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Clinical applications of flow cytometry.

By providing multiple analyses on single cells, flow cytometry allows the description of cellular heterogeneity, establishing the biologic counterpart of clinical heterogeneity common to most tumors. Analysis of DNA content, a reflection of cell ploidy, is useful in establishing the prognosis of many solid tumors, while analysis of other markers has been crucial in increasing our knowledge of lymphoid differentiation, classifying hematologic malignancies, and detecting minimal residual disease.

Biomarkers, Tumor↗

Nine color eleven parameter immunophenotyping using three laser flow cytometry.

BACKGROUND: This study describes a three laser flow cytometer, reagents, and software used to simultaneously evaluate nine distinct fluorescent parameters on one cell sample. We compare the quality of data obtained with (1) full software compensation and (2) the use of partial spectral compensation of selected pairs of parameters in analog hardware, in combination with final software compensation. An application characterizing low frequency murine B cell subpopulations is given. METHODS: The fluorochromes used are: fluorescein (FITC), phycoerythrin (PE), Cy5PE and Cy7PE, excited at 488 nm by an argon laser; Texas Red (TR), allophycocyanin (APC), and Cy7APC excited at 595 nm by a pumped dye laser; and cascade blue (CB) and cascade yellow (CY) excited at 407 nm by a violet-enhanced krypton laser. Custom additions to commercial electronics and an extended optical bench allow the measurement of these nine parameters plus forward and side scatter light signals. RESULTS: We find the use of partial analog compensation reduces the variation in the background staining levels introduced by the compensation process. Novel B cell populations with frequencies below 1% are characterized. CONCLUSIONS: Nine color flow cytometry is capable of providing measurements with high information content. The choice of reagent-dye combinations and the ability to compensate in multi-parameter measurement space are crucial to obtaining satisfactory results.

Animals↗

[Multiparameter analysis of uterine cancer cells using flow-cytometry-computer].

In recent progress, Laser-based flow cytometric technique makes it possible to do quantitative determination of nuclear DNA-RNA content and proteins on monodisperse cell population simultaneously. Gynecologic cytology specimens that derived from the cervix and the endometrium were stained with a combination of propidium iodide for nuclear DNA-RNA and fluorescein isothiocyanate for protein in cells, then analyzed using a flow cytometry system with computer. These results included assessment of the presence or absence of malignant cells. They also demonstrated the dispersion contour of the normal squamous cell population, and inflammatory responding cell population. Measurements of clinical specimens were resulted with a 9.6% false negative rate and a 27.0% false positive rate (80.6% in accuracy rate) by comparison with routine visual cytologic evaluation of the same samples.

Computers↗

[Flow cytometry and malignant pleural mesotheliomas. Value in the histologic and cytologic diagnosis].

To contribution the help of flow cytometry in the diagnosis of mesothelioma in pleural effusions, we studied the aneuploid frequency in paraffin-embedded pleural mesotheliomas. The low aneuploidy rate (31%) explains the moderate yield of mesothelioma diagnosis in pleural effusions. Because of the possibility of false aneuploidies, flow cytometry cannot replace of a cytologic or histopathologic evidence.

DNA, Neoplasm↗

CD45RA is detected in all thymocyte subsets defined by CD4 and CD8 by using three-colour flow cytometry.

In the mouse, using three-colour flow cytometry, the presence of CD45RA+ cells is demonstrated amongst all of the thymocyte subsets defined by expression of CD4 and CD8, i.e. amongst the double negatives, immature CD8 single positives, double-positive blasts and CD4 and CD8 single positives. This evidence is compatible with the existence of a continuous lineage of T cells expressing CD45RA which would develop from double-negative to mature single-positive T cells.

Aging↗

Quantification of the X- and Y-chromosome-bearing spermatozoa of domestic animals by flow cytometry.

The relative content of DNA in spermatozoa presumed to be the X- and Y-chromosome-bearing gametes from bulls, boars, rams and rabbits and the amount of DNA in spermatozoa of cockerels was determined by flow cytometry. Differences in the relative content of DNA and proportions of the presumed X- and Y-sperm populations in cryopreserved semen from Holstein, Jersey, Angus, Hereford and Brahman bulls were also determined. Spermatozoa were washed by centrifugation using a series of dimethyl sulfoxide solutions made in isotonic sodium citrate, fixed in ethanol, treated with papain and dithioerythritol to loosen the chromatin structure and remove cellular organelles, and stained quantitatively for DNA with the fluorochrome 4'-6-diamidino-2-phenylindole (DAPI). Approximately 5000 stained sperm nuclei, which were nonviable due to the removal of other cellular organelles during the washing procedure, were measured for DNA in an epi-illumination flow cytometer. A single distinct peak for cockerel spermatozoa and two symmetrical, overlapping peaks for species with X- and Y-spermatozoa were seen. This and other evidence strongly supports the interpretation that the peaks represent the X- and Y-sperm populations. The content of DNA in sperm nuclei from cockerels, bulls, boars, rams and rabbits, as determined by fluorescence flow cytometry, corresponded to biochemical estimates of DNA per sperm cell. Analyses of the bimodal histograms by computer-fitting two Gaussian distributions to the data showed the means of the peaks differed by 3.9, 3.7, 4.1 and 3.9% for bulls, boars, rams and rabbits, respectively. In four replicate analyses of semen from 25 bulls representing 5 breeds, the average population of sperm nuclei in the Y-peaks ranged from 49.5 to 50.5% for all breeds. The X-Y peak differences did not vary within each breed, but were significantly different when the breeds were compared. Spermatozoa from Jersey bulls had larger X-Y peak differences (P less than 0.001) than spermatozoa from Holstein, Hereford, and Angus bulls; spermatozoa from Brahman bulls had smaller X-Y differences (P less than 0.004). It is suggested from the evidence obtained in these studies that flow cytometry can be used to assess the proportion of X- and Y-spermatozoa in semen of domestic animals and is thereby applicable to verification of the effectiveness of enrichment techniques for X- or Y-spermatozoa.

Animals↗

Flow cytometry and factor analysis evaluation of confocal image sequences of morphologic and functional changes occurring at the mitochondrial level during 7-ketocholesterol-induced cell death.

OBJECTIVE: To analyze functional and morphologic alterations that occur at the mitochondrial level by flow cytometry and laser scanning confocal microscopy (CLSM) combined with factor analysis of biomedical image sequences (FAMIS). STUDY DESIGN: Under treatment of U937 cells with 7-ketocholesterol, functional alterations that occur at the mitochondrial level (especially loss of transmembrane mitochondrial potential [delta psi m]) were assessed with 3,3'-dihexyloxacarbocyanine iodide (DiOC6(3)) and mitotracker red (CMXRos), whereas morphologic changes were analyzed with nonyl acridine orange (NAO). By flow cytometry, these different dyes were excited at 488 nm, whereas on CLSM, excitation of NAO and CMXRos was performed by lines of an argon laser. By CLSM, spectral sequences were performed to characterize NAO and CMXRos. FAMIS was used to transform the image sequences in factor images. RESULTS: By flow cytometry, rapid loss of delta psi m induced by 7-ketocholesterol was detected with both DiOC6(3) and CMXRos, which gave similar results. Morphologic alterations of mitochondria were revealed with NAO. The factor images obtained from confocal image sequences confirmed these results. CONCLUSION: The simultaneous use of NAO, CMXRos and FAMIS constitutes a new method to detect morphologic and functional alterations occurring at the mitochondrial level during cell death.

Cell Death↗

Flow cytometry and conventional enumeration of microorganisms in ships' ballast water and marine samples.

Conventional methods for bacteriological testing of water quality take long periods of time to complete. This makes them inappropriate for a shipping industry that is attempting to comply with the International Maritime Organization's anticipated regulations for ballast water discharge. Flow cytometry for the analysis of marine and ship's ballast water is a comparatively fast and accurate method. Compared to a 5% standard error for flow cytometry analysis the standard methods of culturing and epifluorescence analysis have errors of 2-58% and 10-30%, respectively. Also, unlike culturing methods, flow cytometry is capable of detecting both non-viable and viable but non-culturable microorganisms which can still pose health risks. The great variability in both cell concentrations and microbial content for the samples tested is an indication of the difficulties facing microbial monitoring programmes. The concentration of microorganisms in the ballast tank was generally lower than in local seawater. The proportion of aerobic, microaerophilic, and facultative anaerobic microorganisms present appeared to be influenced by conditions in the ballast tank. The gradual creation of anaerobic conditions in a ballast tank could lead to the accumulation of facultative anaerobic microorganisms, which might represent a potential source of pathogenic species.

DNA, Bacterial↗

Malignancy index based on flow cytometry and histology for renal cell carcinomas and its correlation to prognosis.

Fifty-five human renal cell carcinomas, removed by nephrectomy, were classified using flow cytometry and histology. The parameters obtained by flow cytometry were DNA index, fractions of cells in the phases, and fractions of tumor cells versus normal cells. From histology, the routine classification of tumor structure and morphology were obtained, and a nuclear grading according to Arner et al. (Acta Chir Scand [Suppl] 346:1-12, 1965) was determined. All parameters including tumor stage according to Robson et al. (J Urol 101:297-301, 1969) were subjected to discriminant analysis in order to define a malignancy index. The patients were divided into two groups with good and poor prognosis (low and high risk). Those patients who were free of multiple metastases in 2 years and more after nephrectomy were assigned to the group "good prognosis"; those who developed multiple metastases for 2 years represented the "poor prognosis" group. The malignancy index determined by discriminant analysis yielded 91% correct predictions of prognosis.

Carcinoma, Renal Cell↗

[Factors that affect DNA content analysis by flow cytometry].

DNA ploidy and cell cycle analysis by flow cytometry is used to obtain additional information about the diagnosis and prognosis of different types of cancer. However, there are several disagreements among authors about the tissue source (fresh-frozen or paraffin embedded), cellular dissociation methods (mechanical, enzymatic or other), use of different dyes, lasers, analysis software with different mathematical models and interpretation of results. A discussion about the different aspects that affect the study of DNA ploidy and cell cycle and a consensus in publications is mandatory. A strict control of analysis processes and data interpretation is also necessary.

Cell Cycle↗

[Standardized counting of particles in the urine: a comparison between flow cytometry, cell chamber counting and traditional sediment analysis].

We compared the number of particles in the urine with flow cytometry and manual methods: cell chamber and standardised sediment analysis. The correlation (r) between the KOVA-cell chamber and the flow cytometer UF-100 was 0.966 for erythrocytes, 0.935 for leukocytes and 0.902 for squamous epithelial cells. Similar results were obtained by a standardised preparation of the sediment. Today, the estimation of the cell number in the sediment analysis is still common. The KOVA cell chamber system is a cheap alternative for microscopy, whereas automation with flow cytometry is only used for large laboratories. Reference values were established under optimal conditions (erythrocytes < 14/microliter, leukocytes < 16/microliter) with a cut-off of 20/microliter.

Algorithms↗

Reticulocyte counts in canine and rat blood made by flow cytometry.

Absolute and percentage reticulocyte counts for sequestrated blood samples from healthy Wistar rats (n = 132) and beagles (n = 64) were made by thiazole orange and flow cytometry. The flow cytometric method showed good agreement with a manual counting method for both species, and the precision data for both of these counting methods were similar.

Animals↗

[Comparison of positivity between density gradient centrifugal method and whole blood method in lymphocyte surface marker analysis with flow-cytometry].

The lymphocyte surface marker analysis with flow-cytometry is usually performed using a density gradient centrifugal method or a whole blood method. We have compared these two methods using several monoclonal antibodies and have found the significant difference in positivity all monoclonal antibodies except TCR-1 (anti alpha/beta receptor on T-lymphocyte). We found the significantly higher positivity of Leu12 and HLA-DR as well as lower of the other monoclonal antibodies by using whole blood method than by density gradient centrifugal method. We conclude that it is necessary to make a distinct description of the method used in the surface marker analysis.

Adult↗

DNA content and cell cycle analysis by flow cytometry in clinical samples: application in breast cancer.

Flow cytometry (FCM) analysis of cellular DNA content has become an increasingly important clinical research tool for the measurement and identification of abnormal cell populations. Examination of cellular DNA content can provide information for use in cell cycle analysis in cancer studies. Most researchers would agree that tumor cell proliferation indices should be leading candidates in the search for prognostic factors in breast cancer. FCM is certainly a powerful technique but the assignment of DNA index and synthetic phase of cycle are subject to a number of technical pitfalls which limit the accuracy and reproducibility of this information. This paper will focus on the difficulties encountered in FCM-DNA analyses performed in a clinical context.

Aneuploidy↗

Flow cytometry of peritoneal washings in gynecologic neoplasia.

A prospective, double blind study was initiated to compare flow cytometry to cytopathology in detecting malignant cells within peritoneal washings. Deoxyribonucleic acid (DNA) histograms were generated using 4',6-diamidino-2-phenylindole (DAPI) as a DNA fluorochrome. Evaluation of these data revealed a correlation of 84.5% with the cytologic findings. Two specimens demonstrated euploidy in the presence of cytologically malignant cells (false negative), 28 of 128 specimens (21.8%) manifested aneuploidy with negative cytologic findings (false positive). Further evaluation of this latter subgroup revealed 22 of the 28 to possess unequivocal histologic evidence of malignancy, thus yielding an actual false positive rate of 4.7%. This preliminary study demonstrates that flow cytometry is a highly sensitive, accurate, and analytic method for the detection of malignant cells within peritoneal washings and that it may augment the cytologic examination. However, additional comparative studies are necessary to conclusively demonstrate its apparent diagnostic potential.

Cell Nucleus↗

Evaluation of red blood cell lysing solutions for the detection of intracellular antigens by flow cytometry.

When analyzing leukocyte cell surface antigens by flow cytometry, leukocytes are usually first labeled in whole blood and the red blood cells are finally lysed with lysing solutions. The erythrocytes are lysed, but the leukocytes are expected to remain intact. Six commercial red blood cell lysing methods were investigated for possible leukocyte permeabilization effect. The effectiveness of permeabilization was studied by propidium iodide staining, and the detectability of intracellular antigens was studied by using monoclonal antibodies toward two model antigens. Most of the lysing methods caused permeabilization of at least part of the leukocytes, but only one method, already found in our previous studies, was applicable for complete permeabilization of leukocytes and for detection of intracellular antigens alone or simultaneously with the cell surface antigens.

Antigens↗

Role of DNA flow cytometry and image cytometry on effusion fluid.

The objective of the study was to assess the value of DNA flow cytometry (FCM) and image cytometry (ICM) as an adjunct to routine diagnostic cytology. In this prospective study, 100 consecutive effusion fluids were studied for routine cytology, DNA FCM, and in selected cases, ICM. One half of the centrifuged fluid sample was used for routine cytology and the remaining portion was used for DNA FCM. Nuclear area, nuclear diameter, nuclear perimeter, nuclear convex perimeter, nuclear roundess, and nuclear convex area were measured on at least 100 cells by ICM in cytologically malignant or DNA aneuploid cases along with control cases. Clinical follow-up was done in all cases. There were 22 cytologically malignant cases and 78 cytologically benign cases. Among the 22 cytologically malignant cases, there were 11 aneuploid and diploid cases each by DNA FCM. Out of 78 cytologically benign cases, six (7.7%) were aneuploid by DNA FCM. Smears of these cases showed predominantly reactive mesothelial cells, but the DNA histograms showed hypodiploid (one), hyperdiploid (three), tetraploid (one), and hypertetraploid (one) aneuploidy. Follow-up of these cases showed clinical or histologic features of malignancy except in one case of tetraploid aneuploidy, which did not show any features of malignancy and responded well to antitubercular therapy. Therefore, out of 27 malignant effusions, DNA FCM picked up 16 cases and routine cytology detected 22 cases. Sensitivity and specificity of DNA FCM were thus 59.25% and 98.63%, respectively. There was a statistically significant difference (Student's unpaired t-test, P < 0.05) between cytologically malignant cases and control benign cases in all the nuclear morphometric parameters except for nuclear roundness. There was, however, no statistically significant difference of nuclear morphometric parameters between cytologically benign vs. DNA aneuploid cases and control benign cases. DNA FCM is a useful adjunct for routine diagnostic cytology. Visual diagnostic cytology and morphometric digital microscopy miss some cases of malignancy which can be detected by DNA flow cytometry. Diagn. Cytopathol. 2000;22:81-85.

Adult↗