Name: database-guided flow-cytometry for evaluation of bone marrow myeloid cell maturation
Uploaded: 2018-11-03T14:00:00
Description: Watch this Scientific Journal Video about Database-guided Flow-cytometry for Evaluation of Bone Marrow Myeloid Cell Maturation at JoVE.com

The antibodies used in this study were provided by BD Biosciences. The authors would like to thank their colleague, Dr. Pascale Flandrin-Gresta, from the Department of Molecular Biology, Hematology laboratory, University Hospital of Saint-Etienne, France, who provided expertise for interpretation of NGS data for the second MDS case. The authors are thankful for the clinician hematologists for their interest and involvement in this study and for the patients and healthy donors for their agreement to participate in this study. The authors would also like to thank the "Les Amis de R&#233;mi" Foundation for financial support for publication.

The protocol listed below has been approved by the &#34;Comit&#233; de Protection des Personnes&#34; (Independant Ethics Committee) Sud-Est 1 from University Hospital of Saint-Etienne, France.
1. Cytometer Settings
NOTE: The cytometer settings were performed according to France Flow recommendations, in accordance with EuroFlow Procedure &#34;EuroFlow Standard Operating Protocol (SOP) for Instrument Setup and Compensation (https://www.euroflow.org/usr/pub/protocols.php...

<ol>
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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=NCCN+Clinical+Practice+Guidelines+in+Oncology:+myelodysplastic+syndromes.">NCCN Clinical Practice Guidelines in Oncology: myelodysplastic syndromes.</a> Journal of the National Comprehensive Cancer Network. 9, 30-56 (2011).</li><li>Greenberg, P. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Myelodysplastic+Syndromes,+Version+2.2017,+Clinical+Practice+Guidelines+in+Oncology.">Myelodysplastic Syndromes, Version 2.2017, Clinical Practice Guidelines in Oncology.</a> Journal of the National Comprehensive Cancer Network. 15, (2017).</li><li>Swerdlow, S. 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The quality of BM aspirate could impact on the final results. The hemodilution of the BM aspirate could distort the distribution of cells in different stages of maturation due to the absence of progenitors or precursors cells. Probably employing a bulk lysing method may help in normalization of BM aspirates for hemodilution in flow cytometric analyses. In addition, the critical steps for the evaluation of BM myeloid dysplasia by flow-cytometry are the sample processing and staining, data acquisition, and interpretation<s...

In the absence of phenotypic markers specific to the dysplastic changes occurring in myeloid cells during MDS initiation and progression, a new approach has been proposed in recent years based on the evaluation of the maturation pathways (altered expression of myeloid antigens during the production of mature myeloid cells) or of the abnormal distribution of different cell types within bone marrow (BM) cell compartments1,2.
This article presents a new method for standardized application of MFC in order to detect dysplastic changes in BM myeloid cell compartments related to myelodysplastic syndromes (MDS) or other myeloid hematological diseases. This study also shows the utility of using maturation databases for MFC data analysis.
Standardization of the sample preparation procedure, data acquisition, and analysis using the databases would allow the identification of the most relevant phenotypic abnormalities related to dysplastic changes in BM myeloid cells. Therefore, statistically selected subsets based on well-labeled and well-recognized formats (Automatic Population Separator (APS) diagrams, histograms, and dot plots) are required for developing an analysis strategy that can be used in subsequent analysis rounds. The discovery of robust phenotypic abnormalities in MDS would ease the diagnosis in cases with or without minimal morphological dysplasia and without cytogenetic aberrancies. Identification of discriminatory parameters allowing for the reduction of immunophenotypic panels may simplify the current scores2, permitting their applicability in clinical pathology&#160;laboratories.
This method limits the subjective interpretations of cytometry data, as have been signaled in MDS diagnosis3. This step is a prerequisite for the development of automated tools for processing and analyzing flow data4.
MDS comprises a heterogeneous group of clonal hematopoietic stem cell (HSC) disorders in which the spliceosome mutations cooperate with specific epigenetic modifiers to yield the MDS phenotype. It is now known that, along with HSC mutations, other mechanisms are involved in MDS pathophysiology, such as aberrant immune-mediated inflammation and interactions between malignant HSCs and the stromal microenvironment of the BM. However, these mechanisms remain poorly understood. The wide clinical and biological heterogeneity of MDS makes the diagnosis and selection of the optimal therapy a challenge. In the last decade, multiple studies have shown that MFC is often more sensitive in detecting dysplasia2 than morphology, but technical and economic constraints make this technique difficult to standardize, with results often depending on the experience of the interpreter3. In addition, it is unclear how MFC can tip the balance toward MDS in cases with or without minimal morphological dysplasia and in the absence of cytogenetic anomalies, or in borderline cases such as hypocellular MDS, with a low blast count, from other non-clonal BM disorders such as bone marrow failure (i.e., aplastic anemia). It also remains difficult to differentiate borderline cases of MDS with an excess of blasts from acute myeloid leukemia (AML). For all these reasons, the clinical guidelines do not integrate MFC testing into the MDS final diagnosis. In 2011, the US National Comprehensive Cancer Network (NCCN) recommended MFC for the estimation of the percentage of CD34+ cells, detection of paroxysmal nocturnal hemoglobinuria clones, and presence of cytotoxic T-cell clones in hypocellular MDS5. These two latter situations also involve a therapeutic goal because clinical data have shown a good response of these patients to immunosuppressive therapy6. The 2017 NCCN guidelines, citing the International Working Group (IWG) recommendations, listed aberrant immunophenotyping detection by MFC among the co-criteria for MDS diagnosis, but without making any specifications6. In addition, the recently published WHO classification stipulates that MFC findings alone are not sufficient to establish a primary diagnosis of MDS in the absence of conclusive morphological and/or cytogenetic data7. However, MFC can be used as an additional test showing the dysregulation of myeloid cell maturation patterns and quantifying the &#34;distance from normal&#34; for a patient at a specific time in the disease course.
This method is applicable at clinical laboratories interested in the evaluation of dysplasia in BM myeloid cells using MFC immunophenotyping, in order to refine the diagnosis in MDS or other myeloid disorders with dysplastic abnormalities.

<table border="0" cellpadding="0" cellspacing="0" style="width:1217px;" width="1216">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:295px;">BD FACSCanto II flow-cytometer</td>
			<td style="width:235px;">BD Biosciences, CA, USA</td>
			<td style="width:344px;">SN: V33896301336</td>
			<td style="width:344px;">3-laser, 4-2-2 configuration, Filters and mirrors details: https://www.bdbiosciences.com/documents/BD_FACSCanto_II_FilterGuide.pdf</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Awel C48-R Centrifuge</td>
			<td>AWEL Industries, FR</td>
			<td>SN: 910120016; Model No: 320002001</td>
			<td>low speed centrifuges; capacity 60 FACS tubes</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Pipetts of 10&#181;l and 200&#181;l</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Pasteur pipettes</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">15 mL Falcon tubes</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">polypropylene tube for FACS</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human HLA-DR</td>
			<td>BD Biosciences, CA, USA</td>
			<td>655874</td>
			<td style="width:344px;">clone L243 
			Mouse BALB/c IgG2a, &#954; 
			Fluorochrome Horizon V450 
			(Ex max 404 nm/ 
			Em max 448 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD45</td>
			<td>BD Biosciences, CA, USA</td>
			<td>560777</td>
			<td style="width:344px;">clone HI30 
			Mouse IgG1, &#954; 
			Fluorochrome Horizon V500 (Ex max 415 nm/ 
			Em max 500 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD16</td>
			<td>BD Biosciences, CA, USA</td>
			<td>656146</td>
			<td style="width:344px;">clone CLB/fcGran1 Mouse BALB/c IgG2a, &#954; 
			Fluorochrome FITC 
			(Ex max 494 nm/ 
			Em max 520 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD13</td>
			<td>BD Biosciences, CA, USA</td>
			<td>347406</td>
			<td style="width:344px;">clone L138 
			Mouse BALB/c X C57BL/6 IgG1, &#954; 
			Fluorochrome PE 
			(Ex max 496 nm/ 
			Em max 578 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD34</td>
			<td>BD Biosciences, CA, USA</td>
			<td>347222</td>
			<td style="width:344px;">clone 8G12 
			Mouse BALB/c IgG1, &#954; 
			Fluorochrome PerCP-Cy5.5 
			(Ex max 482 nm/ 
			Em max 678 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD117</td>
			<td>BD Biosciences, CA, USA</td>
			<td>339217</td>
			<td style="width:344px;">clone 104D2 
			Mouse BALB/c IgG1 
			Fluorochrome PE-Cy7 
			(Ex max 496 nm/ 
			Em max 785 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD11b</td>
			<td>BD Biosciences, CA, USA</td>
			<td>333143</td>
			<td style="width:344px;">clone D12 
			Mouse BALB/c IgG2a, &#954; 
			D12, Fluorochrome APC 
			(Ex max 650 nm/ 
			Em max 660nm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD10</td>
			<td>BD Biosciences, CA, USA</td>
			<td>646783</td>
			<td style="width:344px;">clone HI10A 
			Mouse BALB/c IgG1, &#954; 
			Fluorochrome APC-H7 
			(Ex max 496 nm/ 
			Em max 785nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD35</td>
			<td>BD Biosciences, CA, USA</td>
			<td>555452</td>
			<td style="width:344px;">clone E11 
			Mouse IgG1, &#954; 
			Fluorochrome FITC 
			(Ex max 494 nm/ 
			Em max 520 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD64</td>
			<td>BD Biosciences, CA, USA</td>
			<td>644385</td>
			<td style="width:344px;">clone 10.1 
			Mouse BALB/c IgG1, &#954; 
			Fluorochrome PE 
			(Ex max 496 nm/ 
			Em max 578 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD300e</td>
			<td>Immunostep</td>
			<td>IREM2A-T100</td>
			<td style="width:344px;">clone UP-H2 
			Mouse BALB/c IgG1, k 
			Fluorochrome APC 
			(Ex max 496 nm/ 
			Em max 578 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD14</td>
			<td>BD Biosciences, CA, USA</td>
			<td>641394</td>
			<td style="width:344px;">clone MoP9 
			Mouse BALB/c IgG2b, &#954; 
			Fluorochrome APC-H7 
			(Ex max 496 nm/ 
			Em max 785nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD36</td>
			<td>BD Biosciences, CA, USA</td>
			<td>656151</td>
			<td style="width:344px;">clone CLB-IVC7 
			Mouse IgG1, &#954; 
			Fluorochrome FITC 
			(Ex max 494 nm/ 
			Em max 520 nm)</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Mouse Anti-Human CD105</td>
			<td>BD Biosciences, CA, USA</td>
			<td>560839</td>
			<td style="width:344px;">clone 266 
			Mouse BALB/c IgG1, &#954; 
			Fluorochrome PE 
			(Ex max 496 nm/ 
			Em max 578 nm)</td>
		</tr>
		<tr height="68">
			<td height="68" style="height:68px;">Mouse Anti-Human CD33</td>
			<td></td>
			<td>345800</td>
			<td style="width:344px;">clone P67.6 
			Mouse BALB/c IgG1, &#954; 
			Fluorochrome APC 
			(Ex max 496 nm/ 
			Em max 578 nm)</td>
		</tr>
		<tr height="68">
			<td height="68" style="height:68px;">Mouse Anti-Human CD71</td>
			<td>BD Biosciences, CA, USA</td>
			<td>655408</td>
			<td style="width:344px;">clone M-A712 
			Mouse BALB/c IgG2a, &#954; 
			Fluorochrome APC-H7 
			(Ex max 496 nm/ 
			Em max 785nm)</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Lysing Solution 10X Concentrate (IVD)</td>
			<td>BD Biosciences, CA, USA</td>
			<td>349202</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">FACSFlow Sheath Fluid</td>
			<td>BD Biosciences, CA, USA</td>
			<td>342003</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">FACSDiva CS&#38;T IVD beads</td>
			<td>BD Biosciences, CA, USA</td>
			<td>656046</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">RAINBOW CALIBRATION PARTICLES, 8 PEAKS</td>
			<td>Cytognos, Salamanca, Spain</td>
			<td>SPH-RCP-30-5A</td>
			<td>lots EAB01, EAC01, EAD05, EAE01, EAF01, EAG01, EAH01, EAI01, EAJ01, EAK01</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Compensation Particles Multicolor CompBeads(CE/IVD)</td>
			<td>BD Biosciences, CA, USA</td>
			<td>ref. #51-90-9001229 + #51-90-9001291</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Diva software versions 6.1.2 and 6.1.3</td>
			<td>BD Biosciences, CA, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Phosphate buffered saline tablets</td>
			<td>R&#38;D Systems, Minneapolis, USA</td>
			<td>5564</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Bovine serum albumin&#160;(BSA)</td>
			<td>Sigma-Aldrich, France</td>
			<td>A9647</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:295px;">Sodium azide 99%</td>
			<td>Sigma-Aldrich, France</td>
			<td style="width:344px;">199931</td>
			<td style="width:344px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:295px;">Infinicyt software version 1.8.0.e</td>
			<td>Cytognos, Salamanca, Spain</td>
			<td style="width:344px;"></td>
			<td style="width:344px;"></td>
		</tr>
	</tbody>
</table>

database-guided flow-cytometry for evaluation of bone marrow myeloid cell maturation

A working group initiated within the French Cytometry Association (AFC) was developed in order to harmonize the application of multiparameter flow cytometry (MFC) for myeloid disease diagnosis in France. The protocol presented here was agreed-upon and applied between September 2013 and November 2015 in six French diagnostic laboratories (University Hospitals of Saint-Etienne, Grenoble, Clermont-Ferrand, Nice, and Lille and Institut Paoli-Calmettes in Marseille) and allowed the standardization of bone marrow sample preparation and data acquisition. Three maturation databases were developed for neutrophil, monocytic, and erythroid lineages with bone marrow from "healthy" donor individuals (individuals without any evidence of a hematopoietic disease). A robust method of analysis for each myeloid lineage should be applicable for routine diagnostic use. New cases can be analyzed in the same manner and compared against the usual databases. Thus, quantitative and qualitative phenotypic abnormalities can be identified and those above 2SD compared with data of normal bone marrow samples should be considered indicative of pathology. The major limitation is the higher variability between the data achieved using the monoclonal antibodies obtained with the methods based on hybridoma technologies and currently used in clinical diagnosis. Setting criteria for technical validation of the data acquired may help improve the utility of MFC for MDS diagnostics. The establishment of these criteria requires analysis against a database. The reduction of investigator subjectivity in data analysis is an important advantage of this method.

The 54 BM samples harvested in K-EDTA anticoagulant were included in the study. The MFC data were analyzed in the absence of any information about the patients. Retrospective study showed that the BM samples were from 7 healthy donors (5 males and 2 females with a median age of 47.4 [35-48], 11 individuals with no evidence of a hematopoietic disease (8 males and 3 females with a median age of 57.9 [35-72]) and 36 cases with various pathological conditions: 1 case with anemia and low creat...

Watch this Scientific Journal Video about Database-guided Flow-cytometry for Evaluation of Bone Marrow Myeloid Cell Maturation at JoVE.com

Database-guided Flow-cytometry for Evaluation of Bone Marrow Myeloid Cell Maturation

The MDS diagnosis is difficult in the absence of morphological criteria or non-informative cytogenetics. MFC could help refine the MDS diagnostic process. To become useful for clinical practice, the MFC analysis must be based on parameters with sufficient specificity and sensitivity, and data should be reproducible between different operators.

A working group initiated within the French Cytometry Association (AFC) was developed in order to harmonize the application of multiparameter flow ...

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Flow Cytometry Analysis of Immune Cell Subsets within the Murine Spleen, Bone Marrow, Lymph Nodes and Synovial Tissue in an Osteoarthritis Model

Osteoarthritis (OA) is one of the most prevalent musculoskeletal diseases, affecting patients suffering from pain and physical limitations. Recent ...

Isolation and Cultivation of Mandibular Bone Marrow Mesenchymal Stem Cells in Rats

Here we present an efficient method for isolating and culturing mandibular bone marrow mesenchymal stem cells (mBMSCs) in vitro to rapidly obtain numerous ...