Optimization, Design and Avoiding Pitfalls in Manual Multiplex Fluorescent Immunohistochemistry

Summary

Multiplex fluorescent immunohistochemistry is an emerging technology that enables the visualization of multiple cell types within intact formalin-fixed, paraffin embedded (FFPE) tissue. Presented are guidelines for ensuring a successful 7-color multiplex with instructions for optimizing antibodies and reagents, preparing slides, design and tips for avoiding common problems.

Abstract

Microenvironment evaluation of intact tissue for analysis of cell infiltration and spatial organization are essential in understanding the complexity of disease processes. The principle techniques used in the past include immunohistochemistry (IHC) and immunofluorescence (IF) which enable visualization of cells as a snapshot in time using between 1 and 4 markers. Both techniques have shortcomings including difficulty staining poorly antigenic targets and limitations related to cross-species reactivity. IHC is reliable and reproducible, but the nature of the chemistry and reliance on the visible light spectrum allows for only a few markers to be used and makes co-localization challenging. Use of IF broadens potential markers but typically relies on frozen tissue due to the extensive tissue autofluorescence following formalin fixation. Flow cytometry, a technique that enables simultaneous labeling of multiple epitopes, abrogates many of the deficiencies of IF and IHC, however, the need to examine cells as a single cell suspension loses the spatial context of cells discarding important biologic relationships. Multiplex fluorescent immunohistochemistry (mfIHC) bridges these technologies allowing for multi-epitope cellular phenotyping in formalin fixed paraffin embedded (FFPE) tissue while preserving the overall microenvironment architecture and spatial relationship of cells within intact undisrupted tissue. High fluorescent intensity fluorophores that covalently bond to the tissue epitope enables multiple applications of primary antibodies without worry of species specific cross-reactivity by secondary antibodies. Although this technology has been proven to produce reliable and accurate images for the study of disease, the process of creating a useful mfIHC staining strategy can be time consuming and exacting due to extensive optimization and design. In order to make robust images that represent accurate cellular interactions in-situ and to mitigate the optimization period for manual analysis, presented here are methods for slide preparation, optimizing antibodies, multiplex design as well as errors commonly encountered during the staining process.

Introduction

Visualization of an intact tumor microenvironment (TME) is essential in evaluating not only cellular infiltration in solid malignancies but cell to cell interactions as well. Multiplex fluorescent immunohistochemistry (mfIHC) has emerged as an effective tool for multi-antigen phenotyping of cells in the study of cancer and associated diseases^{1,2,3,4,5,6,7}. This, in combination with novel software and programs designed to analyze large dat....

Protocol

All work has been approved by the University of Michigan’s internal review board.

1. Optimizing primary antibodies and slide preparation

1. Determine ideal concentration of antibodies for multiplex using conventional IHC.
   1. Test the antibodies for the multiplex by manual conventional immunohistochemistry (IHC)¹³.
   2. Use specific tissues that have an abundant cell type for each antibody tested such as using tonsil tissue for CD3 antibody testing.
   3. Use the reference concentration for IHC recommended by the company and then complete IHC with antibody concentrations at the recommended c....

Results

The overall process of obtaining a 7-color multiplex assay follows a repetitive pattern. Figure 1 describes the process in a diagrammatic form. Once slides are cut and dried or are received from the laboratory and baked in a hybridization oven at 60 °C for 1 h, then proceed to deparaffinization and rehydration, fix the slides in formalin again followed by antigen retrieval. Each round of multiplexing starts at antigen retrieval and finishes at antibody removal (Figure 1<.......

Discussion

Intact tissue specimens from solid tumor biopsy and surgical resection remain important diagnostic and predictive tools for disease analysis as well as patient prognosis. Multiplex fluorescent immunohistochemistry (mfIHC) is a novel technique that combines the benefits of immunohistochemistry (IHC), immunofluorescence (IF) and flow cytometry. Previous methods to probe cells in situ have allowed for evaluation of cell-to-cell arrangements in a tissue environment⁸, however, the low number of epitope.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
100% ethanol	Fisher	HC8001GAL
70% ethanol	Fisher	HC10001GL
95% ethanol	Fisher	HC11001GL
Analysis software	Akoya Biosciences	CLS135783	inForm version 2.3.0
Antifade mountant	ThermoFisher	P36961	ProLong Diamond
Blocking solution	Vector	SP-6000	Bloxall
Bovine Serum Albumin (BSA)	Sigma Life Sciences	A9647-100G
Cover Slips	Fisher	12-548-5E
Delicate task wipe	Kimberly-Clark	34120
Fluorescent diluent	Akoya Biosciences	ARD1A01EA	Opal TSA diluent
Fluorophore 520	Akoya Biosciences	FP1487001KT	1:100
Fluorophore 540	Akoya Biosciences	FP1494001KT	1:100
Fluorophore 570	Akoya Biosciences	FP1488001KT	1:100
Fluorophore 620	Akoya Biosciences	FP1495001KT	1:100
Fluorophore 650	Akoya Biosciences	FP1496001KT	1:100
Fluorophore 690	Akoya Biosciences	FP1497001KT	1:100
Fluorophore DAPI	Akoya Biosciences	FP1490	3 drops in TBST or PBS
Heat resistant box	Tissue-Tek	25608-904	Plastic slide box-green
Humidified Chamber	Ibi Scientific	AT-12
Hybridization oven	FisherBiotech
Hydrophobic barrier pen	Vector	H-4000	ImmEdge
Microscope	Perkin Elmer	CLS140089	Mantra quantitative pathology workstation
Microwave	Panasonic	NN-A661S	with inverter technology
Neutral buffered formalin	Fisher Scientific	SF100-4	10% neutral buffered formalin
pH 6 antigen retrieval buffer	Akoya Biosciences	AR600	AR6
pH 9 antigen retrieval buffer	Akoya Biosciences	AR900	AR9
Phosphate buffered saline	Fisher	BP3994	PBS
Plastic slide box	Tissue-Tek	25608-906
Plastic wrap	Fisher	NC9070936
Polysorbate 20	Fisher	BP337-800	Tween 20
Primary antibody CD163	Lecia	NCL-LCD163	1:400
Primary antibody CD3	Dako	A0452	1:400
Primary antibody CD8	Spring Bio	M5390	1:400
Primary antibody FOXP3	Dako	M3515	1:400
Primary antibody pancytokeratin	Cell Signaling	12653	1:500
Primary antibody PD-L1	Cell Signaling	13684	1:200
Secondary antibody	Akoya Biosciences	ARH1001EA	Opal polymer
Slide stain set	Electron Microscopy Sciences	6254001
Tris buffered saline	Corning	46-012-CM	TBS
Vertical slide rack	Electron Microscopy Sciences	50-294-72
Xylene	Fisher	X3P1GAL