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Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009
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Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

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Page 1: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Duke University School of Medicine

Immunology Quality Assessment Center

Tania Garrelts / Raul Louzao

ACTG Meeting

June 23,2009

Page 2: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

OUTLINE

• Role of IQA

• Frequently Asked Questions1) Reagents

2) Equipment

3) Cell counts

• Site Visit Findings

Page 3: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is the role of the IQA?

• To assess the ability of laboratories to process and store viable peripheral blood mononuclear cells (PBMC) for use in various immunology and virology based assays.

• To provide assistance to faltering laboratories.

• Currently there are 63 domestic and 21 international laboratories enrolled in the program.

Page 4: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How is the assessment accomplished?

• The assessment is accomplished by comparing the viability of PBMCs and the viable yield before freezing and after thawing.

• Proper processing and freezing is a critical component of the process for storage of viable PBMCs.

Page 5: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How often do participating sites should submit samples?

• Every three months (March, June, September

and December), frozen PBMCs must be shipped

from the participating laboratory to the NIAID

Immunology Quality Assessment Program (IQA)

• Shipping schedule can be found at our website

(iqa.center.duke.edu)

Page 6: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What should the participating labs achieve?

Network*Minimum

Viability (%)Minimum Viable

Recovery (%)

ACTG 80 80

IMPAACT 75 70

*Laboratories who serve both the ACTG and IMPAACT must conform to the more stringent criteria of the ACTG (80% viability and 80% viable cell recovery)

Page 7: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Frequently Asked Questions About

The Cryopreservation Of

Peripheral Blood Mononuclear Cells

Page 8: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Are Ficoll–Hypaque and Histopaque-1077 the same?

Page 9: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Are Ficoll–Hypaque and Histopaque-1077 the same?

• IQA currently uses Histopaque-1077 by

Sigma Aldrich because of the known density

gradient, 1.077 ± 0.001 gram/ml which is

between that of plasma and red blood cells. • One part of blood to one of part of buffer,

equal part of density gradient.

Page 10: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is the difference between Ficoll Ovelayering and Undelayering

Technique?

Page 12: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Video of Overlaying Technique

Manual Ficoll using Overlay and Underlay Methods

Click on the link bellow

http://youtu.be/-SqlIMLUfcI

Page 13: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Video of Overlaying Technique

Click on Link http://youtu.be/andvFWRzQ0c

Page 14: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.
Page 15: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Insufficient amount of density gradient

Page 16: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Buffy Coat Isolation

Page 17: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Good versus Poor Mononuclear cell isolation

Page 18: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Why do I have to remove the supernatant (HBSS-Plasma layer)?

• Removing the PBMC band with the

supernatant will promote contamination by

platelets and plasma proteins.

Leave Platelets + proteins= cell clumps

Page 19: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Why I can’t remove all the density gradient?

• Removing the excess amount of Ficoll with the

mononuclear layer will increase a chance of

granulocyte contamination.

Granulocyte contamination = misleading cell counts

Page 20: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How much supernatant should I leave before isolate the PBMC band?

• Remove the plasma-HBSS fraction down to within approximately 1-2 cm of the PBMC band.

Page 21: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Common used techniques to isolate theMononuclear Layers.

Page 22: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.
Page 23: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Should I remove the cells stuck to the side of the test tube?

• From previous experience the cells attached

to the inner walls of the tubes are

erythrocytes, cell debri and platelets.

• The density gradient will separate the viable

lymphocytes and monocytes.

Page 24: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What should I do if I accidently mix the layered blood with ficoll?

• Don’t Panic.

• Finish Mixing the blood with ficoll. (New mixture)

• Set up new ficoll tubes and overlay or underlay them with the new mixture.

Page 25: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Why do we need to use a centrifuge with swinging -bucket rotor?

• In swinging bucket rotors, the sample tubes are loaded into individual buckets that hang vertically while the rotor is at rest. When the rotor begins to rotate the buckets swing out to a horizontal position This rotor is particularly useful when samples are to be resolved in density.

Page 26: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Can a vertical rotor be used with Ficoll?

• In vertical rotors, sample tubes are held in vertical position during rotation. This type of rotor is not suitable for pelleting applications.

Page 27: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Difference between Vertical versus Swinging-Bucket Rotor

Page 28: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What temperature should I use during centrifugation?

• During separation the centrifuge temperature

should be control between 18-25 °C because the

density components changes with temperature.

For Example: Centrifugation at 4 °C may result in

poor cell recovery due to cell clumping.

Page 29: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What speed and time should I use in my centrifuge?

• If using Sigma Ficoll centrifuge at 800 x g for 30 minutes. GE Ficoll centrifuge at 400 x g for 40 minutes.

• If using Cell Separation tube with Frit Barrier (CSTFB) , centrifuge at 800 x g for 15 minutes or 1000 x g for 10 minutes.

• No Brake, if brake is on it will disrupt the layers.

Page 30: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What should I check if I do not get a PBMC layer?

Check:• The centrifuge speed and time. • The centrifuge brake was off.• The centrifuge buckets are not sticking.• If the centrifuge buckets are balanced

properly.• Maintenance record for last calibration.

Page 31: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How much buffer do I need for my cell wash and why?

• For the 1st cell wash, measure your isolated PBMC layer and the balanced salt solution volume should be add at least 3 times the volume of the harvest. Do not exceed 45 ml.

• Centrifuge at 300 x g for 10 minutes.

Low centrifugation + QS buffer= removes platelets and plasma contamination

Page 32: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is the total number of cell washes?

• Minimum two cell washes, depending on the tech

buffy coat isolation technique.

• Decant or aspirate the medium solution.

• Resuspend your pellet by gently pipetting them

up and down, or finger flick.

• Gently mix the solution by inverting the test tube.

Page 33: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Video of incorrect pellet re-suspension

Click on Linkhttp://youtu.be/4wuSfHmPZ-k

Page 34: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Video of gentle pellet re-suspension

Click on Linkhttp://youtu.be/4WObBqpJD0I

Page 35: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How much buffer is left in my test tube after I decant the supernatant?

• The amount of balanced buffer left over with

the pellet after the HBSS is decanted is

approximately 200 to 400uls.

• You have enough buffer to gently finger flick your

cells.

Page 36: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What volume of buffer should I use to re-suspend my pellets?

• If you have multiple tubes combine the pellets

by adding 1ml of buffer on each tube.

• Depending on the size of the cell pellet, the

re-suspension volume would range from 10%

to 50% of the usable whole blood.• For example:

Starting volume of whole blood is 17 mls. IQA would re-suspend cells in 5 mls ~30%

Page 37: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What type of pipettes and tips do I need to have?

Page 38: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is the Forward Pipetting Technique?

Page 39: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What are the effects of how I pipette?

Page 40: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What are some common pipetting technique errors?

— Human Factor, working too quickly.

— Removing the pipette tip before sample aspiration is

complete.

— Angle pipettes takes up too much liquid. Keep

vertical.

— Releasing the plunger too rapidly.

— Not pre-wetting a new tip.

Page 41: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What type of pipette aid should I use?

Page 42: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What type of plasticware should I use?

• Avoid using high binding plastics such

as polystyrene to prevent monocyte

adhesion.

• Use Polypropylene

Page 43: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Are powered gloves acceptable for processing PBMCS?

• Powered gloves will contaminate the process

by activating monocytes which will cause a

lower percent recovery.

Page 44: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is the pH, solution storage requirement, and length of time that cells can stay in

trypan blue?

• pH: 7.0 – 7.4

• Storage requirement: 15-30 °C. Some of vendors recommend that it be protected from light and filter after prolonged storage.

• Cells should be count within 3-10 minutes of mixing with trypan blue, longer incubation will result in cell death and low viability counts.

Page 45: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What are some common problems with a Hemacytometer?

1. Dirty hemacytometer or cover slip, clean with 70% alcohol and lens paper.

2. The chamber may have been loaded incorrectly.

3. The cover slip may have been bumped.

4. Insufficient mixing of sample.

5. Using a wrong cover slip.

Page 46: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Definition for Dilution

• Dilutions are expressed as the ratio of the quantity of a desired solute (serum, urine, chemical solution, etc.) contained in a solvent (diluent).

For example:

A 1:10 dilution of serum was made by adding one part serum to nine parts diluent to make a total of ten parts.

volume of serum/volume of solution = [1.0 mL serum ]/[1.0 ml serum + 9.0 mL H20]

Page 47: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Video of Counting Cells

Click on Linkhttp://youtu.be/GTlAdxUX9mU

Page 48: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How to perform an accurate count?

Page 49: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Example: IQA re-suspend pellet in 5 mls

• Mix cells with buffer by inverting the tube.• Take 20 uls of cellular solution and mix with

20 uls of trypan blue. (1:2 dilution)• Load in clean hematocytomer. Wait 10

seconds, for cells to settle and stain.• Count 4 quadrants. • Record Viable and Nonviable PBMCs.

Page 50: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What are the formulas for cell counts?

Page 51: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Example

Live (L) Dead (D) Dilution Factor Final Volume

488 20 1:2 5 ml

Answer: 488/4x2x5x10^4=12.2 x10^6 (total cell concentration)

Cell concentration per ml=488/4x2x10^4=2.44 cells/ml

Percent Viability= L/L+Dx 100 488/488+20=488/508 =0.96x100=96%

Page 52: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.
Page 53: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

10X Objective with Cells

Page 54: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

What is purpose of using DMSO?

Serves as a cryoprotective agent, it helps dehydrate the cells prior to intracellular freezing.

Page 55: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How much DMSO do I need to add to cryopreservation media?

• The cryopreservation solution (CPS) is composed

by 10% DMSO and 90% FBS.

• Make sure CPS is chilled prior to adding to cells.

DMSO is highly toxic and produces an exothermic

reaction.

Page 56: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Rate Control Freezer

Page 57: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Stratacooler versus Mr. Frosty

Page 58: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Cooling Rate for Mr. Frosty and Rate Control Freezer

Page 59: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Amount of Cells per vial?

Page 60: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

How do we know a reagent is stable?

• Deterioration of Ficoll and DMSO is indicated by

the appearance of a yellow color, cloudy or

particulate material in the clear solution.

• PBS is indicated by cloudiness in the clear solution.

• Fetal Bovine Serum is indicated by turbidity in the

bottle, or by microscopy.

Page 61: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Causes for Unsatisfactory Performance

• Some reagents were not properly stored according to

manufacturer recommendation.

• Several bottles of this item were found on the shelf without

receiving dates. Therefore IQA could not determine how

long reagents were stored in that environment.

• Heavy RBC contamination in their PBMC samples due to

inadequate blood and HBSS dilution. The current HBSS has

Phenol red which makes it difficult to isolate buffy coat.

Page 62: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Causes for Unsatisfactory Performance

• Having trouble aspirating the cell layer without mixing the density gradient media.

• Mr. Frosty had an insufficient amount of isopropyl alcohol and it was filled with wrong alcohol (Ethyl).

• Centrifuge and pipettes not calibrated. The centrifuge was set at the wrong speeds.

• Wrong cryopreservation vials, no O-ring and unknown material.

Page 63: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Work Cited

• Cross- Network PBMC Processing Procedure

• Duke University Standard Operating Procedures.

• Cryopreservation Technical Manual by Nalgene,

Nunc

• Reagent Manufacturer inserts.

• Beckman Coulter

• Guide to Pipetting by AccuTek Laboratories

Page 64: Duke University School of Medicine Immunology Quality Assessment Center Tania Garrelts / Raul Louzao ACTG Meeting June 23,2009.

Acknowledgments

IQA Center LaboratoryTom DennyAmbrosia Garcia-LouzaoRaul LouzaoJohn WongEugene UrrutiaTania GarreltsEstelle Berengier

DHVI

Tony Moody

Josh Eudley

Dongning WangKyle LieblBrooke ParkerSherry LeonardSara BrownChristie BrinkleyJamilia Davis