This research was supported by the R&#38;D Program for the Society&#160;of the National Research Foundation (NRF), funded by the Ministry of Science, ICT &#38; Future Planning (Grant No. 2013M3C8A1075908).

1. DNA Extraction from FFPE Reference Standard Cell Lines
Note: For this procedure, DNA extraction was performed from FFPE reference standard cell lines (HD598, HD593, HD617, HD273 and wildtype (WT)) using the FFPE Tissue DNA isolation kit as described in the protocol below. Automated DNA extraction was achieved by following the manufacturer&#39;s instructions for total DNA isolation.
<ol>
	<li>Using a microtome and the original FFPE block, manually prepare fresh sections prior to DNA extraction and analysis, according to established procedures. Ensure that the sample input for the tissue section(s) analyzed does not exceed a combined total thickness of 10 &#181;m and that the surface area does not exceed 600 mm2 for a single section.</li>
</ol>
1.2 TPS protocol
Note: The volumes shown in Table 1 correspond to the minimum required to process 48 samples, and the procedure shown is in accordance with the TPS guidelines. Before starting the experiment settle down the FFPE samples in the e-tube by centrifugation&#160;at 600 x g, to avoid loss of samples during the automated program.
<ol>
	<li>Turn on the automated DNA isolation instrument and computer. Open the Run control software and insert an auto load tray into the TPS deck loading area.</li>
	<li>Dispense reagents into their corresponding troughs as shown in Figure&#160;1.
	<ol>
		<li>Place the 4 samples (BRAF WT, BRAF V600E 50%, 5% and 1%) in the sample carrier racks.</li>
		<li>Place the tip boxes in the troughs in columns 2 and 3 and check the tips for presence of more than one filter per tip, which will abort the run.</li>
		<li>Ensure proper mixing of the lysis buffer and wash buffer by inverting them 3&#8211;5 times and load them into the respective troughs in column 4 ( Figure&#160;1).</li>
		<li>After inverting for few times or mild vortexing, load the elution buffer, magnetic beads, and FFPE buffer in the small troughs in column 5, leaving 1 slot empty where indicated ( Figure&#160;1, Table&#160;1).</li>
		<li>Load a 2&#160;ml&#160;deep well plate (DWP) onto the plate carrier (Figure&#160;1).</li>
	</ol>
	</li>
	<li>Perform the following final steps before starting a run:
	<ol>
		<li>Uncap all tubes and reagent troughs. Confirm that sufficient capacity is available in the liquid waste bottle. Confirm that the solid waste bottle is empty and lined with a biohazard bag. Confirm that the tip eject plate is centered in the waste assembly.</li>
		<li>Close the front cover.</li>
	</ol>
	</li>
	<li>Start the software. Open the NA_Prep_Main_MLSTARlet.med file.</li>
	<li>Click &#8220;Start.&#8221; The instrument status will switch from idle to running.</li>
	<li>Enter the number of samples for this run. Choose the desired method for this run (DNA = 0). Enter the position of the first high volume tip, selecting &#8220;1&#8221; if all trays are full. Enter the position of the first standard volume tip, selecting &#8220;1&#8221; if all trays are full. 
	Note: The instrument will then run through automated steps without user intervention. A detailed workflow is shown in Figure&#160;2. Once the experiment is finished, reagent waste and tips are injected into the waste assembly.</li>
	<li>Quantify purified genomic DNA by using a fluorometric method. 
	Note: DNA samples which contain a minimum concentration of 3.3 ng/&#181;l&#160;are subjected to ddPCR analysis (section 2).</li>
</ol>
2. DNA Mutation Profiling: ddPCR Protocol
Note: The protocol for DNA mutation profiling consists of 3 major steps:1) Droplet generation, 2) Conventional PCR amplification, 3) Droplet reading and 4) DNA mutation profiling.
2.1. Droplet generation
Note: ddPCR supermix is recommended for ddPCR, as this mix contains reagents required for droplet generation.
<ol>
	<li>To avoid contamination, follow standard precautions, such as wearing gloves, using a clean PCR hood, clean pipets, and low-protein-binding tubes.</li>
	<li>Ensure that the minimum concentration of human genomic DNA sample is 3.3 ng/&#181;l. Note: The amount of purified DNA sample concentration will vary based on the analysis of % mutation frequency detection.</li>
	<li>Assemble reaction mixtures in 96-well PCR plates. Thaw and equilibrate the reaction components to RT. Prepare PCR reactions by combining 2X ddPCR supermix (10 &#181;l) and 20 primers (forward and reverse, 900 nM) and probe (250 nM) with each purified DNA sample (66ng/2 &#181;l) make up to 20 &#181;l&#160;with distilled water (as per the droplet generator protocol)</li>
	<li>Vortex the mix thoroughly to ensure homogeneity and briefly centrifuge to collect the contents at the bottom of the tube before dispensing. Load 20 &#181;l&#160;onto the cartridge for droplet formation.</li>
	<li>Operation of the droplet generator, per the manufacturer&#8217;s recommended protocol
	<ol>
		<li>Insert the cartridge into the holder with the notch in the cartridge positioned on the upper left side of the holder. Add 20 &#181;l&#160;of reaction mix containing samples into the middle, and 70 &#181;l&#160;of generator oil into the bottom wells.</li>
		<li>Attach the gasket across the top of the cartridge. Ensure that the gasket is securely hooked on both ends of the holder; otherwise, sufficient pressure for droplet generation will not be achieved.</li>
		<li>Open the droplet generator by pressing the green button on the top of the instrument and insert the cartridge. When the holder is in the correct position, both the power (left right) and holder (middle right) indicator lights are green.</li>
		<li>Press the top button on the instrument again to close the door and initiate droplet generation. Note: After pressing the button, a manifold positions itself over the outlet wells, drawing oil and samples through the microfluidic channels, where droplets are created. Droplets flow into the droplet well, where they accumulate. The droplet indicator light (at right) flashes green after 10 sec to indicate that droplet generation is in progress.</li>
		<li>When droplet generation is complete, all 3 indicator lights change to solid green; open the door by pressing the button, and remove the holder from the unit. Remove the disposable gasket from the holder and discard it. Note: The top wells of the cartridge contain droplets, and the middle and lower wells are nearly empty, with a small amount of residual oil.</li>
	</ol>
	</li>
</ol>
2.2. Preparation for PCR
<ol>
	<li>For each sample, pipet out 40 &#181;l&#160;of the droplet contents from the top well the cartridges into a single well of a recommended 96-well PCR plate as indicated in the manufacturer&#8217;s instrument protocol. Note: Using a multi-channel pipette is ideal for transferring the droplets emulsions. Slow and gentle aspiration of droplets is recommended to minimize droplet shearing during transfers.</li>
	<li>Seal the PCR plate with foil immediately after transferring droplets to avoid evaporation. Use pierceable foil plate seals that are compatible with the PCR plate sealer and the needles in the droplet reader. Follow the instructions in the PCR plate sealer instruction manual.</li>
	<li>Set the plate sealer temperature to 180 &#176;C and the time to 5 sec.</li>
	<li>Touch the arrow to open the tray door. Position the support block on the tray with the 96-well side facing up. Place the 96-well plate onto the support block and ensure that all plate wells are aligned with the support block.</li>
	<li>Cover the 96-well plate with 1 sheet of pierceable foil seal. Once the 96-well plate is secured on the support block and covered with the pierceable foil seal, touch the seal button. The tray will close and heat sealing will initiate.</li>
	<li>When heat sealing is complete, the door opens automatically; remove the plate from the heat block for thermal cycling and then remove the heat block.</li>
	<li>Ensure that all the wells in the plate are sealed by checking that depressions in the foil are readily apparent over each well. Once sealed, the plate is ready for thermal cycling.</li>
	<li>Once droplets are removed, press the latches on the cartridge holder to open it. Remove the empty cartridge and discard it.</li>
	<li>Perform conventional PCR amplification by following the parameters detailed in&#160; Table 2.</li>
</ol>
2.3 Droplet reading (as per the manufacturer&#8217;s recommended protocol)
Note: Following PCR amplification of the nucleic acid target in the droplets, the droplet reader instrument analyzes each droplet individually using a 2-color detection system13. We typically set to detect FAM and VIC reporter fluorophores.
<ol>
	<li>Click &#8220;Flush system&#8221; to prime the droplet reader and make it ready for ddPCR analysis.</li>
	<li>Load the plate into the droplet reader and click &#8220;start.&#8221; The droplet reader aspirates each sample, singulates the droplets, and streams them in single file past a 2-color detector. The detector reads the droplets to enumerate positive and negative samples.</li>
	<li>When droplet reading is complete, open the door and remove the plate holder from the unit. Remove the 96-well PCR plate from the holder and discard it.</li>
	<li>For proper maintenance, replace the droplet reader oil and empty the waste receptacle as needed. Add 50 ml&#160;of 10% bleach to the waste bottle to prevent microbial growth.</li>
</ol>
2.4 DNA mutation profiling (as per the manufacturer&#8217;s recommended protocol)
Note: PCR-positive and PCR-negative droplets are counted to provide absolute quantification of target BRAF V600E DNA mutations in digital form, using data analysis software.
<ol>
	<li>Click Setup to enter information about the samples, assays, and experiments.</li>
	<li>In the Setup window, load a plate (filename.qlp), then click Analyze to open and analyze the data. The data analysis interface is separated into three windows: Results Table, Well Selector and Processed Data/Graphical Display.</li>
	<li>In the Processed Data window, concentration data for each target appear in the wells in the plate map and are tabulated in the Results Table. Click Concentration to visualize data in concentration plots.</li>
</ol>

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S., 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=BRAF+and+RAS+mutations+in+human+lung+cancer+and+melanoma.">BRAF and RAS mutations in human lung cancer and melanoma.</a> Cancer research. 62, 6997-7000 (2002).</li><li>Wang, 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=BRAF+mutations+in+colon+cancer+are+not+likely+attributable+to+defective+DNA+mismatch+repair.">BRAF mutations in colon cancer are not likely attributable to defective DNA mismatch repair.</a> Cancer research. 63, 5209-5212 (2003).</li><li>Hindson, B. 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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=Evaluation+of+a+Droplet+Digital+Polymerase+Chain+Reaction+Format+for+DNA+Copy+Number+Quantification.">Evaluation of a Droplet Digital Polymerase Chain Reaction Format for DNA Copy Number Quantification.</a> Anal Chem. 84, 1003-1011 (1021).</li><li>Jones, 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=Low+copy+target+detection+by+Droplet+Digital+PCR+through+application+of+a+novel+open+access+bioinformatic+pipeline,+'definetherain'.">Low copy target detection by Droplet Digital PCR through application of a novel open access bioinformatic pipeline, 'definetherain'.</a> Journal of virological methods. 202, 46-53 (2014).</li><li>Strain, M. C., 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=Highly+precise+measurement+of+HIV+DNA+by+droplet+digital+PCR.">Highly precise measurement of HIV DNA by droplet digital PCR.</a> PloS one. 8, e55943 (2013).</li><li>Miotke, L., Lau, B. T., Rumma, R. T., Ji, H. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High+sensitivity+detection+and+quantitation+of+DNA+copy+number+and+single+nucleotide+variants+with+single+color+droplet+digital+PCR.">High sensitivity detection and quantitation of DNA copy number and single nucleotide variants with single color droplet digital PCR.</a> Anal Chem. 86, 2618-2624 (2014).</li><li>Bizouarn, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+applications+using+digital+PCR.">Clinical applications using digital PCR.</a> Methods in molecular biology. 1160, 189-214 (2014).</li><li>McDermott, G. P., 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=Multiplexed+target+detection+using+DNA-binding+dye+chemistry+in+droplet+digital+PCR.">Multiplexed target detection using DNA-binding dye chemistry in droplet digital PCR.</a> Anal Chem. 85, 11619-11627 (2013).</li><li>Milbury, C. A., 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=Determining+lower+limits+of+detection+of+digital+PCR+assays+for+cancer-related+gene+mutations.">Determining lower limits of detection of digital PCR assays for cancer-related gene mutations.</a> Biomolecular detection and quantification. 1, 8-22 (2014).</li><li>Zhu, G., 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=Highly+Sensitive+Droplet+Digital+PCR+Method+for+Detection+of+EGFR+Activating+Mutations+in+Plasma+Cell-Free+DNA+from+Patients+with+Advanced+Non-Small+Cell+Lung+Cancer.">Highly Sensitive Droplet Digital PCR Method for Detection of EGFR Activating Mutations in Plasma Cell-Free DNA from Patients with Advanced Non-Small Cell Lung Cancer.</a> The Journal of molecular diagnostics: JMD. , (2015).</li><li>Fan, H., Gulley, M. 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Myung Ryuri Oh, Si Eun Kim, and Young Deug Kim are employees of ABION CRO.

Here, we highlight the applicability of ddPCR and DNA isolation from FFPE reference standard cell line samples for a specific gene mutation assessment. In this study, TPS automated DNA isolation method is used which can be readily adapted, automated, and can accommodate up to 48 different samples simultaneously, allowing for larger scale experiments and lower variability. One of the limitations of the DNA isolation in the present work is that every FFPE sample is unique, and will vary one another in surface contaminants,...

The accumulation of genetic mutations in key regulatory genes alters normal cell programing like cell proliferation, differentiation, and survival, leading to cancer1. The RAS-RAF-MAP kinase pathway mediates cellular responses to growth signals. Oncogenic BRAF mutations can result from driver mutations in the&#160;BRAF&#160;gene, which may cause the BRAF oncoprotein to become overactive2.&#160;Mutations in the&#160;BRAF&#160;gene also result in overactive downstream signaling via MEK and ERK3, which, in turn, leads to excessive cell growth and proliferation independently of growth&#160;factor-mediated regulation4-6.
Several tools are available for DNA mutation profiling, such as quantitative real-time&#160;BRAF V600E mutations in formalin-fixed, paraffin-embedded (FFPE) reference standard cell lines by ddPCR. ddPCR is an PCR-based method for absolute quantification offering higher accuracy compared to conventional quantitative real-time PCR (qPCR)7,8. ddPCR also provides higher resolving power and accuracy for the detection of rare mutations in DNA templates, enabling more informative cancer research and diagnosis9. Additional advantages of ddPCR over conventional qPCR include its enhanced sensitivity and accuracy when studying low template copy numbers10-12. Herein, a protocol for automatically extracting DNA from FFPE reference standard cell lines, followed by determining the presence or absence of BRAF V600E mutations by ddPCR is demonstrated. The usage of software for data analysis and a graphical representation of the results are also described. The entire procedure is relatively simple and totally depends on the number of samples to be profiled and the number of conventional PCR and ddPCR machines available.
The following protocol describes standard procedures for BRAF V600E-positive FFPE reference standard cell lines (HD598, HD593, HD617, HD273 and wildtype (WT)) is performed in a fully automated instrument using the Tissue Preparation System (TPS) protocol. Subsequently, isolated DNA samples are analyzed for the presence of BRAF V600E mutations using ddPCR system. Targeted mutation analysis is performed after all samples have been profiled and the data has been loaded into the data analysis software. Depending on the number of samples/groups studied, data analysis may require from one to several hours. The experimental component of the methodology requires accuracy in handling&#160;<a href="http://www.jove.com/science-education/5096/isolating-nucleic-acids-from-yeast" title="Isolating Nucleic Acids from Yeast, a JoVE Science Education video explaining more about about the context of RNA">DNA</a>&#160;and <a href="http://www.jove.com/science-education/5034/introduction-to-serological-pipettes-and-pipettors" title="Introduction to Serological Pipettes and Pipettors, a JoVE Science Education video explaining more about about the context of pipetting">pipetting</a>&#160;into 96 well plates, while data analysis is performed using software.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>&#160;Hamilton MICROLAB STARlet IVD instrument</td>
			<td>Siemens</td>
			<td>10701001</td>
			<td>Automated DNA isolation instrument</td>
		</tr>
		<tr>
			<td>QX200 Droplet Generator&#160;</td>
			<td>Bio-Rad</td>
			<td>772BR1119</td>
			<td></td>
		</tr>
		<tr>
			<td>QX200 Droplet Reader</td>
			<td>Bio-Rad</td>
			<td>771BR1497</td>
			<td></td>
		</tr>
		<tr>
			<td>Conventional PCR machine capable of ramp-time adjustment</td>
			<td></td>
			<td>621BR17718</td>
			<td></td>
		</tr>
		<tr>
			<td>PX1 PCR plate sealer</td>
			<td>Bio-Rad</td>
			<td>770BR1575</td>
			<td></td>
		</tr>
		<tr>
			<td>QuantaSoft software</td>
			<td>Bio-Rad</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>DNA isolation kit&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>VERSANT Tissue Preparation Reagents Box 1&#160;</td>
			<td>Siemens</td>
			<td>10632398</td>
			<td></td>
		</tr>
		<tr>
			<td>VERSANT Tissue Preparation Reagents Box 1&#160;</td>
			<td>Siemens</td>
			<td>10632399</td>
			<td></td>
		</tr>
		<tr>
			<td>CO-RE tips</td>
			<td>Siemens</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>ddPCR mutation analysis</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>ddPCR Supermix&#160;</td>
			<td>Bio-Rad&#160;</td>
			<td>BR186-3010</td>
			<td>2X concentration</td>
		</tr>
		<tr>
			<td>DG8 cartridge&#160;</td>
			<td>Bio-Rad&#160;</td>
			<td>BR186-4008</td>
			<td></td>
		</tr>
		<tr>
			<td>Droplet Generator oil</td>
			<td>Bio-Rad&#160;</td>
			<td>BR-186-3005</td>
			<td></td>
		</tr>
		<tr>
			<td>Gasket</td>
			<td>Bio-Rad&#160;</td>
			<td>BR186-3006</td>
			<td></td>
		</tr>
		<tr>
			<td>Droplet reader oil</td>
			<td>Bio-Rad&#160;</td>
			<td>BR-186-3004</td>
			<td></td>
		</tr>
	</tbody>
</table>

employing digital droplet pcr to detect braf v600e mutations in formalin-fixed paraffin-embedded reference standard cell lines

ddPCR is a highly sensitive PCR method that utilizes a water-oil emulsion system. Using a droplet generator, an extracted nucleic acid sample is partitioned into ~20,000 nano-sized, water-in-oil droplets, and PCR amplification occurs in individual droplets. The ddPCR approach is in identifying sequence mutations, copy number alterations, and select structural rearrangements involving targeted genes. Here, we demonstrate the use of ddPCR as a powerful technique for precisely quantitating rare BRAF V600E mutations in FFPE reference standard cell lines, which is helpful in identifying individuals with cancer. In conclusion, ddPCR technique offers the potential to precisely profile the specific rare mutations in different genes in various types of FFPE samples.

For our ddPCR analysis, we studied the BRAF V600E mutation FFPE reference standard cell lines. The droplet reader connects to a laptop computer running data analysis software. Each individual droplet is defined on the basis of fluorescent amplitude as being either positive or negative. The software provided by manufacturer also allows a user-defined cutoff to be entered to define the threshold between the positive and negative droplets. The number of positive and negative droplets in a sample is used to calculat...

Watch this Scientific Journal Video about Employing Digital Droplet PCR to Detect BRAF V600E Mutations in Formalin-fixed Paraffin-embedded Reference Standard Cell Lines at JoVE.com

Employing Digital Droplet PCR to Detect BRAF V600E Mutations in Formalin-fixed Paraffin-embedded Reference Standard Cell Lines

The goal of this video is to demonstrate how to perform&#160;automated DNA extraction from formalin-fixed paraffin-embedded (FFPE) reference standard cell lines and digital droplet PCR&#160;(ddPCR) analysis to detect rare mutations in a clinical setting. Detecting mutations in FFPE samples demonstrates the clinical utility of ddPCR in FFPE samples.

ddPCR is a highly sensitive PCR method that utilizes a water-oil emulsion system. Using a droplet generator, an extracted nucleic acid sample is ...

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13.1K Views.  Seoul National University. The goal of this video is to demonstrate how to perform automated DNA extraction from formalin-fixed paraffin-embedded (FFPE) reference standard cell lines and digital droplet PCR (ddPCR) analysis to detect rare mutations in a clinical setting. Detecting mutations in FFPE samples demonstrates the clinical utility of ddPCR in FFPE samples.