$$\rightleftharpoonup{xx}$$
$$\longleftharp{xx}$$,
$$\longrightharp{xx}$$,
Sporadic AD patients with CAA (n = 5; mean age = 83.2 y) and aged subjects with senile plaque free (SP O) and CAA (n = 5; mean age = 77.2 y) were analyzed (Table 1). The CAA phenotypes of patient #3 were most prominent in this study. Distributions of Aβ1-40 and Aβ1-42 deposits in the brain tissue from patient #3 were visualized with MALDI-IMS (Figure 1). There were no significant signals in nonpathological control brains (patients #9 and #10), as shown in Figure 1. Here, MALDI-IMS clearly visualized that Aβ1-42 was preferentially deposited as SPs in the cerebral parenchyma. By contrast, shorter Aβs, such as Aβ1-36 to 1-41, were preferentially deposited on the leptomeningeal vascular areas (Figure 1).
Distributions of Aβ40 and Aβ42 were further validated with IHC using adjacent frozen sections of the tissues. The anti-Aβ40 antibody labeled CAA (arrows in Figure 2B), which is in clear contrast to the distribution of Aβ42 in the cerebral parenchyma as SPs. For Aβ1-41, we are the first to detect this fragment in human brains, and we have generated specific antibodies that can differentiate Aβ41 from Aβ40 andAβ4221.
The spatial resolution of the MALDI-IMS is generally the most important factor to be improved upon. In Figure 1 and Figure 2 show MALDI-IMS with a 100 µm pitch resolution and obtain an overall distribution profile for a relatively wide area21. It is difficult to define amyloid deposition exactly at the subarachnoid space, including vascular structure. To portray fine tissue structures of subarachnoid vessels and the surface of the cortex, high-resolution MALDI imaging (40 µm: Figure 3; 20 µm: Figure 4 and Figure 5) was performed. As a result, MALDI-IMS clearly demonstrated that shorter Aβs, such as Aβ1-36 to 1-41, are distributed in the walls of arteries, which is comparable with IHC.
MALDI-IMS demonstrated the detailed distributions of both Aβx-40 and Aβx-42 (x = 2, 4, 5, 6, 7, 8, 9, and 11pE) in AD accompanied with moderate CAA brain. For example, while Aβx-40 species showed a similar distribution profile to Aβ1-40, Aβx-42 species showed a different distribution pattern with Aβ1-4221. By the current protocol, single ion images of the individual Aβ peptides observed with MALDI-IMS are assigned to Aβ species. By contrast, acquired image data can be investigated using unsupervised multivariate statistics in order to obtain image segmentation of anatomical regions of interest for the further analysis of undefined proteins. Figure 5 shows a segmentation map obtained with a bisecting k-means analysis applied to the same section from patient #321. This clustering method successfully identified plaque-like structures in the parenchyma (blue in Figure 5C) and vascular structures in the subarachnoid space (green in Figure 5C). It is interesting to find a small circular area in the parenchyma, which is detected just around a small arteriole in the parenchyma, as well as in the subarachnoid space (purple in Figure 5C). This is verified by single ion images of these individual Aβ peptides in Figure 5D-5F.

Figure 1: MALDI-IMS of a frozen AD/CAA brain section. Various C-terminal truncated Aβ peptides in AD accompanying severe CAA (patient #3) are visualized in the left panel and controls (patient #9 on the right and patient #10 on the left in all images) in the right panel. Aβ1-36 to Aβ1-41 are preferentially deposited in leptomeningeal blood vessels, while Aβ1-42 and Aβ1-43 are deposited in the cerebral parenchyma as senile plaques in case #3, while there was no signal in the control patients' brains (cases #9 and #10). Resolution = 100 μm. Scale bar = 5 mm. This figure has been modified with permission from Kakuda et al.21. Please click here to view a larger version of this figure.

Figure 2: MALDI-IMS of frozen AD/CAA brain sections and adjacent sections of the occipital cortex from AD brains. (A - C) The frozen AD/CAA brain sections and (D and E) adjacent sections of the occipital cortex from AD brains were immune-stained and focused on arteriole and cerebral parenchyma, using antibodies against Aβ40 (D: BA27) or Aβ42 (E: anti-Aβ42 polyclonal). Both analyses demonstrated that Aβ40 is preferentially deposited in leptomeningeal blood vessels (arrows in panel D) and arterioles in the subarachnoid space and the cerebral parenchyma forming CAA. In contrast, Aβ42 is mainly deposited in SPs. For IMS, Resolution = 100 μm. Scale bar = 5 mm (A, B, and C) = 5 mm, 500 (D and E). This figure has been modified with permission from Kakuda et al.21. Please click here to view a larger version of this figure.

Figure 3: MALD-IMS of frozen AD/CAA brain sections (patient #3) at a resolution of 40 µm. Various C-terminal and N-terminal truncated and modified Aβ peptides in AD accompanying severe CAA (patient #3). Aβ1-36 to Aβ1-41 are preferentially deposited in leptomeningeal blood vessels, while Aβ1-42 and Aβ1-43 are deposited in the cerebral parenchyma as senile plaques. Scale bars = 1 mm (A-B), 2 mm (upper left). Resolution = 40 μm. Please click here to view a larger version of this figure.

Figure 4: MALDI-IMS of frozen AD/CAA brain sections (patient #3) at a resolution of 20 µm. This panel shows various C-terminal and N-terminal truncated and modified Aβ peptides in AD accompanying severe CAA (patient #3). Aβ1-36 to Aβ1-41 are preferentially deposited in leptomeningeal blood vessels, while Aβ1-42 and Aβ1-43 are deposited in the cerebral parenchyma as senile plaques. Scale bars = 200 μm (a, b, c), 1 mm (upper left). Resolution = 20 μm. Please click here to view a larger version of this figure.

Figure 5: Segmentation map, obtained by MALDI-IMS of a frozen AD brain section, reveals putative senile plaque, large subarachnoid vessel structures, and small parenchymal arterioles. (A) Segmentation map obtained from a multivariate image analysis of MALDI-IMS data. (B) Bisecting k-means based clustering analysis identified plaque-like and vessel-like structures in the occipital cortex. The clusters and substructures and their relations are shown as nodes (e.g.,1-0-0). (C) Distinct Aβ peptide localization patterns resembling plaques (blue), subarachnoid vessels (green), and arteriole (red) structures. Note that a few red clusters are also distributed in the subarachnoid space. This is verified by single ion images of these individual Aβ peptides at a 20 µm resolution: (D) Aβ 1-40, (E) Aβ 1-41, and (F) Aβ 1-42. Please click here to view a larger version of this figure.
| Case | Gender | Age at death | Braak SP | CAA |
| 1 | M | 83 | C | 0.5 |
| 2 | M | 88 | C | 1 |
| 3 | M | 84 | C | 2 |
| 4 | M | 78 | C | 1 |
| 5 | M | 83 | C | 1 |
| 6 | M | 84 | O | 0 |
| 7 | M | 78 | O | 0 |
| 8 | M | 70 | O | 0 |
| 9 | M | 73 | O | 0 |
| 10 | M | 81 | O | 0 |
Table 1: Clinical and pathological data of AD with CAA cases and aged SP O subjects. Human cortical specimens for IMS and IHC were obtained from the Brain Bank at Tokyo Metropolitan Institute of Gerontology. Each brain specimen was taken from the occipital cortex of five AD patients and five age-matched controls. The extent of amyloid deposition as shown by an Aβ monoclonal antibody was defined by Braak SP (amyloid) stages. At stage O, there are almost no senile plaques throughout the isocortex. At stage C, virtually all the isocortical areas are affected. AD brains are invariable at stage C. This table has been modified with permission from Kakuda et al.21.