Formalin-fixed paraffin embedded tissues are used for pathologic diagnosis and are archived for a long period of time. These samples could be used for molecular research and diagnostic purposes. However, this type of preservation makes it difficult to perform molecular analysis on these type of samples due to nucleic acid modification by significant protein-protein and protein-nucleic acid crosslinks, following formalin/paraformaldehyde fixation. The fixation process itself doesn’t cause nucleic acid fragmentation (
12,
13), instead, the embedding process, which requires high temperature and vacuum for the paraffin penetrance to the tissue, may lead to chemical reactions, which subsequently modify RNA and DNA. These modifications can cause fragmentation over time (
14).
Investigation of gene expression profile can be performed by detecting specific RNA expression levels, using a variety of methods, including microarray analysis, qPCR, and southern blotting. mRNA comprises only of 1% to 3% of total RNA, by a weak extracting method from FFPE samples, gene expression pattern is not readily detectable in this sample even with the most sensitive methods. On the other hand, ribosomal RNA makes up > 80% of total RNA samples, with the majority comprised by the 28S and 18S rRNA species (in mammalian cells).
In this study, the researchers sought to obtain a suitable protocol for RNA extraction FFPE tissue by using RNA extraction kits from the Roche Company. The study compared the RNA extraction method proposed by Roche kit with current conventional methods, such as tissue slices, as well as the proteinase K.
Mark Abramowitz et al. in their study, indicated that proteinase K could improve RNA extraction yield (
15). In this study, the researchers attempted to use a combination of 2 different types of proteinase K to investigate the effect of Proteinase K on RNA degradation during the RNA extraction process. Comparing Intact RNA electrophoresis on agarose gel indicated that 28S and 18S rRNA bands resolution was increased by adding proteinase K (eukaryotic ribosomal RNA).
Commonly, 28S rRNA band should be about twice as strong as the 18S rRNA band. This 2:1 ratio (28S:18S) shows that the RNA is completely intact. RNA from FFPE samples is usually more degraded than RNA from fresh tissues. Partially degraded RNA appears as smeared or does not exhibit the 2:1 ratio of high quality RNA (
16). The current results showed that combination of 2 proteinase K increases the yield and also reduces the degradation of RNA. Proteinase K can improve the efficiency of RNA extraction by rapid degradation of DNase and RNase released from the tissue during the RNA extraction process (
17).
This study also checked the effect of tissue storage time on RNA extraction yield. In previous studies scientists showed that formaldehyde crosslinks with amino groups in nucleic acid bases and proteins in irreversible manner does not degrade RNA (
18). However, over time, the methylene bridges of formaldehyde with proteins and DNA will increase. This does not effect the length of the extracted RNA yet it has a negative effect on the performance of reverse transcription enzyme, by disrupting base pairing and the process of converting RNA to cDNA. To clarify this effect, this study considered the
β-actin gene amplification in 78 formalin fixed tissue samples with a lifetime of 1 to 3 years and less than 12 months. B-actin mRNA quantification indicated that samples with less than 12 months had a better quantity of mRNA than samples with 1 to 3 years of lifespan. In a similar study in 2014, Soo Kyung et al. reported that long storage time limits the RNA extraction yield (
19). However, Kokkat et al. in their study in 2013 reported that long storage time had no effect on RNA extraction yield from lung, salivary glands, and thyroid tissues (
20). The following recommendation should be considered if one wants to use FFPE specimens for gene expression analysis, in addition to histopathology: RNA should be isolated within 1 year after embedding, i.e. before degradation during storage of FFPE samples and the application of this sample should be limited (
18).
Some kits use column filters to extract RNA. Enormous amounts of tissue can close the pores of these filters, resulting failure to extract RNA. Also, to extract RNA from tissue, it should be thoroughly homogenized to increase the efficiency of RNA extraction and prevent clogging of filters (
21). The remarkable finding of this study was that less time of incubation for extracting RNA led to less tissue breakdown. By applying this effect, the efficiency of RNA extraction will increase.
In this study, the researchers tried to keep a constant volume of tissue mass in accordance with the kit recommendations (
10). It was attempted to provide more homogeneous tissue with smaller sections. The results indicated that a smaller section size could improve extraction efficiency (
Figure 2). According to this study, homogeneity of paraffin samples as well as the use of proteinase K could increase the RNA extraction efficiency. In this study, FFPE was used from breast tissue specimens and it was assumed that similar results could be obtained from other tissue specimens.