Name: microsatellite dna genotyping and flow cytometry ploidy analyses of formalin-fixed paraffin-embedded hydatidiform molar tissues
Uploaded: 2019-10-20T15:00:00
Description: Watch this Scientific Journal Video about Microsatellite DNA Genotyping and Flow Cytometry Ploidy Analyses of Formalin-fixed Paraffin-embedded Hydatidiform Molar Tissues at JoVE.com

The authors thank Sophie Patrier and Marianne Par&#233;sy for sharing the original flow cytometry protocol, and Promega and Qiagen for providing supplies and reagents. This work was supported by the R&#233;seau Qu&#233;b&#233;cois en Reproduction and the Canadian Institute for Health Research (MOP-130364) to R.S.

This research study was approved by the McGill Institutional Review Board. All patients provided written consent to participate in the study and to have their FFPE products of conception (POCs) retrieved from various pathology departments.
NOTE: While there are several methods for genotyping and ploidy determination by flow cytometry, the protocols provided here describe one method of analysis using one platform for each.
1. Genotyping
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<ol>
	<li>Szulman, A. E., Surti, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+syndromes+of+hydatidiform+mole.+II.+Morphologic+evolution+of+the+complete+and+partial+mole.">The syndromes of hydatidiform mole. II. Morphologic evolution of the complete and partial mole.</a> American Journal of Obstetrics &amp; Gynecology. 132 (1), 20-27 (1978).</li><li>Fukunaga, 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=Interobserver+and+intraobserver+variability+in+the+diagnosis+of+hydatidiform+mole.">Interobserver and intraobserver variability in the diagnosis of hydatidiform mole.</a> The American Journal of Surgical Pathology. 29 (7), 942-947 (2005).</li><li>Gupta, 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=Diagnostic+reproducibility+of+hydatidiform+moles:+ancillary+techniques+(p57+immunohistochemistry+and+molecular+genotyping)+improve+morphologic+diagnosis+for+both+recently+trained+and+experienced+gynecologic+pathologists.">Diagnostic reproducibility of hydatidiform moles: ancillary techniques (p57 immunohistochemistry and molecular genotyping) improve morphologic diagnosis for both recently trained and experienced gynecologic pathologists.</a> The American Journal of Surgical Pathology. 36 (12), 1747-1760 (2012).</li><li>Howat, A. 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=Can+histopathologists+reliably+diagnose+molar+pregnancy?.">Can histopathologists reliably diagnose molar pregnancy?.</a> Journal of Clinical Pathology. 46 (7), 599-602 (1993).</li><li>Banet, N., 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=Characteristics+of+hydatidiform+moles:+analysis+of+a+prospective+series+with+p57+immunohistochemistry+and+molecular+genotyping.">Characteristics of hydatidiform moles: analysis of a prospective series with p57 immunohistochemistry and molecular genotyping.</a> Modern Pathology. 27 (2), 238-254 (2014).</li><li>Lipata, F., 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=Precise+DNA+genotyping+diagnosis+of+hydatidiform+mole.">Precise DNA genotyping diagnosis of hydatidiform mole.</a> Obstetrics &amp; Gynecology. 115 (4), 784-794 (2010).</li><li>Buza, N., Hui, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Partial+hydatidiform+mole:+histologic+parameters+in+correlation+with+DNA+genotyping.">Partial hydatidiform mole: histologic parameters in correlation with DNA genotyping.</a> International Journal of Gynecologic Pathology. 32 (3), 307-315 (2013).</li><li>Fisher, R. 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=Frequency+of+heterozygous+complete+hydatidiform+moles,+estimated+by+locus-specific+minisatellite+and+Y+chromosome-specific+probes.">Frequency of heterozygous complete hydatidiform moles, estimated by locus-specific minisatellite and Y chromosome-specific probes.</a> Human Genetics. 82 (3), 259-263 (1989).</li><li>Murdoch, 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=Mutations+in+NALP7+cause+recurrent+hydatidiform+moles+and+reproductive+wastage+in+humans.">Mutations in NALP7 cause recurrent hydatidiform moles and reproductive wastage in humans.</a> Nature Genetics. 38 (3), 300-302 (2006).</li><li>Parry, D. 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=Mutations+causing+familial+biparental+hydatidiform+mole+implicate+c6orf221+as+a+possible+regulator+of+genomic+imprinting+in+the+human+oocyte.">Mutations causing familial biparental hydatidiform mole implicate c6orf221 as a possible regulator of genomic imprinting in the human oocyte.</a> American Journal of Human Genetics. 89 (3), 451-458 (2011).</li><li>Nguyen, N. M., Slim, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genetics+and+Epigenetics+of+Recurrent+Hydatidiform+Moles:+Basic+Science+and+Genetic+Counselling.">Genetics and Epigenetics of Recurrent Hydatidiform Moles: Basic Science and Genetic Counselling.</a> Current Obstetrics and Gynecology Reports. 3, 55-64 (2014).</li><li>Sebire, N. J., Savage, P. M., Seckl, M. J., Fisher, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histopathological+features+of+biparental+complete+hydatidiform+moles+in+women+with+NLRP7+mutations.">Histopathological features of biparental complete hydatidiform moles in women with NLRP7 mutations.</a> Placenta. 34 (1), 50-56 (2013).</li><li>Nguyen, N. 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=Comprehensive+genotype-phenotype+correlations+between+NLRP7+mutations+and+the+balance+between+embryonic+tissue+differentiation+and+trophoblastic+proliferation.">Comprehensive genotype-phenotype correlations between NLRP7 mutations and the balance between embryonic tissue differentiation and trophoblastic proliferation.</a> Journal of Medical Genetics. 51 (9), 623-634 (2014).</li><li>Brown, 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=Recurrent+pregnancy+loss+in+a+woman+with+NLRP7+mutation:+not+all+molar+pregnancies+can+be+easily+classified+as+either+"partial"+or+"complete"+hydatidiform+moles.">Recurrent pregnancy loss in a woman with NLRP7 mutation: not all molar pregnancies can be easily classified as either "partial" or "complete" hydatidiform moles.</a> International Journal of Gynecologic Pathology. 32 (4), 399-405 (2013).</li><li>Colgan, T. J., Chang, M. C., Nanji, S., Kolomietz, 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+Reappraisal+of+the+Incidence+of+Placental+Hydatidiform+Mole+Using+Selective+Molecular+Genotyping.">A Reappraisal of the Incidence of Placental Hydatidiform Mole Using Selective Molecular Genotyping.</a> The International Journal of Gynecological Cancer. 26 (7), 1345-1350 (2016).</li><li>Murphy, K. M., McConnell, T. G., Hafez, M. J., Vang, R., Ronnett, B. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Molecular+genotyping+of+hydatidiform+moles:+analytic+validation+of+a+multiplex+short+tandem+repeat+assay.">Molecular genotyping of hydatidiform moles: analytic validation of a multiplex short tandem repeat assay.</a> The Journal of Molecular Diagnostics. 11 (6), 598-605 (2009).</li></ol>

HM are abnormal human pregnancies with heterogeneous etiologies and have different histological and genotypic types, which makes their accurate classification and diagnosis challenging. Histopathological morphological evaluation was often proven inaccurate and is therefore unreliable on its own to classify HM into CHM and PHM and distinguish them from non-molar miscarriages. Therefore, an accurate diagnosis of HM requires the use of other methods such as multiplex microsatellite DNA genotyping, ploidy analysis by flow cy...

A hydatidiform mole (HM) is an abnormal human pregnancy characterized by abnormal embryonic development, hyperproliferation of the trophoblast, and hydropic degeneration of chorionic villi (CV). Historically, HM used to be divided into two types, complete HM (CHM) and partial HM (PHM) based only on morphological evaluation1. However, it has been shown that morphological evaluation alone is not sufficient to classify HM into the two subtypes (CHM and PHM) and distinguish them from non-molar miscarriages2,3,4.
Because CHM and PHM have different propensities to malignancies, it is therefore important to accurately determine the genotypic type of HM to provide appropriate follow-up and management to the patients. Consequently, in the past decades, several methodologies have been developed and evolved for the purpose of identifying the parental contribution to the molar tissues and reaching a correct classification of HM. These include karyotype analysis, chromosomal banding polymorphism, human leukocyte antigen (HLA) serological typing, restriction fragment length polymorphism, variable number of tandem repeats, microsatellite genotyping, flow cytometry, and p57KIP2 immunohistochemistry. This has allowed accurate subdivision of HM conceptions based on the parental contribution to their genomes, as follows: CHM, which are diploid androgenetic monospermic or diploid androgenetic dispermic, and PHM, which are triploid, dispermic in 99% and monospermic in 1% of the cases5,6,7,8. Furthermore, there is another genotypic type of HM that emerged in the past two decades, which is diploid biparental. The latter is mostly recurrent and may affect a single family member (simplex cases) or at least two family members (familial cases). These diploid biparental moles are mostly caused by recessive mutations in NLRP7 or KHDC3L in the patients9,10,11,12. Diploid biparental HM in patients with recessive mutations in NLRP7 may be diagnosed as CHM or PHM by morphological analysis and this appears to be associated with the severity of the mutations in the patients13,14. In addition to the classification of HM according to their genotypes, the introduction and use of several genotyping methods allowed the distinction of the various molar entities from non-molar miscarriages, such as aneuploid diploid biparental conceptions and other types of conceptions5,15. Such conceptions may have some trophoblast proliferation and abnormal villous morphology that mimic, to some extent, some morphological features of HM.
The purpose of this article is to provide detailed protocols for multiplex genotyping and flow cytometry of formalin-fixed paraffin-embedded (FFPE) tissues, and comprehensive analyses of the results of these methods and their integration with other methods for correct and conclusive diagnosis of molar tissues.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>BD FACS Canto II</td>
			<td>BD BioSciences</td>
			<td>338960</td>
			<td></td>
		</tr>
		<tr>
			<td>Capillary electrophoresis instrument: Genomes Applied Biosystems 3730xl DNA Analyzer</td>
			<td>Applied biosystems</td>
			<td>313001R</td>
			<td>Service offered by the Centre for Applied Genomics (http://www.tcag.ca)</td>
		</tr>
		<tr>
			<td>Citric acid</td>
			<td>Sigma</td>
			<td>251275</td>
			<td></td>
		</tr>
		<tr>
			<td>Cytoseal 60, histopathology mounting medium</td>
			<td>Fisher</td>
			<td>23244257</td>
			<td></td>
		</tr>
		<tr>
			<td>Eosin Y stock solution (1%)</td>
			<td>Fisher</td>
			<td>SE23-500D</td>
			<td></td>
		</tr>
		<tr>
			<td>FCSalyzer - flow cytometry analysis software</td>
			<td>SourceForge</td>
			<td>-</td>
			<td>https://sourceforge.net/projects/fcsalyzer/</td>
		</tr>
		<tr>
			<td>FFPE Qiagen kit</td>
			<td>Qiagen</td>
			<td>80234</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps</td>
			<td>Fine Science Tools</td>
			<td>11295-51</td>
			<td>For sectioning and for the cleaning process</td>
		</tr>
		<tr>
			<td>Glacial Acetic Acid (Concentrated)</td>
			<td>Sigma</td>
			<td>A6283-500mL</td>
			<td></td>
		</tr>
		<tr>
			<td>Glass coverslips: Cover Glass</td>
			<td>Fisher</td>
			<td>12-541a</td>
			<td></td>
		</tr>
		<tr>
			<td>Hematoxylin</td>
			<td>Fisher</td>
			<td>CS401-1D</td>
			<td></td>
		</tr>
		<tr>
			<td>Highly deionized formamide: Hi-Di Formamide</td>
			<td>Thermofisher</td>
			<td>4311320</td>
			<td></td>
		</tr>
		<tr>
			<td>IHC platform: Benchmark Ultra</td>
			<td>Roche</td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>Kimwipes</td>
			<td>Ultident</td>
			<td>30-34120</td>
			<td></td>
		</tr>
		<tr>
			<td>Microtome</td>
			<td>Leica</td>
			<td>RM2135</td>
			<td></td>
		</tr>
		<tr>
			<td>Microtome blades</td>
			<td>Fisher</td>
			<td>12-634-1C</td>
			<td></td>
		</tr>
		<tr>
			<td>Nitex filtering mesh, 48 microns</td>
			<td>Filmar</td>
			<td>74011</td>
			<td>http://www.filmar.qc.ca/index.php?filet=produits&#38;id=51&#38;lang=en ; any other filter is suitable, but this is an inexpensive and effective option from a non-research company</td>
		</tr>
		<tr>
			<td>p57 antibody</td>
			<td>Cell Marque</td>
			<td>457M</td>
			<td></td>
		</tr>
		<tr>
			<td>Pasteur pipette</td>
			<td>VWR</td>
			<td>53499-632</td>
			<td></td>
		</tr>
		<tr>
			<td>PCR machine</td>
			<td>Perkin Elmer, Applied Biosystems</td>
			<td>GeneAmp PCR System 9700</td>
			<td></td>
		</tr>
		<tr>
			<td>PeakScanner 1.0</td>
			<td>Applied Biosystems</td>
			<td>4381867</td>
			<td>Software for genotyping analysis.</td>
		</tr>
		<tr>
			<td>Pepsin from porcine gastric mucosa</td>
			<td>Sigma</td>
			<td>P7012</td>
			<td></td>
		</tr>
		<tr>
			<td>Polystyrene round-bottom tubes</td>
			<td>BD Falcon</td>
			<td>352058</td>
			<td></td>
		</tr>
		<tr>
			<td>Positively charged slides: Superfrost Plus 25x75mm</td>
			<td>Fisher</td>
			<td>1255015</td>
			<td></td>
		</tr>
		<tr>
			<td>PowerPlex 16 HS System</td>
			<td>Promega Corporation</td>
			<td>DC2102</td>
			<td></td>
		</tr>
		<tr>
			<td>Propidium Iodide</td>
			<td>Sigma</td>
			<td>P4864</td>
			<td></td>
		</tr>
		<tr>
			<td>Ribonuclease A from bovine pancreas</td>
			<td>Sigma</td>
			<td>R4875</td>
			<td></td>
		</tr>
		<tr>
			<td>Separation matrix: POP-7 Polymer</td>
			<td>Thermofisher</td>
			<td>4352759</td>
			<td></td>
		</tr>
		<tr>
			<td>UltraPure Agarose</td>
			<td>Fisher</td>
			<td>16500-500</td>
			<td></td>
		</tr>
		<tr>
			<td>Xylene</td>
			<td>Fisher</td>
			<td>X3P1GAL</td>
			<td></td>
		</tr>
	</tbody>
</table>

microsatellite dna genotyping and flow cytometry ploidy analyses of formalin-fixed paraffin-embedded hydatidiform molar tissues

Hydatidiform mole (HM) is an abnormal human pregnancy characterized by excessive trophoblastic proliferation and abnormal embryonic development. There are two types of HM based on microscopic morphological evaluation, complete HM (CHM) and partial HM (PHM). These can be further subdivided based on the parental contribution to the molar genomes. Such characterization of HM, by morphology and genotype analyses, is crucial for patient management and for the fundamental understanding of this intriguing pathology. It is well documented that morphological analysis of HM is subject to wide interobserver variability and is not sufficient on its own to accurately classify HM into CHM and PHM and distinguish them from hydropic non-molar abortions. Genotyping analysis is mostly performed on DNA and tissues from formalin-fixed paraffin-embedded (FFPE) products of conception, which have less than optimal quality and may consequently lead to wrong conclusions. In this article, detailed protocols for multiplex genotyping and flow cytometry analyses of FFPE molar tissues are provided, along with the interpretation of the results of these methods, their troubleshooting, and integration with the morphological evaluation, p57KIP2 immunohistochemistry, and fluorescence in situ hybridization (FISH) to reach a correct and robust diagnosis. Here, the authors share the methods and lessons learned in the past 10 years from the analysis of approximately 400 products of conception.

The complexity of molar tissues and the fact that they may have various genotypes necessitates stringent analysis and the use of several methods such as morphological evaluation, p57 immunohistochemistry, microsatellite genotyping, flow cytometry, and FISH. For example, one patient (1790) was referred with two PHM that were found to be triploid by microarray analysis of the POCs only. The patient was therefore diagnosed with recurrent PHM. Microsatellite genotyping of her two &#34;PHM&#34...

Watch this Scientific Journal Video about Microsatellite DNA Genotyping and Flow Cytometry Ploidy Analyses of Formalin-fixed Paraffin-embedded Hydatidiform Molar Tissues at JoVE.com

Microsatellite DNA Genotyping and Flow Cytometry Ploidy Analyses of Formalin-fixed Paraffin-embedded Hydatidiform Molar Tissues

Hydatidiform moles are abnormal human pregnancies with heterogeneous aetiologies that can be classified according to their morphological features and parental contribution to the molar genomes. Here, protocols of multiplex microsatellite DNA genotyping and flow cytometry of formalin-fixed paraffin-embedded molar tissues are described in detail, together with results&#8217; interpretation and integration.

Hydatidiform mole (HM) is an abnormal human pregnancy characterized by excessive trophoblastic proliferation and abnormal embryonic development. There are ...

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