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Kerner AM, Biedermann U, Bräuer L, Caspers S, Doll S, Engelhardt M, Filler TJ, Ghebremedhin E, Gundlach S, Hayn-Leichsenring GU, Heermann S, Hettwer-Steeger I, Hiepe L, Hirt B, Hirtler L, Hörmann R, Kulisch C, Lange T, Leube R, Meuser AH, Müller-Gerbl M, Nassenstein C, Neckel PH, Nimtschke U, Paulsen F, Prescher A, Pretterklieber M, Schliwa S, Schmidt K, Schmiedl A, Schomerus C, Schulze-Tanzil G, Schumacher U, Schumann S, Spindler V, Streicher J, Tschernig T, Unverzagt A, Valentiner U, Viebahn C, Wedel T, Weigner J, Weninger WJ, Westermann J, Weyers I, Waschke J, Hammer N. The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries. ANATOMICAL SCIENCES EDUCATION 2023; 16:814-829. [PMID: 37183973 DOI: 10.1002/ase.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.
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Affiliation(s)
- Alexander Michael Kerner
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Uta Biedermann
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
| | - Lars Bräuer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Svenja Caspers
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sara Doll
- Department of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Maren Engelhardt
- Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Timm J Filler
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Stefanie Gundlach
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | | | - Stephan Heermann
- Institute for Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Laura Hiepe
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Kulisch
- Institute of Functional Anatomy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Lange
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Leube
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Annika Hela Meuser
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | | | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Ute Nimtschke
- Institute of Anatomy, Technical University Carl Gustav Carus Dresden, Dresden, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Prescher
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Michael Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Stefanie Schliwa
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Bonn, Germany
| | - Katja Schmidt
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Andreas Schmiedl
- Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christof Schomerus
- Institute of Anatomy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Nuremberg, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Spindler
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Johannes Streicher
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, Homburg, Germany
| | - Axel Unverzagt
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ursula Valentiner
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Janet Weigner
- Institute of Veterinary Anatomy, Freie Universität Berlin, Berlin, Germany
| | - Wolfgang J Weninger
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Imke Weyers
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Jens Waschke
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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Jansen van Vuren P, Singanallur NB, Keck H, Eschbaumer M, Vosloo W. Chemical inactivation of foot-and-mouth disease virus in bovine tongue epithelium for safe transport and downstream processing. J Virol Methods 2022; 305:114539. [PMID: 35523370 DOI: 10.1016/j.jviromet.2022.114539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/18/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022]
Abstract
Epithelial tissue or vesicular fluid from an unruptured or recently ruptured vesicle is the sample of choice for confirmatory laboratory diagnosis of foot-and-mouth disease (FMD). However, in 'FMD-free' countries the transport and downstream processing of such samples from potentially infected animals present a biosafety risk, particularly during heightened surveillance, potentially involving decentralised testing in laboratories without adequate biocontainment facilities. In such circumstances, rapid inactivation of virus, if present, prior to transport becomes a necessity, while still maintaining the integrity of diagnostic analytes. Tongue epithelium collected from cattle infected with FMD virus (FMDV) of serotype O (O/ALG/3/2014 - Lineage O/ME-SA/Ind-2001d) or A (A/IRN/22/2015 - Lineage A/ASIA/G-VII) was incubated in the PAXGene Tissue System Fixative (pH 4) and Stabiliser (pH 6.5) components respectively, in McIlvaine's citrate-phosphate buffer (pH 2.6) or in phosphate-buffered saline (PBS, pH 7.4) at room temperature for 2, 6, 24 or 48h. Following incubation, tissues were homogenised and tested by virus isolation and titration using LFBKαVβ6 cells. The integrity of FMD viral RNA was assessed by RT-qPCR (3Dpol coding region), Sanger sequencing of the VP1 region and transfection of LFBKαVβ6 cells to recover infectious virus. Viable virus could be recovered from samples incubated in PBS for at least 48hours. The PAXgene Tissue System Stabiliser component yielded variable results dependent on virus serotype, requiring at least 6hours of incubation to inactivate A/IRN/22/2015 in most samples, whereas the Fixative component required up to 2hours in some samples. McIlvaine's citrate-phosphate buffer rapidly inactivated both viruses within 2hours of incubation. There was no demonstrable degradation of FMD viral RNA resulting from incubation in any of the buffers for up to 48hours, as assessed by RT-qPCR, and 24hours by sequencing and transfection to recover infectious virus. McIlvaine's citrate-phosphate buffer (pH 2.6) is easy to prepare, inexpensive and inactivates serotype A and O FMDV in epithelial tissue within 2hours, while maintaining RNA integrity for downstream diagnostic processes and virus characterisation.
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Affiliation(s)
- Petrus Jansen van Vuren
- Australian Centre for Disease Preparedness, CSIRO Health and Biosecurity, 5 Portarlington rd, Geelong, VIC, Australia
| | | | - Hanna Keck
- National Reference Laboratory for FMD, Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Suedufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Michael Eschbaumer
- National Reference Laboratory for FMD, Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Suedufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Wilna Vosloo
- Australian Centre for Disease Preparedness, CSIRO Health and Biosecurity, 5 Portarlington rd, Geelong, VIC, Australia.
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Rezoana R, Akter L, Islam R, Bhakta S, Ayman U, Rabiul Karim M, Haque Z. The hazardous effects of formalin and alcoholic fixative in mice: A public health perspective study. Saudi J Biol Sci 2022; 29:3366-3371. [PMID: 35844360 PMCID: PMC9280259 DOI: 10.1016/j.sjbs.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/29/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022] Open
Abstract
Formalin is used for different purposes due to its preservation capability. But continuous exposure to formalin may result various health related issues leading to cancer and death. A new alcohol-based fixative, EMA (ethanol, methanol and acetic acid = 3:1:1) could be a safer option in this regard. To compare the health hazards of formalin and EMA, a total 15 adult male mice were randomly distributed into three groups- exposure groups (formalin and EMA) and control group. The mice were subjected to natural inhalation exposure of the fixatives followed by behavioral depression test (forced swimming test), histopathology and serum biochemical tests. Our results showed that the hazardous effects of formalin were remarkably higher than that of EMA. Formalin exposed group showed severe depression (P < 0.001) in the forced swimming test compared to EMA and control groups. Histopathologically, diffuse lymphocytic infiltrations around the lung alveoli and bronchioles and severe inflammation with accumulation of reactive cells in the cerebral cortex were detected in the formalin exposed group, whereas little or no inflammation with fibrinous exudates in the bronchioles was reported in the EMA group and no inflammatory cells were detected in the cerebral tissues. The serum biochemical analysis of the inflammatory mediators (Interleukin-6 and C-reactive protein) revealed that both significantly (P < 0.001) increased in the formalin exposed group compared to EMA and control groups. These results confer that EMA could be a safer option to reduce health hazards of formalin in the workplace environment.
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Rahman MA, Sultana N, Ayman U, Bhakta S, Afrose M, Afrin M, Haque Z. Alcoholic fixation over formalin fixation: A new, safer option for morphologic and molecular analysis of tissues. Saudi J Biol Sci 2022; 29:175-182. [PMID: 35002406 PMCID: PMC8716893 DOI: 10.1016/j.sjbs.2021.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 11/05/2022] Open
Abstract
Formalin is a widely used fixative but there is potential public health risks to exposure. Besides, alcoholic fixation is advantageous over formalin fixation because of faster fixation, optimal preservation and safer workplace environment. Following fixation by EMA and 10% neutral buffered formalin (NBF), we analyzed the tissue morphology, antigenic stability, DNA and RNA quantity with quality (OD value). The findings of EMA fixing on both the tissue morphology and molecular characterization, were satisfactory. Specially, EMA was faster in penetration of tissues than NBF, fixed ideally as early as 8 h of fixation whereas improper fixation was evident for NBF. In Hematoxylin and Eosin (H & E) staining, better cellular details with stronger affinity for staining were observed. In immunohistochemistry, better antigenic stability was reported for EMA-fixed tissues. The nucleic acid analysis revealed that total genomic DNA and RNA yield from EMA fixed tissues were significantly higher (P < 0.05) with superior quality than NBF fixed tissues. Our results suggest that EMA could be a potential alternative to NBF for fixation and preservation of tissues. These data provide new insights into an option for a safer working environment to support study and research.
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Affiliation(s)
- Md Asabur Rahman
- Department of Anatomy and Histology, Faculty of Animal Science and Veterinary Medicine, Patuakhali Science and Technology University, Babugonj, Barisal 8210, Bangladesh
| | - Nasrin Sultana
- Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Ummay Ayman
- Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Sonali Bhakta
- Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Marzia Afrose
- Department of Livestock Science and Veterinary Medicine, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
| | - Marya Afrin
- Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Ziaul Haque
- Department of Anatomy and Histology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
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Panzacchi S, Gnudi F, Mandrioli D, Montella R, Strollo V, Merrick BA, Belpoggi F, Tibaldi E. Effects of short and long-term alcohol-based fixation on Sprague-Dawley rat tissue morphology, protein and nucleic acid preservation. Acta Histochem 2019; 121:750-760. [PMID: 31277893 DOI: 10.1016/j.acthis.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
Safety concerns on the toxic and carcinogenic effects of formalin exposure have drawn increasing attention to the search for alternative low risk fixatives for processing tissue specimens in laboratories worldwide. Alcohol-based fixatives are considered some of the most promising alternatives. We evaluated the performance of alcohol-fixed paraffin-embedded (AFPE) samples from Sprague-Dawley (SD) rats analyzing tissue morphology, protein and nucleic acid preservation after short and extremely long fixation times (up to 7 years), using formalin-fixed paraffin-embedded (FFPE) samples as a comparator fixative. Following short and long-term alcohol fixation, tissue morphology and cellular details in tissues, evaluated by scoring stained sections (Hematoxylin-Eosin and Mallory's trichrome), were optimally preserved if compared to formalin fixation. Immunoreactivity of proteins (Ki67, CD3, PAX5, CD68), evaluated by immunohistochemistry, showed satisfactory results when the fixation period did not exceed 1 year. Finally, we confirm the superiority of alcohol fixation compared to formalin, in terms of quantity of nucleic acid extracted from paraffin blocks, even after an extremely long time of alcohol fixation. Our results confirm that alcohol fixation is a suitable and safe alternative to formalin for pathological evaluations. There is a need for standardization of formalin-free methods and harmonization of diagnosis in pathology department worldwide.
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Tauber Z, Stetkova I, Cizkova K. Influence of fixation method and duration of archiving on immunohistochemical staining intensity in embryonic and fetal tissues. Ann Anat 2019; 224:55-61. [PMID: 31005572 DOI: 10.1016/j.aanat.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/07/2019] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In this study we detail the effect of different fixation agents and the duration of storage has on the immunohistochemical staining positivity of samples of archival embryonic and fetal tissues. MATERIALS AND METHODS The samples were stained by indirect two-step immunohistochemistry (IHC) method for Ki-67, cyclin A and β-actin. RESULTS Irrespective of the length of tissue archiving, tissue fixation with 10% neutral buffered formalin had better IHC intensity results in all cases when compared to methacarn-fixed tissues. In the case of β-actin, this difference was statistically significant, while differences in Ki-67 and cyclin A were not. The second aspect studied was which effect tissue block archiving duration has on the IHC reactivity. We demonstrated a statistically significant decrease in IHC positivity for all studied antigens between the samples that were archived for 10-19 or 20-45 years, regardless the fixative solution. CONCLUSION To the best of our knowledge, the influence that the duration of tissue block archiving has on IHC positivity in human embryo and fetal tissue material has not yet been studied. Although the causes of the IHC positivity decline in archived tissue blocks are not well understood, a possible decrease in IHC over time should be considered, particularly in retrospective studies.
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Affiliation(s)
- Z Tauber
- Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.
| | - I Stetkova
- Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.
| | - K Cizkova
- Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.
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Abstract
In anatomic pathology, the current state encompassing the pre-analytic processes of tissue collection, handling, examination, preparation, processing, and storage are largely uncontrolled, inconsistently performed, and/or not standardized according to the sound scientific data. Pre-analytic defects result in nearly three-quarters of the problems in laboratory diagnostics. This is evident in quality surveys from well-respected institutions that document high miss rates in the required basics of information related to patient and tissue identity, let alone parameters documenting quality aspects related to the surgical specimen and its preservation. This talk will describe the historical approach to tissue processing and identify gaps from worldwide observations in current laboratory practices. It will also offer potential methodological and technological solutions and process improvements that laboratories may consider in serving the ultimate users of pathology information: the clinician and the patient. It illustrates the need for scientifically validated specimen guidelines and a performance based, standardized and documented "chain of custody" of the pre-analytical steps from the patient's body through fixation. For thought leaders and professional standard setters, opportunities for optimizing molecular studies exist in specimen collection, transfer, grossing, fixation, and decalcification protocols. In this evolving era of molecular profiling and personalized therapeutic decision-making, a well-reasoned and coordinated focus on pre-analytic processes that optimizes specimens for subsequent testing will result in: Improved specimen quality for molecular testing Improved accuracy of diagnostic and molecular test results Reduced Turnaroundtimes for same-day diagnosis Enhanced satisfaction of clinicians and patients.
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Affiliation(s)
- Franco Visinoni
- Milestone Srl, Via Fatebenefratelli 1/5, 24010, Sorisole Bergamo, Italy,
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Ali Jamal A, Abd El-Aziz GS, Hamdy RM, Al-Hayani A, Al-Maghrabi J. The innovative safe fixative for histology, histopathology, and immunohistochemistry techniques: "pilot study using shellac alcoholic solution fixative". Microsc Res Tech 2014; 77:385-93. [PMID: 24633954 DOI: 10.1002/jemt.22356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 11/09/2022]
Abstract
The concerns over health and workplace hazards of formalin fixative, joined to its cross-linking of molecular groups that results in suboptimal immunohistochemistry, led us to search for an innovative safe fixative. Shellac is a natural material which is used as a preservative in foods and pharmaceutical industries. This study was undertaken to evaluate the fixation adequacy and staining quality of histopathological specimens fixed in the "shellac alcoholic solution" (SAS), and also to determine the validity of immunohistochemical staining of SAS-fixed material in comparison to those fixed in formalin. Fresh samples from 26 cases from various human tissues were collected at the frozen section room of King Abdulaziz University Hospital, and fixed in SAS fixative or in neutral buffered formaldehyde (NBF) for 12, 18, 24, and 48 h, and processed for paraffin sectioning. Deparaffinized sections were stained with hematoxylin and eosin (H&E) and immunostained for different antigens. The tissues fixed in SAS for >18 h showed best staining quality of H&E comparable to NBF-fixed tissues. Comparison of the immunohistochemical staining of different tissues yielded nearly equivalent readings with good positive nuclear staining quality in both fixatives. These findings support the fixation and preservation adequacy of SAS. Furthermore, it was concluded that the good staining quality obtained with SAS-fixed tissues, which was more or less comparable with the quality obtained with the formalin fixed tissues, supports the validity of this new solution as a good innovative fixative.
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Affiliation(s)
- Awatif Ali Jamal
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
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Ramos-Vara JA, Miller MA. When tissue antigens and antibodies get along: revisiting the technical aspects of immunohistochemistry--the red, brown, and blue technique. Vet Pathol 2013; 51:42-87. [PMID: 24129895 DOI: 10.1177/0300985813505879] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Once focused mainly on the characterization of neoplasms, immunohistochemistry (IHC) today is used in the investigation of a broad range of disease processes with applications in diagnosis, prognostication, therapeutic decisions to tailor treatment to an individual patient, and investigations into the pathogenesis of disease. This review addresses the technical aspects of immunohistochemistry (and, to a lesser extent, immunocytochemistry) with attention to the antigen-antibody reaction, optimal fixation techniques, tissue processing considerations, antigen retrieval methods, detection systems, selection and use of an autostainer, standardization and validation of IHC tests, preparation of proper tissue and reagent controls, tissue microarrays and other high-throughput systems, quality assurance/quality control measures, interpretation of the IHC reaction, and reporting of results. It is now more important than ever, with these sophisticated applications, to standardize the entire IHC process from tissue collection through interpretation and reporting to minimize variability among laboratories and to facilitate quantification and interlaboratory comparison of IHC results.
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Affiliation(s)
- J A Ramos-Vara
- Animal Disease Diagnostic Laboratory and Department of Comparative Pathobiology, Purdue University, 406 South University, West Lafayette, IN 47907, USA.
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Cadoret K, Bridle AR, Leef MJ, Nowak BF. Evaluation of fixation methods for demonstration of Neoparamoeba perurans infection in Atlantic salmon, Salmo salar L., gills. JOURNAL OF FISH DISEASES 2013; 36:831-839. [PMID: 23384040 DOI: 10.1111/jfd.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 06/01/2023]
Abstract
Formaldehyde-based fixatives are generally employed in histopathology despite some significant disadvantages associated with their usage. Formaldehyde fixes tissue by covalently cross-linking proteins, a process known to mask epitopes which in turn can reduce the intensity of immunohistochemical stains widely used in disease diagnostics. Additionally, formaldehyde fixation greatly limits the ability to recover DNA and mRNA from fixed specimens to the detriment of further downstream molecular analyses. Amoebic gill disease (AGD) has been reliably diagnosed from histological examination of gills although complementary methods such as in situ hybridization (ISH) and polymerase chain reaction (PCR) are required to confirm the presence of Neoparamoeba perurans, the causative agent of AGD. As molecular techniques are becoming more prevalent for pathogen identification, there is a need to adapt specimen collection and preservation so that both histology and molecular biology can be used to diagnose the same sample. This study used a general approach to evaluate five different fixatives for Atlantic salmon, Salmo salar L., gills. Neutral-buffered formalin and seawater Davidson's, formaldehyde-based fixatives commonly used in fish histopathology, were compared to formalin-free commercial fixatives PAXgene®, HistoChoice™MB* and RNAlater™. Each fixative was assessed by a suite of analyses used to demonstrate AGD including routine histochemical stains, immunohistochemical stains, ISH and DNA extraction followed by PCR. All five fixatives were suitable for histological examination of Atlantic salmon gills, with seawater Davidson's providing the best quality histopathology results. Of the fixatives evaluated seawater Davidson's and PAXgene® were shown to be the most compatible with molecular biology techniques. They both provided good DNA recovery, quantity and integrity, from fixed and embedded specimens. The capacity to preserve tissue and cellular morphology in addition to allowing molecular analyses of the same specimens makes seawater Davidson's and PAXgene® appear to be the best fixation methods for diagnosis and research on AGD in Atlantic salmon gills.
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Affiliation(s)
- K Cadoret
- National Centre for Marine Conservation and Resource Sustainability, Australian Maritime College, University of Tasmania, Launceston, Tasmania, Australia
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Zbaeren J, Solenthaler M, Schaper M, Zbaeren-Colbourn D, Haeberli A. A New Fixative Allowing Accurate Immunostaining of Kappa and Lambda Immunoglobulin Light Chain Expressing B-cells without Antigen Retrieval in Paraffin-Embedded Tissue. J Histotechnol 2013. [DOI: 10.1179/his.2004.27.2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chieco C, Rotondi A, Morrone L, Rapparini F, Baraldi R. An ethanol-based fixation method for anatomical and micro-morphological characterization of leaves of various tree species. Biotech Histochem 2012; 88:109-19. [PMID: 23244233 DOI: 10.3109/10520295.2012.746472] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of formalin constitutes serious health hazards for laboratory workers. We investigated the suitability and performance of the ethanol-based fixative, FineFIX, as a substitute for formalin for anatomical and cellular structure investigations of leaves by light microscopy and for leaf surface and ultrastructural analysis by scanning electron microscopy (SEM). We compared the anatomical features of leaf materials prepared using conventional formalin fixation with the FineFIX. Leaves were collected from ornamental tree species commonly used in urban areas. FineFIX was also compared with glutaraldehyde fixation and air drying normally used for scanning electron microscopy to develop a new method for evaluating leaf morphology and microstructure in three ornamental tree species. The cytological features of the samples processed for histological analysis were well preserved by both fixatives as demonstrated by the absence of nuclear swelling or shrinkage, cell wall detachment or tissue flaking, and good presentation of cytoplasmic vacuolization. In addition, good preservation of surface details and the absence of shrinkage artefacts confirmed the efficacy of FineFIX fixation for SEM analysis. Cuticular wax was preserved only in air dried samples. Samples treated with chemical substances during the fixation and dehydration phases showed various alterations of the wax structures. In some air dried samples a loss of turgidity of the cells was observed that caused general wrinkling of the epidermal surfaces. Commercial FineFIX is an adequate substitute for formalin in histology and it can be applied successfully also for SEM investigation, while reducing the health risks of glutaraldehyde or other toxic fixatives. To investigate the potential for plants to absorb and capture particulates in air, which requires preservation of the natural morphology of trichomes and epicuticular waxes, a combination of FineFIX fixation and air drying is recommended.
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Affiliation(s)
- C Chieco
- Institute of Biometeorology, National Research Council, Via Gobetti 101, 40129, Bologna, Italy
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Boon ME, Kok LP. Theory and practice of combining coagulant fixation and microwave histoprocessing. Biotech Histochem 2009; 83:261-77. [PMID: 19031284 DOI: 10.1080/10520290802553476] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The German, F. Blum, introduced formalin as a fixative in 1893. Formalin rapidly became popular for hardening and preserving gross human and animal specimens. As a result, microscopy for diagnostic pathology by combining paraffin embedding and formalin fixation was developed. Alcohol-based fixatives have coagulation of proteins as their main preservative effect. Because there is no cross-linking, immunostaining is not compromised, and DNA and RNA is not damaged. Ethyl alcohol was used by Dutch scientists of the 18th century, but was replaced by the cheaper formalin. Addition of low molecular weight polyethylene glycol (PEG) optimized the coagulant fixative, Kryofix. The polyethylene glycol prevents excessive hardening and enhances the speed of coagulation of proteins. Kryofix was used on a large scale for skin biopsies in Leiden between 1987 and 2001. DNA preservation by the formulated coagulant fixative, BoonFix, is related to the concentration of ethyl alcohol, PEG and acetic acid. BoonFix has been used since 2004 in Leiden for over 40,000 diagnostic skin biopsies and more than 100,000 cervical samples. A literature review and three decades of experience with coagulant, formalin-free fixatives in pathology suggest that when health authorities realize that formalin invalidates expensive tests, it might eventually be eliminated legislatively from diagnostic pathology. Finally, coagulant fixation is optimal for microwave histoprocessing where ethyl alcohol is followed by isopropanol.
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Affiliation(s)
- M E Boon
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
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Burns JA, Li Y, Cheney CA, Ou Y, Franlin-Pfeifer LL, Kuklin N, Zhang ZQ. Choice of fixative is crucial to successful immunohistochemical detection of phosphoproteins in paraffin-embedded tumor tissues. J Histochem Cytochem 2008; 57:257-64. [PMID: 19001637 DOI: 10.1369/jhc.2008.952911] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Protein phosphorylation is frequently used as an indicator of cellular signaling activity. Elevated phosphorylation of tyrosine kinase receptors plays an important role in cancer pathogenesis. However, phosphoproteins are usually poorly preserved in clinical tissue samples that are routinely fixed in 10% formalin. Nonetheless, in oncology clinical trials, use of phosphoproteins as biomarkers has been considered to be of great value in evaluating the effectiveness of a given drug candidate. Therefore, it is worthy of investigating whether alternative fixatives would improve the preservation of phosphoproteins in tissue. We compared the IHC staining of a number of phosphoproteins in xenograft and human surgical tumor tissues fixed in three different fixatives: 10% formalin, 4% paraformaldehyde (PFA), and Streck's tissue fixative (STF). We found that STF significantly enhanced the staining intensity of phosphoproteins compared with 10% formalin or 4% PFA. STF fixative also showed superiority of preservation of phosphoproteins in human surgical samples. Our results indicate that the choice of fixative could significantly affect the usability of clinical tissue samples for evaluating phosphoprotein by IHC.
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Affiliation(s)
- Janine A Burns
- Department of Biologics Research, Merck Research Laboratories, West Point, PA 19486, USA
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16
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Abstract
Because formalin is toxic, carcinogenic, and a poor preserver of nucleic acids, for more than 20 years, there have been numerous attempts to find a substitute, with as many different alternative fixatives, none totally successful. With a fast penetration, formaldehyde is a slow and reversible fixative that requires 24 to 48 hours to completely bind to tissue; thus, any surgical specimen arriving to the laboratory between 8 AM and 4 PM and processed conventionally for the slides to be ready the following day will be only between 30% and 66% bound and even less fixed when the dehydration starts, resulting in an additional and also incomplete alcoholic fixation. This causes infiltration problems and can affect subsequent tests, especially immunohistochemistry. Formaldehyde fixation is tissue thickness independent between 16 microm and 4 mm but is faster at above room temperature, so the fixation of specimens with less than 24 hours in formalin can be improved if the fixing stations in the conventional tissue processors are set at 40 degrees C. If the safety measures are improved to offer a work environment with a time weighted average level of 0.4 ppm, and the contact with formalin is reduced to a minimum by discouraging its neutralization and limiting the recycling practice to filtering methods, formalin could remain as the routine fixative, with modified methacarn for those specimens requiring nucleic acids studies. This is a preferred solution than having to validate all the standard and special procedures, including those US Food and Drug Administration approved, if formalin is replaced by another fixative without its advantages. To the question posed in the title of this article, the answer is "Yes, it can be done, but that is neither likely nor worth it!"
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Nassiri M, Ramos S, Zohourian H, Vincek V, Morales AR, Nadji M. Preservation of biomolecules in breast cancer tissue by a formalin-free histology system. BMC Clin Pathol 2008; 8:1. [PMID: 18230182 PMCID: PMC2267798 DOI: 10.1186/1472-6890-8-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 01/29/2008] [Indexed: 11/10/2022] Open
Abstract
Background The potential problems associated with the use of formalin in histology, such as health hazards, degradation of RNA and cross-linking of proteins are well recognized. We describe the utilization of a formalin-free fixation and processing system for tissue detection of two important biopredictors in breast cancer – estrogen receptor and HER2 – at the RNA and protein levels. Methods Parallel sections of 62 cases of breast cancer were fixed in an alcohol-based molecular fixative and in formalin. Molecular fixative samples were processed by a novel formalin-free microwave-assisted processing system that preserves DNA, RNA and proteins. Formalin-fixed samples were processed using the conventional method. Estrogen receptor was assessed by immunohistochemistry and real-time PCR. HER2 was assessed by immunohistochemistry, FISH, CISH and real-time PCR. Results The immunohistochemical reaction for estrogen receptor was similar in molecular- and formalin-fixed samples (Spearman Rank R = 0.83, p < 0.05). Also HER2 result was similar to that of formalin-fixed counterparts after elimination of antigen retrieval step (Spearman Rank R = 0.84, p < 0.05). The result of HER2 amplification by FISH and CISH was identical in the molecular fixative and formalin-fixed samples; although a shorter digestion step was required when using the former fixative. Real-time PCR for both estrogen receptor and HER2 were successful in all of the molecular fixative specimens. Conclusion The formalin-free tissue fixation and processing system is a practical platform for evaluation of biomolecular markers in breast cancer and it allows reliable DNA and RNA and protein studies.
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Affiliation(s)
- Mehdi Nassiri
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Abstract
Immunohistochemistry is an integral technique in many veterinary laboratories for diagnostic and research purposes. In the last decade, the ability to detect antigens (Ags) in tissue sections has improved dramatically, mainly by countering the deleterious effects of formaldehyde with antigen retrieval (AR) and increasing sensitivity of the detection systems. In this review, I address these topics and provide an overview of technical aspects of immunohistochemistry, including those related to antibodies (Abs) and Ags, fixation, AR, detection methods, background, and troubleshooting. Microarray technology and the use of rabbit monoclonal Abs in immunohistochemistry are also discussed.
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Affiliation(s)
- J A Ramos-Vara
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.
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Morales AR, Essenfeld H, Essenfeld E, Duboue MC, Vincek V, Nadji M. Continuous-specimen-flow, high-throughput, 1-hour tissue processing. A system for rapid diagnostic tissue preparation. Arch Pathol Lab Med 2002; 126:583-90. [PMID: 11958665 DOI: 10.5858/2002-126-0583-csfhth] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Current conventional tissue-processing methods employ fixation of tissues with neutral buffered formalin, dehydration with alcohol, and clearing with xylene before paraffin impregnation. Because the time required for this procedure is usually 8 hours or longer, it is customary to process tissues in automated instruments throughout the night. Although this time-honored method continues to serve histology laboratories well, it has a number of shortcomings, such as a 1-day delay of diagnosis, the need to batch specimens, the relatively large volumes and toxicity of reagents used, and the extent of RNA degradation. OBJECTIVE To describe a rapid new method of tissue processing using a continuous-throughput technique. Design.-We used a combination of common histologic reagents, excluding formalin and xylene, as well as microwave energy, to develop a rapid processing method. The effect of this method on the quality of histomorphology, histochemistry, immunohistochemistry, and RNA content of processed tissue was compared with that of adjacent tissue sections processed by the conventional processing technique. We also assessed the impact of this rapid processing system on our practice by comparing the turnaround times of surgical pathology reports before and after its implementation. RESULTS The new processing method permitted preparation of paraffin blocks from fresh or prefixed tissue in about 1 hour. The procedure allowed continuous flow of specimens at 15-minute intervals. It eliminated the use of formalin and xylene in the processing and used considerably lower volumes of other chemical reagents. Histomorphologic, histochemical, and immunohistochemical results were comparable to the parallel sections prepared by the conventional method. The new technique, however, preserved higher quality RNA. Use of the new methodology led to the diagnosis and reporting of more than one third of surgical pathology specimens on the same day that they were received, as compared to 1% of same-day reporting before the implementation of the rapid processing system. CONCLUSION The quality of hematoxylin-eosin, histochemical, and immunohistochemical tissue sections provided by the new system is comparable to that obtained following the conventional processing method. The new system preserves RNA better than the conventional method. It also shortens the processing time to about 1 hour from the receipt of fresh or prefixed tissue, eliminates the need for formalin and xylene, and reduces the volume of other chemicals. Most importantly, it impacts overall patient management by allowing for considerably shorter turnaround times for completion of surgical pathology reports.
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Affiliation(s)
- Azorides R Morales
- Department of Pathology, University of Miami/Jackson Memorial Medical Center, Miami, FL 33101, USA.
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