Tissue clearing, combined with immunofluorescence microscopy, allows spatial visualization and quantification of immune-cell populations and virus proteins within intact tissues. Optical sectioning of cleared tissues with confocal and light sheet fluorescence microscopy can generate 3D models of complex tissue environments and reveal spatial heterogeneity exhibited during HIV infection.
Human Immunodeficiency Virus (HIV), the causative agent of Acquired Immune Deficiency Syndrome (AIDS), is a major global health concern with nearly 40 million individuals infected worldwide and no widely accessible cure. Despite intensive efforts, a detailed understanding of virus and host cell interactions in tissues during infection and in response to therapy remains incomplete. To address these limitations, water-based tissue clearing techniques CUBIC (Clear, Unobstructed Brain/Body Imaging Cocktails and Computational analysis) and CLARITY (Clear Lipid-exchanged Acrylamide-hybridized Rigid Imaging/Immunostaining/in situ-hybridization-compatible Tissue hYdrogel) are applied to visualize complex virus host-cell interactions in HIV-infected tissues from animal models and humans using confocal and light sheet fluorescence microscopy. Optical sectioning of intact tissues and image analysis allows rapid reconstruction of spatial information contained within whole tissues and quantification of immune cell populations during infection. These methods are applicable to most tissue sources and diverse biological questions, including infectious disease and cancer.
The growing need for quantitative spatial tissue imaging in biological research recently led to the emergence of tissue clearing techniques for generating larger-volume (mm3-cm3) images of intact tissues with single-cell resolution. Tissues include complex organizations of biomolecules with uniquely defined structures, compositions, and functions. Unfortunately, many biomolecules present in tissues (e.g., lipids and chromophores) scatter, absorb, or emit light when imaged via light microscopy, making large-volume imaging difficult. Furthermore, tissues often exhibit a refractive index mismatched with standard imaging solutions and optical lenses, resulting in optical distortions during imaging. An optimal approach for imaging large volumes of tissue with a light microscope should involve matching the refractive index of tissues, imaging solutions, and objectives, while allowing light penetration deep into the tissue without disrupting the biological features of intact tissues during processing. Initial attempts to reduce the differences in refractive index between tissues and imaging solutions through clearing of opaque tissue samples were carried out by German anatomist Werner Spalteholz in the late 1800s1. This tissue clearing technique involved harsh chemical solvents, which can damage tissue samples, but nevertheless represented the first reported larger-volume imaging of intact tissues. Modern light microscopy methods, combined with computing power for image capture and analysis, recently brought tissue clearing into vogue again as a method for imaging large, intact tissue samples with single-cell resolution. During the past two decades, dozens of advanced tissue clearing techniques emerged, including both organic- and water-based, each with strengths and weaknesses for specific applications.
3D tissue imaging can probe more complex biological interactions that cannot be reproduced in cell culture. For example, cell signaling patterns2, spatial distributions of distinct cell types3, and brain connectivity4 were previously mapped in a quantitative manner using whole tissue/organ imaging methods. Described here is an application of water-based tissue clearing protocols to clear, immunostain, and visualize distinct HIV target-cell populations within intact HIV-infected lymphoid tissues during active infection. Within the body, HIV predominantly infects CD4+ T-cells and integrates a copy of its genome into genomes of infected host cells. The virus subsequently hijacks the infected host-cell machinery to replicate itself, resulting in virus dissemination, host-cell killing, immune dysfunction, and long-term progression toward AIDS. It is important to note that the behaviors of infected T-cells in tissue and cell culture are notably discrepant. Cultured CD4+ T-cells incubated with HIV can produce massive HIV-induced syncytia that may include dozens of nuclei5, while similar experiments with primary CD4+ T-cells cultured in 3D extracellular matrix (ECM) hydrogels or tissue samples from HIV-infected humanized mice (hu-mice) generally yield syncytia with 2-5 nuclei6. Understanding local cell-to-cell transmission and systemic dissemination of the virus within HIV-infected individuals is likely even more complicated, involving the transportation of virus by multiple infected cell types from tissues to blood vessels to new tissues, where free virions and virus producing cells can access a large number of susceptible lymphocytes7. These scenarios are not currently possible to recapitulate in cell culture systems, and tissues from animal models and humans remain an important resource for understanding virus pathogenesis in the context of a complex organism with a functioning immune system.
Current antiretroviral therapies (ARTs) greatly increase the life expectancy and quality for people with HIV (PWH) by inhibiting HIV replication and stopping disease progression toward AIDS. Unfortunately, ART does not eliminate latently infected immune cells containing an insertion of the retroviral genome that are quiescent and not actively producing virus. Though virus is not detectable in the blood of most individuals on ART, virus loads rebound rapidly after ART is interrupted and disease progression continues8. The persistent nature of HIV infection caused by the latent reservoir of infected cells represents a massive impediment to establishing an HIV cure. Tissue reservoirs of HIV remain poorly understood, and it is crucial to establish a deeper understanding of these reservoirs in lymphoid tissues before, during, and after ART, to completely characterize virus pathogenesis and assess novel treatments that effectively eliminate latently infected cells not actively producing virus.
Here, CUBIC3 and CLARITY9, two previously adapted water-based tissue clearing protocols, were applied to image immune cell populations within numerous intact lymphoid tissues from HIV-infected mice with humanized immune systems (hu-mice), SIV/SHIV-infected non-human primates (NHP), and HIV-infected humans. These protocols are adaptable to both confocal and light sheet fluorescence microscopy depending on the goals of the imaging (higher resolution versus larger volume) and instrumentation available. Although light microscopy cannot resolve individual virions, the use of immunofluorescence can identify regions of tissue containing virus and virus producing cells that can be further analyzed with higher resolution methods. The methods presented here can be adapted to visualize nearly any tissue in the body with single-cell resolution in order to quantify the spatial relationships between specific cell-types in different conditions during infection and are readily translatable to highly relevant human patient samples for the study of infectious diseases or cancer.
Lymphoid tissues of interest should be collected rapidly post-mortem and immediately placed into pre-chilled fixative buffers to avoid tissue necrosis (dark or black tissue) that can negatively impact staining and imaging. After harvesting the desired tissues, immediately submerge tissues in ice-cold 4%-8% paraformaldehyde (PFA) overnight for fixing, which also inactivates potential pathogens associated with the samples. 4% PFA is optimal for fixing LM samples, whereas 8% PFA can adequately preserve tissues for both LM and EM. Following these procedures and storing samples in fixative at 4 °C in the dark can effectively preserve tissues for LM imaging for several years. One caveat is that longer-term storage in fixative can lead to the introduction of staining artifacts, especially antigen masking which is caused by crosslinking of adjacent proteins to the protein of interest, which can occlude accessibility of staining antibodies to the epitope13,14. If the tissues contain endogenously expressed fluorescent proteins, take measures to avoid exposing the tissues to light whenever possible throughout the entire protocol. Typically, endogenous fluorescent proteins will retain fluorescence for 6-12 months after fixing, but individual tissue samples can vary for longer or shorter periods of time. If endogenous fluorescence is lost due to protein degradation, fluorescent proteins can often be detected using a primary antibody specific for the protein of interest. Perfusion is another option for rapidly fixing tissues prior to clearing12; however, due to concerns when working with pathogens such as HIV, the route of tissue necropsy followed by immersion in ice-cold fixative was chosen to prepare samples as safely as possible.
One advantage of the water-based clearing protocols described is they are generally milder than organic-based protocols, which can sometimes damage tissues that are more fragile, such as the liver. Water-based clearing protocols will generally require a longer time to achieve complete sample clearing (weeks vs. days) in comparison with organic-based clearing protocols. The CLARITY and CUBIC protocols can be conducted more rapidly using perfusion to simultaneously clear all organs within a rodent11,12; however, this was not a feasible option for NHP and human autopsies. Samples processed with CLARITY tend to show some volume expansion, whereas CUBIC revealed reduced influence on sample volume9. Although generally more rapid, many organic-based tissue clearing protocols cause tissues to undergo shrinkage15, which can make detection of single cell or subcellular details more difficult to observe within cell dense tissues such as lymph nodes and spleen. Expansion induced by clearing can effectively increase the resolution of imaging, making it easier to observe aspects that would be hard to observe in the tissue's original size. Alternatively, tissue shrinkage can effectively decrease the overall size of the sample, which can make whole organ imaging without dissection possible. A benefit of both the CLARITY and CUBIC protocol is that they preserve fluorescence from endogenously expressed fluorescent proteins in tissue while remaining amenable to immunofluorescence staining11,12. Immunostaining can be conducted using aqueous or organic tissue clearing methods; however, personal experience showed a higher proportion of antibody compatibility using water-based protocols in comparison to organic-based protocols. Researchers need to consider which tissue clearing method to use based on the tissue(s) imaged and biological questions addressed (e.g., whole organ imaging versus specific region of interest imaging). There is no universal tissue clearing technique that allows robust turn-key analysis for all large-volume imaging questions and available methods exhibit distinct advantages and disadvantages depending on the biological application.
When conducting antibody staining, numerous aspects need to be considered. Because CLARITY samples are embedded in acrylamide hydrogel, they tend to require longer times for incubation12. The time needed for antibody incubation also depends on the volume and thickness of each sample. Most samples described here were ~2-3 millimeters thick, and 3 days was sufficient for complete staining throughout the tissue. If the target is to image a whole mouse brain, the antibody incubation time can take 1 week or longer12. Choosing an aqueous versus organic tissue clearing method for immunofluorescence imaging can hinge on antibody compatibility. In general, for CUBIC or CLARITY, the hit rate for antibodies that work in cultured cells and tissues is ~70%. Whether utilizing an aqueous or organic tissue clearing method, it is necessary to assess the compatibility and effectiveness of all antibodies with the specific method used. As shown in this protocol section, immunostaining for CUBIC and CLARITY processed samples takes place after the clearing is finished. On the contrary, this step takes place before the clearing procedure for some organic-based protocols, followed by post-fixing.
It is critically important for tissues to be completely immersed in an imaging medium that matches their refractive index. Failure to do so will introduce spherical aberrations while imaging and distort the light captured during image acquisition. Care must be taken to remove all air bubbles from the imaging media when mounting samples for both confocal and LSFM, as bubbles can disrupt the path of light to or away from the sample. Bubbles can be manually removed with a pipette prior to final sample mounting. For imaging thicker samples with a confocal microscope, multiple silicone spacers can be layered on top of one another to accommodate tissues greater than 0.5 mm thick. One recommendation is to equilibrate all tissues in RIMS for several hours to overnight while mounted on the microscope with no additional sample movement. Full equilibration of the tissue and imaging media will prevent mixing of solutions with mismatched refractive indices that can generate aberrations during imaging. It is important to remember that when mounting cleared tissue samples, there is not a single turnkey mounting method to image all samples in all microscopes. This protocol discusses sample mounting options that worked optimally in one context, but there are numerous approaches for sample mounting depending on the individual microscope used and biological question addressed. These approaches can include, but are not limited to, embedding the sample in agarose, suspending the sample from a hook or refractive index matched plastic line, using porcupine adapter, 3D printing a sample holder, or attaching the sample with adhesive to a plastic dish.
Confocal microscopes can work well for imaging tissue volumes ~1 mm3-1 cm3. For confocal microscopes, use a 2-10x objective to initially locate regions of interest and acquire larger-volume or whole-tissue Z-stacks with single-cell resolution. Switch to 20-63x objectives for acquiring higher-resolution images of specific regions of interest with subcellular information. The ideal objective for imaging CUBIC and CLARITY cleared tissues is a CLARITY/Scale specific objective that is accurately matched to the refractive index of the tissue and imaging solution. If this type of objective is not available, it is optimal to image samples with a glycerol or oil immersion objective (e.g., LD LCI Plan-Apochromat 25 x 0.8 NA Imm Corr DIC M27 multi-immersion objective: working distance = 0.57 mm) rather than an air objective. This will minimize introducing optical distortions due to mismatched refractive indices during image capture. The 20-25x objectives can balance larger-volume image acquisition with obtaining staining details from individual cells in a complex tissue environment. Importantly, most confocal microscopes contain modules that allow 3D tiling of imaging volumes. This type of image acquisition can ideally generate larger-volume Z-stacks that contain sub-cellular information.
LSFM imaging can allow 3D visualization of specific cell populations within the context of a large volumes of tissue (>1 cm3) and even entire organs. During the past 10 years, tissue clearing combined with LSFM largely focused on understanding brain connectivity within rodents; however, more recent applications include visualizing tumor metastatic landscapes16, cell distribution within anatomical compartments9,17, and pathogen dispersion18. In comparison to cultured cells, most biological events in tissues are non-uniform and LSFM can be particularly adept for visualizing and quantifying the spatial tissue heterogeneity of these events (e.g., virus replication, immune signaling, cell distribution, etc.).
3D datasets acquired via confocal or LSFM can be post-processed with numerous image analysis platforms. The Imaris software suite can be used for construction of surfaces, generation of 3D animation, and cell quantification; however, there are numerous image analysis systems available that enable efficient image post-processing and analysis. ImageJ/Fiji freeware19 is an appealing alternative image processing platform accessible to most labs, but there is no one-size-fits-all analysis software that excels at all forms of image analysis and visualization. Many image analysis software suites can be prohibitively expensive if not available through shared use facilities. Finally, a critical aspect of LSFM or large tiled confocal 3D datasets is data management. These imaging platforms can generate massive files (>1 Tb) that require higher-end computer workstations for data visualization and quantification. Ultimately, this imaging workflow can streamline the acquisition and quantification of spatially distinct cell populations within whole tissues and is widely applicable to most tissue sources and biological systems.
The authors have nothing to disclose.
Thank you to the University of Illinois at Urbana-Champaign Institute for Genomic Biology Core Facilities for use of Confocal and Light Sheet Fluorescence Microscopes. Thank you to the amazing individuals from "The Last Gift" cohort for human tissue samples, which was funded by the following grants: I147821, DA051915, AI131385, and P30 AI036214. Thank you to Nancy Haigwood and Ann Hessell for SHIV-infected NHP tissue samples.
Acrylamide Solution (in 0.1 M PBS, 40 mL in total) | |||
40% Acrylamide: 4 mL | Bio-Rad | 1610144 | |
VA-044 Thermal Initiator: 0.1g | Fujifilm | 011-19365 | |
CLARITY Blocking solution (in 0.1 M PBS, 5 mL in total) | |||
Fetal bovine serum (FBS): 200 µL | Atlas Biologicals | F-0500-D | |
Rat anti-human or anti-mouse FcR: 50 µL | Miltenyi | 130-092-575(mouse)/130-059-901(human) | |
Sodium azide (from stock solution): 5 µL | Sigma | 71289-50G | |
Tween-20: 5 µL | Fisher Scientific | BP337-500 | |
CLARITY wash solution (in 0.1M PBS, 50 mL in total) | |||
Sodium azide (from stock solution): 50 µL | Sigma | 71289-50G | |
Tween-20: 50 µL | Fisher Scientific | BP337-500 | |
CUBIC Blocking solution (in 0.1M PBS, 5 mL in total) | |||
Fetal bovine serum (FBS): 200 µL | Atlas Biologicals | F-0500-D | |
Rat anti-human or anti-mouse FcR: 50 µL | Miltenyi | 130-092-575(mouse)/130-059-901(human) | |
Sodium azide (from stock solution): 5 µL | Sigma | 71289-50G | |
Triton X-100: 5 µL | VWR | M143-1L | |
CUBIC Reagent-1 (in 0.1M PBS, 50 mL in total) | |||
N, N, N’, N’-tetrakis (2-hydroxypropyl) ethylenediamine: 12.5 g | Aldrich | 122262 | |
Triton X-100: 7.5 g | VWR | M143-1L | |
Urea: 12.5 g | Fisher chemical | U15-500 | |
CUBIC Reagent-2 (in 0.1M PBS, 50 mL in total) | |||
Sucrose: 25 g | Sigma | S1888-500G | |
Sodium azide (in powder form): 10 g | Sigma | 71289-50G | |
Sodium azide stock solution (in DI H2O, 50 mL in total) | Sigma | 71289-50G | |
Triethanolamine: 5 g | Sigma | 90270-500mL | |
Triton X-100: 50 µL | VWR | M143-1L | |
Urea: 12.5 g | Fisher chemical | U15-500 | |
CUBIC wash solution (in 0.1M PBS, 50 mL in total) | |||
Sodium azide (from stock solution): 50 µL | Sigma | 71289-50G | |
Triton X-100: 50 µL | VWR | M143-1L | |
DAPI staining solution (0.5 µg/mL) | |||
DAPI stock solution: 1 µL | Sigma-Aldrich | D9542-1MG | |
Wash solution: 10 mL | |||
DAPI powder: 5 mg | Sigma-Aldrich | D9542-1MG | |
DAPI stock solution (5 mg/mL) | Sigma-Aldrich | D9542-1MG | |
DMSO (100%): 1 mL | ThermoFisher | D12345 | |
Imaging Media RI-2 (in dH2O) | |||
90% Histodenz | Sigma | D2158-100G | |
0.01% Sodium azide | Sigma | 71289-50G | |
0.02 Sodium Phosphate Buffer, pH 7.5 | Sigma-Aldrich | S9638-250G | |
0.1% Tween-20 | Fisher Scientific | BP337-500 | |
Primary antibodies (in blocking solution without rat anti-mouse FcR, 2 mL in total) | |||
Goat anti-HIV p24: 10 µL (1:200) | Creative Diagnostics | DPATB-H81692 | |
Mouse anti-human CD68: 10 µL(1:200) | Dako | M0876 | |
Rabbit anti-human CD3: 10 µL (1:200) | Dako | A0452 | |
8% SDS Solution (in 0.1 M PBS, 50 mL in total) | |||
SDS powder: 4 g | Sigma-Aldrich | L3771-500G | |
Secondary antibodies (in blocking solution without rat anti-mouse FcR, 2 mL in total) | |||
Donkey anti-goat conjugated with AlexaFluor647: 2 µL | Invitrogen | A21447 | |
Donkey anti-mouse conjugated with AlexaFluor594: 2 µL | Invitrogen | A21203 | |
Donkey anti-rabbit conjugated with AlexaFluor488: 2 µL | Invitrogen | A21206 |
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