Name: multiplexed fluorescent immunohistochemical staining, imaging, and analysis in histological samples of lymphoma
Uploaded: 2019-01-09T14:00:00
Description: Watch this Scientific Journal Video about Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma at JoVE.com

S.-B.N. and A.D.J. are supported by the Singapore Ministry of Health&#39;s National Medical Research Council Transition Awards (NMRC/TA/0020/2013 and NMRC/TA/0052/2016). The authors acknowledge a Yong Siew Yoon Research Grant to A.D.J. from the National University Cancer Institute of Singapore toward the purchase of a Vectra spectral imaging microscope. This study is approved by the Singapore NHG Domain Specific Review Board B (2014/00693).

All tissues used in this protocol were obtained under the Singapore NHG Domain Specific Review Board B study 2014/00693.
1. Selection and Validation of Antibodies
NOTE: Before proceeding with the establishment of any multiplexed panel, ensure that all antibodies stain robustly, identifying only the target antigen of interest. The aim is to select antibodies that specifically recognize the antigen of interest in tissue sections.
<ol>
	<li>For an antibody with a wel...

<ol>
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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immunohistochemistry+for+Pathologists:+Protocols,+Pitfalls,+and+Tips.">Immunohistochemistry for Pathologists: Protocols, Pitfalls, and Tips.</a> Journal of Pathology and Translational Medicine. 50 (6), 411-418 (2016).</li><li>Stack, E. C., Wang, C., Roman, K. A., Hoyt, C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multiplexed+immunohistochemistry,+imaging,+and+quantitation:+a+review,+with+an+assessment+of+Tyramide+signal+amplification,+multispectral+imaging+and+multiplex+analysis.">Multiplexed immunohistochemistry, imaging, and quantitation: a review, with an assessment of Tyramide signal amplification, multispectral imaging and multiplex analysis.</a> Methods. 70 (1), 46-58 (2014).</li><li>Anderson, M. W., Natkunam, Y., Jones, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immunohistochemical+profiling+of+lymphoma.">Immunohistochemical profiling of lymphoma.</a> Neoplastic Hematopathology: Experimental and Clinical Approaches. , 21-44 (2010).</li><li>Parra, E. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+Platforms+of+Multiplexed+Immunofluorescence+for+Study+of+Paraffin+Tumor+Tissues.">Novel Platforms of Multiplexed Immunofluorescence for Study of Paraffin Tumor Tissues.</a> Journal of Cancer Treatment and Diagnosis. 2 (1), 43-53 (2018).</li><li>Cregger, M., Berger, A. J., Rimm, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immunohistochemistry+and+Quantitative+Analysis+of+Protein+Expression.">Immunohistochemistry and Quantitative Analysis of Protein Expression.</a> Archives of Pathology &amp; Laboratory Medicine. 130 (7), 1026-1030 (2006).</li><li>Parra, E. R., 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=Validation+of+multiplex+immunofluorescence+panels+using+multispectral+microscopy+for+immune-profiling+of+formalin-fixed+and+paraffin-embedded+human+tumor+tissues.">Validation of multiplex immunofluorescence panels using multispectral microscopy for immune-profiling of formalin-fixed and paraffin-embedded human tumor tissues.</a> Scientific Reports. 7 (1), 13380 (2017).</li><li>T&#243;th, Z. E., Mezey, &. #. 2. 0. 1. ;. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+Visualization+of+Multiple+Antigens+with+Tyramide+Signal+Amplification+using+Antibodies+from+the+same+Species.">Simultaneous Visualization of Multiple Antigens with Tyramide Signal Amplification using Antibodies from the same Species.</a> Journal of Histochemistry &amp; Cytochemistry. 55 (6), 545-554 (2007).</li><li>Ng, S. -. B., 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=Quantitative+Analysis+of+a+Multiplexed+Immunofluorescence+Panel+in+T-Cell+Lymphoma.">Quantitative Analysis of a Multiplexed Immunofluorescence Panel in T-Cell Lymphoma.</a> SLAS TECHNOLOGY: Translating Life Sciences Innovation. 23 (3), 252-258 (2017).</li><li>Bogusz, A. M., 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=Diffuse+large+B-cell+lymphoma+with+concurrent+high+MYC+and+BCL2+expression+shows+evidence+of+active+B-cell+receptor+signaling+by+quantitative+immunofluorescence.">Diffuse large B-cell lymphoma with concurrent high MYC and BCL2 expression shows evidence of active B-cell receptor signaling by quantitative immunofluorescence.</a> PLoS One. 12 (2), e0172364 (2017).</li><li>Kalyuzhny, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Signal Transduction Immunohistochemistry: Methods and Protocols. , (2011).</li><li>Bordeaux, J., 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=Antibody+validation.">Antibody validation.</a> BioTechniques. 48 (3), 197-209 (2010).</li><li>PerkinElmer. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Vectra 3 Quantitative Pathology Imaging System User's Manual. , (2012).</li><li>Ho, J., Tumkaya, T., Aryal, S., Choi, H., Claridge-Chang, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Moving+beyond+P+values:+Everyday+data+analysis+with+estimation+plots.">Moving beyond P values: Everyday data analysis with estimation plots.</a> bioRxiv. , (2018).</li><li>Feng, Z., 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=Multispectral+Imaging+of+T+and+B+Cells+in+Murine+Spleen+and+Tumor.">Multispectral Imaging of T and B Cells in Murine Spleen and Tumor.</a> The Journal of Immunology Author Choice. 196 (9), 3943-3950 (2016).</li><li>PerkinElmer. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Opal Multiplex IHC Assay Development Guide. , (2017).</li></ol>

mf-IHC has the potential to enable pathologists to refine diagnosticcriteria in lymphoid pathology and to analyze the role of biomarkers in specific cell types toward a prediction of clinical outcome. As a new research method, mf-IHC is increasingly applied to the quantitative and spatial identification of multiple immune parameters of tumor cells17. The detection of mf-IHC for the co-expression of tumor biomarkers has been shown to be reproducible and reliable5. However, t...

Lymphoid neoplasms are caused by the uncontrolled malignant proliferation of lymphocytes. These cells are vital components of the immune system and localize to the primary and secondary immune organs, such as the bone marrow, lymph nodes, spleen, and other mucosa-associated lymphoid system. Lymphoid neoplasms are a heterogeneous group of disorders who are classified based on a constellation of features, including morphology, immunophenotype, genetic features, and clinical presentation. While each parameter plays a part, lineage remains a defining feature and forms the basis for the WHO classification system which recognizes neoplasms derived from B cells, T cells, and natural killer (NK) cells1.
Key to the classification of lymphoma has been the characterization of the antibodies against leukocyte surface markers of the various subtypes of lymphocytes2. Immunohistochemistry (IHC) has been traditionally used for the analysis of such markers and is based on the principle of the specific antigen-antibody recognition to detect cell- and tissue-based molecules that can be visualized through the light microscope3. However, the identification of multiple targets on a single slide by conventional bright-field chromogenic multiplex IHC has limitations because it is often difficult to distinguish multiple color signals on a single tissue section reliably&#8212;especially for antigens with a very low expression4. Visual assessment and quantification of staining can also be subjective, causing variability in the analysis and data interpretation5.
Therefore, conventional IHC on formalin-fixed, paraffin-embedded (FFPE) samples is not feasible for the simultaneous detection of multiple targets in immunologically diverse diseases like lymphoma. Furthermore, distinguishing neoplastic lymphocytes from the surrounding immune cells is often imprecise. This hinders studies looking at the relevance of novel biomarkers in lymphoma. In this context, multiplex fluorescent IHC (mf-IHC) offers a promising alternative as it allows the quantitative assessment of antigen coexpression and a spatial relationship with higher precision while conserving limited samples6,7. When this imaging technology is partnered with the digital image analysis software, the data interpretation is made more efficient and facilitates the study of tumor and microenvironment heterogeneity8,9. In this protocol, a tyramide-based immunofluorescence (IF) multiplexing method is applied to amplify the signal and is compatible with any IHC-validated antibody from any host species, even those developed in the&#160;same species5,7,10. The tyramide-based protocol allows for the direct conjugation of the fluorophore to the tissue of interest so that the primary and secondary antibody can be stripped after each step, allowing for the sequential application of multiple stains without antibody cross-reactivity.
A multiplexed strategy will be useful for predicting prognosis and treatment outcomes by identifying targets and their variant immunologic patterns in lymphomas. Multiplex fluorescent IHC has been applied in our lab for the study of a panel of T and B lymphocyte markers and T-follicular helper markers in angioimmunoblastic T-cell lymphoma (AITL), a subtype of a peripheral T-cell lymphoma characterized by aggressive clinical behavior and tumor heterogeneity11. The utility of this method is also illustrated in diffuse large B-cell lymphoma (DLBCL) where the increased signaling of a B-cell receptor with simultaneous C-MYC and BCL-2 expression suggests the potential therapeutic use of Bruton&#39;s tyrosine kinase inhibition12. 
Here we describe the entire protocol from antibody validation to the selection of appropriate control tissues and multiplexing using lymphoma FFPE tissues, with an eventual analysis of stained slides using a scanning automated quantitative pathology imaging system.

<table>
	<tbody>
		<tr>
			<td>Antibody diluent</td>
			<td>DAKO</td>
			<td>REF S3022</td>
			<td>Blocking</td>
		</tr>
		<tr>
			<td>Peroxidase Blocking Solution</td>
			<td>DAKO</td>
			<td>S2023</td>
			<td>For peroxide blocking</td>
		</tr>
		<tr>
			<td>Vectra multispectral automated microscope</td>
			<td>Perkin Elmer</td>
			<td>Vectra2.0.8</td>
			<td>Spectral imaging</td>
		</tr>
		<tr>
			<td>absolute Ethanol</td>
			<td>EMSURE</td>
			<td>1.00983.2500</td>
			<td>Ethyl alcohol for rehydration</td>
		</tr>
		<tr>
			<td>Amplification Diluent</td>
			<td>PERKIN ELMER</td>
			<td>FP1135</td>
			<td>Fluorophore diluent buffer</td>
		</tr>
		<tr>
			<td>Anti-Mouse IgG [Goat] HRP-Labeled</td>
			<td>PERKIN ELMER</td>
			<td>NEF822001EA</td>
			<td>Secondary antibody</td>
		</tr>
		<tr>
			<td>Anti-Rabbit IgG [Goat] HRP-Labeled</td>
			<td>PERKIN ELMER</td>
			<td>NEF812001EA</td>
			<td>Secondary antibody</td>
		</tr>
		<tr>
			<td>BCL2</td>
			<td>DAKO</td>
			<td>clone 124 ( Lot No. 20031561)(RRID-AB578693)</td>
			<td>primary antibody</td>
		</tr>
		<tr>
			<td>BCL6</td>
			<td>LEICA</td>
			<td>NCL-L-Bcl6-564(Lot No.6050438)(RRID-AB563429)</td>
			<td>primary antibody</td>
		</tr>
		<tr>
			<td>CD20</td>
			<td>DAKO</td>
			<td>Clone L26 (Lot No.20028627) (RRID-AB442055)</td>
			<td>primary antibody</td>
		</tr>
		<tr>
			<td>c-MYC</td>
			<td>ABCAM</td>
			<td>Y 69 clone ab32072 (Lot NO.GR29511133)(RRID-AB731658)</td>
			<td>primary antibody</td>
		</tr>
		<tr>
			<td>Cy 5</td>
			<td>PERKIN ELMER</td>
			<td>FP1171</td>
			<td>Appropriate tyramide based fluorescent reagent</td>
		</tr>
		<tr>
			<td>Graphpad Prism 7</td>
			<td>Graph pad</td>
			<td></td>
			<td>Statisitcal software</td>
		</tr>
		<tr>
			<td>HistoClear Clearing Agent</td>
			<td>SIGMA</td>
			<td>H2779-1L</td>
			<td>Histoclear for dewaxing and clearing</td>
		</tr>
		<tr>
			<td>inForm Advanced 
			Image Analysis Software</td>
			<td>Perkin Elmer</td>
			<td>Inform Software 2.2.1</td>
			<td>Data Analysis software</td>
		</tr>
		<tr>
			<td>KI67</td>
			<td>DAKO</td>
			<td>Clone MIB-1 (Lot No.20040401) (RRID-AB2314699)</td>
			<td>primary antibody</td>
		</tr>
		<tr>
			<td>KOS MILESTONE multifunctional tissue processor</td>
			<td>Milestone</td>
			<td></td>
			<td>Microwave for Heat induced epitope retrieval</td>
		</tr>
		<tr>
			<td>Microwave</td>
			<td>PANASONIC</td>
			<td>NN-ST651M</td>
			<td>Microwave stripping</td>
		</tr>
		<tr>
			<td>Mowiol</td>
			<td>SIGMA ALDRICH</td>
			<td>81381 Aldrich Mowiol&#174; 4-88</td>
			<td>mounting media</td>
		</tr>
		<tr>
			<td>Opal 570</td>
			<td>PERKIN ELMER</td>
			<td>FP1488</td>
			<td>Appropriate tyramide based fluorescent reagent</td>
		</tr>
		<tr>
			<td>Opal520</td>
			<td>PERKIN ELMER</td>
			<td>FP1487B21</td>
			<td>Appropriate tyramide based fluorescent reagent</td>
		</tr>
		<tr>
			<td>Opal540</td>
			<td>PERKIN ELMER</td>
			<td>FP1494</td>
			<td>Appropriate tyramide based fluorescent reagent</td>
		</tr>
		<tr>
			<td>Opal620</td>
			<td>PERKIN ELMER</td>
			<td>FP1495</td>
			<td>Appropriate tyramide based fluorescent reagent</td>
		</tr>
		<tr>
			<td>Poly-L-lysine coated slide</td>
			<td>FISHER SCIENTIFIC</td>
			<td>120-550-15</td>
			<td>Slide for tissue section adhesion in routine histological use</td>
		</tr>
		<tr>
			<td>Spectral DAPI</td>
			<td>PERKIN ELMER</td>
			<td>FP1490</td>
			<td>nucleic acid stain</td>
		</tr>
		<tr>
			<td>Target Retrieval Solution, pH9.0(10x)</td>
			<td>DAKO</td>
			<td>S2367</td>
			<td>For HIER</td>
		</tr>
		<tr>
			<td>Tris Buffer saline (TBS)</td>
			<td>1st BASE</td>
			<td>BUF3030 20X4L</td>
			<td>for buffer wash</td>
		</tr>
		<tr>
			<td>Tween 20</td>
			<td>SIGMA ALDRICH</td>
			<td>P1379-1L</td>
			<td>Tween</td>
		</tr>
	</tbody>
</table>

multiplexed fluorescent immunohistochemical staining, imaging, and analysis in histological samples of lymphoma

Immunohistochemical (IHC) methods for the in-situ analysis of protein expression by light microscopy are a powerful tool for both research and diagnostic purposes. However, the visualization and quantification of multiple antigens in a single tissue section using conventional chromogenic IHC is challenging. Multiplexed imaging is especially relevant in lymphoma research and diagnostics, where markers have to be interpreted in the context of a complex tumor microenvironment. Here we describe a protocol for multiplexed fluorescent IHC staining to enable the quantitative assessment of multiple targets in specific cell types of interest in lymphoma.The method covers aspects of antibody validation, antibody optimization, the multiplex optimization with markers of lymphoma subtypes, the staining of tissue microarray (TMA) slides, and the scanning of the slides, followed by data analysis, with specific reference to lymphoma. Using this method, scores for both the mean intensity of a marker of interest and the percentage positivity are generated to facilitate further quantitative analysis. Multiplexing minimizes sample utilization and provides spatial information for each marker of interest.

mf-IHC images for a DLBCL sample with C-MYC and BCL2 gene rearrangement (double-hit lymphoma) are shown in Figure 1. Figure 2 illustrates the simulated bright-field immunohistochemical images. Figure 3 indicates the generation of percentage data. Figure 4 displays the details of a median formula for the generation of numeric data. Figure 5 s...

Watch this Scientific Journal Video about Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma at JoVE.com

Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma

Here we describe a protocol for multiplex fluorescent immunohistochemical staining and imaging for the simultaneous localization of multiple cancer-associated antigens in lymphoma. This protocol can be extended to the colocalization analysis of biomarkers within all tissue sections.

Immunohistochemical (IHC) methods for the in-situ analysis of protein expression by light microscopy are a powerful tool for both research and diagnostic ...

Lymphomas are histologically complex tumors. Therefore, multiplexed fluorescent immunohistochemistry offers advantages over conventional chromogenic immunohistochemistry to study markers of interest in the tumor cells and the microenvironment. This technique has the potential for standardizing scoring of antibody based staining in histological lymphoma samples, a process that has historically been challenging due to the complexity of the tumor microenvironment.Specifically, multiplexed fluorescent immunohistochemistry and spectral imaging allows the quantitative measurement of multiple stains within a single slide, thereby allowing the assessment of antigen co expression and spacial relationship within clinical material. Begin by immersing the de-waxed and rehydrated slides in a standard antigen retrieval buffer in a microwave save glass jar and performing heat-induced epitope retrieval in a suitable microwave. Perform additional rounds of microwave stripping based on the position of the antibody in the final multiplex sequence.For example, the fourth antibody requires three additional rounds of microwave stripping prior to staining. After completion of the stripping process, use forceps and heat-proof gloves to transfer the slides to distilled water at room temperature for an at least 10 minute cool down. When the antigen retrieval solution has cooled, block the tissue peroxidase activity with a commercial peroxidase block for 10 minutes followed by a five minute wash in tris-buffered saline, or TBS, and a non ionic detergent.Block any nonspecific staining with a 10 minute incubation in blocking buffer followed by incubation with the primary antibody of interest at room temperature for 30 minutes and three five minute washes with TBS-D buffer. Next, incubate the samples with an appropriate horseradish peroxidase conjugated secondary antibody for 15 minutes at room temperature, followed by three washes in TBS-D buffer as demonstrated. After the last wash, apply an appropriate tyramide based fluorescent reagent to the slides for a five minute incubation at room temperature followed by three five minute TBS-D washes.Perform an additional microwave based stripping to remove the primary and secondary antibodies in fresh antigen retrieval solution as demonstrated. At the end of the retrieval, cool the slides in distilled water and dry the areas on the slides without tissue with lab wipes. Incubate slide with dappy for 10 minute at room temperature followed by three TBS-D washes.Then, carefully dry the slides with lab wipes without contacting the tissues and mount the samples with an appropriate mounting medium for imaging. For monoplex slide scanning, select the appropriate filters from the fluorophores used for labeling the samples and examine each marker and its corresponding fluorescence channel to identify a suitable exposure time for obtaining a clean signal, focusing on the tissue component that should have the strongest signal for the marker. To allow cross-sample comparison of the pixel intensity, use the live camera setting to adjust the exposure time in each individual channel until there are no overexposed areas in the live camera image.When all of the slides have been scanned, acquire simulated bright field images to visually compare with the normal immunohistochemical pattern and to determine if the staining pattern is correct. To scan tissue microarray slides, use the tissue microarray scanning mode in the imaging system and an appropriate auto focus algorithm. For whole tissue section slides, have the slides reviewed by a qualified pathologist to select optimal images from the most representative tumor areas.Before beginning the analysis, select a tumor marker to identify the cells of interest for the analysis. Have a pathologist review the images and decide whether tissue segmentation is required. If required, select the appropriate control regions for segmentation and check whether the image analysis software can correctly identify such regions.After the cell segmentation, have the pathologist review the segmentation map to ensure the fidelity of the intended segmentation approach and review individual images to determine whether the cell segmentation is adequate or if additional tissue segmentation is required to select regions enriched for tumor cells, stroma, and or necrosis. Then determine the optical intensity positive cutoff value for each marker in conjunction with the pathologist and generate histograms in an appropriate statistic software program to analyze the frequency distribution of the marker intensity per cell. To generate percentage data for specific markers of interest within defined cells, insert a pivot table into the datasheet and select Sum to calculate the positivity percentage of a single marker of interest.The total number of marker positive cells divided by the total number will be calculated. The result is the marker positive cell percentage with one core, or one study number. To generate numeric data, obtain the mean intensity of each marker of interest in all of the cells study within a sample to extract the median normalized count for each marker of each core or study number.Here, representative multiplex fluorescent immunohistochemical images for a diffuse large B-cell lymphoma sample with c-MYC and BCL2 gene rearrangement are shown. Simulated bright field immunohistochemical images demonstrate a similar tumor marker staining pattern. The application of multiplex fluorescent immunohistochemical images to a T-cell panel in angioimmunoblastic T-cell lymphomas reveals the cell heterogeneity of the tumor sample.Here, the optimization of a tonsil control sample and the resulting data analysis are shown. A variety of image analysis software programs can be used after the unmixing step to quantitate marker expression and localization in tumor cells and the tumor microenvironment. This technique paves the way for researchers to study the co expression of multiple markers within specific cell types in single tissues sections of lymphoma.Take care to prevent heat-induced injury during the microwaving steps and be aware of fall risks during the scanning steps that are performed in the deck.

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