Availability of new optical clearing methods has permitted unprecedented large-scale examinations of the central and peripheral nervous systems in animal models. The overall innervation patterns of the human pancreas are largely unexplored due to tissue density and difficulties in acquiring high quality biospecimens. This protocol offers an optimized tissue clearing protocol for human pancreas tissue from either fixed or paraffin-embedded archival samples.
Clearing time depends on the sample size, fixative type, duration, storage duration and may require 1 - 8 weeks, so the following considerations are critical. It is best to clear tissues soon after the 4% PFA fixation if possible because long-term storage increases clearing time. To minimize clearing time, the amount of PFA in the hydrogel monomer was decreased from 4% as used in the fixation step to 1% for the human pancreas. For other tissues, especially mouse tissues, the amount of PFA necessary to provide sufficient hydrogel rigidity to preserve antigens must be determined empirically. Adequate clearing is also essential since antibody penetration is reduced in poorly cleared tissues and surface staining by secondary antibodies is increased. Changing the clearing solution every other day (or, even daily) is best to keep the pH constant and detergent fresh. Conversely, over-clearing negatively impacts cellular morphology and increases tissue friability. Since some pancreas samples clear unevenly due to inherent pathologies such as regions of fibrosis from chronic pancreatitis or other pathologies, it is important to frequently monitor this process. Use of vibratome thick sections can also be used to make uniform thicknesses yet are not required. Monitoring the clearing process, so samples are removed from detergent as soon as light passes easily through the sample, ensures that the sample is sufficiently cleared.
Antibody penetration and surface staining are important issues to consider with PACT samples. To ensure good antibody penetration, it is critical to incubate samples with the primary antibodies for at least 2 days. Various antibodies have different diffusion rates and should be optimized individually, but for most antibodies, 4 days was sufficient duration for full penetration in a 1 mm3 sample. If surface staining is a problem, especially for Lightsheet imaging, the sample may be cut in half, or the surface dissected away after staining. Small format antibodies when available would be expected to assist with tissue penetration8. Preconjugated antibodies do not appear to work as well as the same unconjugated clone and higher background from nonspecific binding and poorer tissue penetration can be observed if they work at all. For improved success with preconjugated antibodies, increase serum and TritonX-100 concentrations in the staining buffer and use longer incubations (>4 days). After staining, incubation of the sample in RIMS for several days is critical. Cleared tissues swell in PBS and RIMS incubation causes them to shrink back to original size. Especially with lightsheet imaging, the sample should be fully equilibrated before imaging.
When imaging samples on the confocal microscope, the correction must be set each time a new position is chosen. Various acquisition depths and variation in staining intensity throughout the tissue necessitates adjustments for each area of the tissue to be imaged optimally. Likewise, the secondary antibodies used must be carefully considered. Spectral unmixing is challenging in PACT samples, so fluorophores must be appropriately chosen for a low excitation or emission overlap to ensure a bright signal when filtering emissions on the confocal microscope. For each application, a balance must be struck between resolution, imaging speed, and noise reduction so that the best quality image can be acquired without photo-bleaching. Resolution greater than 1024 x 1024 is not detectable by the human eye but may be necessary for certain applications if quantification of a stain is needed.
There are many things to consider when choosing an optical clearing technique and when choosing optical clearing over other more traditional methods. Low abundance antigens may not be detectable using the PACT method thus there are limitations on antigen detection. Certain antigens such as immunological antigens (CD3, CD4, CD8, etc.) are destroyed by the PACT method and are undetectable despite high quality antibodies available to detect them. Another limitation of this method is the inherent variability between donor pancreases which are difficult to discern until after clearing staining. Each donor tissue tends to clear and stain similarly between procedures, but different donor tissues have widely varying clearing times and tissue morphology quality after clearing. The ability to use archival tissue may mitigate this limitation if one can have adequate access to a large number of patient pancreas samples though this has not been thoroughly investigated. The PACT protocol reported herein was found to be inexpensive and readily implemented with standard laboratory equipment. Cleared samples were suitable for imaging via traditional confocal microscopy, as well as 2-photon and Lightsheet technologies and provided high resolution 3D images of nerves and islets in large sections of the human pancreas. Future applications of this procedure include studies on the development of the fetal pancreas for both exocrine and endocrine compartments and islet studies in type 1 and type 2 diabetes.