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Amyloid Aβ plaque formation is the main neuropathological hallmark of Alzheimer's disease (AD). However increasing evidence suggests important roles of the immune system in disease progression1,2. In particular, new data from preclinical and clinical studies established immune dysfunction as a main driver and contributor to AD pathology. With these findings, central and peripheral immune cells have emerged as promising therapeutic targets for AD3. The following protocol combines light and electron microscopy (EM) to generate new insights into the relationship between Aβ plaque deposition and microglial phenotypic alterations in AD. This protocol allows the labeling of Aβ plaques in mouse models of AD using in vivo injection of the fluorescent dye methoxy-X04. Methoxy-X04 is a Congo Red derivative that can easily cross the blood-brain barrier to enter the brain parenchyma and bind β-pleated sheets with high affinity. Since the dye is fluorescent, it can be used for in vivo detection of Aβ plaque deposition with two-photon microscopy4. Once bound to Aβ, methoxy-X04 does not dissociate or redistribute away from plaques, and it retains its fluorescence over time. It is generally administered peripherally to allow for non-invasive imaging of brain dynamics5. The fluorescence also remains following aldehyde fixation, allowing for correlative post-mortem analyses, including investigation of neuronal death in the vicinity of Aβ plaques6.
This protocol takes advantage of the properties of methoxy-X04 to select brain sections from APPSWE/PS1A246E mice (APP-PS1; coexpressing a double mutation at APP gene Lys670Asn/Met671Leu, and human presenilin PS1-A264E variant)7 that exhibit Aβ plaques in specific regions of interest (hippocampus CA1, strata radiatum, and lacunosum-moleculare) prior to pre-embedding immunostaining against the microglial marker ionized calcium-binding adapter molecule 1 (IBA1) to visualize microglial cell bodies and processes with EM. The mice are given intraperitoneal injection of methoxy-X04 solution, 24 hr prior to brain fixation through transcardial perfusion. Coronal brain sections are obtained using a vibratome. Sections containing the hippocampus CA1 are screened under a fluorescent microscope for the presence of Aβ plaques in strata radiatum and lacunosum-moleculare. Immunostaining for IBA1, osmium tetroxide post-fixation, and plastic resin embedding are then performed on the selected brain sections. At the end of this protocol, the sections can be archived without further ultrastructural degradation, ready for ultrathin sectioning and ultrastructural examination. Importantly, the plaques are still fluorescent after immunostaining with different antibodies, for instance IBA1 as in the present protocol. They become darker than their surrounding neuropil following osmium tetroxide post-fixation, independently of methoxy-X04 staining, which helps to accurately identify the regions of interest, generally down to a few square millimeters, to be examined with the transmission electron microscope.
This correlative approach offers an efficient way to identify specific brain sections to examine at the ultrastructural level. This is particularly helpful when studying early AD pathology, within specific brain regions or layers that may only contain a few Aβ plaques, present in only a small fraction of tissue sections. During these times especially, it would be inefficient to use immunostaining for Aβ (and dual labeling for other cellular markers such as IBA1) on several brain sections simply to yield a small fraction containing Aβ plaques at the right location. In addition, injection of live mice with methoxy-X04 prior to sacrifice and tissue processing does not compromise the ultrastructural preservation. Alternative methods such as post-mortem staining with Congo Red, Thioflavin S, Thioflavin T or methoxy-X04 on fixed tissue sections require staining differentiation in ethanol,8-11 which causes osmotic stress and disrupts the ultrastructure. Congo Red is also a known human carcinogen12.