Supported in part by NIH grant (R43/44CA122444) and DOD BRCP grant (W81XWH-06-1-0682) to YL.

1. Sample, Equipment, and Reagent Preparation
<ol>
	<li>Cut tissue specimen into blocks of 3-4 mm in thickness, fix in fresh 10% neutral-buffered formalin for 16-32 hr at room temperature (25 &#176;C) and embed in paraffin. Cut FFPE into sections of 5&#177;1 &#181;m thickness from FFPE blocks, mount sections on slides&#160;and air dry. Note: The slides can be stored at room temperature under desiccation for up to 3 months. The mounted tissue slides should be baked in a dry over at 60 &#176;C for 1 hr prior to the RNAscope assay.</li>
	<li>Bring Hybridization Oven to 40 &#176;C. Place a Humidifying Paper in the Humidity Control Tray. Add 50 ml dH2O to the Humidifying Paper to wet it completely. Insert the covered Tray into the Oven to prewarm for at least 30 min before use.</li>
	<li>Make 700 ml 1x Pretreat 2 Solution (10 nl, pH 6 citrate buffer) by diluting 10x Pretreatment Solution in dH2O. Heat the 1x Pretreat 2 Solution to boil and maintain the temperature between 100-104 &#176;C while preventing over-boiling.</li>
	<li>Make 3 L 1x Wash Buffer (0.1x SSC) by diluting prewarmed 50x Wash Buffer in dH2O.</li>
	<li>Prepare 2 x 200 ml of xylene and 2 x 200 ml of 100% EtOH for deparaffinization under a fume hood.</li>
	<li>Prepare 50% Hematoxylin staining solution and bluing reagent (0.01% ammonia water) for post-staining under a fume hood.</li>
	<li>Prepare 200 ml of xylene, 200 ml of 70%, and 2 x 200 ml of 100% EtOH for dehydration under a fume hood.</li>
	<li>Prewarm Target probes at 40 &#176;C for 10 min and bring RTU Detection Kit reagent to room temperature, including RTU Amp1, Amp2, Amp3, Amp4, Amp 5-Brown, and Amp6-Brown, except DAB Chromogen Brown-A and Brown-B.</li>
</ol>
2. RNAscope Assay
Deparaffinization and Dehydration
After baking, deparaffinize tissue sections in xylene for 2 x 5 min with frequent agitation, and dehydrate in 100% EtOH for 2 x 3 min with frequent agitation. Air dry for 5 min and draw a hydrophobic barrier around the tissue section with a Hydrophobic Barrier Pen.
Pretreatments
<ol>
	<li>Incubate tissue sections with Pretreat 1 for 10 min at RT for quenching of endogenous peroxidase activity, rinse in dH2O.</li>
	<li>Incubate tissue sections with Pretreat 2 maintained at a boiling temperature for 15 min for RNA retrieval, rinse twice in dH2O.</li>
	<li>Incubate tissue sections with Pretreat 3 for 30 min at 40&#176;C for protein digestion in HybEZ oven, rinse twice in dH2O.</li>
</ol>
Target Probe Hybridization
Target probes HPV-HR 7 pool include: HPV16, 18, 31, 33, 35, 52, and 58. Add HPV probes, Ubiquitin C (UBC) and bacterial gene dapB probes separately onto three adjacently tissue sections. Hybridize at 40 &#176;C in oven for 2 hr, then rinse in 1x Wash buffer for 2 x 2 min at RT.
Signal Amplification
<ol>
	<li>Incubate tissue sections with Amp1 (preamplifier) for 30 min at 40 &#176;C, Amp2 (background reducer) for 15 min at 40 &#176;C, Amp3 (amplifier) for 30 min at 40 &#176;C, and Amp4 (label probe) for 15 min at 40 &#176;C in HybEZ oven. After each hybridization step, rinse in 1x Wash buffer for 2 x 2 min at RT.</li>
	<li>Incubate tissue sections with Amp5 for 30 min and Amp6 for 15 min at RT. After each incubation step, rinse in 1x Wash buffer for 2 x 2 min at RT.</li>
</ol>
Signal Detection
Incubate tissue sections with 1:1 DAB Mixture by mixing equal volume of Brown-A and Brown-B for 10 min at RT, rinse twice in dH2O.
Counterstaining
Stain tissue sections with 50% Hematoxylin solution for 2 min at RT, rinse with dH2O until slides are clear while tissue remain purple. Dip slides into 0.01% ammonia in dH2O for 5x and followed with 5 dips in dH2O.
Slide Mounting
Dehydrate tissue sections in 70%, 100%, and 100% EtOH for 2 min each, xylene for 5 min, mount with xylene-based mounting media.

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	<li>Parkin, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+global+health+burden+of+infection-associated+cancers+in+the+year+2002.">The global health burden of infection-associated cancers in the year 2002.</a> Int. J. Cancer. 118 (12), 3030-3044 (2006).</li><li>Chaturvedi, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+papillomavirus+and+rising+oropharyngeal+cancer+incidence+in+the+United+States.">Human papillomavirus and rising oropharyngeal cancer incidence in the United States.</a> J. Clin. Oncol. 29 (32), 4294-4301 (2011).</li><li>Ang, K. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+papillomavirus+and+survival+of+patients+with+oropharyngeal+cancer.">Human papillomavirus and survival of patients with oropharyngeal cancer.</a> N. Engl. J. Med. 363 (1), 24-35 (2010).</li><li>Smeets, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+algorithm+for+reliable+detection+of+human+papillomavirus+in+paraffin+embedded+head+and+neck+cancer+specimen.">A novel algorithm for reliable detection of human papillomavirus in paraffin embedded head and neck cancer specimen.</a> Int. J. Cancer. 121 (11), 2465-2472 (2007).</li><li>Wang, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=RNAscope:+a+novel+in+situ+RNA+analysis+platform+for+formalin-fixed,+paraffin-embedded+tissues.">RNAscope: a novel in situ RNA analysis platform for formalin-fixed, paraffin-embedded tissues.</a> J. Mol. Diagn. 14 (1), 22-29 (2012).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Specific+regulation+of+NRG1+isoform+expression+by+neuronal+activity.">Specific regulation of NRG1 isoform expression by neuronal activity.</a> J. Neurosci. 31 (23), 8491-8501 (2011).</li><li>Yan, K. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+intestinal+stem+cell+markers+Bmi1+and+Lgr5+identify+two+functionally+distinct+populations.">The intestinal stem cell markers Bmi1 and Lgr5 identify two functionally distinct populations.</a> Proc. Natl. Acad. Sci. U.S.A. 109 (2), 466-471 (2012).</li><li>Payne, R. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Viable+circulating+tumour+cell+detection+using+multiplex+RNA+in+situ+hybridisation+predicts+progression-free+survival+in+metastatic+breast+cancer+patients.">Viable circulating tumour cell detection using multiplex RNA in situ hybridisation predicts progression-free survival in metastatic breast cancer patients.</a> Br. J. Cancer. 106 (11), 1790-1797 (2012).</li><li>Bordeaux, J. 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R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasensitive+RNA+in+situ+Hybridization+for+Detection+of+Restricted+Clonal+Expression+of+Low+Abundance+Immunoglobulin+Light+Chain+mRNA+in+B-Cell+Lymphoproliferative+Disorders.">Ultrasensitive RNA in situ Hybridization for Detection of Restricted Clonal Expression of Low Abundance Immunoglobulin Light Chain mRNA in B-Cell Lymphoproliferative Disorders.</a> Am. J. Surg. Pathol. In press, (2013).</li><li>Ukpo, O. C., Flanagan, J. J., Ma, X. J., Luo, Y., Thorstad, W. L., Lewis, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-risk+human+papillomavirus+E6/E7+mRNA+detection+by+a+novel+in+situ+hybridization+assay+strongly+correlates+with+p16+expression+and+patient+outcomes+in+oropharyngeal+squamous+cell+carcinoma.">High-risk human papillomavirus E6/E7 mRNA detection by a novel in situ hybridization assay strongly correlates with p16 expression and patient outcomes in oropharyngeal squamous cell carcinoma.</a> Am. J. Surg. Pathol. 35 (9), 1343-1350 (2011).</li><li>Lewis, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcriptionally-active+high-risk+human+papillomavirus+is+rare+in+oral+cavity+and+laryngeal/hypopharyngeal+squamous+cell+carcinomas--a+tissue+microarray+study+utilizing+E6/E7+mRNA+in+situ+hybridization.">Transcriptionally-active high-risk human papillomavirus is rare in oral cavity and laryngeal/hypopharyngeal squamous cell carcinomas--a tissue microarray study utilizing E6/E7 mRNA in situ hybridization.</a> Histopathology. 60 (6), 982-991 (2012).</li><li>Lewis, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Partial+p16+staining+in+oropharyngeal+squamous+cell+carcinoma:+extent+and+pattern+correlate+with+human+papillomavirus+RNA+status.">Partial p16 staining in oropharyngeal squamous cell carcinoma: extent and pattern correlate with human papillomavirus RNA status.</a> Mod. Pathol. 25 (9), 1212-1220 (2012).</li><li>Bishop, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+transcriptionally+active+high-risk+HPV+in+patients+with+head+and+neck+squamous+cell+carcinoma+as+visualized+by+a+novel+E6/E7+mRNA+in+situ+hybridization+method.">Detection of transcriptionally active high-risk HPV in patients with head and neck squamous cell carcinoma as visualized by a novel E6/E7 mRNA in situ hybridization method.</a> Am. J. Surg. Pathol. 36 (12), 1874-1882 (2012).</li><li>Schache AG, ., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+novel+diagnostic+standard+in+HPV-positive+oropharyngeal+squamous+cell+carcinoma.">Validation of a novel diagnostic standard in HPV-positive oropharyngeal squamous cell carcinoma.</a> Br. J. Cancer. 108 (6), 1332-1339 (2013).</li><li>Mehrad, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Papillary+Squamous+Cell+Carcinoma+of+the+Head+and+Neck:+Clinicopathologic+and+Molecular+Features+With+Special+Reference+to+Human+Papillomavirus.">Papillary Squamous Cell Carcinoma of the Head and Neck: Clinicopathologic and Molecular Features With Special Reference to Human Papillomavirus.</a> Am. J. Surg. Pathol. Jun. , (2013).</li><li>Jordan, R. 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All authors are employed by and own stock in Advanced Cell Diagnostics, Inc.

The RNAscope HPV assay allowed direct visualization of E6/E7 mRNA in situ in HPV-associated head and neck squamous cell carcinoma. The RNAscope assay is fully compatible with routinely fixed tumor tissue and preserves tissue morphology for histopathological correlations (Figure 2). A key advantage of the RNAscope assay over conventional CISH methods is that it specifically amplifies the hybridization signals (Figures 2B and&#160;2E) without amplifying the background noise (Figures 2C and&#160;2F).
In practice, the RNAscope HPV assay procedure can be completed within 8 hr or conveniently divided over two days. The RNAscope HPV assay has been used to determine HPV status in head and neck squamous cell carcinoma12-16, demonstrating 97% sensitivity and 93% specificity using qRT-PCR as the reference method16. Conventional chromogenic ISH for HR-HPV DNA is highly specific but has a sensitivity of ~80%12. Immunohistochemical (IHC) staining for the cellular surrogate marker p16 demonstrates excellent sensitivity but may generate false positive results15,18, especially in nonoropharyngeal head and neck cancers15. The current &#8220;gold standard&#8221; method of qRT-PCR for HPV E6/E7 mRNA detection requires fresh frozen tissue for optimal results and is technically complex, which limits its use to the research laboratory only. In addition, it requires RNA extraction which makes it impossible to correlate HR-HPV E6/E7 mRNA expression with histopathology.
There are several critical factors for the success of the RNAscope assay. First, for best results, tissues should be fixed in fresh 10% neutral-buffered formalin at room temperature for 16-32 hr according to ASCO/CAP guidelines19. Second, the HybEZ oven is highly recommended since it enables optimal control of temperature and humidity for probe hybridization and signal amplification steps. Thirdly, it is important to remove excess residual buffers before each step but still keep the tissue section from drying during any of these steps.
The manual RNAscope procedure described here has been fully automated on a commercial slide auto-staining system10. This should greatly facilitate standardization of assay conditions and saving precious manual labor in clinical pathology laboratories. In addition, dedicated image analysis software has been developed10 to automatically identify the cells and staining signals on a digitalized slide, which should help to eliminate subjectivity and improve reproducibility in scoring.
In summary, the RNAscope HPV assay detects the presence of HR-HPV E6/E7 mRNA transcripts in situ in FFPE tissues. It has a workflow that is familiar to clinical pathology laboratories by permitting the directly visualization of these in tissue sections. It offers an ideal platform for examining (FFPE) tissue samples, and can be easily adopted by diagnostic pathology laboratories.

High-risk human papillomavirus (HR-HPV) infection accounts for approximately 5% of all cancers worldwide1. The incidence of HPV-associated oropharyngeal cancer has increased during the past decades, especially among men. HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) will likely constitute a majority of all head and neck cancers in the United States in the next 20 years2. Oropharyngeal squamous cell carcinomas caused by HPV are associated with favorable survival, and tumor HPV status is a strong and independent prognostic factor for survival3.
Evidence for transcriptional activation of the viral oncogenes E6 and E7 is regarded as the gold standard for the presence of clinically relevant HPV4. However, detection of E6/E7 mRNA from fresh tumor tissue by RT-PCR technique is not practical in routine clinical practice and has been limited to the research laboratories. Recently, we have developed a novel RNA ISH technology called RNAscope, which enables multiplex detection in individual cells with single RNA molecule sensitivity in formalin fixed paraffin embedded tissue specimens (FFPE)5-10. We provided three lines of evidence for single molecule detection5. First, the RNAscope probe design and signal amplification system allowed detection of single copy HER2 genomic DNA targets in HeLa and SK-BR-3 cell lines. Second, when compared with HER2 genomic DNA signals, the distribution of the fluorescent intensities of HER2 mRNA signal dots in HeLa cells was consistent with one molecule per dot. Thirdly, the number of HER2 mRNA signal dots per cell matched closely the HER2 mRNA copy number estimated by a solution-based quantification assay, further supporting single molecule detection. Furthermore, counterstaining of nuclei with DAPI in fluorescent microscopy or with hematoxylin in bright-field microscopy allows visualization of individual nuclei, which in turn allows detection and quantification of RNA targets on a single-cell basis10. The ability to analyze gene expression in situ in routine clinical specimens makes RNAscope a promising platform for diagnostic pathology, especially those FFPE tissue section-based assays10,11. We have developed an RNAscope-based HPV assay to detect E6/E7 mRNA of seven high-risk HPV genotypes (HPV16, 18, 31, 33, 35, 52, and 58) using a pool of genotype-specific probes. Our recent studies in OPSCC have shown that the RNAscope HPV assay is highly sensitive and specific in determining HPV status on FFPE tissues12-17, and also informs prognosis in OPSCC12,16.
The principle of the RNAscope technology has been previously described5. Here, we describe the complete RNAscope assay protocol and demonstrate its use in the detection of HR-HPV in FFPE tumor tissue sections.

&#160;
<table border="0" cellpadding="0" cellspacing="0" width="580">
	<colgroup>
		<col span="4" />
	</colgroup>
	<tbody>
		<tr height="39">
			<td height="60" rowspan="2" style="height:60px;width:145px;">SuperFrost Plus slides</td>
			<td rowspan="2" style="width:145px;">Fisher Scientific</td>
			<td rowspan="2" style="width:145px;">12-550-15</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:145px;">HybEZ Oven, Tray, and Rack</td>
			<td style="width:145px;">Advanced Cell Diagnostics</td>
			<td style="width:145px;">310011, 310012, 310014</td>
			<td style="width:145px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:145px;">RNAscope 2.0 FFPE Reagent Kit - Brown</td>
			<td style="width:145px;">Advanced Cell Diagnostics</td>
			<td style="width:145px;">310035</td>
			<td style="width:145px;"></td>
		</tr>
		<tr height="81">
			<td height="81" style="height:81px;width:145px;">RNAscope HPV-HR7 Probe for HPV 16,18,31,33,35,52 and 58, E6/E7 mRNA</td>
			<td style="width:145px;">Advanced Cell Diagnostics</td>
			<td style="width:145px;">312351</td>
			<td style="width:145px;"></td>
		</tr>
		<tr height="61">
			<td height="61" style="height:61px;width:145px;">ImmEdge Hydrophobic Barrier Pen</td>
			<td style="width:145px;">Vector Laboratory</td>
			<td style="width:145px;">H-4000</td>
			<td style="width:145px;"></td>
		</tr>
		<tr height="59">
			<td height="80" rowspan="2" style="height:80px;width:145px;">100% EtOH</td>
			<td rowspan="2" style="width:145px;">American Master Tech Scientific</td>
			<td rowspan="2" style="width:145px;">ALREAGAL</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="20">
			<td height="41" rowspan="2" style="height:41px;width:145px;">Xylene&#160;</td>
			<td rowspan="2" style="width:145px;">Fisher Scientific</td>
			<td rowspan="2" style="width:145px;">X3P-1GAL</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="59">
			<td height="80" rowspan="2" style="height:80px;width:145px;">Gill&#8217;s Hematoxylin I</td>
			<td rowspan="2" style="width:145px;">American Master Tech Scientific</td>
			<td rowspan="2" style="width:145px;">HXGHE1LT</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="59">
			<td height="80" rowspan="2" style="height:80px;width:145px;">Ammonia hydroxide</td>
			<td rowspan="2" style="width:145px;">Sigma-Aldrich</td>
			<td rowspan="2" style="width:145px;">320145-500mL</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="59">
			<td height="80" rowspan="2" style="height:80px;width:145px;">Cover Glass 24x50 mm</td>
			<td rowspan="2" style="width:145px;">Fisher Scientific</td>
			<td rowspan="2" style="width:145px;">12-545-F</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="20">
			<td height="41" rowspan="2" style="height:41px;width:145px;">Hot Plate</td>
			<td rowspan="2" style="width:145px;">Fisher Scientific</td>
			<td rowspan="2" style="width:145px;">11-300-49SHP</td>
			<td rowspan="2" style="width:145px;"></td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="99">
			<td height="120" rowspan="2" style="height:120px;width:145px;">Drying Oven</td>
			<td rowspan="2" style="width:145px;"></td>
			<td rowspan="2" style="width:145px;"></td>
			<td rowspan="2" style="width:145px;">Capable of holding temperature at 60 &#177; 1&#176;C</td>
		</tr>
		<tr height="21">
		</tr>
		<tr height="99">
			<td height="120" rowspan="2" style="height:120px;width:145px;">Water Bath</td>
			<td rowspan="2" style="width:145px;"></td>
			<td rowspan="2" style="width:145px;"></td>
			<td rowspan="2" style="width:145px;">Capable of holding temperature at 40 &#177; 1&#176;C</td>
		</tr>
		<tr height="21">
		</tr>
	</tbody>
</table>

rnascope for in situ detection of transcriptionally active human papillomavirus in head and neck squamous cell carcinoma

The &#39;gold standard&#39; for oncogenic HPV detection is the demonstration of transcriptionally active high-risk HPV in tumor tissue. However, detection of E6/E7 mRNA by quantitative reverse transcription polymerase chain reaction (qRT-PCR) requires RNA extraction which destroys the tumor tissue context critical for morphological correlation and has been difficult to be adopted in routine clinical practice. Our recently developed RNA in situ hybridization technology, RNAscope, permits direct visualization of RNA in formalin-fixed, paraffin-embedded (FFPE) tissue with single molecule sensitivity and single cell resolution, which enables highly sensitive and specific in situ analysis of any RNA biomarker in routine clinical specimens. The RNAscope HPV assay was designed to detect the E6/E7 mRNA of seven high-risk HPV genotypes (HPV16, 18, 31, 33, 35, 52, and 58) using a pool of genotype-specific probes. It has demonstrated excellent sensitivity and specificity against the current &#39;gold standard&#39; method of detecting E6/E7 mRNA by qRT-PCR. HPV status determined by RNAscope is strongly prognostic of clinical outcome in oropharyngeal cancer patients.

RNAscope HPV assay workflow
The RNAscope assay has a highly streamlined workflow that is similar to IHC (Figure 1). It consists of four major steps: pretreatments, hybridization, signal amplifications, and detection. It employs a unique probe design strategy that ensures high fidelity signal amplification5. In the RNAscope HPV assay, the seven HR-HPV probe sets are pooled, all recognized by the same signal amplification system linked to horseradish peroxidase (HRP). Specific hybridization signals are detected as brown precipitates formed by HRP catalyzed chromogenic reaction using DAB as substrate, which can be readily visualized by standard bright field microscopy.
Representative staining for HPV detection
Figure 2 shows example images from stained FFPE sections of head and neck squamous cell carcinoma. In the HPV-positive case (Figure 2A), the HR-HPV probes detected strong punctate signals specifically in the tumor cells. The UBC probe detected numerous punctate cytoplasmic signals in both tumor cells and stromal cells (Figure 2B). The bacterial gene dapB probe demonstrated a clean background (Figure 2C). In the HPV-negative case, both the HR-HPV probe and the dapB probe detected no signals (Figures 2D and&#160;2F), whereas strong signals were detected using the UBC probe (Figure 2E). In this assay, UBC serves as positive control to assess tissue RNA quality and dapB as negative control for background signals. The scoring for HPV status determination involves examining all three slides for each case. The staining level on the negative control slide (dapB) slide is used as cutoff: HPV positivity is defined by the presence of punctate cytoplasmic and/or nuclear staining that was above the signal on the dabpB slide.
<img alt="Figure 1" fo:content-width="5in" fo:src="/files/ftp_upload/51426/51426fig1highres.jpg" src="/files/ftp_upload/51426/51426fig1.jpg" /> 
Figure 1. Flowchart of RNAscope assay. Illustration of RNAscope assay workflow. The RNAscope assay contains 4 major steps, pretreatments, target probe hybridization, signal amplification and signal detection. The entire assay procedure can be completed in 8 hr. <a href="https://www.jove.com/files/ftp_upload/51426/51426fig1highres.jpg" target="_blank">Click here to view larger image.</a>
<img alt="Figure 2" fo:content-width="5in" fo:src="/files/ftp_upload/51426/51426fig2highres.jpg" src="/files/ftp_upload/51426/51426fig2.jpg" /> 
Figure 2. Example images of RNAscope-stained slides. FFPE sections stained with probes for HR-HPV, UBC (positive control) and dapB (negative control) from two HNSCC cases. A-C. HPV-positive case. A, HR-HPV E6/E7 mRNA expression in tumor cells. Inset, 40X&#160;magnification to show punctate signals. B and C)&#160;adjacent tissue sections showing positive UBC staining (B) and negative for dapB (C), respectively. D-F)&#160;HPV-negative case. D)&#160;no staining for HPV E6/E7 mRNA, similar to the dapB negative control (F). E) UBC positive staining. <a href="https://www.jove.com/files/ftp_upload/51426/51426fig2highres.jpg" target="_blank">Click here to view larger image.</a>

Watch this Scientific Journal Video about RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma at JoVE.com

RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma

The presence of high-risk HPV in head and neck tumor tissue is associated with favorable outcomes. The recently developed RNA in situ hybridization technique called RNAscope allows direct visualization of HPV E6/E7 mRNA in FFPE tissue sections.

RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma

The &#39;gold standard&#39; for oncogenic HPV detection is the demonstration of transcriptionally active high-risk HPV in tumor tissue. However, detection ...

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27.1K Views.  Advanced Cell Diagnostics, Inc.. The presence of high-risk HPV in head and neck tumor tissue is associated with favorable outcomes. The recently developed RNA in situ hybridization technique called RNAscope allows direct visualization of HPV E6/E7 mRNA in FFPE tissue sections.

Video: RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma

Multi-photon Imaging of Tumor Cell Invasion in an Orthotopic Mouse Model of Oral Squamous Cell Carcinoma

Loco-regional invasion of head and neck cancer is linked to metastatic risk and presents a difficult challenge in designing and implementing patient management strategies. Orthotopic mouse models of oral cancer have been developed to facilitate the study of factors that impact invasion and serve as model system for evaluating anti-tumor therapeutics. In these systems, visualization of disseminated tumor cells within oral cavity tissues has typically been conducted by either conventional histology or with in vivo bioluminescent methods. A primary drawback of these techniques is the inherent inability to accurately visualize and quantify early tumor cell invasion arising from the primary site in three dimensions. Here we describe a protocol that combines an established model for squamous cell carcinoma of the tongue (SCOT) with two-photon imaging to allow multi-vectorial visualization of lingual tumor spread. The OSC-19 head and neck tumor cell line was stably engineered to express the F-actin binding peptide LifeAct fused to the mCherry fluorescent protein (LifeAct-mCherry). Fox1nu/nu mice injected with these cells reliably form tumors that allow the tongue to be visualized by ex-vivo application of two-photon microscopy. This technique allows for the orthotopic visualization of the tumor mass and locally invading cells in excised tongues without disruption of the regional tumor microenvironment. In addition, this system allows for the quantification of tumor cell invasion by calculating distances that invaded cells move from the primary tumor site. Overall this procedure provides an enhanced model system for analyzing factors that contribute to SCOT invasion and therapeutic treatments tailored to prevent local invasion and distant metastatic spread. This method also has the potential to be ultimately combined with other imaging modalities in an in vivo setting.

A comprehensive overview of the techniques involved in generating a mouse model of oral cancer and quantitative monitoring of tumor invasion within the tongue through multi-photon microscopy of labeled cells is presented. This system can serve as a useful platform for the molecular assessment and drug efficacy of anti-invasive compounds.

Loco-regional invasion of head and neck cancer is linked to metastatic risk and presents a difficult challenge in designing and implementing patient ...

Primary Culture of Human Vestibular Schwannomas

Vestibular schwannomas (VSs) represent Schwann cell (SC) tumors of the vestibular nerve, compromising 10% of all intracranial neoplasms. VSs occur in either sporadic or familial (neurofibromatosis type 2, NF2) forms, both associated with inactivating defects in the NF2 tumor suppressor gene. Treatment for VSs is generally surgical resection or radiosurgery, however the morbidity of such procedures has driven investigations into less invasive treatments. Historically, lack of access to fresh tissue specimens and the fact that schwannoma cells are not immortalized have significantly hampered the use of primary cultures for investigation of schwannoma tumorigenesis. To overcome the limited supply of primary cultures, the immortalized HEI193 VS cell line was generated by transduction with HPV E6 and E7 oncogenes. This oncogenic transduction introduced significant molecular and phenotypic alterations to the cells, which limit their use as a model for human schwannoma tumors. We therefore illustrate a simplified, reproducible protocol for culture of primary human VS cells. This easily mastered technique allows for molecular and cellular investigations that more accurately recapitulate the complexity of VS disease.

Vestibular Schwannomas (VSs) are non-malignant tumors of Schwann cell (SC) origin, associated with mutations in the NF2 tumor suppressor gene. We report a reproducible, efficient protocol for primary human VS cell culture that allows for molecular and cellular experimental manipulation and analysis and recapitulates the heterogeneous nature of human disease.

Vestibular schwannomas (VSs) represent Schwann cell (SC) tumors of the vestibular nerve, compromising 10% of all intracranial neoplasms. VSs occur in ...

The In Ovo Chick Chorioallantoic Membrane (CAM) Assay as an Efficient Xenograft Model of Hepatocellular Carcinoma

The chick chorioallantoic membrane (CAM) begins to develop by day 7 after fertilization and matures by day 12. The CAM is naturally immunodeficient and highly vascularized, making it an ideal system for tumor implantation. Furthermore, the CAM contains extracellular matrix proteins such as fibronectin, laminin, collagen, integrin alpha(v)beta3, and MMP-2, making it an attractive model to study tumor invasion and metastasis. Scientists have long taken advantage of the physiology of the CAM by using it as a model of angiogenesis. More recently, the CAM assay has been modified to work as an in vivo xenograft model system for various cancers that bridges the gap between basic in vitro work and more complex animal cancer models. The CAM assay allows for the study of tumor growth, anti-tumor therapies, and pro-tumor molecular pathways in a biologically relevant system that is both cost- and time-effective. Here, we describe the development of CAM xenograft model of hepatocellular carcinoma (HCC) with embryonic survival rates of up to 93% and reliable tumor take leading to growth of three-dimensional, vascularized tumors.

The In Ovo Chick Chorioallantoic Membrane CAM Assay as an Efficient Xenograft Model of Hepatocellular Carcinoma

The chick chorioallantoic membrane (CAM) is immunodeficient and highly vascularized, making it a natural in vivo model of tumor growth and angiogenesis. In this protocol, we describe a reliable method of growing three-dimensional, vascularized hepatocellular carcinoma (HCC) tumors using the CAM assay.

The chick chorioallantoic membrane (CAM) begins to develop by day 7 after fertilization and matures by day 12. The CAM is naturally immunodeficient and ...

Isolation and Characterization of a Head and Neck Squamous Cell Carcinoma Subpopulation Having Stem Cell Characteristics

Despite advances in the understanding of head and neck squamous cell carcinomas (HNSCC) progression, the five-year survival rate remains low due to local recurrence and distant metastasis. One hypothesis to explain this recurrence is the presence of cancer stem-like cells (CSCs) that present inherent chemo- and radio-resistance. In order to develop new therapeutic strategies, it is necessary to have experimental models that validate the effectiveness of targeted treatments and therefore to have reliable methods for the identification and isolation of CSCs. To this end, we present a protocol for the isolation of CSCs from human HNSCC cell lines that relies on the combination of two successive cell sortings performed by fluorescence activated cell sorting (FACS). The first one is based on the property of CSCs to overexpress ATP-Binding Cassette (ABC) transporter proteins and thus exclude, among others, vital DNA dyes such as Hoechst 33342. The cells sorted with this method are identified as a &#34;side population&#34; (SP). As the SP cells represent a low percentage (&#60;5%) of parental cells, a growing phase is necessary in order to increase their number before the second cell sorting. The next step allows for the selection of cells that possess two other HNSCC stem cell characteristics i.e. high expression level of the cell surface marker CD44 (CD44high) and the over-expression of aldehyde dehydrogenase (ALDHhigh). Since the use of a single marker has numerous limitations and pitfalls for the isolation of CSCs, the combination of SP, CD44 and ALDH markers will provide a useful tool to isolate CSCs for further analytical and functional assays requiring viable cells. The stem-like characteristics of CSCs was finally validated in vitro by the formation of tumorispheres and the expression of &#946;-catenin.

Understanding the role of cancer stem-like cells in tumor recurrence and resistance to therapies has become a topic of great interest in the last decade. This article describes the isolation and characterization of the sub-population of cancer stem-like cells from head and neck squamous carcinoma cell lines (HNSCC).

Despite advances in the understanding of head and neck squamous cell carcinomas (HNSCC) progression, the five-year survival rate remains low due to local ...

Posterior Semicircular Canal Approach for Inner Ear Gene Delivery in Neonatal Mouse

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of inner ear gene therapy is to find a delivery method which results in consistent transduction efficiency of targeted cell types while minimizing hearing loss. In this study, we describe the posterior semicircular canal approach as a viable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear. The easy anatomic identification of the posterior semicircular canal, as well as minimal manipulation of the temporal bone required, make this surgical approach an attractive option for inner ear gene delivery.

In this study, we describe the posterior semicircular canal approach as a reliable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear.

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of ...

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Meni&#232;re's Disease Ears and Normal Hearing Ears

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this patient group but has yet to be confirmed. This protocol describes a method of in vivo evaluation of neural changes especially well suitable for cranial nerve analysis using magnetic resonance imaging (MRI). MD-patients and normal hearing persons were examined in a 3-T MR-scanner using a scan protocol including strongly T2-weighted 3D gradient-echo-sequence (3D-CISS). In the patient group, MD was additionally confirmed using MRI-based assessment of endolymphatic hydrops. Morphometric analysis was performed using a freeware DICOM viewer. Evaluation of cranial nerves included measurements of cross-sectional areas (CSAs) of the nerves at different levels as well as orthogonal diametric measurements.

&lt;em&gt;In Vivo&lt;/em&gt; Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Meni&amp;#232;re&#039;s Disease Ears and Normal Hearing Ears

To evaluate morphological changes of cranial nerves such as loss of neural structures or swelling of cranial nerves in Meni&#232;re&#39;s Disease (MD) or in healthy persons in vivo, a protocol of evaluation has been developed using magnetic resonance imaging (MRI). Additional MRI-based confirmation of MD was performed.

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this ...

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes have been available for years in many surgical fields. We used the female (because they are easy to handle for the procedure) Yorkshire pigs for the head and neck reconstruction by harvesting the deep inferior epigastric artery perforator or the superior epigastric artery perforator flap. The anastomosis site (neck skin defect or tracheal wall defect) was prepared via the dissection of the common carotid artery and the internal jugular vein, in which 3.5&#215; loupe magnification was used for anastomosis as we use on human cases in real life. This procedure demonstrates a new training method using a reliable learning model and provides a detailed anatomy in a live scenario. We focused on the ischemia time, harvesting, vessel anastomosis, and designing the flap to fit the defect site. This model improves tissue handling and with the use of proper instruments can be repeated many times so that the surgeon is fully confident before starting the surgery on humans.

Here we present a protocol for the use of the pig superior epigastric artery perforator flap as a learning module for head and neck microvascular reconstruction.

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes ...

The Chick Chorioallantoic Membrane In Vivo Model to Assess Perineural Invasion in Head and Neck Cancer

Perineural invasion is a phenotype in which cancer surrounds or invades the nerves. It is associated with poor clinical outcome for head and neck squamous cell carcinoma and other cancers. Mechanistic studies have shown that the molecular crosstalk between nerves and tumor cells occurs prior to physical interaction. There are only a few in vivo models to study perineural invasion, especially to investigate early progression, before physical nerve-tumor interactions occur. The chick chorioallantoic membrane model has been used to study cancer invasion, because the basement membrane of the chorionic epithelium mimics that of human epithelial tissue. Here we repurposed the chick chorioallantoic membrane model to investigate perineural invasion, grafting rat dorsal root ganglia and human head and neck squamous cell carcinoma cells onto the chorionic epithelium. We have demonstrated how this model can be useful to evaluate the ability of cancer cells to invade neural tissue in vivo.&#160;

The Chick Chorioallantoic Membrane In Vivo Model to Assess Perineural Invasion in Head and Neck Cancer

Perineural invasion is an aggressive phenotype for head and neck squamous cell carcinomas and other tumors. The chick chorioallantoic membrane model has been used for studying angiogenesis, cancer invasion, and metastasis. Here we demonstrate how this model can be utilized to assess perineural invasion in vivo.

Perineural invasion is a phenotype in which cancer surrounds or invades the nerves. It is associated with poor clinical outcome for head and neck squamous ...

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course &#34;Lary-Gym&#34;. Further perspectives on robotic surgical training are described.

The purpose of this paper is to illustrate how to organize a reproducible laboratory for laryngeal surgery on affordable and closely similar animal laryngeal models in order to improve anatomical and surgical knowledge and skills.

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is ...

Preparation of Decellularized Kidney Scaffolds in Rats

Tissue engineering is a cutting-edge discipline in biomedicine. Cell culture techniques can be applied for regeneration of functional tissues and organs to replace diseased or damaged organs. Scaffolds are needed to facilitate the generation of three-dimensional organs or tissues using differentiated stem cells in vivo. In this report, we describe a novel method for developing vascularized scaffolds using decellularized rat kidneys. Eight-week-old Sprague-Dawley rats were used in this study, and heparin was injected into the heart to facilitate flow into the renal vessels, allowing heparin to perfuse into the renal vessels. The abdominal cavity was opened, and the left kidney was collected. The collected kidneys were perfused for 9 h using detergents, such as Triton X-100 and sodium dodecyl sulfate, to decellularize the tissue. Decellularized kidney scaffolds were then gently washed with 1% penicillin/streptomycin and heparin to remove cellular debris and chemical residues. Transplantation of stem cells with the decellularized vascular scaffolds is expected to facilitate the generation of new organs. Thus, the vascularized scaffolds may provide a foundation for tissue engineering of organ grafts in the future.

This protocol introduces a method to develop a scaffold using decellularized rat kidneys. The protocol includes decellularization and recellularization processes to confirm bioavailability. Decellularization is performed using Triton X-100 and sodium dodecyl sulfate.

Tissue engineering is a cutting-edge discipline in biomedicine. Cell culture techniques can be applied for regeneration of functional tissues and organs ...