Volume 53 (1): 23-34, 2005 Copyright ©The Histochemical Society, Inc. Quantification of Viability in Organotypic Multicellular Spheroids of Human Malignant Glioma using Lactate Dehydrogenase Activity : A Rapid and Reliable Automated Assay
Departments of Neurosurgery (PCDWH,SL), Cell Biology and Histology (AJ,CJFVN), and Anatomy and Embryology (JMR), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Correspondence to: Philip C. De Witt Hamer, MD, Academic Medical Centre, University of Amsterdam, Dept. of Neurosurgery, Room H2-230, PO Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail: P.C.deWittHamer{at}amc.nl
Organotypic spheroids from malignant glioma resemble the biological complexity of the original tumor and are therefore appealing to study anticancer drug responses. Accurate and reproducible quantification of response effect has been lacking to determine drug responses in this three-dimensional tumor model. Lactate dehydrogenase (LDH) activity was demonstrated in cryostat sections of spheroids using the tetrazolium salt method. Calibrated digital image acquisition of the stained cryostat sections enables quantification of LDH activity. Fully automated image cytometry reliably demarcates LDH-active and LDH-inactive tissue areas by thresholding at specific absorbance values. The viability index (VI) was calculated as ratio of LDH-active areas and total spheroid tissue areas. Duplicate staining and processing on the same tissue showed good correlation and therefore reproducibility. Sodium azide incubation of spheroids induced reduction in VI to almost zero. We conclude that quantification of viability in cryostat sections of organotypic multicellular spheroids from malignant glioma can be performed reliably and reproducibly with this approach. (J Histochem Cytochem 53:2334, 2005)
Key Words: spheroids glioma lactate dehydrogenase enzyme histochemistry metabolic activity toxicity test biological assay drug screening assays image cytometry cryostat sections
MALIGNANT GLIOMA [anaplastic astrocytoma, WHO grade 3 (AA) or glioblastoma multiforme, WHO grade 4 (GBM)] is a devastating primary CNS tumor with a median patient survival of 10 and 18 months, respectively, despite standard treatment consisting of gross total surgical resection and radiotherapy (Gupta and Sarin 2002
Screening of cytostatic drugs is commonly carried out with the use of monolayer cell cultures. Apparent advantages of these tumor models are ease of culture and availability of assays that enable quantification of drug response effects. However, new agents with promising effects in these in vitro models repeatedly fail to be efficacious in patients (Wolff et al. 1999
The organotypic multicellular spheroid (OMS) model retains the heterogeneity of the original tumor tissue in addition to the presence of extracellular matrix, vascular elements, and cellcell interactions (Sutherland 1988
This anaerobic glycolytic enzyme was considered as a viability marker for four reasons: (a) stained LDH-active and LDH-inactive tissue areas contrast sharply, allowing accurate discrimination using image cytometry; (b) established techniques also based on reduction of tetrazolium salt are in use for determination of experimental myocardial and hepatic infarction size (Frederiks et al. 1984 Here we present the reliability and reproducibility of an automated quantification method using LDH activity as a marker for viability in cryostat sections of OMSs.
Suppliers of Resources Dulbecco's modified Eagle's medium was supplied by ICN Biochemicals (Aurora, OH) and normal human serum by BioWhittaker (Walkersville, MD). L-Glutamine, penicillin, and streptomycin were supplied by Gibco Invitrogen (Breda, The Netherlands). Agarose and gelatin were supplied by Sigma (St Louis, MO). Corning Life Sciences (Schiphol, The Netherlands) supplied the Costar 48-well culture plates. Potassium dihydrogen phosphate, disodium hydrogen phosphate, sodium azide, and dimethylformamide were supplied by Merck (Darmstadt, Germany). Polyvinyl alcohol (average molecular weight 70,000100,000) and nitroblue tetrazolium were supplied by Sigma. Sodium L-lactate and 1-methoxyphenazine methosulfate (mPMS) were supplied by Serva (Heidelberg, Germany). NAD was supplied by Roche Diagnostics (Mannheim, Germany).
Organotypic Multicellular Spheroids in Culture Minimal essential medium consists of Dulbecco's modified Eagle's medium with 10% heat-inactivated normal human serum, 2% L-glutamine, penicillin (100 IU/ml), and streptomycin (100 µg/ml). Each well was coated with 100 µl 50% medium containing agarose to avoid cell adhesion and 300 µl medium overlay was added. Tumor fragments were cultured in a SteriCult 200 tissue culture incubator (CleanAir; Woerden, The Netherlands) at 37C, 100% humidity, 95% air, and 5% CO2. After 1 week, tumor fragments that had evolved to OMSs were manually selected using a phase-contrast microscope. This is the empirically found shortest time in culture for development of fragments to OMSs. The manual selection was based on spherical morphology, cell shedding, and transparency. Figure 1A illustrates a typical fragment meeting these requirements, and Figure 1B shows a typical fragment that disintegrated to a flock of debris that is not suitable for further analysis. The fraction of OMSs that evolved from initial fragments was 6578% [150 from 192 fragments for one tumor from a 74-year-old woman with a GBM (internal reference no. A26); 62 from 96 fragments for another tumor from a 47-year-old man with a GBM (A27)]. OMSs were then cultured for another week after medium overlay replacement with a Pasteur's pipette until harvesting for analysis. The OMSs stabilized in volume and had a mean diameter (SD) of 923 (213) µm.
Gelatin Embedding and Cryosectioning After harvesting, OMSs were embedded in plastic containers (20 x 30 mm) containing a liquefied solution of 8% gelatin at 37C in 100 mM phosphate buffer (pH 7.45). Gelatin embedding resulted in a better quality of the sections compared with various other embedding agents tested (data not shown). Multiple OMSs were embedded in one gelatin unit to incorporate OMSs from a 48-well plate all together. The unit was then snap-frozen in liquid nitrogen and stored at 80C until cryostat sectioning. Sectioning was carried out on a Jung Frigocut 2800-E cryostat (Leica Microsystems; Bannockburn, IL) using disposable knives at a cabinet temperature of 22C to cut sections of 8-µm thickness.
Histochemistry of LDH Activity
The incubation medium consisted of 18% polyvinyl alcohol dissolved in 100 mM phosphate buffer (pH 7.45) containing sodium L-lactate (150 mM), NAD (3 mM), mPMS (0.32 mM), sodium azide (5 mM), and tetra nitroblue tetrazolium (5 mg/ml medium first dissolved in 20 µl ethanol and 20 µl dimethylformamide solution; final dilution of each solvent in the medium 2%). We used tetra nitroblue tetrazolium because it produces the finest formazan precipitate of all tetrazolium salts and thus increases detail (Van Noorden and Frederiks 1992
Kinetic Measurements of LDH Activity
Digital Image Acquisition
Image Cytometry to Determine the Viability Index
The VI is a ratio ranging from 0 to 1. A VI of 0.00 represents a minimally viable OMS section, whereas a VI of 1.00 represents a maximally viable OMS section. Two absorbance thresholds are required to discriminate between absence of tissue, LDH-inactive tissue, and LDH-active tissue. The absorbance thresholds were resolved by correlating contours of LDH-active tissue and LDH-inactive tissue in serial sections of OMSs after conventional HE staining and histochemical localization of LDH activity. Conventional HE staining is generally considered to be the standard for determination of viable tissue in OMS sections. Absorbance thresholds were established on the basis of 40 OMS sections in three separately calibrated acquisition sessions [tumor material from a 47-year-old man with a GBM (A27)]. Average absorbance values (± SD) for the thresholds were determined to be 0.10 (± 0.03) for the value discriminating between absence of tissue and LDH-inactive tissue and 0.40 (± 0.10) for discrimination between LDH-inactive and LDH-active tissue.
Image Procressing Algorithm The concept of the image processing algorithm is based on the construction of a new OMS section contour to which VI calculations are limited. The new contour is created by shrinking the original OMS section contour to the size of the most frequently occurring distance between the original OMS section rim and LDH-active tissue. The elementary processing steps are schematically drawn in Figure 2. An example of the algorithm applied to an OMS section is outlined in Figure 3.
To demonstrate the impact of this rim exclusion algorithm on the total tissue area measurement, an algorithm impact (AI) on total tissue area was calculated for each OMS section (n=4136) of 64 OMSs from two tumors [from a 47-year-old man with a GBM (A27) and a 74-year-old woman with a GBM (A26)] as:
The original total tissue area is the sum of LDH-active and LDH-inactive tissue areas before application of the rim exclusion algorithm, and the new total tissue area is the area remaining after application of the rim exclusion algorithm.
Reliability of the Histochemical VI Analysis
Reproducibility of the VI
The correlation between the two sets of 32 VI estimates was analyzed with a scatter diagram and the Pearson's correlation coefficient.
Detection of Viability Reduction by the VI Because of the non-normal distribution, a Kruskal-Wallis test was performed to test differences of the three VI group means.
Kinetic Measurements of LDH Activity Reaction curves describing formazan precipitation due to LDH activity in LDH-active tissue increase nonlinearly in time (Figure 4A) as described previously (Van Noorden and Vogels 1989a
Reliability of the Histochemical VI Analysis The comparison between tissue appearance using conventional HE-stained sections of OMSs, OMS sections stained for LDH activity, and digital images with contours for LDH-active and LDH-inactive tissue areas provided by automated image cytometry is illustrated in Figure 5. OMSs shown are either predominantly LDH-active (Figures 5A5C) or harbor complex alternations of LDH-active and LDH-inactive tissue areas (Figures 5D5I), or are predominantly LDH-inactive (Figures 5J5L). Although the tissue was sectioned in a cryostat, the morphology of the tissue sections is sufficiently maintained and major cutting artifacts can usually be avoided. When the HE-stained sections are compared with the LDH activity-stained sections, it is evident that LDH-active and LDH-inactive tissue areas contrast sharply after LDH activity staining. Viable and nonviable tissue areas in HE-stained OMS sections appeared difficult to determine on the basis of morphological aspects, such as the center of the OMS section in Figure 5A (located with *). This area shows marked LDH activity, which unambiguously ascertains viability of this tissue area (Figure 5B). Comparison of the LDH activity-stained sections with the digital images indicated that the reliability of the contour finding cytometry is manifest. Even complex contours of the LDH-inactive tissue areas in Figures 5E and 5H are detected correctly. The value of the rim exclusion algorithm can be appreciated from the way the LDH-inactive tissue area bordering the artifactual rim is handled in Figure 5K. The red line in Figure 5L outlines the OMS section contour that was used for the VI calculation after application of the rim exclusion algorithm. The large LDH-inactive tissue area is included in the OMS section enclosed by the red line. Furthermore, the mean AI (SD) for the analyzed sections all together was 23% (17%). In addition to this, decreasing VIs of tissue sections in Figures 5C, 5F, 5I, and 5L reflect the decreasing extent of LDH-active tissue areas in the successive OMS sections. Based on these observations, we conclude that, first, localization of LDH activity reliably separates LDH-active and LDH-inactive tissue areas. Second, these areas can be automatically segmented by image cytometry independently of the complexity of the tissue areas. Third, the impact of the rim exclusion algorithm is nontrivial, and fourth, the viability can be adequately quantified using the VI.
Reproducibility of the VI According to the scatter diagram (Figure 6), the entire procedure of histochemical localization of LDH activity, digital image acquisition and cytometric analysis to determine the VI are reproducible (Pearson's correlation coefficient 0.935; p<0.01).
Detection of Viability Reduction by the VI The frequency plot of untreated and sodium azide-treated samples is shown in Figure 7. These data highlight the detection of the cytotoxic effects of sodium azide by the VI. In fact, four of eight treated OMSs express a VI less than 0.02.
A number of interesting details arise from this frequency plot. First, the two untreated OMS groups have closely similar average VIs (0.72 vs 0.79) and distributions. Second, some overlap is observed in VI extremes for treated and untreated OMSs. On the one hand, there are respectively two and three OMSs with a VI less than 0.50 in the two untreated samples. Closer inspection indicated that the sections involved were correctly stained and processed to determine VIs. LDH activity levels and morphological aspects after HE staining were in agreement with LDH-inactive tissue with low viability. These specific OMSs harbor reduced levels of LDH activity, presumably due to spontaneous necrosis. On the other hand, a single outlier with a VI of 0.48 was found in the sodium azide-treated OMS group. This outlier contributes considerably to the average VI of 0.09 for sodium azide-treated OMSs. Again, closer inspection of the sections indicated that staining and processing to determine the VI appeared to be correct. Perhaps this OMS was less dependent on oxidative phosphorylation for its metabolic needs by having switched to anaerobic glycolysis and, as a consequence, became less susceptible to the toxic effects of sodium azide.
The Kruskal-Wallis test shows a
This report describes the quantification of viability in cryostat sections of organotypic multicellular spheroids (OMSs) from human malignant glioma on the basis of LDH activity using image cytometry.
This focus on the OMS tumor model to study the behavior of human malignant glioma is our answer to the multitude of treatment strategies that arise rapidly and demand a suitable model for screening of their potential. The ideal tumor model for this purpose would be a system that is rapid in providing results in the short term, valid with respect to the original responsiveness of tumors, efficient, and allows analysis of multiple aspects of tumor biology. On the one hand, it is obvious that assessment of the anticancer potential of an unselected panel of promising novel agents in malignant glioma patients, although highly biologically valid, is slow, inefficient, and ethically unacceptable. On the other hand, initial drug screening in malignant glioma research is generally based on observations with monolayer cell line cultures that allow rapid and efficient high-throughput analysis. However, the discrepancy between results obtained in these basic culture systems and human glioma responses is probably due to shortcomings in the validity of representation of human glioma biology by monolayer cell cultures (Wolff et al. 1999
However, a test to evaluate drug responsiveness is required for the OMS tumor model that under the best circumstances is rapid, accurate in terms of quantifiability, reproducible, based on transparent principles, takes advantage of the spatial information available from the three-dimensional structure, and allows multiple comparative analysis of different aspects of tumor responses in the same tissue material. Other approaches to quantify responsiveness in OMS models are in use, including growth in diameter (Bjerkvig et al. 1990
Before weighing the merits of these approaches, it is of importance to discern two categories of tumor spheroids. In the first place, there are multicellular aggregated spheroids that evolved from monolayer cell cultures by aggregation and, in the second place, there are OMSs with an architecture native to the surgical specimens from which they are grown. The latter OMSs stabilize in volume over time (Bjerkvig et al. 1990
Poor penetration of fluorescence probes in OMSs [up to In the present study, localization of LDH activity in cryostat sections of OMSs is described as a tumor-responsiveness test. This test provides an assay that is rapid, accurate in quantification, reproducible, transparent by being founded on generally established concepts of tissue viability, enables the use of spatial information, and is available for further analysis of other aspects of tumor responsiveness in serial sections from the same tissue material. Furthermore, an example of sodium azide responsiveness has provided proof of principle for the validity of the VI to detect a cytotoxic response in OMSs. Some issues remain to be resolved, however, before relevant results can be provided with this OMS tumor model and the LDH activity assay. In the first place, LDH-inactive tissue is interpreted as nonviable tissue based on the rationale that viable cells contain LDH and therefore that absence of LDH in tissue is in accordance with absence of viable cells. Nevertheless, the LDH-inactive tissue areas do not entirely consist of necrosis, according to preliminary analysis (unpublished data). Apparently, part of the LDH-inactive tissue stains positive for picrosirius red, indicating collageneous elements of the extracellular matrix. Other parts stain positive for vimentin IX, indicating vascular elements. In the second place, another important issue is whether the OMS model proves to be sufficiently biologically valid. The superior validity of the OMS model compared with the monolayer cell culture has only been theoretically deduced. In the third place, the outliers in VI in untreated and sodium azide-treated samples illustrate the need to compensate for the heterogeneity of OMSs by inclusion of multiple samples in a treatment group. Apparently, eight OMSs sufficed for statistical analysis in the sodium azide experiment. In general, the consequence of heterogeneity of tumor tissue needs to be addressed for a tumor model to be efficient. Crucial to this point are the minimal numbers of OMSs in a treatment group and the minimal numbers of cryostat sections per OMS required (given a predetermined biologically relevant detectable difference in VI, power, and significance level). These issues need to be addressed for this tumor model in succeeding studies. We conclude that the viability of OMSs can be quantified in a rapid, reliable, and reproducible way using localization of LDH activity in cryostat sections with automated image cytometric analysis. This is an important advance towards relevant drug screening in this human malignant glioma tumor model.
Our gratitude is expressed to Professor Dr D. Troost, head of the Department of Neuropathology, for his contribution to interpretation of the HE-stained sections of OMSs, and to Ing P.J. van Amstel, head of the research laboratory of the Department of Pathology, for facilitation of the culture incubators and reagents. We also wish to thank K.S. Bosch and W.M. Frederiks, PhD, from the Department of Cell Biology and Histology, for their contribution to the enzyme histochemical laboratory protocols and facilities. Support with the software development provided by N.O.E. Vischer, PhD, software engineer at the Faculty of Biology, is kindly appreciated.
Received for publication February 27, 2004; accepted August 10, 2004
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