profile the genome and transcriptome from single rare cells. We validated GeTMoR by spiking in cancer cell lines into whole blood to evaluate the quality of recovered gene expression and copy number profile from the same cell. The GeTMoR approach provides the ability to link the phenotype of rare cells, including CTCs, to their genome and transcriptome, thereby enabling insight into rare cell biology.