1
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Eidan AJ. Direct immunofluorescence on formalin-fixed, paraffin-embedded versus fresh frozen human renal biopsies: a comparative study. J Immunoassay Immunochem 2024; 45:292-305. [PMID: 38263688 DOI: 10.1080/15321819.2024.2306324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The data referring to the value of direct immunofluorescence on formalin-fixed, paraffin-embedded tissue (IF-Paraffin) in the diagnosis of renal diseases is controversial. The aim of this study was to investigate whether renal biopsies evaluated by routine immunofluorescence on frozen tissue (IF-Frozen) would yield adequate findings to confirm diagnoses when the IF-Paraffin technique was applied. METHODS To show immunoglobulins, complement components, and light chains, 55 native renal biopsies were subjected to IF-Paraffin and IF-Frozen staining techniques. The intensity of the staining was compared, and the sensitivity and specificity were calculated. RESULTS The IF-Paraffin technique showed a sensitivity of 89%, 81%, 86%, 30%, 71%, 60%, and 77% for IgG, IgM, IgA, C1q, C3, κ, and λ, respectively, whereas specificity was 91%, 100%, 100%, 96%, 94%, 98%, and 100%. It showed diagnostic findings in 87% of cases. Compared to cases that had both IF-Paraffin and IF-Frozen staining techniques, 43 of 55 showed either equal intensity for the diagnostic immunoglobulin/complement or a little difference. CONCLUSIONS Direct immunofluorescence on formalin-fixed, paraffin-embedded sections cannot replace immunofluorescence on frozen sections in the assessment of renal biopsies, but may be a "salvage technique" when frozen tissue is insufficient or unavailable and must be interpreted with great caution.
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Affiliation(s)
- Ali J Eidan
- Immunology, Department of Basic Science, Faculty of Nursing, University of Kufa, Al-Najaf, Iraq
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2
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Reissig LF, Carrero-Rojas G, Maierhofer U, Moghaddam AS, Hainfellner A, Gesslbauer B, Haider T, Streicher J, Aszmann OC, Pastor AM, Weninger WJ, Blumer R. Spinal cord from body donors is suitable for multicolor immunofluorescence. Histochem Cell Biol 2023; 159:23-45. [PMID: 36201037 PMCID: PMC9899749 DOI: 10.1007/s00418-022-02154-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 02/07/2023]
Abstract
Immunohistochemistry is a powerful tool for studying neuronal tissue from humans at the molecular level. Obtaining fresh neuronal tissue from human organ donors is difficult and sometimes impossible. In anatomical body donations, neuronal tissue is dedicated to research purposes and because of its easier availability, it may be an alternative source for research. In this study, we harvested spinal cord from a single organ donor 2 h (h) postmortem and spinal cord from body donors 24, 48, and 72 h postmortem and tested how long after death, valid multi-color immunofluorescence or horseradish peroxidase (HRP) immunohistochemistry is possible. We used general and specific neuronal markers and glial markers for immunolabeling experiments. Here we showed that it is possible to visualize molecularly different neuronal elements with high precision in the body donor spinal cord 24 h postmortem and the quality of the image data was comparable to those from the fresh organ donor spinal cord. High-contrast multicolor images of the 24-h spinal cords allowed accurate automated quantification of different neuronal elements in the same sample. Although there was antibody-specific signal reduction over postmortem intervals, the signal quality for most antibodies was acceptable at 48 h but no longer at 72 h postmortem. In conclusion, our study has defined a postmortem time window of more than 24 h during which valid immunohistochemical information can be obtained from the body donor spinal cord. Due to the easier availability, neuronal tissue from body donors is an alternative source for basic and clinical research.
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Affiliation(s)
- Lukas F. Reissig
- Division of Anatomy, MIC, Medical University Vienna, Vienna, Austria
| | | | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Bernhard Gesslbauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Haider
- Department of Orthopedic and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Streicher
- Department of Anatomy and Biomechanics, Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Science, Krems an der Donau, Austria
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Angel M. Pastor
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, Seville, Spain
| | | | - Roland Blumer
- Division of Anatomy, MIC, Medical University Vienna, Vienna, Austria
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3
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Diagnostic Accuracy of Direct Immunofluorescence Test on Paraffin-Embedded Blocks in Comparison with Frozen Section Blocks in Renal Biopsies. Int J Nephrol 2022; 2022:4974031. [PMID: 36226196 PMCID: PMC9550505 DOI: 10.1155/2022/4974031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023] Open
Abstract
Background In several published research, the evaluation of renal disorders using immunofluorescence on formalin-fixed, paraffin-embedded (FFPE) tissue sections versus immunofluorescence on frozen sections was compared. Each technique's accuracy varies greatly. This study's objective was to assess IF-P as a potential replacement for IF-F in the diagnosis of renal biopsy specimens. Materials and Methods To show immunoglobulin IgA, IgG, IgM, and C3 immune deposits, proteinase K digestion of paraffin-embedded renal biopsy was standardized and used in 51 renal biopsies. Sensitivity, specificity, false-positive, and false-negative values were calculated. Results IF-P showed a sensitivity of 93.1%, 76.9%, 63.6%, and 33.3%, and a specificity of 100%, 97.3%, 95%, and 100% for IgG, IgA, IgM, and C3, respectively. Compared to cases that had both routine IF and IF-P, 50 of 51 showed either the same amount of staining for the diagnostic immunoglobulin/complement or a small amount of difference. In most of the cases (49 of 51), diagnostic findings were found. Conclusion IF-P is a sensitive and precise approach for assessing immune deposits in renal tissue biopsies. We come to the conclusion that IF-P serves as a beneficial salvage immunohistochemistry method for renal biopsies that do not contain enough cortical tissue for IF-F.
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4
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Gouda HR, Talaat IM, Bouzid A, El-Assi H, Nabil A, Venkatachalam T, Manasa Bhamidimarri P, Wohlers I, Mahdami A, EL-Gendi S, ElKoraie A, Busch H, Saber-Ayad M, Hamoudi R, Baddour N. Genetic analysis of CFH and MCP in Egyptian patients with immune-complex proliferative glomerulonephritis. Front Immunol 2022; 13:960068. [PMID: 36211394 PMCID: PMC9539770 DOI: 10.3389/fimmu.2022.960068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Glomerulonephritis (GN) is a complex disease with intricate underlying pathogenic mechanisms. The possible role of underlying complement dysregulation is not fully elucidated in some GN subsets, especially in the setting of autoimmunity or infection. In the current study, diagnosed cases of lupus nephritis (LN) and post-infectious GN (PIGN) were recruited for molecular genetic analysis and targeted next-generation DNA sequencing was performed for two main complement regulating genes: in the fluid phase; CFH, and on tissue surfaces; MCP. Three heterozygous pathogenic variants in CFH (Q172*, W701*, and W1096*) and one likely pathogenic heterozygous variant in MCP (C223R) have been identified in four of the studied LN cases. Additionally, among the several detected variants of uncertain significance, one novel variant (CFH:F614S) was identified in 74% of the studied LN cases and in 65% of the studied PIGN cases. This variant was detected for the first time in the Egyptian population. These findings suggest that subtle mutations may be present in complement regulating genes in patients with immune-complex mediated category of GN that may add to the disease pathogenesis. These findings also call for further studies to delineate the impact of these gene variants on the protein function, the disease course, and outcome.
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Affiliation(s)
- Heba R. Gouda
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman M. Talaat
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Bouzid
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Hoda El-Assi
- Human Genetics Unit, Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira Nabil
- Human Genetics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Thenmozhi Venkatachalam
- Department of Physiology and Immunology, College of Medicine, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Inken Wohlers
- Medical Systems Biology Division, Lübeck Institute of Experimental Dermatology and Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Amena Mahdami
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Saba EL-Gendi
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed ElKoraie
- Nephrology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hauke Busch
- Medical Systems Biology Division, Lübeck Institute of Experimental Dermatology and Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Maha Saber-Ayad
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Pharmacology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rifat Hamoudi
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Nahed Baddour
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Kannan L. A Unique Case of Membranous Lupus Nephritis Identified After Pronase Digestion. Cureus 2022; 14:e29083. [PMID: 36249657 PMCID: PMC9555807 DOI: 10.7759/cureus.29083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Membranous nephropathy (MN) is a common etiology of nephrotic syndrome (NS) in Caucasian adults. With treatment strategies heavily dependent on differentiating between primary versus secondary MN, tissue diagnosis remains paramount in the setting of indeterminant serological studies and remains the gold standard. Direct immunofluorescence on frozen sections remains standard practice, though with inadequate kidney tissue, antigen retrieval with proteases on formalin-fixed paraffin-embedded tissue can be a viable alternative for direct immunofluorescence. We report a patient who presented with nephrotic syndrome, indeterminant serological workup including primary antigen phospholipase-2 receptor antibody (PLA2R). Histology revealed a membranous pattern of injury with a negative standard panel of immunocomplex deposits on direct immunofluorescence. Upon re-examination of paraffin-embedded tissue via protease processing, Immunofluorescence unmasked membranous lupus nephritis. This case highlights the possibility of negative direct immunofluorescence on viable frozen tissue which is unmasked after protease treatment on formalin-fixed paraffin-embedded tissue sample revealing immunocomplex deposits.
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6
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Bosisio FM, Van Herck Y, Messiaen J, Bolognesi MM, Marcelis L, Van Haele M, Cattoretti G, Antoranz A, De Smet F. Next-Generation Pathology Using Multiplexed Immunohistochemistry: Mapping Tissue Architecture at Single-Cell Level. Front Oncol 2022; 12:918900. [PMID: 35992810 PMCID: PMC9389457 DOI: 10.3389/fonc.2022.918900] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 01/23/2023] Open
Abstract
Single-cell omics aim at charting the different types and properties of all cells in the human body in health and disease. Over the past years, myriads of cellular phenotypes have been defined by methods that mostly required cells to be dissociated and removed from their original microenvironment, thus destroying valuable information about their location and interactions. Growing insights, however, are showing that such information is crucial to understand complex disease states. For decades, pathologists have interpreted cells in the context of their tissue using low-plex antibody- and morphology-based methods. Novel technologies for multiplexed immunohistochemistry are now rendering it possible to perform extended single-cell expression profiling using dozens of protein markers in the spatial context of a single tissue section. The combination of these novel technologies with extended data analysis tools allows us now to study cell-cell interactions, define cellular sociology, and describe detailed aberrations in tissue architecture, as such gaining much deeper insights in disease states. In this review, we provide a comprehensive overview of the available technologies for multiplexed immunohistochemistry, their advantages and challenges. We also provide the principles on how to interpret high-dimensional data in a spatial context. Similar to the fact that no one can just “read” a genome, pathological assessments are in dire need of extended digital data repositories to bring diagnostics and tissue interpretation to the next level.
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Affiliation(s)
- Francesca Maria Bosisio
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- *Correspondence: Frederik De Smet, ; Francesca Maria Bosisio,
| | | | - Julie Messiaen
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- The Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Maddalena Maria Bolognesi
- Pathology, Department of Medicine and Surgery, Università di Milano-Bicocca, Monza, Italy
- Department of Pathology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Ospedale San Gerardo, Monza, Italy
| | - Lukas Marcelis
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Matthias Van Haele
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Giorgio Cattoretti
- Pathology, Department of Medicine and Surgery, Università di Milano-Bicocca, Monza, Italy
- Department of Pathology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Ospedale San Gerardo, Monza, Italy
| | - Asier Antoranz
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- The Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Frederik De Smet
- Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- The Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- *Correspondence: Frederik De Smet, ; Francesca Maria Bosisio,
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7
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Ten Approaches That Improve Immunostaining: A Review of the Latest Advances for the Optimization of Immunofluorescence. Int J Mol Sci 2022; 23:ijms23031426. [PMID: 35163349 PMCID: PMC8836139 DOI: 10.3390/ijms23031426] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/04/2022] Open
Abstract
Immunostaining has emerged as one of the most common and valuable techniques that allow the localization of proteins at a quantitative level within cells and tissues using antibodies coupled to enzymes, fluorochromes, or colloidal nanogold particles. The application of fluorochromes during immunolabeling is referred to as immunofluorescence, a method coupled to widefield or confocal microscopy and extensively applied in basic research and clinical diagnosis. Notwithstanding, there are still disadvantages associated with the application of this technique due to technical challenges in the process, such as sample fixation, permeabilization, antibody incubation times, and fluid exchange, etc. These disadvantages call for continuous updates and improvements to the protocols extensively described in the literature. This review contributes to protocol optimization, outlining 10 current methods for improving sample processing in different stages of immunofluorescence, including a section with further recommendations. Additionally, we have extended our own antibody signal enhancer method, which was reported to significantly increase antibody signals and is useful for cervical cancer detection, to improve the signals of fluorochrome-conjugated staining reagents in fibrous tissues. In summary, this review is a valuable tool for experienced researchers and beginners when planning or troubleshooting the immunofluorescence assay.
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8
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Abstract
Immunofluorescence is an important immunochemical technique that utilizes fluorescence-labeled antibodies to detect specific target antigens. It is used widely in both scientific research and clinical laboratories. Immunofluorescence allows for excellent sensitivity and amplification of signal in comparison to immunohistochemistry. However, analysis of samples labeled with fluorescence-labeled antibodies has to be performed using a fluorescence microscope or other type of fluorescence imaging. There are two methods available: direct (primary) and indirect (secondary) immunofluorescence. Here, we describe the principle of immunofluorescence methods as well as the preparation of fresh-frozen and formalin-fixed, paraffin embedded tissues for both direct and indirect immunofluorescence labeling.
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Affiliation(s)
| | | | - Sergio Piña-Oviedo
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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9
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Wunderlich LCS, Ströhl F, Ströhl S, Vanderpoorten O, Mascheroni L, Kaminski CF. Superresolving the kidney-a practical comparison of fluorescence nanoscopy of the glomerular filtration barrier. Anal Bioanal Chem 2021; 413:1203-1214. [PMID: 33277998 PMCID: PMC7813708 DOI: 10.1007/s00216-020-03084-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/31/2020] [Accepted: 11/19/2020] [Indexed: 01/19/2023]
Abstract
Immunofluorescence microscopy is routinely used in the diagnosis of and research on renal impairments. However, this highly specific technique is restricted in its maximum resolution to about 250 nm in the lateral and 700 nm in the axial directions and thus not sufficient to investigate the fine subcellular structure of the kidney's glomerular filtration barrier. In contrast, electron microscopy offers high resolution, but this comes at the cost of poor preservation of immunogenic epitopes and antibody penetration alongside a low throughput. Many of these drawbacks were overcome with the advent of super-resolution microscopy methods. So far, four different super-resolution approaches have been used to study the kidney: single-molecule localization microscopy (SMLM), stimulated emission depletion (STED) microscopy, structured illumination microscopy (SIM), and expansion microscopy (ExM), however, using different preservation methods and widely varying labelling strategies. In this work, all four methods were applied and critically compared on kidney slices obtained from samples treated with the most commonly used preservation technique: fixation by formalin and embedding in paraffin (FFPE). Strengths and weaknesses, as well as the practicalities of each method, are discussed to enable users of super-resolution microscopy in renal research make an informed decision on the best choice of technique. The methods discussed enable the efficient investigation of biopsies stored in kidney banks around the world. Graphical abstract.
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Affiliation(s)
- Lucia C S Wunderlich
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, UK
| | - Florian Ströhl
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, UK
- Department of Physics and Technology, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Stefan Ströhl
- Department of Nephrology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Oliver Vanderpoorten
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, UK
- Department of Physics and Technology, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Luca Mascheroni
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, UK
| | - Clemens F Kaminski
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, UK.
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10
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Zhang X, Wang B, Liu Z, Zhou Y, Du L. How to Fluorescently Label the Potassium Channel: A Case in hERG. Curr Med Chem 2020; 27:3046-3054. [DOI: 10.2174/0929867326666181129094455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 11/22/2022]
Abstract
hERG (Human ether-a-go-go-related gene) potassium channel, which plays an essential
role in cardiac action potential repolarization, is responsible for inherited and druginduced
long QT syndrome. Recently, the Cryo-EM structure capturing the open conformation
of hERG channel was determined, thus pushing the study on hERG channel at 3.8 Å
resolution. This report focuses primarily on summarizing the design rationale and application
of several fluorescent probes that target hERG channels, which enables dynamic and real-time
monitoring of potassium pore channel affinity to further advance the understanding of the
channels.
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Affiliation(s)
- Xiaomeng Zhang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (MOE), School of Pharmacy, Shandong University, Jinan, Shandong 250012, China
| | - Beilei Wang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (MOE), School of Pharmacy, Shandong University, Jinan, Shandong 250012, China
| | - Zhenzhen Liu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (MOE), School of Pharmacy, Shandong University, Jinan, Shandong 250012, China
| | - Yubin Zhou
- Institute of Biosciences and Technology, College of Medicine, Texas A&M University, Houston, TX 77030, United States
| | - Lupei Du
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (MOE), School of Pharmacy, Shandong University, Jinan, Shandong 250012, China
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11
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Alwahaibi NY, Alsidiri RM, Alsinawi TA, Almalki WH, Alsinawi SS, Alriyami MA. Immunoperoxidase and Immunofluorescence on Formalin-Fixed, Paraffin-Embedded Tissue Sections versus Immunofluorescence on Frozen Sections in the Assessment of Renal Biopsies. Indian J Nephrol 2019; 30:8-13. [PMID: 32015593 PMCID: PMC6977388 DOI: 10.4103/ijn.ijn_356_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/10/2019] [Accepted: 05/07/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: There are few published studies comparing immunofluorescence on formalin-fixed, paraffin-embedded (FFPE) tissue sections (IF-P) and immunoperoxidase on FFPE tissue sections (IP-P) with immunofluorescence on frozen sections (IF-F) for evaluation of renal diseases. Also, the accuracy for each method differs greatly. The aim of this study was to evaluate IF-P and IP-P as an alternative to IF-F (gold standard method) in the diagnosis of renal biopsies specimens. Methods: In all, 101 renal biopsies were subjected to IF-P, IP-P, and IF-F staining to demonstrate immunoglobulin IgA, IgG, and IgM immune deposits. Sensitivity, specificity, false-positive, and false-negative values were calculated. Results: IP-P showed sensitivity of 61.8%, 74.2%, and 64.2%, and specificity of 84.8%, 69.2%, and 66.7% for IgA, IgG, and IgM, respectively. IF-P showed a sensitivity of 45.6%, 69.4% and 52.8%, and specificity of 87.9%, 87.2% and 77.1% for IgA, IgG and IgM, respectively. False-positive cases of IF-P and IP-P were 4, 5, and 11 and 5, 12, and 16 for IgA, IgG, and IgM, respectively. Conclusion: Where IF-F lacks glomeruli or fresh renal biopsies are not available, IP-P is a sensitive method, whereas IF-P is a specific method for the evaluation of immune deposits in the renal tissue biopsies. The presence of false-positive cases in both methods deserves further research.
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Affiliation(s)
- Nasar Yousuf Alwahaibi
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Rajaa Mohammed Alsidiri
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Thuraiya Amer Alsinawi
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Wafa Hamed Almalki
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Shadia Said Alsinawi
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Marwa Abdullah Alriyami
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
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Kaur G, Chen G. Membranous or membranous-like GN: A case report of massive proteinuria, positive serum with negative PLA2R on biopsy. Clin Case Rep 2018; 6:2198-2201. [PMID: 30455920 PMCID: PMC6230598 DOI: 10.1002/ccr3.1849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/30/2018] [Accepted: 09/09/2018] [Indexed: 11/06/2022] Open
Abstract
This case report represents primary membranous glomerulonephritis (MGN) with positive serum anti-PLA2R antibodies, 2+ positivity for IgG4 on immunofluorescence with routine fresh-frozen sections and negative PLA2R stain on biopsy. He was treated as primary MGN based on positive serum PLA2R and the absence of clinical symptoms or signs suggestive of any secondary MGN.
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Affiliation(s)
- Gurwant Kaur
- Department of Medicine (Nephrology)Penn State Milton S. Hershey Medical CentreHersheyPennsylvania
| | - Guoli Chen
- Department of PathologyPenn State Milton S. Hershey Medical CentreHersheyPennsylvania
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13
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Paraffin Immunofluorescence: A Valuable Ancillary Technique in Renal Pathology. Kidney Int Rep 2018; 3:1260-1266. [PMID: 30450452 PMCID: PMC6224795 DOI: 10.1016/j.ekir.2018.07.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023] Open
Abstract
Immunofluorescence on frozen tissue is the gold standard immunohistochemical technique for evaluation of immune deposits in the kidney. When frozen tissue is not available or lacks glomeruli, immunofluorescence can be performed on paraffin tissue after antigen retrieval (paraffin immunofluorescence). Excellent results can be obtained by paraffin immunofluorescence in most immune complex-mediated glomerulonephritides and dysproteinemia-associated kidney lesions, and thus this technique has become a valuable salvage technique in renal pathology. Furthermore, new data have emerged suggesting that paraffin immunofluorescence can be used as an unmasking technique, as it is more sensitive than frozen tissue immunofluorescence in some kidney lesions, such as crystalline light chain proximal tubulopathy and is needed to establish the diagnosis of certain unique lesions, such as membranous-like glomerulopathy with masked IgG kappa deposits and membranoproliferative glomerulonephritis with masked monotypic Ig deposits. However, it is important to recognize and be aware of the limitations and pitfalls associated with paraffin immunofluorescence. These include poor sensitivity for detection of C3 deposits and for the diagnosis of primary membranous nephropathy. Here, we summarize the available techniques of paraffin immunofluorescence, review its role and performance as a salvage and unmasking technique in renal pathology, address its limitations and pitfalls, and highlight unusual forms of glomerulopathy that require paraffin immunofluorescence for diagnosis.
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14
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Miyamoto D, Maruta C, Santi C, Zoroquiain P, Dias AB, Fukumori L, Perigo A, Aoki V, Burnier M. How can immunohistochemistry improve the diagnosis of pemphigus foliaceus? HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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15
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Bouatou Y, Kers J, Chevalier-Florquin MSN, Claessen N, Nguyen TQ, Damman J, Proença H, Roelofs JJTH, Florquin S. Diagnostic accuracy of immunofluorescence versus immunoperoxidase staining to distinguish immune complex-mediated glomerulonephritis and C3 dominant glomerulopathy. Histopathology 2017; 72:601-608. [PMID: 28881045 DOI: 10.1111/his.13385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
AIMS The technique used for classification of membranoproliferative glomerulonephritis (MPGN) has been changed from an electron microscopy-based to an immunofluorescence (IF)-based semiquantitative technique with immunoperoxidase (IP) staining as a backup option when IF is not possible. Since data on that matter is lacking, our aims were to study the interobserver variability, the correlation and the reclassification of MPGN based on these two techniques. METHODS AND RESULTS We retrospectively analysed cases of type 1 MPGN. We repeated IF staining and performed IP staining for IgG, kappa, lambda, C3c and C4d in 35 renal biopsies, among which 19 biopsies had matched IP and IF samples. We observed substantial to near-perfect agreement among the seven observers for both IF and IP (W coefficients from 0.66 for IF lambda to 0.89 for IF C4d). Of the 19 cases with matched IP and IF samples, five (26%) turned out to have different diagnoses on IF and on IP. Also, the ability of C4d to discriminate immune complex-mediated glomerulonephritis (ICGN) from C3 glomerulopathy (C3G) was poor, with areas under the curve of 0.44 [95% confidence interval (CI) 0.24-0.63] and 0.66 (95% CI 0.50-0.81) for the receiver operating characteristic curves of IF and IP respectively. Limitations include the fact that no clinical data regarding complement activation were available. CONCLUSION The diagnosis of ICGN versus C3GN depends on the immunochemical technique used. Also, the use of C4d failed to discriminate ICGN from C3G in our study. Further validation studies are required to avoid misdiagnosis based on kidney biopsy.
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Affiliation(s)
- Yassine Bouatou
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Jesper Kers
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Nike Claessen
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrique Proença
- Department of Pathology, Hospital do Rim e Hipertensão, São Paulo, Brazil
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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16
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Yabuki A, Sawa M, Kohyama M, Hamamoto T, Yamato O. Paraffin immunofluorescence for detection of immune complexes in renal biopsies: an efficient salvage technique for diagnosis of glomerulonephritis in dogs. BMC Vet Res 2017; 13:371. [PMID: 29191199 PMCID: PMC5709965 DOI: 10.1186/s12917-017-1287-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/17/2017] [Indexed: 01/10/2023] Open
Abstract
Background Renal biopsy is an essential tool for the diagnosis of proteinuric kidney diseases in dogs, and evaluation of immune complexes (IC) by immunofluorescence (IF) of frozen sections (IF-F) is required for the diagnosis of IC-mediated glomerulonephritis (ICGN). However, the use of frozen sections from renal biopsies can have limitations. The aim of this study was to develop a reliable IF method using formalin-fixed and paraffin-embedded (FFPE) sections to detect ICs in dog ICGN. Methods Renal biopsy specimens were obtained from dogs with protein-losing nephropathies. FFPE sections were prepared, and eight antigen retrieval pretreatment protocols were performed: digestion with trypsin, microwave (MW) heating in citrate buffer (MW-CB; pH 6.0), MW heating in Tris-EDTA buffer (MW-TEB; pH 9.0), as well as combinations of the above, and a non-treated control. Results A combination of trypsin for 30 min (Try-30) and MW-TEB; pH 9.0 was the most effective antigen retrieval pretreatment, with clear positive signals for IgG, IgA, IgM, and C3 detected by IF-FFPE. Granular signals, an important diagnostic indicator of ICGN, were clearly observed by both IF-F and IF-FFPE after combined pretreatment with Try-30 and MW-TEB, and IgG, IgA, IgM, and C3 signals were almost completely matched in all samples by IF-F and IF-FFPE. Conclusion IF-FFPE with Try-30 and MW-TEB pretreatment is a valuable technique for the diagnosis of renal diseases in dogs. This method could be an efficient tool when standard IF-F cannot be used, or does not provide useful results due to lack of glomeruli in the specimens for IF-F.
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Affiliation(s)
- Akira Yabuki
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan.
| | - Mariko Sawa
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan
| | - Moeko Kohyama
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan
| | - Takeshi Hamamoto
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan
| | - Osamu Yamato
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 890-0065, Japan
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17
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Nada R, Kumar A, Kumar VG, Gupta KL, Joshi K. Unmasking of complements using proteinase-K in formalin fixed paraffin embedded renal biopsies. Indian J Nephrol 2016; 26:182-7. [PMID: 27194832 PMCID: PMC4862263 DOI: 10.4103/0971-4065.159558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal biopsy interpretation requires histopathology, direct immunofluorescence (DIF) and electron microscopy. Formalin-fixed, paraffin-embedded tissue (FFPE) sent for light microscopy can be used for DIF after antigen retrieval. However, complement staining has not been satisfactory. We standardized DIF using proteinase-K for antigen retrieval in FFPE renal biopsies. A pilot study was conducted on known cases of membranous glomerulonephritis (MGN), membranoproliferative type-1 (MPGN-1), immunoglobulin A nephropathy (IgAN), and anti-glomerular basement disease (anti-GBM). Immunofluorescence panel included fluorescein isothiocyanate (FITC) conjugated IgG, IgA, IgM, complements (C3 and C1q), light chains (kappa, lambda) and fibrinogen antibodies. After standardization of the technique, 75 renal biopsies and 43 autopsies cases were stained. Out of 43 autopsy cases, immune-complex mediated glomerulonephritis (GN) was confirmed in 18 cases (Lupus nephritis-11, IgAN-6, MGN-1), complement-mediated dense deposit disease (DDD-1) and monoclonal diseases in 4 cases (amyloidosis-3, cast nephropathy-1). Immune-mediated injury was excluded in 17 cases (focal segmental glomerulosclerosis -3, crescentic GN-6 [pauci-immune-3, anti-GBM-3], thrombotic microangiopathy-5, atherosclerosis-3). Renal biopsies (n-75) where inadequate or no frozen sample was available; this technique classified 52 mesangiocapillary pattern as MPGN type-1-46, DDD-2 and (C3GN-4). Others were diagnosed as IgAN-3, lupus nephritis-2, MGN-4, diffuse proliferative glomerulonephritis (DPGN)-1, Non-IC crescentic GN-1, monoclonal diseases-3. In nine cases, DIF on FFPE tissue could not help in making diagnosis. Proteinase-K enzymatic digestion of FFPE renal biopsies can unmask complements (both C3 and C1q) in immune-complexes mediated and complement-mediated diseases. This method showed good results on autopsy tissues archived for as long as 15 years.
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Affiliation(s)
- R Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kumar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V G Kumar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Joshi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Messias NC, Walker PD, Larsen CP. Paraffin immunofluorescence in the renal pathology laboratory: more than a salvage technique. Mod Pathol 2015; 28:854-60. [PMID: 25676556 DOI: 10.1038/modpathol.2015.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 12/30/2022]
Abstract
Immunofluorescence studies on paraffin-embedded tissue after Pronase digestion (paraffin immunofluorescence) is used as a salvage technique in renal pathology, when frozen tissue for routine immunofluorescence is inadequate. We have recently found that it is also useful in rare cases in which the immune deposits are 'masked' on routine immunofluorescence, giving false-negative staining by routine immunofluorescence and positive staining by paraffin immunofluorescence. This study aims to evaluate the role of paraffin immunofluorescence in clinical practice with emphasis on its utility to avoid misdiagnosis of cases with masked immune complex deposits. Paraffin immunofluorescence was used in 304 (6.1%) of 4969 native biopsies reviewed from our files. In 207 (68.1%) cases, paraffin immunofluorescence was used as a salvage technique. It was necessary for diagnosis in 24 (11.6%) and had a significant contribution in 63 (30.4%) of these cases. Paraffin immunofluorescence was used to evaluate masked deposits in 97 (31.9%) cases. In 61 (62.9%) of these cases it was used to evaluate masked immune complex glomerular deposits, and in 36 cases (37.1%) it was used to evaluate masked paraproteins. Of the cases where immune complex deposits were sought, paraffin immunofluorescence was necessary for diagnosis in 16 (26.2%) cases and had a significant contribution in 4 (6.6%) cases. Fourteen of the 20 cases with masked deposits had C3 dominant stain by routine immunofluorescence, which could have been misdiagnosed as C3 glomerulopathy. Overall, paraffin immunofluorescence was necessary or had a significant contribution to diagnosis in >1/3 of the cases and is a valuable technique in renal pathology.
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Abstract
Membranous-like glomerulopathy with masked IgG-κ deposits (MGMID) is a novel entity requiring antigen retrieval on formalin-fixed paraffin-embedded tissue to detect the immunoglobulin by immunofluorescence. MGMID is clinically distinct from other glomerulopathies with non-organized monoclonal IgG deposits, although the source of the kappa-restricted IgG is uncertain. Careful examination including ultrastructural analysis is essential for identifying diseases such as MGMID that may be misclassified by routine methods and ultimately require alternative techniques for accurate diagnosis.
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Affiliation(s)
- Christine VanBeek
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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20
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Abstract
Risk factors for kidney cancers and medical kidney diseases are similar; therefore, it is not surprising that up to 25% of renal cell carcinoma patients have chronic kidney disease prior to nephrectomy and a significant number of patients with normal prenephrectomy renal function markers progress to chronic kidney disease over time. Evaluation of non-neoplastic parenchyma in tumor nephrectomy specimens can identify patients at risk for progression to chronic kidney disease, which is a critical step for early intervention and potential improvement of morbidity and mortality rates in this patient population.
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21
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Owen-Casey MP, Sim R, Cook HT, Roufosse CA, Gillmore JD, Gilbertson JA, Hutchison CA, Howie AJ. Value of antibodies to free light chains in immunoperoxidase studies of renal biopsies. J Clin Pathol 2014; 67:661-6. [PMID: 24817705 PMCID: PMC4112424 DOI: 10.1136/jclinpath-2014-202231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Because immunoglobulin abnormalities may affect the kidney, investigation of renal biopsies requires immunohistological study of light chains. A problem is that most antibodies to light chains react with whole immunoglobulins as well as free light chains, and there are generally many more whole immunoglobulins than free light chains. The usefulness of antibodies that only detected free light chains was investigated. METHODS Antibodies to free light chains were used in an immunoperoxidase method on paraffin sections of 198 renal biopsies, and compared with conventional antibodies against light chains examined by immunofluorescence on 13 frozen sections and by immunoperoxidase on 46 paraffin sections. RESULTS Immunofluorescence and immunoperoxidase were concordant on 10 of 13 biopsies. Immunofluorescence detected slight deposition of light chains in three biopsies not shown by immunoperoxidase, of undetermined clinical significance. Using immunoperoxidase, the free light chain antibodies were more sensitive than conventional antibodies, giving much cleaner staining and better detection of deposits in AL amyloid, light chain deposition disease and cryoglobulinaemic glomerulonephritis. The free light chain antibodies showed discordance or ambiguity between immunohistological and clinical findings in seven (4%) of 185 patients with known immunoglobulin status. These included two of 28 cases of AL amyloid that showed no light chain deposition. The method was not designed for detection of light chain restriction in neoplastic plasma or lymphoplasmacytic cells. CONCLUSIONS Polyclonal antibodies to free light chains are an improvement on conventional antibodies in immunoperoxidase study of paraffin sections of renal biopsies and are useful in everyday practice.
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Affiliation(s)
| | - Rosalind Sim
- Department of Cellular Pathology, Royal Free Hospital, London, UK
| | - H Terence Cook
- Department of Histopathology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Candice A Roufosse
- Department of Histopathology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Julian D Gillmore
- UCL Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, London, UK
| | - Janet A Gilbertson
- UCL Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, London, UK
| | - Colin A Hutchison
- Department of Nephrology, Hawke's Bay District Health Board, Hastings, New Zealand
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22
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Rojko JL, Evans MG, Price SA, Han B, Waine G, DeWitte M, Haynes J, Freimark B, Martin P, Raymond JT, Evering W, Rebelatto MC, Schenck E, Horvath C. Formation, Clearance, Deposition, Pathogenicity, and Identification of Biopharmaceutical-related Immune Complexes. Toxicol Pathol 2014; 42:725-64. [DOI: 10.1177/0192623314526475] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vascular inflammation, infusion reactions, glomerulopathies, and other potentially adverse effects may be observed in laboratory animals, including monkeys, on toxicity studies of therapeutic monoclonal antibodies and recombinant human protein drugs. Histopathologic and immunohistochemical (IHC) evaluation suggests these effects may be mediated by deposition of immune complexes (ICs) containing the drug, endogenous immunoglobulin, and/or complement components in the affected tissues. ICs may be observed in glomerulus, blood vessels, synovium, lung, liver, skin, eye, choroid plexus, or other tissues or bound to neutrophils, monocytes/macrophages, or platelets. IC deposition may activate complement, kinin, and/or coagulation/fibrinolytic pathways and result in a systemic proinflammatory response. IC clearance is biphasic in humans and monkeys (first from plasma to liver and/or spleen, second from liver or spleen). IC deposition/clearance is affected by IC composition, immunomodulation, and/or complement activation. Case studies are presented from toxicity study monkeys or rats and indicate IHC-IC deposition patterns similar to those predicted by experimental studies of IC-mediated reactions to heterologous protein administration to monkeys and other species. The IHC-staining patterns are consistent with findings associated with generalized and localized IC-associated pathology in humans. However, manifestations of immunogenicity in preclinical species are generally not considered predictive to humans.
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Affiliation(s)
| | | | - Shari A. Price
- Charles River Pathology Associates, Frederick, Maryland, USA
| | - Bora Han
- Pfizer, Inc, San Diego, California, USA
| | - Gary Waine
- CSL Limited, Parkville, Melbourne, Australia
| | | | - Jill Haynes
- CSL Limited, Parkville, Melbourne, Australia
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23
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Membranous-like glomerulopathy with masked IgG kappa deposits. Kidney Int 2014; 86:154-61. [PMID: 24429395 DOI: 10.1038/ki.2013.548] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/24/2013] [Accepted: 11/14/2013] [Indexed: 02/07/2023]
Abstract
The diagnostic classification of glomerulonephritis is determined by the interplay of changes seen using light, immunofluorescence, and electron microscopy of the renal biopsy. Routine direct immunofluorescence on fresh tissue is currently considered the gold standard for the detection and characterization of immune deposits. We recently found a peculiar form of glomerular immune complex deposition in which masked deposits required an antigen-retrieval step to be visualized. Over a 2-year period, 14 cases were characterized by numerous, large subepithelial deposits visualized by electron microscopy and C3-predominant staining by routine immunofluorescence on fresh tissue with weak to negative immunoglobulin staining. Repeat immunofluorescence after digestion of the formalin-fixed paraffin-embedded tissue with pronase elicited strong IgG-κ staining restricted within the deposits. The patients were often young with a mean age of 26 years and commonly had clinical evidence of vague autoimmune phenomenon. The clinicopathologic findings in this unusual form of glomerulopathy do not fit neatly into any currently existing diagnostic category. We have termed this unique form of glomerulopathy membranous-like glomerulopathy with masked IgG-κ deposits.
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Peuscher A, Gassler N, Schneider U, Thom P, Rasche S, Spiegel H, Schillberg S. An immunohistochemical assay on human tissue using a human primary antibody. J Immunoassay Immunochem 2014; 35:322-334. [PMID: 24350651 DOI: 10.1080/15321819.2013.864974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Non human antibodies administered to human patients often generate anti-antibody responses, leading in extreme cases to anaphylactic shock. Completely human antibodies are therefore favored over their murine, chimeric and humanized counterparts. However, the accurate evaluation of human antibodies on human tissue samples cannot be achieved using indirect immunohistochemical methods because of endogenous immunoglobulins that are co-detected by the secondary antibodies. Direct detection is often used instead, but this lacks the signal amplification conferred by the secondary antibody and is therefore less sensitive. We developed a simple fluorescence-based indirect immunohistochemical method that allows human primary antibodies bound specifically to their target antigens in human tissue samples to be detected clearly and without interfering background staining. This approach involves a biotinylated human primary antibody (H10(Biotin)) and Cy3-conjugated streptavidin (Strep(Cy3)). We tested the protocol using a human carcinoembryonic antigen (CEA) specific IgG1 (H10). We identified an exposure time threshold that allowed the elimination of low Strep(Cy3) background staining, yet achieved sufficient signal amplification to make our approach four times more sensitive than comparable direct immunohistochemical procedures. The principle of this indirect immunohistochemical assay should be transferable to other species allowing the specific and sensitive detection of any primary antibody on homologous tissues.
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Affiliation(s)
- Anne Peuscher
- a Fraunhofer Institute for Molecular Biology and Applied Ecology IME , Aachen , Germany
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25
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Volovăt C, Cãruntu I, Costin C, Stefan A, Popa R, Volovăt S, Siriopol D, Voroneanu L, Nistor I, Segall L, Covic A. Changes in the histological spectrum of glomerular diseases in the past 16 years in the North-Eastern region of Romania. BMC Nephrol 2013; 14:148. [PMID: 23855530 PMCID: PMC3716947 DOI: 10.1186/1471-2369-14-148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the findings of renal biopsies from a large nephrology center in Iasi, Romania, performed between 2005 and 2010. We compared these findings with our previous ones, from 1995 to 2004, as well as with similar reports. METHODS We studied retrospectively 239 renal biopsies. The indications for renal biopsy were categorized into: nephrotic syndrome, acute nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology. RESULTS During the past 16 years, a gradual increase in the annual number of renal biopsies/per million population (p.m.p.)/year was observed, although this incidence remained lower than in other European countries. Nephrotic syndrome was the indication for renal biopsy in over 50% of cases. Glomerulonephritis (GN) was the main histological diagnosis in 91% of cases, of which 56% were primary GN and 35% were secondary GN. The frequency of various types of primary GN was: membranoproliferative GN (MPGN) - 29.3%, membranous nephropathy (MN) -27.5%, focal segmental glomerulosclerosis (FSGS) - 17.2%, mesangial GN (including IgAN) -13.7%, crescentic GN - 9.4%, and minimal change disease (MCD) - 2.5%. Compared to the previously reported period (1994-2004), we observed a significant decrease in the frequency of MPGN and significant increases in the frequency of FSGS and, particularly MN - which more than doubled. CONCLUSION We report significant changes in the histological spectrum of GN in North-Eastern Romania in 2005-2010, compared to the previously reported 10-yrs. These changes seem to be following a trend that has also been observed in Western countries a few decades ago, and which may have a socioeconomic explanation.
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Affiliation(s)
- Carmen Volovăt
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Irina Cãruntu
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Camelia Costin
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Alina Stefan
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Raluca Popa
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Simona Volovăt
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Dimitrie Siriopol
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Luminita Voroneanu
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Ionut Nistor
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Liviu Segall
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
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Shi S, Zhang P, Cheng Q, Wu J, Cui J, Zheng Y, Bai XY, Chen X. Immunohistochemistry of deparaffinised sections using antigen retrieval with microwave combined pressure cooking versus immunofluorescence in the assessment of human renal biopsies. J Clin Pathol 2013; 66:374-80. [PMID: 23476077 DOI: 10.1136/jclinpath-2012-201125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Immunofluorescence of frozen tissue sections (IF-F) is a traditional technique used in renal biopsy. However, IF-F has certain disadvantages, such as a few or even no glomeruli in the section, and limited long-term preservation of the fluorescently labelled samples. METHODS We compared two-step immunohistochemistry (IHC) staining of deparaffinised sections for antigen retrieval with microwave combined high-pressure cooking to IF-F used to detect antigens of IgG, IgA, IgM, C3, C1q, κ and λ in patient renal biopsy samples. The number of glomeruli detected, sensitivity and specificity of positive staining, tissue structure, and location staining of the antigens were determined using the two methods in 285 patients diagnosed with different renal diseases. RESULTS Concordant observations between IF-F and IHC were 99% for all antigen staining (1969 of 1995 observations) and 100% for IgG, IgA and IgM (all 285 observations). The number of glomeruli in IHC sections was significantly greater compared with IF-F sections (p<0.001). IHC provided clearer images of tissue structure, more precise localisation of positive-staining antigens, and IHC staining allowed simultaneous evaluation of tissue by light microscopy. Correlation between tissue structure and immune deposits are not readily attained by IF-F. CONCLUSIONS IHC is superior to IF-F for immunopathological diagnosis of renal biopsy tissue and is a reliable replacement for the more traditional IF-F method.
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Affiliation(s)
- Suozhu Shi
- Department of Nephrology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
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27
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Shi S, Cheng Q, Zhang P, Wang N, Zheng Y, Bai XY, Chen X. Immunofluorescence with dual microwave retrieval of paraffin-embedded sections in the assessment of human renal biopsy specimens. Am J Clin Pathol 2013; 139:71-8. [PMID: 23270901 DOI: 10.1309/ajcprzg8exn7baid] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Immunofluorescence of frozen tissue sections (IF-F) is a classic technique for renal immunopathologic examination. However, it has certain disadvantages, such as diffuse antigen distribution and few or even no glomeruli in the section. We developed a new technique of immunofluorescence staining using dual microwave retrieval in paraffin-embedded renal tissue sections (IF-DMP) and compared IF-DMP with IF-F in 406 renal biopsy samples. IF-DMP detected significantly more glomeruli than did IF-F (P< .001). There was no significant difference for the specificity and sensitivity in the detection of immunoglobulins, complements, κ, and λ between IF-F and IF-DMP. Concordant observations were 98% for all immunofluorescence, complements, κ, and λ staining and 100% for immunoglobulin staining. Both techniques were completely accurate in confirming diagnoses of various glomerular diseases. IF-DMP provided clearer images of tissue structure and more precise localization of antigens, and it is a suitable alternative for traditional IF-F in clinical renal immunopathologic diagnosis.
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Affiliation(s)
- Suozhu Shi
- Department of Nephrology, State Key Lab of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Qingli Cheng
- Department of Geriatric Nephrology, Chinese PLA General Hospital, Beijing, China
| | - Ping Zhang
- Department of Pathology, Wang Jing Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Nan Wang
- Department of Nephrology, State Key Lab of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ying Zheng
- Department of Nephrology, State Key Lab of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xue-Yuan Bai
- Department of Nephrology, State Key Lab of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, State Key Lab of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
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Mubarak M, Kazi Javed I, Kulsoom U, Ishaque M. Detection of immunoglobulins and complement components in formalin fixed and paraffin embedded renal biopsy material by immunoflourescence technique. J Nephropathol 2012; 1:91-100. [PMID: 24475396 PMCID: PMC3886135 DOI: 10.5812/nephropathol.7518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/05/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The technique of direct immunoflourescence (IF) is essential in the accurate diagnosis of renal glomerular diseases. The optimal results are obtained when the procedure is done on fresh frozen tissue (IF-F). However, techniques are available for IF study on formalin fixed and paraffin embedded (FFPE) renal biopsy specimens with variable reported success rates. OBJECTIVES We evaluated three such techniques on FFPE tissue and compared the results with those obtained by IF-F from the same patients. MATERIALS AND METHODS Heat treatment with Tris buffer and citrate buffer, and pronase treatment of the FFPE material was carried out. Direct IF was done for renal panel immunoglobulins and complement components on all biopsies and the results were compared with the historical IF-F study. RESULTS When compared to the IF-F, the immunoflourescence staining on the paraffin sections was less sensitive and less intense in all immune complex-mediated renal diseases, but the diagnostic findings were detected in majority of the cases. CONCLUSIONS In conclusion, it is possible to establish the diagnosis in most cases of immune complex-mediated glomerular diseases with IF on paraffin embedded tissue specimens.
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Affiliation(s)
- Muhammed Mubarak
- Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - I Kazi Javed
- Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Umme Kulsoom
- Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammed Ishaque
- Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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29
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Norheim KB, Leh S, Gøransson L. Crescentic glomerulonephritis and microangiopathic haemolytic anaemia in a patient with established systemic sclerosis. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2011; 45:470-2. [PMID: 21991985 DOI: 10.3109/00365599.2011.568955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article reports a case of Goodpasture's syndrome and microangiopathic haemolytic anaemia developing in a patient with a 2-year history of systemic sclerosis. Goodpasture's syndrome usually presents with lung haemorrhage and acute renal failure, and kidney biopsy typically shows crescentic glomerulonephritis with linear immunoglobulin staining on the glomerular basement membrane. Treatment of choice for Goodpasture's syndrome is immunosuppressive therapy and plasma exchange, which has greatly improved morbidity and mortality. This unusual case highlights that seemingly unrelated autoimmune diseases may coexist in one patient, and thorough clinical examination combined with serology and histology may be necessary for correct diagnosis.
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Affiliation(s)
- Katrine Brakke Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital Stavanger, Norway.
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30
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Sharma KV, Venkatesan AM, Swerdlow D, DaSilva D, Beck A, Jain N, Wood BJ. Image-guided adrenal and renal biopsy. Tech Vasc Interv Radiol 2010; 13:100-9. [PMID: 20540919 PMCID: PMC2886019 DOI: 10.1053/j.tvir.2010.02.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Image-guided biopsy is a safe and well-established technique that is familiar to most interventional radiologists. Improvements in image guidance, biopsy tools, and biopsy techniques now routinely allow for safe biopsy of renal and adrenal lesions that traditionally were considered difficult to reach or technically challenging. Image-guided biopsy is used to establish the definitive tissue diagnosis in adrenal mass lesions that cannot be fully characterized with imaging or laboratory tests alone. It is also used to establish definitive diagnosis in some cases of renal parenchymal disease and has an expanding role in diagnosis and characterization of renal masses before treatment. Although basic principles and techniques for image-guided needle biopsy are similar regardless of organ, this paper highlights some technical considerations, indications, and complications that are unique to the adrenal gland and kidney because of their anatomic location and physiological features.
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Affiliation(s)
- Karun V Sharma
- Center for Interventional Oncology, Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA.
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31
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Controversies in defining cardiac antibody-mediated rejection: Need for updated criteria. J Heart Lung Transplant 2010; 29:389-94. [DOI: 10.1016/j.healun.2009.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 10/27/2009] [Accepted: 10/27/2009] [Indexed: 11/19/2022] Open
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32
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Mubarak M, Kazi JI. Role of immunofluorescence and electron microscopy in the evaluation of renal biopsies in nephrotic syndrome in a developing country. Ultrastruct Pathol 2009; 33:260-264. [PMID: 19929172 DOI: 10.3109/01913120903296952] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To determine the role of immunofluorescence (IF) and electron microscopy (EM) in the evaluation of renal biopsies in a developing country, the authors carried out a study in 200 patients with nephrotic syndrome. Renal biopsies were studied by light microscopy, IF, and EM. IF study was useful in all, being essential in 23.5% and helpful in remaining cases. EM was useful in 94.5% cases, being essential in 43% and helpful in 51.5% cases. The results demonstrate that IF and EM are essential in the evaluation of renal biopsies in nephrotic syndrome and these should be employed in the pathologic evaluation of renal biopsies.
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Affiliation(s)
- Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
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33
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Guan N, Yu LX, Wu GH, Xing Y, Ding J. Antigen retrieval with protease digestion applied in immunohistochemical diagnosis of Alport syndrome. Nephrol Dial Transplant 2008; 23:3509-13. [PMID: 18524789 DOI: 10.1093/ndt/gfn305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immunofluorescence (IF) staining of type IV collagen alpha chains on fresh frozen renal tissue is a convenient and accurate diagnosis technique for Alport syndrome (AS), which is restricted in the application with a non-frozen section. An alternative method for a paraffin-embedded section is needed in order to extend the application in various specimens. In this study, immunohistochemical staining of type IV collagen alpha chains on paraffin-embedded renal sections was investigated. METHODS Three antigen retrieval methods including autoclave heating, pepsin digestion and protease digestion were tried on paraffin-embedded renal sections from two X-linked male AS patients, two X-linked female AS patients and two autosomal recessive AS patients. Two patients with isolated haematuria were also involved. Normal portions of nephrectomized kidneys from two patients with renal tumours were used as controls. The immunohistochemical staining pattern of type IV collagen was compared with that of IF staining. RESULTS The results showed that both the autoclave heating method and protease digestion can be used for antigen retrieval for type IV collagen alpha chains. Compared to autoclave heating, protease digestion had the advantage of being less time consuming, with less renal sections being lost from the slides; it was the most optimal antigen retrieval method in this study. After protease digestion for 40 min, type IV collagen alpha3 and alpha5 chains showed a clear and proper distribution pattern in AS patients, haematuria patients and controls, which is the same as that of IF staining. CONCLUSIONS Compared to the autoclave heating method, protease antigen retrieval is more convenient and effective and can be used to restore type IV collagen alpha chains on paraffin-embedded renal sections for the diagnosis of AS.
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Affiliation(s)
- Na Guan
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
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34
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Karasalihović Z, Iljazović E, Ferluga D, Cickusić E, Mustedanagić Mujanović J, Stahov J, Skaljić I. Direct immunofluorescence and immunohistochemistry in diagnostics of glomerulonephritis. Bosn J Basic Med Sci 2008; 8:12-9. [PMID: 18318666 PMCID: PMC5724869 DOI: 10.17305/bjbms.2008.2989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The needle biopsies from 60 transplanted and native kidneys have been processed and a prospective analysis of pattern, intensity and distribution of immunoglobulin deposits (IgA, IgG and IgM) and complement components (C3c and C1q) identified in these lesions has been carried out by immunohistochemistry with three step immunoperoxidase, in the period from 2000 to 2004. Those deposits were previously detected and analyzed by immunofluorescence. The samples consisted of 30 renal biopsies, previously diagnosed with glomerulonephritis and positive immunofluorescence and 30 renal biopsies without morphologic changes and deposits on immunofluorescence. 78,7% of the analyzed samples showed the identical results of the deposits of immunoglobulin and components of the complement with both, immunohistochemistry and immunofluorescence method. Sensitivity of the immunohistochemistry method with three step immunoperoxidase for all analyzed immunoglobulin and complement components is high (0,93), while specificity for the same method is 0,79. Standardized method of the three step immunoperoxidase on the paraffin embedded, formalin fixed needle renal biopsies could successfully replace the immunofluorescence method in diagnostic of GN, with the emphasis on a follow up and control of each single step in the procedure of the method.
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Affiliation(s)
- Zinaida Karasalihović
- Polyclinic for Laboratory Diagnostic University Clinical Centre Tuzla, Trnovac 1, 75000 Tuzla, Bosnia and Herzegovina
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35
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Nasr SH, Galgano SJ, Markowitz GS, Stokes MB, D'Agati VD. Immunofluorescence on pronase-digested paraffin sections: a valuable salvage technique for renal biopsies. Kidney Int 2006; 70:2148-51. [PMID: 17063172 DOI: 10.1038/sj.ki.5001990] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Direct immunofluorescence (IF) on frozen tissue is the method of choice for the study of medical renal diseases. When no glomeruli are available, IF can be performed on the formalin-fixed paraffin-embedded tissue allocated for light microscopy after antigen retrieval with proteases. In this study, the results of IF on frozen tissue (IF-F) and on deparaffinized, pronase-treated tissue (IF-P) were compared in 71 renal biopsies representing 12 major renal diseases. Using IF-P, diagnostic findings were obtained in 100% of cases of lupus nephritis, acute post-infectious glomerulonephritis, cryoglobulinemic glomerulonephritis, fibrillary glomerulonephritis, primary amyloidosis, myeloma cast nephropathy, and light-chain Fanconi syndrome (LCFS), 88% of cases of immunoglobulin (Ig)A nephropathy, 80% of cases of light-chain deposition disease, 60% of cases of membranoproliferative glomerulonephritis type 1, 50% of cases of idiopathic membranous glomerulopathy (MGN) and 20% of cases of anti-glomerular basement membrane (GBM) disease. IF-P was less sensitive than IF-F for the detection of C3 in all disease categories and for the detection of IgG in cases of MGN and anti-GBM disease. The diagnostic kappa light-chain staining was demonstrated in 100% of cases of LCFS by IF-P versus 40% by IF-F. We conclude that IF-P is a valuable salvage immunohistochemical technique for renal biopsies lacking adequate cortical sampling for IF-F, and is superior to IF-F for the diagnosis of LCFS.
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Affiliation(s)
- S H Nasr
- Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
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36
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Mölne J, Nyberg G, Blohmé I, Rydberg L, Breimer ME, Svalander CT. Glomerular C3c deposition and intravascular macrophage accumulation in early humoral renal allograft rejection signifies a poor short-term outcome. APMIS 2006; 114:700-11. [PMID: 17004973 DOI: 10.1111/j.1600-0463.2006.apm_422.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
C4d deposition in the walls of peritubular capillaries is considered the key phenomenon in the histopathological diagnosis of humoral, i.e. antibody-mediated, allograft rejection. We have earlier proposed that deposition of C3c in glomerular capillaries and simultaneous intravascular accumulation of macrophages in allografts with immediate or early humoral rejection indicates a potentially serious condition with very poor prognosis. The clinical outcome of 45 cadaveric grafts with this phenomenon among 1960 renal allografts transplanted at our centre during 1984-1999, and the recipients of the contralateral kidneys, was retrospectively evaluated. Graft failure occurred in 44/45 grafts within 3 weeks, with graft loss in 33/45 (77%) within 4 months and 37/45 (82%) within 1 year. From the contralateral kidneys, 5/33 (15%) were lost within 1 year. In a recent series of early biopsies, we recognised that of 13 cases showing C4d positivity in peritubular capillaries but lacking C3c in glomeruli, 10/13 (77%) were still functioning after 4 months. The mean number of CD68(+) macrophages per glomerular profile, i.e. the glomerular macrophage index, shows a significant difference between C4d(+)C3c(-) and C4d(+)C3c(+) cases (p<0.001). Our results indicate the existence of a clinically important subgroup of early humoral rejection with particular morphological features.
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Affiliation(s)
- Johan Mölne
- Department of Clinical Pathology and Cytology, Sahlgrenska University, Göteborg, Sweden.
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Breimer ME, Mölne J, Nordén G, Rydberg L, Thiel G, Svalander CT. Blood group A and B antigen expression in human kidneys correlated to A1/A2/B, Lewis, and secretor status. Transplantation 2006; 82:479-85. [PMID: 16926591 DOI: 10.1097/01.tp.0000231697.15817.51] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In the revived interest in crossing ABO barriers in organ transplantation renal A/B antigen expression has been correlated with donor ABO, Lewis, and secretor subtype to predict antigen expression. METHODS A/B antigen expression was explored by immunohistochemistry in LD renal biopsies. Donor A1/A2/B, Lewis, and secretor status were determined by serology and polymerase chain reaction. RESULTS In the renal vascular bed, three distinct A antigen expression patterns with a major, minor, and minimal staining distribution, and intensity (designated as types 3+, 1+ and (+) respectively) were identified. Type 3+ had a strong A antigen expression in the endothelium of arteries, glomerular/peritubular capillaries and veins. The type 1+ showed an overall weaker antigen expression, whereas type (+) had faint staining of peritubular capillaries only. In all cases, distal tubular epithelium was focally stained, whereas proximal tubules were negative. Type 3+ were all from blood group A1 subtype individuals while A2 cases expressed either a 1+ or (+) pattern. The secretor gene did not appear to influence renal A antigen expression. All B kidneys examined showed a B antigen pattern slightly weaker but otherwise similar to A type 3+. CONCLUSION Renal vascular A antigen expression correlates to donor A1/A2 subtypes, whereas B individuals show one singular antigen pattern. From antigen perspective, A1 and B donors are a "major" and A2 individuals a "minor" antigen challenge in ABO-incompatible renal transplantation.
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Affiliation(s)
- Michael E Breimer
- Department of Surgery, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
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38
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Nordén G, Briggs D, Cockwell P, Lipkin G, Mjörnstedt L, Mölne J, Ready A, Rydberg L, Samuelsson O, Svalander CT, Breimer ME. ABO-incompatible live donor renal transplantation using blood group A/B carbohydrate antigen immunoadsorption and anti-CD20 antibody treatment. Xenotransplantation 2006; 13:148-53. [PMID: 16623810 DOI: 10.1111/j.1399-3089.2006.00280.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blood group ABO-incompatible live donor (LD) renal transplantation may provide a significant source of organs. We report the results of our first 14 cases of ABO-incompatible LD renal transplantation using specific anti-A/B antibody (Ab) immunoadsorption (IA) and anti-CD20 monoclonal Ab (mAb) treatment. PATIENTS AND TREATMENT PROTOCOL: Recipients were blood group O (n = 12), A (n = 1) and B (n = 1). Donors were A1 (n = 2), A2 (n = 3), A2B (n = 1) and B (n = 8), and all were secretor positive. Anti-human leukocyte antigen (HLA) Ab panel reactivity was negative in all recipients except one. All recipients were pre-treated with 3 to 6 IA sessions, using A or B carbohydrate antigen columns, until their anti-A1/B RBC panel indirect antiglobulin test (IAT) titers were < or =8. CDC crossmatch was negative in all cases. Recipients received preoperative mycophenolic acid, and steroids/tacrolimus were started at transplantation. No splenectomy was performed. Eight recipients received one dose of anti-CD20 mAb (rituximab, 375 mg/m2) pre-operatively and 11 recipients had postoperative protocol IA. RESULTS In the initial protocol, anti-CD20 mAbs were used only for recipients receiving A1 grafts. One B graft (HLA-identical donor, 84% panel reactivity) was lost in a severe anti-B Ab-mediated acute rejection. Subsequently, the protocol included anti-CD20 for recipients of both A1 and B grafts and postoperative protocol IA to all recipients. The subsequent 10 grafts had excellent function, giving a total graft survival of 13/14 (observation range 2 to 41 months). At 1 yr, mean serum creatinine was 113 micromol/l (n = 8) and mean glomerular filtration rate was 55 ml/min/1.73 m2 (range 24 to 77). In the remaining five cases, with less than 1 yr follow up, mean serum creatinine was 145 micromol/l at 2 to 9 months follow up. Pre-IA anti-A/B titers were in the range of 2 to 32 (NaCl technique) and 16 to 512 (IAT). More than 90 IA sessions were performed in 14 recipients without any significant side effects. Recipient anti-A/B titers returned after transplantation to pre-IA levels or slightly lower. Postoperative renal biopsies were performed in 10 patients. In the 13 patients with long-term function, one patient experienced cellular rejection (Banff IIB) at 3 months without anti-B titer rise. This rejection was concomitant with low tacrolimus plasma levels and was easily reversed by steroids. In 8 of 10 cases, C4d staining was positive in peritubular capillaries. CONCLUSION Blood group ABO-incompatible LD renal transplantation using A and B carbohydrate-specific IA and anti-CD20 mAbs has excellent graft survival and function.
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Affiliation(s)
- Gunnela Nordén
- Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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