Chapter 14 | Dual Color CISH and FISH to CISH Conversion
Ulla Henriksen PhD, Sven Maller PAD and Andreas Schonau MS, EBA
Fluorescence in stu hybridization (FISH) isa sansive yet rallablo,
technique for evaluating gene status on a cell-to-cell basis. The
technique has been utilized as a research tool for more than 20 yea
to evaluate the presence or absence of speciic DNA sequences on
‘chromosomes (1). The method has become popular as a clagnostic
{oo in clinical oncology. In tho eld of pathology, FISH has boon
‘applied as an alternative or adjunct to IHC tasting, and the method has
‘been shown to have a prognostic and a predictive value with regard to
certain cancer markers 2,8). Recently, anew ISH technique based
‘on chromogenic signals instead of fuorescont signals has evolved.
“The technique, chromogenic in stu hybridization (CISH), has proven
‘qualities with respect to ease of use that might explain the recent
growth in popularity:
1. CISH results are easly intarpreted bythe use ofa bright fld
‘eroscope which is generally used in elagnosticaboratres.
2. CISH enables viualizaton ofthe nucious and i also able to
istngulsh Invasive from in stu carcinomas.
8. CISH signals do not general fade over tm allowing the tssue
‘samples tobe archived and reviowod itr.
4. CISH resembles IHC to a largo extent (as opposed to FISH) due
to the use of conventional counterstains, e.g hematoxylin, for
Visualization of issue morphology
Because CISH combines the genstic information from FISH with the
Visualization and interpretation resembling IHC, the CISH technique
{s a practical and user frendly alternative to FISH.
Chromogenic In Situ Hybridization
‘The frst description ofthe C1SH procedure asa practical atsmative
to FISH for the detection of genetic alterations was published in
2000 (4). Since then, many publications comparing FISH and CISH
have emerged and all have reached the conclusion that CISH ls an
‘accurate, reproducibie technique with high concordance to FISH (6-9).
‘The technique is as senstive as FISH with reference to borderine and
'ow ampitication samps (9). Chromogenic visualization (colorimetric
‘mathod) is based on enzyme-conjugated antibodies thet recognize
{the target of interest. Reaction of substrates with onzymas euch as
horseradish peroxidase (HAP) andlor akaline phosphatase (AP) leads
to.chromogen precipitates, which then can be dotectod with a bright-
field microscope, Another approach for brightfeld evaluation of the
‘colorimetric method Is metallographic in stu hybridization by which
«targets visualized using a probe or antibody that deposits matal
‘solectively at its binding site. One metallographic method includes
sliverenhanced in situ hybxcization (or ISH). SISH is based on the
‘same basic principle as CISH, but with SISH the signal appears asa
black coloration due to siver precipitation (1,11). Athough both CISH
‘and SISH have their advantages, they sufer from one drawback. In
the tradtonal CISH/S'SH procedures described so fr, only signals
cf one color can be detected on each side. As a consequence, the
target gone and tho roferance signals are detected on two separate
slides, which sometimes can be cumbersome, DuoCiSH™, a dua calor
CCISH kit dovolopod by Dako Denmark A/S, overcomes this barier
by simpliying the interpretation of cases with bordertine gene copy
‘number and making it sasir to visualize two probes simultancously
{.g.theabiltyoditinguish between rus gene ampiiction/Sletion
‘and chromosomal aneuploidy) onthe same slide.
{At prasont, only few procedures enabling datetion ot argot and
reference gene on the same side apart from DuoCISH™ have been
Sarl uted wich oles reayauton wit orl
iets Fay sine CI an aoe the FISH pce
possible to redevelop an already mounled and developed FISH sido
{or reinteptetation(ee0 gure 2).
Dual Color CISH and FISH to CISH Conversion
Applications of Dako DuoCISH™
‘Dako DucCISH™ can be applied to samples hybridized with a Texas,
FRed-labeled probe and a FITC-labeled probe, Although the kit has
‘not yet been validated against any specific probe, the kt reagents
‘can be used to visualize genetic alterations, inckiding amplification,