Riana
Gaifulina
ab,
Daren J.
Caruana
b,
Dahmane
Oukrif
c,
Naomi J.
Guppy
d,
Siân
Culley
ae,
Robert
Brown
f,
Ian
Bell
f,
Manuel
Rodriguez-Justo
g,
Katherine
Lau
*f and
Geraint M. H.
Thomas
*a
aDepartment of Cell and Developmental Biology, University College London, UK. E-mail: g.thomas@ucl.ac.uk; Tel: +44 (0)20 7679 6098
bDepartment of Chemistry, University College London, UK
cResearch Department of Pathology, University College London, UK
dUCL Advanced Diagnostics, University College Hospital, UK
eMRC Laboratory for Molecular Cell Biology, University College London, UK
fSpectroscopy Products Division, Renishaw plc, UK. E-mail: katherine.lau@nikon.com
gDepartment of Gastrointestinal Pathology, University College Hospital and Department of Research Pathology/Cancer Institute, UCL, UK
First published on 19th December 2019
Incomplete removal of paraffin and organic contaminants from tissues processed for diagnostic histology has been a profound barrier to the introduction of Raman spectroscopic techniques into clinical practice. We report a route to rapid and complete paraffin removal from a range of formalin-fixed paraffin embedded tissues using super mirror stainless steel slides. The method is equally effective on a range of human and animal tissues, performs equally well with archived and new samples and is compatible with standard pathology lab procedures. We describe a general enhancement of the Raman scatter and enhanced staining with antibodies used in immunohistochemistry for clinical diagnosis. We conclude that these novel slide substrates have the power to improve diagnosis through anatomical pathology by facilitating the simultaneous combination of improved, more sensitive immunohistochemical staining and simplified, more reliable Raman spectroscopic imaging, analysis and signal processing.
Following the discovery using RS that FFPE histology sections retain paraffin contamination,11 investigators have attempted to achieve complete deparaffinization using a variety of known solvents. Faoláin et al. were first to use RS to detect paraffin in FFPE tonsil and cervical tissues and they later went on to test whether paraffin can be completely removed using an array of well-known deparaffinizing agents: xylene, Histo-Clear, heat-mediated antigen retrieval (HMAR) processes using xylene and citrate buffer, and Trilogy (combined deparaffinization and unmasking of antigens). The potential of hexane as a dewaxing agent was also investigated. They found that none of the solvents completely removed paraffin and only after 18 hours of immersion in hexane, an industrial degreasing agent, that paraffin although much reduced was still retained. However, prolonged treatment with hexane gave a 28% increase in IHC staining intensity when compared to the conventional brief xylene treatment.8 Clearly there is potential to improve antigen detection if paraffin can be reliably removed, however it is not known if hexane degrades other signals in tissue that might be diagnostically useful like nucleic acids or lipids, or if protracted periods of solvent extraction provide sufficient benefit for cost in pathology lab workflows.
This opportunity to greatly improve diagnostic sensitivity is not well-known in the histopathology community perhaps due to a lack of easily available and reliable methods to detect the degree of paraffin contamination. A later study by Nallala et al. compared the deparaffinization efficacy of xylene, hexane and paraffin oil with an additional hexane wash using IR spectroscopy.9 They estimated the amount of paraffin remaining after each solvent immersion by using coefficients based on the fit of a pure paraffin model. They found paraffin oil followed by a hexane wash to be superior to using xylene and hexane alone, but confirmed that neither completely removed paraffin. A variable degree of paraffin retention was also found to be dependent upon tissue architecture with connective tissue regions retaining more wax than glandular tissue. Other groups have attempted to minimise the contamination of Raman spectra with paraffin peaks using a number of computational processing approaches. This includes digital dewaxing12 and paraffin component isolation and subsequent subtraction, however these approaches necessitate transformation of the raw dataset which may impact on diagnostic power or reliability of disease classification downstream.13 As a result, the current situation is that complete removal of paraffin wax from FFPE histological sections and the Raman signals derived from them has not yet been achieved.
Here, we report experimental results revealing complete paraffin removal from tissue sections mounted onto a novel backing substrate – super mirror finish stainless steel (SS) slides. We demonstrate that enhanced IHC staining can be achieved using this substrate and propose a plausible mechanism for the paraffin removal phenomenon. In addition to IHC enhancement we also report an enhancement in the overall Raman signal compared to that achieved on the conventional CaF2 slides. The SS slide have other significant advantages in that they are mechanically robust and inexpensive in comparison to the standard RS CaF2 slides which are both very costly and brittle. The SS slides will overcome these barriers that have so far prevented the routine adoption of RS into diagnostic pathology and medicine.
Performing unsupervised MCR-ALS analysis on a high resolution Raman map taken across the full thickness of rat colon on CaF2 enabled us to reconstruct a pure component spectral profile of paraffin and identify the spatial distribution of paraffin contamination (Fig. 1c and d). We chose to use rat colon for this study as we wanted to capture a high-resolution Raman map of the full thickness of the colon wall and hence attempt to identify if paraffin adheres selectively to specific tissue types and architecture. It would have been more challenging to deliver a Raman image of the same resolution in human colon due to its significantly larger size. Results show that paraffin is predominantly localised at the luminal edge of the mucosa (Fig. 1c).
Given that paraffin appeared to selectively adhere to the mucosa in rat tissue, Raman maps were taken specifically from the mucosa and muscularis propria from human colonic tissue mounted on SS slides and CaF2 (ESI Fig. 1†). Using unsupervised principal component analysis we were able to demonstrate the presence of paraffin contamination only in tissue mounted on CaF2, there were no peaks associated with paraffin in either the mucosa or muscle regions of the colon mounted on SS (ESI Fig. 2 and 3†). Contamination however was found in both the mucosa and muscle regions of the colonic tissues mounted on CaF2.
Similar maps, albeit of lower spatial resolution, were taken across deparaffinized FFPE human ovaries, brain, tonsil, colon and oesophageal tissue sections mounted on mirror SS. In total, we have analysed 18 ovarian cancer tissues, 50 samples encompassing four different pathologies of paediatric brain tumours, 36 healthy human tonsils, 65 colon tissues encompassing normal and cancer and 154 oesophageal samples across normal tissue and multiple different cancer pathologies. Of all the 323 Raman maps analysed, none showed any sign of paraffin contamination following xylene washes, the results of these independent studies are yet to be published. This suggests that the properties of complete paraffin removal on mirrored SS slides are independent of the tissue type and its anatomical complexity, morphology and biochemistry. Importantly, complete deparaffinization is achieved with xylene within minutes on SS slides. We have tested a wide range of xylene incubation protocols, varying the number of washes in fresh xylene, the incubation time as well as the temperature of xylene. All combinations proved to be ineffective in completely removing paraffin contamination from tissues mounted on CaF2, synthetic fused silica (quartz) or standard glass, however all combinations were successful in achieving complete paraffin removal from tissues mounted on super mirror steel. As a result, we opted for a 10-minute xylene step (fresh xylene) which is comparable to standard pathology lab protocols in terms of exposure time although in our hands complete deparaffinization can be completed in less than 1 minute with a single wash if required. We also note the potential benefit of minimising the washing step in reducing extraction of non-polar biochemical components, for example lipids, which could be retained for future analysis and use as biomarkers.
Unlike conventional glass microscopy slides where sections can be easily viewed using transmission white light illumination, opaque substrates such as steel can only be viewed under epi-illumination (reflectance optics). Consequently, one of the main difficulties in obtaining a fair comparison between the two backing substrates is the different optical pathways used in transmitted and reflectance microscopy, as well as the use of different image acquisition settings. To ensure optimal visualisation of the tissue sections mounted on each of the substrate types, sections mounted on glass were visualised using transmission microscopy, whilst sections on SS were visualised using reflectance microscopy. In addition, IHC staining is not stoichiometric and hence it is difficult to obtain a reliable quantifiable measure of staining intensity.15,16 As a result, we did not attempt to quantify the staining intensity but instead estimated the total number of stained cells using machine learning-based image segmentation.17 This approach provided an automated method for investigating the potential impact of paraffin wax as a barrier between the tissue and applied histological stains and has also provided a quantitative output for direct comparison. Hence, both the 3,3′-diaminobenzidine (DAB) and hematoxylin stained cells were considered together.
Visual inspection of the IHC stains revealed that the MLH1 staining was greater in tissues mounted on mirror SS compared to glass (Fig. 2, top two panels). To confirm that the perceived staining enhancement was not caused by the nature of the reflective surface alone, visualisation of tissues mounted on glass and viewed with a super mirror steel slide placed behind the slide and visualised using epi-illumination was performed (ESI Fig. 4†). This arrangement did not show an increase in intensity, suggesting that the observed increase is not caused by the reflective surface. The same trend was observed for the MHS6 immunostain whereby the staining was much stronger on steel than the glass counterpart (Fig. 2, bottom two panels). There was an obvious enhancement in the image contrast, which is particularly evident around the goblet cells within the crypts (see arrows). This was confirmed visually by independent “blinded” inspection by our consultant pathologist and senior biomedical scientist – specialists trained in the visual inspection of IHC samples for diagnostic and pathology sample quality control.
To determine if the enhanced staining derives from any interaction between reagents used in the standard IHC protocols and the surfaces of the SS slides a series of control stains were created by omitting some components e.g. the primary antibody, the DAB reagent or hematoxylin. These protocols did not reveal any unusual interaction between the steel surface and antibodies or stains used for visualisation (Fig. 3). Control staining with DAB and hematoxylin alone but without primary antibody (No primary, Fig. 3) showed that the blue hematoxylin staining was much darker on SS slides. The absence of any brown staining provided reassurance that no false positive antigen detection arises from unexpected interactions between the SS slide surface, the DAB reagent and hematoxylin. Using the antibody and DAB alone, without hematoxylin, (DAB only, Fig. 3) revealed that the enhanced nuclear staining is not due to the counter staining (both MLH1 and MSH6 antigens are localised in the nucleus). Lastly, use of the counter stain alone without primary antibody or DAB (Hematoxylin only, Fig. 3) again confirmed the much denser colouration of the tissue on SS slides indicating that simple chemical staining is improved as well as IHC staining.
Segmentation of nuclei from the magnified images shown in Fig. 2 indicated a total cell count of 978 on glass and 1169 on mirror SS; an estimated 20% increase in the total number of cells stained (Fig. 4). Furthermore, using the mirrored SS did not have any adverse effect on immunostaining: a Lynch Syndrome colorectal cancer resection with loss of MLH1 immunostain (case confirmed as MLH1 germline mutation by Sanger sequencing) was seen to have achieved comparable staining results to glass without compromising the diagnosis. In addition to superior staining performance on SS slides, we also observed that using a standard mounting agent and cover slipping facilitates prolonged storage of previously stained tissues mounted on SS slides. This in turn facilitates the archiving of slides as is normally done with standard glass slides following pathological review.
After ensuring complete, reliable tissue adhesion, we acquired point spectra at gradually increasing signal integration times across the mucosa and muscle regions of FFPE colonic tissue. The tissue was checked post-measurement and confirmed to not have sustained any photo-thermal degradation during any of the measurements taken. A substantial signal enhancement was generally observed on mirrored SS but more so from the muscle tissue regions with the longest integration time (Fig. 5b). The magnitude of the enhancement is shown to increase with the acquisition time, with a maximum enhancement of 3.6 times and this also appears to be dependent on the composition and overall behaviour of the tissue (Fig. 5c). Unlike the mucosa which contains a heavy collagenous component, the muscle layer is predominantly composed of muscle cells, hence the muscle region will be more transparent resulting in a maximum signal enhancement that can in principle reach a theoretical upper bound of four-fold.19 The enhancements seen here are likely to be a result of a ‘double pass’ effect whereby the laser effectively passes through the tissue twice as it is reflected from the slide surface (Fig. 5d). This would therefore enable the collection of front scattered Raman that is often lost through transparent substrates. In principle, this should enhance the Raman signal by a factor of up to four, because front and backscattered Raman from the incident laser excitation is combined with the front and backscattered Raman originating from the reflected laser excitation. This is in accord with a previous study by Kamemoto et al. that used cervical tissue mounted on front coated aluminium mirrors.19 Considered in terms of speed, this improvement in signal acquisition (3.6 fold in these studies) will significantly reduce the time required for Raman imaging of tissue samples (here 72%) greatly enhancing the potential of RS for routine tissue analysis and diagnosis.
We also note that if limited by tissue damage we would expect to lose half of the advantage, i.e. be forced to reduce the laser power as the mirrored surface enhances the laser power density in the tissue by up to two-fold. On the other hand, SS might provide a better heat sink and therefore facilitate better heat transfer away from the interaction region, which is certainly a mitigating factor.
The problems of sample heating and subsequent burning caused by the double-pass of the laser could necessitate reducing the laser power during measurement. However in our hands the efficient heat sink properties of a metal slide compensate for this (with the possible exception of heavily pigmented or extensively dehydrated tissues) allowing faster, measurements.
The possibility of electrochemical effects playing a role in paraffin removal arose when it was observed that the paraffin tissue section ribbon could be visibly repelled from the SS during mounting. Parreira and Schulman have previously reported that paraffin wax has a net negative charge above pH 5,21 subsequent pH measurements of xylene indicate a neutral environment during deparaffinization. The zeta potential of SS is reported to be negative at neutral and alkaline pH.22,23 We can therefore hypothesize that the negative charge carried by the SS surface and paraffin wax in an insulating xylene environment facilitates repulsion from the surfaces of the slide and the tissue. Previous work has shown that the work function property of metals is directly correlated to the surface charge or zero charge (pzc). A low metal work function correlates to a negative surface charge, whereas a high work function results in a positive surface charge on the dielectric after contact.24
To test whether metals with different work functions have different paraffin removal properties, a range of metals were mounted with 8 μm tissue sections and deparaffinized as before. Table 1 illustrates the paraffin retention properties from metal surfaces with variable work functions. There appears to be a threshold work function below which complete paraffin removal is possible, whereas a work function above this threshold value facilitates paraffin retention. The natural charge the electrode acquires which determines the surface charge, is reflected in the potential of zero charge (pzc). The pzc is a combination of the absolute electrode potential, dictated by the electrode material and the surface potential in a given electrolyte, which will determine the surface electrical charge of the metals with respect to the solution. To confirm the relation between work function and pzc in liquid, experiments outlined by Peretz et al. were then carried out to obtain an estimate of the pzc for each of the metals in aqueous electrolyte.25 These potentiostatic experiments allowed us to gain an insight into the polarity of the surface relative to the electrolyte.
Metal | Work function (eV) | Paraffin detected (Y/N) | pzc (V vs. Ag/AgCl) |
---|---|---|---|
Aluminium coated glass | 4.06–4.26 | No | — |
Titanium | 4.33 | No | −0.145 ± 0.01 |
Stainless steel (304L) | 4.40 | No | −0.196 ± 0.01 |
Iron | 4.67–4.81 | No | −0.610 ± 0.01 |
Platinum | 5.12–5.93 | Yes | +0.336 ± 0.01 |
Gold | 5.1–5.47 | Yes | +0.027 ± 0.01 |
All of the metals shown in Table 1 that did not retain paraffin following deparaffinization (titanium, iron, stainless steel) had a negative pzc (Fig. 6) with respect to that for gold and platinum which did retain paraffin. This indicates that in a neutral environment such as that of xylene, the surface of SS will possess a net negative surface charge which can facilitate the repulsion of paraffin wax, also known to have a negative charge above pH 5. It would be desirable to make these measurements in xylene, however, due to the low solubility of electrolytes it was not possible to make any meaningful measurement. Nevertheless, from the determined relative pzc for each metal, we can extrapolate the potential where the surface charge switches from negative to positive in the xylene paraffin removal experiments. We can deduce that the xylene potential lies somewhere between the pzc of gold and titanium, to ensure that the surface of the SS is negative with respect to the xylene solution. We conclude that it is by this electrochemical effect that all paraffin is removed from the tissue sections.
Fig. 6 Charging current–potential traces for gold (A), platinum (B), titanium (C) and 304L stainless steel (D) obtained using KCl electrolyte solution. The measurement is based on a dropping electrolyte onto the surface of the electrode and instantaneously making contact with a counter and reference electrode to create an electrochemical cell to measure the non-faradaic charging current, the method outlined in ref. 25. The right panel depicts a diagrammatic representation of the changing surface electrode potential relative to the electrolyte solution of the different metals tested. |
Given that aluminium foil has previously been shown to be a suitable substrate for Raman imaging and has also been shown by us to undergo complete paraffin removal in xylene (Table 1), aluminium foil or coated glass slides were not deemed as suitable for Raman imaging in pathology when compared to stainless steel.26 Implementation of using foil alone is not feasible in routine histopathological practice as its flexibility would not be able to retain the structural integrity of the tissue under investigation, as well as generally being hard to handle. Inspection of a more structurally stable aluminium coated glass alternative not only showed an intense broad feature around 750 cm−1 attributed to the stretching vibration of the AlO3 coating, but signals from the glass under the coating became more evident when used with thinner tissue sections at 785 nm excitation (ESI Fig. 7†).
The easy elimination of paraffin contamination within tissue sections using these novel SS slides, without a significant disruption in sample preparation workflow, could bring significant advantages in diagnostic pathology. Not only will it facilitate improved protein antigen/biomarker detection, but it will also aid in the elimination of variation in antigen accessibility across a single tissue section. Clinical uptake of SS slides may potentially lead to a more clear-cut diagnostic outcome and a reduction in the antibody concentrations used and associated processing costs. Furthermore, digital archiving of pathology slides is becoming increasingly popular, with the majority of commercial slide scanners being well equipped for reflectance microscopy necessary for non-transparent slides. Aside from the superior paraffin removal properties of SS compared to CaF2, the APES-coated mirrored SS are particularly suitable for Raman analysis. At a fraction of the cost to the conventionally used Raman CaF2 slides, APES-coated SS provides a much lower Raman background and up to four times signal enhancement leading to an increase in the overall signal to noise ratios as well as imaging speed. As a result these substrates provide a valuable stepping-stone to adoption and integration of Raman technology within the clinical environment.27
MLH1 (Monoclonal Mouse Antibody NCL-L-MLH1, Leica clone ES05) was diluted down to 1:200 in TBS Tween, whilst MSH6 (Monoclonal Rabbit Anti-Human MutS Protein Homolog 6, Dako Clone EP49) was used at a 1:50 dilution. Both antibody concentrations were optimised by UCL Advanced Diagnostics for use on charged glass slides. Negative control stains were also carried out by omitting the primary antibodies, using DAB only and hematoxylin only.
Sections were then deparaffinized the following day using two sequential 5 minutes washes in fresh xylene and rehydrated in graded ethanol baths (100%, 90%, 70%, 50%) and a final incubation in distilled water. Raman analysis was carried out using a Renishaw benchtop RA816 Raman Biological Analyser (Renishaw plc, Wotton-under-edge, UK) using a 785 nm laser line. A total laser intensity of approximately 160 mW was focused onto the sample through a 50×/NA 0.8 objective. A 1500 l mm−1 grating was used to disperse the light providing a spectral range of 0 to 2100 cm−1 in the low wavenumber range.
Calibration of the spectrum x-axis in absolute wavenumber was done using internal rare-gas emission lines (neon and argon) and in Raman shift using an internal silicon reference to the well-characterised reference peak at 520.5 cm−1. Repeatability and reproducibility of response and wavenumber calibrations were tested using a standard internal sample of polystyrene.
The high-resolution rat colonic map was acquired using a 2.8 μm step size with an integration time of 20 seconds producing a Raman map consisting of 81405 unique spectra. Low resolution mucosa and muscle maps obtained from human colonic tissue mounted on CaF2 and SS were at a significantly lower resolution as we were only interested in detecting the paraffin signals. Each map consisted of 336 spectra and were acquired using a 15.7 μm step size with a 15 seconds integration time.
A paraffin reference spectrum was obtained from histological grade paraffin attained from the UCLH department of histopathology.
Multivariate Curve Resolution-Alternating Least Squares (MCR-ALS) was done using the Renishaw WiRE 4 software utilising the Empty Modelling™ chemometrics feature. This approach decomposes the Raman mapped image into a linear combination of 10 pure component spectra to try and identify regions of paraffin contamination. As a result we were able to obtain spatial information on the regions of contamination in addition to the spectral profile of the contaminating molecular species. Principal Component Analysis (PCA) was also carried our using the Renishaw WiRE 4 software. In short, PCA is a dimensionality reduction approach that reduces a large set of variables into a smaller set that captures most of the variability in the dataset. The first principal component displaying the largest possible variance in the data is often the difference between the tissue material and the backing substrate. The remaining components display the remaining variance in the tissue dataset. Image segmentation was performed using the freely-available Trainable Weka Segmentation (v3.2.5) plugin for Fiji/ImageJ.
Samples of the SS slides can be obtained on request to G. M. H. T.
This study was funded through the UCL Impact PhD Scheme (to RG) with support from Renishaw Spectroscopy Division (Renishaw plc) and the Medical Research Council (to GT, reference MC_PC_14118 v.2 PO 050471026). Dr Manuel Rodriguez-Justo is supported by the UCLH/UCL NIHR Biomedical Research Centre. Dr Siân Culley is funded by the Wellcome Trust. We would like to thank UCLH Advanced Diagnostics for providing help with tissue processing. We would also like to extend our gratitude to Mr Tim Smith, Dr Tim Batten and Dr Yan Wong at Renishaw for instrument support.
Footnote |
† Electronic supplementary information (ESI) available. See DOI: 10.1039/c9an01030k |
This journal is © The Royal Society of Chemistry 2020 |