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7 protocols using clone g168 15

1

Immunohistochemical Analysis of MLH1 and MSH2

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Sections were dewaxed in xylene and rehydrated through a graded series of ethanol concentrations (100, 95 and 70%) to water. Antigen retrieval was performed by immersing the slides in BD Retrievagen A (pH 6.5 for MLH1 and pH 6.0 for MSH2; BD Biosciences, San Jose, CA, USA) and heating the slides in a microwave oven for 30 min at 95°C. Sections were treated with 3% hydrogen peroxide for 5 min to block endogenous peroxidase activity. Sections were washed in PBS and subsequently placed in 20% normal goat serum (G9023; Sigma-Aldrich; Merck Millipore) in PBS for 20 min to reduce non-specific staining. Sections were then incubated with monoclonal antibodies raised against human (h) MLH1 (1:10; clone G168-15; BD Biosciences) for 1 h 32 min at 42°C or against MSH2 (1:25; clone 25D12; Thermo Fisher Scientific, Inc.) for 1 h at room temperature. Subsequently, visualization was performed using the EnVision+Dual Link system-HRP (Dako) according to the manufacturer's protocol, using 3,3′-diaminobenzidine as a chromogen. Finally, slides were counterstained with hematoxylin solution. Both MLH1 and MSH2 were scored as either negative or positive staining. Tissue specimens were analyzed by two independent pathologists blinded to the conditions.
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2

Evaluating Mismatch Repair Deficiency

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We retrospectively evaluated the mismatch repair (MMR) protein status using immunohistochemical staining of MLH1 (Clone G168-15; BD Biosciences, San Jose, CA, USA) and MSH2 (FE11; Invitrogen, Carlsbad, CA, USA). Immunohistochemistry was performed as previously described [20 (link), 23 (link)]. The normal colonic crypt epithelium adjoining the tumor served as the internal control. When expressed, both MLH1 and MSH2 proteins stain positively in the nuclei [24 (link)]. Cancers negative for MLH1 or MSH2 were considered to exhibit a DNA MMR deficiency. With the help of MLH1 and MSH2 protein analyses, Marcus et al. predicted that over 90% of MSI-H cases had an MMR gene defect and that all MSS cancers exhibited intact staining with both antibodies [25 (link)].
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3

Immunohistochemical Detection of MMR Proteins

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Immunohistochemistry was performed on 2 μm paraffin sections by using monoclonal antibodies specific for MLH1 (clone G168-15, dilution 1:25, BD Pharmingen, Heidelberg, Germany), MSH2 (clone FE11, dilution 1:200, Calbiochem, Darmstadt, Germany) or MSH6 (clone44, dilution 1:50, Cell Marque, Rocklin, USA) for detecting loss of MMR protein as described previously [12 (link)]. An immunoperoxidase method was used to visualise the antibodies by labelling them with a chromogen (3-amino-9-ethylcarbazole, Dako, Glostrup, Denmark). The amount of mucosal length and surface analysed was calculated as described previously [12 (link)].
For immunohistochemical staining of immune cells in the vicinity of MMR-DCF the following antibodies were used: CD4 (clone RPA-T4, dilution 1:50, BD Pharmingen, Heidelberg, Germany), CD8 (clone 4B11, dilution 1:50, Novocastra, Wetzlar, Germany) and FoxP3 (clone 236A/E7, dilution 1:50, eBioscience, Frankfurt, Germany).
Immune cell infiltration was qualitatively assessed by two independent observers.
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4

Comprehensive Tumor Biomarker Profiling

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The HER2-and MET-status was assessed as previously described [11] (link), [12] (link), [16] (link), [17] (link), [18] (link) using immunohistochemistry [anti-Her2/neu antibody; clone SP3, Thermo Fisher Scientific; Fremont; USA (#MA5-14509); anti-MET antibody; clone SP44; Spring Bioscience; Pleasanton, California, USA (#M3444)] and in situ–hybridization [ZytoDot 2C SPEC HER2/CEN17 Probe (#C-3032-400), ZytoDot 2C SPEC MET/CEN7 Probe (#C-3057-400) and the ZytoDot 2C CISH Implementation Kit (#C-3044-40); ZytoVision GmbH, Bremerhaven, Germany)]. Epstein–Barr virus (EBV)–encoded RNA was detected using the EBER-probe (Novocastra, Leica Microsystems GmbH, Nussloch, Germany; #PB0589) and the BondMax-detection system according to the manufacturer's instructions (Leica Microsystems GmbH). MSI status was assessed by immunostaining using antibodies directed against MLH1 (clone G168-15, BD Biosciences, Heidelberg, Germany; #MA1-25669), PMS2 (clone MRQ-28; Cell Marque Corporation, Rocklin, USA; #288M-16-ASR), MSH2 (clone FE11; Calbiochem, Merck KGaA, Darmstadt, Germany; #MABE284), and MSH6 (clone 44, BD Biosciences; #610919) as well as by comparison of the allelic profiles of the mononucleotide repeat markers BAT-25, BAT-26, NR-21, NR-24, and NR-27 in tumor and corresponding normal tissue in cases with ambiguous immunostaining [16] (link).
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5

PD-L1 Expression and Mismatch Repair Assessment

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PD-L1 expression was assessed by IHC staining, using SP263 (Ventana Benchmark Ultra, Tuscon, AZ, USA), the 22C3 pharmDx kit (Agilent Technologies, Santa Clara, CA, USA), or E1L3N XP Rabbit mAb (Cell Signaling Technology, Danvers, MA, USA). If more than 1% of viable tumor cells had PD-L1, they were considered PD-L1-positive [18 (link)]. The tumor proportion score (TPS) was defined as the percentage of viable tumor cells showing partial or complete membrane-staining at any intensity [19 (link)]. The combined positive score (CPS) was defined as the number of PD-L1-positive cells (tumor cells, lymphocytes, and macrophages), divided by the total number of viable tumor cells, and multiplied by 100 [20 (link)].
The microsatellite stability was assessed using antibodies specific for mismatch repair proteins, including mutL homolog 1 (1:10; clone G168-15; BD Pharmingen, San Jose, CA, USA), mutS homolog (MSH)-2 (1:100; clone FE11; Calbiochem, San Diego, CA, USA), MSH6 (1:100; clone EP49; Novus Biologicals, Centennial, CO, USA), and PMS1 homolog 2 (1:50; clone A16-4; BD Pharmingen).
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6

Immunohistochemical Analysis of DNA Mismatch Repair Proteins

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Tissue sections were processed by immunohistochemistry for four MMR proteins. The primary antibodies were anti-MLH1 (1:50 dilution, clone G168-15, BD Biosciences, San Jose, CA) mouse monoclonal antibody, anti-MSH2 (1:100 dilution, clone FE11, Merck Millipore, ‎Burlington, MA) mouse monoclonal antibody, anti-PMS2 (1:100 dilution, clone A16-4, BD Biosciences) mouse monoclonal antibody, and anti-MSH6 (1:100 dilution, clone EP49, Agilent Technologies) rabbit monoclonal antibody. Tumors were considered negative for MLH1, MSH2, PMS2, or MSH6 when there was a complete absence of nuclear staining in the tumor cells, whereas the surrounding lymphocytes and normal epithelial cells showed consistently preserved nuclear staining. If any one of the four MMR proteins was negative, the tumor was considered to be dMMR. Tumors that preserved expression of all four proteins were considered to be MMR-proficient (pMMR). The representative immunohistochemical staining images of dMMR are shown in Supplementary Figure 1.
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7

Evaluating MMR Protein Expression in Colorectal and Endometrial Cancers

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We examined MMR-protein expression for the MLH1, MSH2, MSH6, and PMS2 proteins in primary tumors from 317 CRC and 138 EC patients by IHC. Thin (5 µm) sections of representative blocks were deparaffinized and dehydrated using an ethanol gradient. Following antigen retrieval in citrate buffer (pH 6.0), endogenous peroxidase was blocked with 3% H2O2. Thereafter, slides were incubated overnight in the presence of purified mouse monoclonal antibodies against MLH1 (clone G168-15; 1:50; BD Pharmingen, San Diego, CA, USA), MSH2 (clone G219-1129; 1:200; BD Pharmingen), MSH6 (clone 44/MSH6; 1:100; BD Pharmingen), and PMS2 (clone A16-4; 1:200; BD Pharmingen). Additional incubations were performed with a biotin-conjugated secondary antibody (Vector Laboratories, Burlingame, CA, USA), the avidin–biotin–peroxidase complex (Vector Laboratories, Burlingame, CA, USA), and with biotinyl tyramide, followed by streptavidin peroxidase. Diaminobenzidine was used as a chromogen, and hematoxylin was used as a nuclear counterstain. Tumor cells were scored as negative for MMR-protein expression only if the epithelial cells within the tumor tissue lacked nuclear staining while the surrounding stromal cells were positive for MMR staining. Tumor tissue with all MMR proteins present were defined as pMMR, and those showing deficiency in at least one of the four MMR proteins were defined as dMMR.
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