Small Tissue Biopsies Research Articles

Abstract IA11: Promises and challenges of applying molecular profiles to lung cancer treatment and early diagnosis.

Abstract The field of lung cancer molecular pathology is rapidly changing due to advances in our understanding of the molecular pathogenesis of tumors. In the past ten years, the identification of new molecular targets has provided unique opportunities to attack cancer with targeted therapies in a personalized manner. Recent advances in expanding the available non-small cell lung carcinoma (NSCLC) targeted therapies require the analysis of a broad panel of molecular abnormalities in tumor specimens, including gene mutations, amplifications, fusions and expression by applying different methodologies to frequently small tumor tissue (biopsy) and cell (cytology) samples. In addition, there is growing consensus that tumor tissue specimens must represent the setting of the disease to be treated, and increasingly, more tissue samples are being obtained for molecular testing of advanced, metastatic and chemo-refractory NSCLC tumors (e.g., MD Anderson BATTLE Lung Cancer Program). Currently available methodologies and technologies, including microarrays and next-generation sequencing, have variable applicability for the molecular and genomic analysis of these small specimens. Thus, the role of the pathologist is becoming increasingly important to adequately integrate routine histopathology assessments and molecular testing with clinical pathology for the most accurate tumor diagnosis and subsequent selection of the most appropriate therapy. In addition, applying high-throughput molecular methodologies currently used in studying established tumors to epithelial cell samples obtained from the airway of high-risk individuals and lung cancer patients is expanding our understanding of the early pathogenesis of lung cancer. Earlier studies have highlighted a field cancerization phenomenon in which histologically normal-appearing tissue adjacent to neoplastic and preneoplastic lesions display molecular abnormalities some of which are in common with those in the tumors. There is consensus that advances in the understanding of this field phenomenon will help to the development of biomarkers for early detection of and personalized chemoprevention of lung cancer. Citation Format: Ignacio I. Wistuba. Promises and challenges of applying molecular profiles to lung cancer treatment and early diagnosis. [abstract]. In: Proceedings of the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer; 2014 Jan 6-9; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2014;20(2Suppl):Abstract nr IA11.

37. Mutation testing in non-small cell lung cancer - suitability of small biopsy and cytology specimens

Background Patients with non-small cell lung cancer (NSCLC) harbouring sensitising mutations in epidermal growth factor receptor ( EGFR) benefit from treatment with EGFR tyrosine kinase inhibitors. Most patients with NSCLC present with advanced-stage disease, so somatic mutation testing is often performed on small biopsy and cytology specimens. Aims To explore the suitability of small biopsy and cytology specimens for mutation testing in NSCLC. Methods Retrospective review of EGFR, KRAS, and BRAF mutation testing cases in NSCLC, performed at Royal Prince Alfred Hospital over 12 months using OncoCarta Panel v1.0 Kit and analysed on the SequenomMassArray platform and/or by direct sequencing and fragment analysis. Results and conclusions Mutation testing was undertaken on 123 NSCLC cases including 38 (30.9%) resection specimens, 54 (43.9%) small tissue biopsies and 31 (25.2%) cytology specimens. Two cases, both small biopsies, contained insufficient DNA for testing. Mutations were detected in 20/38 (52.6%) resection, 18/54 (33.3%) small biopsy, and 9/31 (29%) cytology specimens. EGFR mutations were identified in 11/38 (28.9%) resection, 6/54(11.1%) small biopsy, and 8/31 (25.8%) cytology cases. Compared to resection specimens, the proportion of EGFR -mutant cases was significantly lower in small biopsy (p — 0.03), but not in cytology specimens ( p = 0.77). The findings suggest small biopsy but not cytology specimens may be suboptimal for mutation testing in some cases, although selection bias of cases may contribute to these findings. Careful assessment of DNA quality and quantity is required in these circumstances, as limited DNA carries a risk of false negative or positive results.

Primary fibroblast cultures and karyotype analysis for the olive ridley sea turtle (Lepidochelys olivacea)

The number of sea turtles in the wild is decreasing because of human activities, such as fishery bycatch (Peckham et al. 2007), oil spills, and marine pollution (Witherington 2001). Furthermore, illegal hunting for their oil, meat, and shells are still continuing (Koch et al. 2013). Hence, protection measures are being implemented in various countries to conserve the endangered species of sea turtles. In the past few decades, a major concern regarding sea turtles in the wild has been hybridization. Interspecific hybridization has been reported in several areas of the world (Karl et al. 1995; Barber et al. 2003; Lara-Ruiz et al. 2006). The original sea turtle species, such as hawksbill, loggerhead, and olive ridley, had established as independent species for more than millions of years despite overlaps among their habitats (Bowen et al. 1993). However, recent reports on intensive hybridization among these species clearly indicate that these unique original species are at a high risk of extinction in the near future. Acquiring information about the basic genetic background of these species, such as karyotype, is necessary to understand the cause of this intensive hybridization. In this study, we established a primary culture from olive ridley sea turtles and determined the karyotype of the primary cells. Since 1976, the San Diego Zoo started the preservation of biological specimens derived from critically endangered species in order to facilitate the use of these specimens as research materials for the following generations; this project was named “Frozen Zoo.” The significance of this project was internationally recognized, and similar projects, such as the Frozen Ark project in the UK, are underway. The establishment of cell cultures from critically endangered animals might contribute to these cryopreservation projects by increasing the stability of cryopreserved materials and facilitating efficient expansion of cultured cells. Since cultured cells have intact genetic information of the critically endangered animals, the cells have a potential to be used for the genetic analysis of future generations. The olive ridley sea turtles were maintained at the Port of Nagoya Public Aquarium. Small (3×3 mm) dermal tissue biopsy specimens were obtained from the flipper-like fin of two olive ridley sea turtles. The tissue biopsy specimens were immediately immersed in the cell culture medium. The biopsy process was supervised by a veterinary doctor of the Port of Nagoya Public Aquarium. For the primary culture, a six-well cell culture dish was coated with type I collagen. The detailed method for collagen coating has been described in our previous study (Fukuda et al. 2012). The cell culture was maintained at 26°C under 5% CO2 in a humidified chamber T. Fukuda (*) :M. Katayama :K. Donai : T. Uchida : E. Isogai Graduate School of Agricultural Science, Tohoku University, 1-1 Tsutsumidori-Amamiyamachi Aoba-ku, Sendai 981-8555, Japan e-mail: tomofukuda@bios.tohoku.ac.jp

Optimising the quantification of cytokines present at low concentrations in small human mucosal tissue samples using Luminex assays

Sensitive measurement of multiple cytokine profiles from small mucosal tissue biopsies, for example human gastric biopsies obtained through an endoscope, is technically challenging. Multiplex methods such as Luminex assays offer an attractive solution but standard protocols are not available for tissue samples. We assessed the utility of three commercial Luminex kits (VersaMAP, Bio-Plex and MILLIPLEX) to measure interleukin-17A (IL-17) and interferon-gamma (IFNγ) concentrations in human gastric biopsies and we optimised preparation of mucosal samples for this application. First, we assessed the technical performance, limits of sensitivity and linear dynamic ranges for each kit. Next we spiked human gastric biopsies with recombinant IL-17 and IFNγ at a range of concentrations (1.5 to 1000pg/mL) and assessed kit accuracy for spiked cytokine recovery and intra-assay precision. We also evaluated the impact of different tissue processing methods and extraction buffers on our results. Finally we assessed recovery of endogenous cytokines in unspiked samples. In terms of sensitivity, all of the kits performed well within the manufacturers' recommended standard curve ranges but the MILLIPLEX kit provided most consistent sensitivity for low cytokine concentrations. In the spiking experiments, the MILLIPLEX kit performed most consistently over the widest range of concentrations. For tissue processing, manual disruption provided significantly improved cytokine recovery over automated methods. Our selected kit and optimised protocol were further validated by measurement of relative cytokine levels in inflamed and uninflamed gastric mucosa using Luminex and real-time polymerase chain reaction. In summary, with proper optimisation Luminex kits (and for IL-17 and IFNγ the MILLIPLEX kit in particular) can be used for the sensitive detection of cytokines in mucosal biopsies. Our results should help other researchers seeking to quantify multiple low concentration cytokines in small tissue samples.

Feasibility of MR Metabolomics for Immediate Analysis of Resection Margins during Breast Cancer Surgery

In this study, the feasibility of high resolution magic angle spinning (HR MAS) magnetic resonance spectroscopy (MRS) of small tissue biopsies to distinguish between tumor and non-involved adjacent tissue was investigated. With the current methods, delineation of the tumor borders during breast cancer surgery is a challenging task for the surgeon, and a significant number of re-surgeries occur. We analyzed 328 tissue samples from 228 breast cancer patients using HR MAS MRS. Partial least squares discriminant analysis (PLS-DA) was applied to discriminate between tumor and non-involved adjacent tissue. Using proper double cross validation, high sensitivity and specificity of 91% and 93%, respectively was achieved. Analysis of the loading profiles from both principal component analysis (PCA) and PLS-DA showed the choline-containing metabolites as main biomarkers for tumor content, with phosphocholine being especially high in tumor tissue. Other indicative metabolites include glycine, taurine and glucose. We conclude that metabolic profiling by HR MAS MRS may be a potential method for on-line analysis of resection margins during breast cancer surgery to reduce the number of re-surgeries and risk of local recurrence.

MALDI profiles of proteins and lipids for the rapid characterisation of upper GI-tract cancers

To identify a reliable MALDI 'cancer fingerprint' to aid in the rapid detection and characterisation of malignant upper GI-tract disease from endoscopic biopsies. A total of 183 tissue biopsies were collected from 126 patients with or without oesophago-gastric malignancy and proteins and lipids separated by methanol/chloroform extraction. Peak intensities in the lipid and protein MALDI spectra from five types of samples (normal oesophageal mucosa from controls, normal oesophageal mucosa from patients with oesophageal adenocarcinoma, nondysplastic Barrett's oesophagus, oesophageal adenocarcinoma, normal gastric mucosa and gastric adenocarcinoma) were compared using non-parametric statistical tests and ROC analyses. Normal oesophageal and gastric tissue generated distinct MALDI spectra characterised by higher levels of calgranulins in oesophageal tissue. MALDI spectra of polypeptides and lipids discriminated between oesophageal adenocarcinoma and Barrett's and normal oesophagus, and between gastric cancer and normal stomach. Many down-regulations were unique to each cancer type whilst some up-regulations, most notably increased HNPs 1-3, were common. MALDI spectra of small tissue biopsies generated with this straightforward method can be used to rapidly detect numerous cancer-associated biochemical changes. These can be used to identify upper GI-tract cancers regardless of tumour location.

DDIT3 Gene Break-apart as a Molecular Marker for Diagnosis of Myxoid Liposarcoma—Assay Validation and Clinical Experience

Myxoid liposarcoma with or without a round cell component is the most common subtype of liposarcoma. The diagnosis of myxoid liposarcoma could be challenging with histology, as a variety of soft tissue tumors with myxoid change might mimic myxoid liposarcoma, especially on small biopsy tissues. Chromosomal translocations of t(12,16) (q13;p11) and t(12;22) (q13;q12), rendering gene fusions of DDIT3 (previously CHOP) with FUS and EWSR1, have been found to be characteristic of myxoid liposarcoma, and were identifiable in more than 95% cases. These genetic alterations, therefore, are ideal as molecular markers to facilitate the diagnosis of this type of tumor. DDIT3 (12q13) dual-color break-apart rearrangement probe for fluorescence in situ hybridization has been commercially available. However, its consistency with DDIT3-associated gene fusion and its clinical use, including sensitivity and specificity, have not been adequately evaluated. In this study, we assessed the locus specificity of the probe on metaphase, and then tested it on 8 cases of myxoid liposarcoma, 12 cases of other sarcomas, and 18 cases of tumors with myxoid differentiation. All 8 myxoid liposarcomas showed DDIT3 gene break-apart, whereas all 12 other sarcomas were negative. All the cases with DDIT3 break-apart also showed FUS-DDIT3 fusion by reverse transcription-polymerase chain reaction, with 100% consistency. In addition, the FISH assay has been clinically applied on 18 myxoid tumors with promising outcome. In conclusion, FISH with DDIT3 break-apart probe is a highly sensitive and specific assay for detection of DDIT3-associated gene fusions, and therefore is a valuable adjunct in diagnosis or differential diagnosis of myxoid liposarcoma.

Numerical Fidelity of Endoscopic Biopsy Fragments in the Processing Sequence of a University Surgical Pathology Laboratory

Diagnostic specimens in surgical pathology are, in general, becoming smaller and smaller, as minimally invasive surgical procedures are used to obtain representative tissue. Conservation and effective utilization of small biopsy tissue is therefore crucial in the pathology laboratory. To identify potential areas where biopsy tissue may be lost in the course of processing in our university-based laboratory. We followed 2934 endoscopic biopsy samples as they moved through our grossing area and histology laboratory by documenting the number of fragments inked and placed within tissue paper at the time of gross assessment, the number of fragments found in each cassette after processing and subsequently embedded in paraffin, and the number of pieces of tissue present on glass slides after staining. In 805 (27.4%) cases, the number of fragments of tissue noted on glass slides containing 2 levels of the paraffin block differed from the number submitted in the tissue cassette. Of these, most (137, 17%) differed between the number of fragments embedded in paraffin and those identified on glass slides. Loss of tissue fragments occurred in only 7.2% of cases, while 26.3% had gains in tissue fragments. Recognition of type(s) and source(s) of variation in biopsy fragment numbers is important in quality control and in the overall practical management of a histology laboratory.

Correlations between in vivo 1H MRS and ex vivo 1H HRMAS metabolite measurements in adult human gliomas

To assess how accurately ex vivo high-resolution magic angle spinning (HRMAS) proton magnetic resonance spectroscopy ((1)H MRS) from small biopsy tissues relate to in vivo (1)H MRS (from larger tumor volumes) in human astrocytomas. In vivo (PRESS, TE = 30 msec) and ex vivo (presaturation) (1)H spectra of 17 human astrocytomas (4 grade II, 1 grade III and 12 glioblastomas) were quantified using LCModel. Concentrations of 11 metabolites and 2 lipid/macromolecules were retrospectively compared, with histogram analysis of the in vivo MRI data used to evaluate tumor heterogeneity. For homogeneous-appearing tumors, significant correlations were found between in vivo and ex vivo (1)H MRS concentrations of those metabolites known to be metabolically stable in postmortem tissues (eg, creatine, myo-inositol, total cholines, and the approximately 1.3 and 0.9 ppm lipids). Anaerobic glycolysis during biopsy surgical removal depletes the tissue of glucose, increasing alanine and lactate, and resulted in no correlation between these in vivo and ex vivo metabolite concentrations. Within defined limitations, ex vivo astrocytoma biopsy HRMAS (1)H spectra have similar metabolic profiles to that obtained in vivo and therefore detailed ex vivo characterization of glioma biopsies can directly relate to the original tumor.

Increased MAPK Activation and Impaired Insulin Signaling in Subcutaneous Microvascular Endothelial Cells in Type 2 Diabetes: The Role of Endothelin-1

OBJECTIVETo establish a method for isolation and culture of subcutaneous microvascular endothelial cells (MVEC) from small human tissue biopsies to compare gene and protein expression of insulin signaling molecules in MVEC from insulin-resistant and healthy control subjects.RESEARCH DESIGN AND METHODSStromavascular cells from subcutaneous needle biopsies of type 2 diabetic and control subjects were expanded in culture and the endothelial cells selected with magnetic immune separation. Western blots and RT-PCR were used for protein and gene expression assays.RESULTSAt least 99% of the expanded primary MVEC could be characterized as endothelial cells. The expression of insulin receptors was low, but insulin increased tyrosine phosphorylation of both the insulin receptor and insulin receptor substrate (IRS)-1 and activated protein kinase B (PKB). The IRS-1 protein expression was reduced and the serine phosphorylation of PKB in response to insulin attenuated whereas basal and insulin-stimulated phosphorylation of extracellular signal–related kinase (ERK)1/2 was increased in type 2 diabetes MVEC. Endothelin (ET)-1 mRNA levels were significantly higher in type 2 diabetes cells. The addition of ET-1 increased the phosphorylation of mitogen-activated protein kinase (MAPK), an effect antagonized by the MEK-1 inhibitor PD98059. Furthermore, the endothelin ETA and ETB receptor antagonists BQ123 and BQ788 decreased basal MAPK activity in type 2 diabetes MVEC and prevented the ET-1–induced activation.CONCLUSIONSWe developed a system for isolation and culture of human MVEC from small needle biopsies. Our observations support the concept of “selective” insulin resistance, involving IRS-1 and the PI3kinase pathway, as an underlying factor for a dysregulated microvascular endothelium in type 2 diabetes. Our data also support a role of ET-1 for the increased MAPK activity seen in nonstimulated type 2 diabetes MVEC.

17β-Estradiol induces the proliferation of the in vitro cultured human urothelium

The genitourinary tract is considered to be a target for the actions of sex steroid hormones. Decreased ovarian function and lack of estrogen after menopause are associated with lower genitourinary tract symptoms as well as bladder dysfunctions such as incontinence. Estrogen may also affect urothelial cells. The estrogen receptors (ERs) are found in the mucosa of the urinary tract. The purpose of this study was to culture human urothelial cells (HUCs) originating from urothelial tissue biopsies and to use them as a reproducible test platform to evaluate the effect of 17beta-estradiol (E2). Urothelial tissue biopsies were obtained from 95 patients undergoing gynaecological open surgery for urinary incontinence, paediatric vesicoureteral reflux or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. HUCs originating from biopsies were cultured in vitro in the absence or in the presence of 0.1 nmol, 0.01 micromol and 1 micromol of E2. ER expression of the cultured HUCs was examined by Western analysis and immunofluorescence microscopy, which was also used for HUC characterization. The effect of E2 in the proliferation of the HUCs was determined by tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT)-assay. HUCs were cultured successfully in four to six passages but there was variation between samples. The cultured cells showed expression of beta(4)-integrin, E-cadherin and cytokeratins 7, 8, 9 and 19, indicating the epithelial origin of the cells. Both types of ERs, ERalpha and ERbeta, were found in the in vitro cultured HUCs. E2 treatment of HUCs did not affect remarkably the expression of ERalpha but cell proliferation was induced. However, no concentration-dependent effect was seen. This study indicates that HUCs originating from small tissue biopsies can be cultured in several passages in vitro and could have potential in repairing or restoring urinary tract tissue by tissue engineering therapy. HUCs serve as a good in vitro test platform, as shown by analysing E2-treated HUCs. E2 induced the proliferation of cultured HUCs even though concentration dependency was not observed. The findings of this study may have relevance in determining the mechanisms of estrogen therapy in postmenopausal urinary tract symptoms and in the future development of tissue engineering technology.

A rapid micro chromatin immunoprecipitation assay (ChIP)

Interactions of proteins with DNA mediate many critical nuclear functions. Chromatin immunoprecipitation (ChIP) is a robust technique for studying protein-DNA interactions. Current ChIP assays, however, either require large cell numbers, which prevent their application to rare cell samples or small-tissue biopsies, or involve lengthy procedures. We describe here a 1-day micro ChIP (microChIP) protocol suitable for up to eight parallel histone and/or transcription factor immunoprecipitations from a single batch of 1,000 cells. MicroChIP technique is also suitable for monitoring the association of one protein with multiple genomic sites in 100 cells. Alterations in cross-linking and chromatin preparation steps also make microChIP applicable to approximately 1-mm(3) fresh- or frozen-tissue biopsies. From cell fixation to PCR-ready DNA, the procedure takes approximately 8 h for 16 ChIPs.

Validation of tissue microarray technology in squamous cell carcinoma of the esophagus

Tissue microarray (TMA) technology has been developed to facilitate high-throughput immunohistochemical and in situ hybridization analysis of tissues by inserting small tissue biopsy cores into a single paraffin block. Several studies have revealed novel prognostic biomarkers in esophageal squamous cell carcinoma (ESCC) by means of TMA technology, although this technique has not yet been validated for these tumors. Because representativeness of the donor tissue cores may be a disadvantage compared to full sections, the aim of this study was to assess if TMA technology provides representative immunohistochemical results in ESCC. A TMA was constructed containing triplicate cores of 108 formalin-fixed, paraffin-embedded squamous cell carcinomas of the esophagus. The agreement in the differentiation grade and immunohistochemical staining scores of CK5/6, CK14, E-cadherin, Ki-67, and p53 between TMA cores and a subset of 64 randomly selected donor paraffin blocks was determined using kappa statistics. The concurrence between TMA cores and donor blocks was moderate for Ki-67 (κ = 0.42) and E-cadherin (κ = 0.47), substantial for differentiation grade (κ = 0.65) and CK14 (κ = 0.71), and almost perfect for p53 (κ = 0.86) and CK5/6 (κ = 0.93). TMA technology appears to be a valid method for immunohistochemical analysis of molecular markers in ESCC provided that the staining pattern in the tumor is homogeneous.

μChIP—a rapid micro chromatin immunoprecipitation assay for small cell samples and biopsies

Chromatin immunoprecipitation (ChIP) is a powerful technique for studying protein–DNA interactions. Drawbacks of current ChIP assays however are a requirement for large cell numbers, which limits applicability of ChIP to rare cell samples, and/or lengthy procedures with limited applications. There are to date no protocols for fast and parallel ChIPs of post-translationally modified histones from small cell numbers or biopsies, and importantly, no protocol allowing for investigations of transcription factor binding in small cell numbers. We report here the development of a micro (μ) ChIP assay suitable for up to nine parallel quantitative ChIPs of modified histones or RNA polymerase II from a single batch of 1000 cells. μChIP can also be downscaled to monitor the association of one protein with multiple genomic sites in as few as 100 cells. μChIP is applicable to small fresh tissue biopsies, and a cross-link-while-thawing procedure makes the assay suitable for frozen biopsies. Using μChIP, we characterize transcriptionally permissive and repressive histone H3 modifications on developmentally regulated promoters in human embryonal carcinoma cells and in osteosarcoma biopsies. μChIP creates possibilities for multiple parallel and rapid transcription factor binding and epigenetic analyses of rare cell and tissue samples.

Cytologic Diagnostic Accuracy in Pleomorphic Adenoma of the Salivary Glands During 2 Periods

To determine if previous experience with the cytologic presentation of pleomorphic adenoma (PA) results in a lower number of diagnostic errors.Comparative analysis of the diagnostic accuracy of PA during 2 periods (1980-1994 and 1995-2003). The first period included 198 tumors and the second, 230. Diagnostic errors were divided into major or minor according to the consequences for patient management. Major errors were considered those that could result in an erroneous surgical approach or treatment delay.Concordant results increased from 88.4% to 91.2%. Sensitivity rose from 92.6% to 95.5%. The false negative rate diminished from 7.1% to 4.5%. Regarding malignancy, false negative diagnoses diminished from 5 to 3. The second period included no false positive diagnoses of malignancy, while the first had 3. A total of 42 errors were present, 6 of them were nonrepresentative cases. Thirteen of the remaining 36 (36.1%) were considered major errors, while 23 (63.9%) were classified as minor errors. Major errors diminished from 8 to 5. The most significant reduction in errors occurred in the category of PA showing cystic transformation.Cytologic diagnostic accuracy of PA is high, and major errors may diminish if special attention is paid to some pitfalls. Sampling limitations and interpretive difficulties may prevent differentiation from afew cases of carcinoma ex-PA and adenoid cystic carcinoma (ACC). A few diagnostic errors are difficult to avoid. Small tissue biopsies will not resolve these problems.

An automated robot arm system for small animal tissue biopsy under dual-image modality

The ability to non-invasively monitor cell biology in vivo is one of the most important goals of molecular imaging. Imaging procedures could be inter-subject performed repeatedly at different investigating stages; thereby need not sacrifice small animals during the entire study period. Thus, the ultimate goal of this study was to design a stereotactic image-guided system for small animals and integrated it with an automatic robot arm for in vivo tissue biopsy analysis. The system was composed of three main parts, including one small animal stereotactic frame, one imaging-fusion software and an automatic robot arm system. The system has been thoroughly evaluated with three components; the robot position accuracy was 0.05±0.02 mm, the image registration accuracy was 0.37±0.18 mm and the system integration was satisfactorily within 1.20±0.39 mm of error. From these results, the system demonstrated sufficient accuracy to guide the micro-injector from the planned delivery routes into practice. The entire system accuracy was limited by the image fusion and orientation procedures, due to its nature of the blurred PET imaging obtained from the small objects. The primary improvement is to acquire as higher resolution as possible the fused imaging for localizing the targets in the future.

An assessment of extraction and assay techniques for quantification of calpain and calpastatin from small tissue samples1,2

Our objective was to evaluate whether small (biopsy-sized) samples could be used to measure calpain and calpastatin activities in skeletal muscle. The accuracy of different separation and assay methods for the quantification of calpains and calpastatin from small (1.0 and 0.2 g) skeletal muscle samples was tested. In Exp. 1, the LM was removed from six lambs, and a 50-g subsample was processed using the reference method (DEAE-Sephacel chromatography and casein assay). Subsamples (1.0 and 0.2 g) also were processed using the two-step separation (1 mL DEAE-Sephacel and bulk elution using 200 and 400 mM NaCl) and heated calpastatin methods; in both cases, fractions were assayed with Bodipy-labeled and [14C]-labeled casein microassays. Finally, casein zymography was used to separate and quantify the calpain proteases from 1.0-and 0.2-g samples. The values obtained after processing the 50-g sample using the reference method were judged most accurate, and the alternative approaches were compared with these. For each extraction and assay approach, we considered: 1) the effect of the sample size on the mean activity; 2) increased or decreased variation of data; and 3) the correlation relative to the reference method. Where possible, we compared the ratio of calpain to calpastatin activities determined using the alternative approaches with the ratios found using the reference method. These methodologies were further investigated in Exp. 2, where single homogenates from different tissues (heart, spleen, lung, and muscle) were assayed using the alternative approaches. Experiment 1 established that most of the approaches suffered from poor correlations and/or unacceptable variation. By using a large, homogenous sample in Exp. 2, however, we determined that this error was not due to the methodologies themselves. Therefore, the unacceptable variation found in Exp. 1 resulted from the small sample size, and we recommend that large tissue samples (e.g., 50 g) should be used for calpain and calpastatin activity measurements in skeletal muscle instead of small tissue biopsies (e.g., 0.2 and 1.0 g).

Immunohistochemical Findings in Embryonal Small Round Cell Tumors With Molecular Diagnostic Confirmation

The diagnosis of pediatric tumors relies heavily on immunohistochemical staining of small tissue biopsies, since many entities share a "small blue cell" phenotype. More recently, molecular genetic analysis for detection of specific gene fusion products has become available. With the increased use of such molecular techniques, the authors have noted that tumors with proven molecular diagnoses can exhibit unusual patterns of immunohistochemical staining. This study examines pediatric tumors with a "small blue cell" phenotype in which molecular diagnoses were available where applicable. A panel of immunohistochemical stains was performed (S100, CD56, NB84, CD99 [MIC2], Bcl-2, CD117, CD34, desmin, MNF116, and WT1). In the 370 sections from 37 cases, all primitive neuroectodermal tumors, with and without the presence of t(11;22), demonstrated uniform membranous membrane staining with CD99 (MIC2) and focal staining with CD56, NB84, MNF116, and WT1. All rhabdomyosarcomas, both alveolar and embryonal, demonstrated uniform desmin, CD56, and cytoplasmic WT1 immunostaining. Desmoplastic small round cell tumors showed positive cytokeratin staining, with half having "dot-like" cytoplasmic desmin and WT1 positivity; some showed focal positivity for NB84, CD99, and Bcl-2. The "undifferentiated" sarcomas showed the widest range of staining, with no marker staining all cases. Neuroblastomas exhibited uniform strong staining for CD56 and NB84 and marked cytoplasmic Bcl-2 positivity, and some cases showed cytoplasmic WT1 expression. Blastematous Wilms' tumors showed uniform strong membranous staining for CD56, uniform cytoplasmic staining for Bcl-2, and nuclear expression of WT1. Embryonal pediatric malignancies can demonstrate apparently nonspecific expression patterns for several antigens, which may reflect developmental immaturity rather than specific differentiation pathways.

Increased expression of minichromosome maintenance protein 2 in active inflammatory bowel disease.

Minichromosome maintenance protein 2 (Mcm2) is an accurate indicator of cell cycle entry in tissue samples, but its expression in inflammatory bowel disease (IBD) has not previously been investigated. We have used immunohistochemistry to assess the expression of Mcm2, in comparison to the existing proliferation marker Ki-67, in active IBD and IBD without inflammatory activity. For this experimental study, sections from colonic biopsy and resection specimens of 48 patients with IBD (5 inactive/quiescent Crohn's disease (CD), 13 active CD, 19 inactive/quiescent ulcerative colitis (UC) and 11 active UC) and 15 normal controls were immunostained with antibodies to Mcm2 and Ki-67. The percentage of immunopositive epithelial nuclei was determined by calculating a labelling index (LI) for entire glands and for gland thirds (superficial, middle and basal). The Mcm2 LI was significantly increased in the superficial third of glands in active vs. inactive/quiescent UC (P < 0.0001) and active vs. inactive/quiescent CD (P = 0.001). The Mcm2 LI was significantly greater than the Ki-67 LI in active IBD, both in entire glands (P < 0.0001) and in the superficial third of glands (UC, P = 0.001; CD, P = 0.0002). Mcm2 LIs for entire glands were significantly higher in UC (all cases) compared to CD (all cases) (P = 0.032). There is increased cell cycle entry, as indicated by expression of Mcm2 and to a lesser extent Ki-67, in the superficial third of colonic glands in active IBD compared to inactive/quiescent IBD. Detection of Mcm2 may contribute to improved histological assessment of small tissue biopsies and may enable the development of a direct stool-based test for detection of active IBD and potentially for assessment of disease activity.

Genetic variation and lactose intolerance: detection methods and clinical implications.

The maturational decline in lactase activity renders most of the world's adult human population intolerant of excessive consumption of milk and other dairy products. In conditions of primary or secondary lactase deficiency, the lactose sugars in milk pass through the gastrointestinal tract undigested or are partially digested by enzymes produced by intestinal bacterial flora to yield short chain fatty acids, hydrogen, carbon dioxide, and methane. The undigested lactose molecules and products of bacterial digestion can result in symptoms of lactose intolerance, diarrhea, gas bloat, flatulence, and abdominal pain. Diagnosis of lactose intolerance is often made on clinical grounds and response to an empiric trail of dietary lactose avoidance. Biochemical methods for assessing lactose malabsorption in the form of the lactose breath hydrogen test and direct lactase enzyme activity performed on small intestinal tissue biopsy samples may also be utilized. In some adults, however, high levels of lactase activity persist into adulthood. This hereditary persistence of lactase is common primarily in people of northern European descent and is attributed to inheritance of an autosomal-dominant mutation that prevents the maturational decline in lactase expression. Recent reports have identified genetic polymorphisms that are closely associated with lactase persistence and nonpersistence phenotypes. The identification of genetic variants associated with lactase persistence or nonpersistence allows for molecular detection of the genetic predisposition towards adult-onset hypolactasia by DNA sequencing or restriction fragment length polymorphism analysis. The role for such genetic detection in clinical practice seems limited to ruling out adult-onset hypolactasia as a cause of intolerance symptoms but remains to be fully defined. Attention should be paid to appropriate interpretation of genetic detection in order to avoid potentially harmful reduction in dairy intake or misdiagnosis of secondary lactase deficiency.