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The protocol described here enables the simultaneous treatment of multiple slices, ranging in thickness from 100 µm to 500 µm, using the SHORT method. This approach significantly reduces the overall processing time for the entire procedure. In this work, we provide a comprehensive description of the entire pipeline (Figure 1) for processing multiple postmortem human brain thick sections simultaneously and we demonstrate the protocol on 24 slices at once (Figure 2A). The duration for clearing and co-labeling ranges from 11 to 30 days, considering the size and thickness of the samples (Table 1), excluding imaging and postimaging processing. Following delipidation and refractive index matching in TDE, optimal and homogeneous transparency of all the tissue slices is achieved in both grey and white matter (Figure 2B).
The image acquisition can be performed with different advanced fluorescence microscopes, including confocal25 and two-photon microscopy14. Here, we used a custom-made inverted LSFM18,23 equipped with four excitation laser lines: 405 nm, 488 nm, 561 nm, and 638 nm, capable of acquiring four different biological features labeled with fluorophore-conjugated antibodies. Figure 3A shows representative images of a 400 µm-thick slice from a human Broca's area co-labeled for NeuN, a pan-neuronal marker, Somatostatin (SST), and Calretinin (CR), which label two different subpopulations of interneurons and the nuclear marker DAPI (Figure 3A,B). In the 400 µm thick slab, we observed that the global fluorescence along Z is not limited to the surface, but it is almost uniform throughout the tissue depth, although the signal intensity slightly decreases in the middle (Figure 3C).
To achieve a more comprehensive cellular characterization of human brain tissue, it is possible to perform multi-round labeling of the same specimens by stripping up the antibodies and relabeling the sample as demonstrated in the SHORT original paper. Figure 4 (adapted from Pesce et al.18) demonstrates the potential application of seven different antibodies on a 500 µm-thick tissue slice processed with SHORT in three consecutive rounds of immunostaining. The antibodies used include NeuN, SST, CR, Parvalbumin (PV), and vasoactive intestinal peptide (VIP) as inhibitory neuronal markers, glial fibrillary acidic protein (GFAP) for glial cells, and vimentin (VIM) for vasculature (Table 2). The results showcase the remarkable ability of SHORT to preserve tissue information throughout various stripping procedures, effectively reduce autofluorescence signals, and achieve efficient specimen clearing.

Figure 1: Timeline of SHORT. Scheme representing the steps required to process the samples with the SHORT protocol. In each step, tens of human brain tissue slabs are processed together. After embedding in agarose and slicing, samples are placed in Switch-on and Switch-off solutions for 1 day each; the inactivation steps are performed overnight while the delipidation through incubation in clearing solution requires 3-7 days. Afterward, samples are incubated with primary and secondary antibody solutions for a maximum of 7 and 6 days, respectively. After refractive index matching, samples are mounted in the sample holder (sandwich) for LSFM imaging and storage. At any time after sandwich assembly, samples can be stripped and relabeled for the detection of different markers. Abbreviations: TDE = 2,2'-thiodiethanol; SHORT = SWITCH - H2O2 - Antigen Retrieval -TDE; o/n = overnight; RI = refractive index; LSFM = light-sheet fluorescence microscopy. Please click here to view a larger version of this figure.

Figure 2: Human brain slices from a Broca area's block processed simultaneously. (A) Twenty-four consecutive slices from Broca's area of 4 x 4 x 0.04 cm3 in PBS before processing with the SHORT method. (B) The same specimens in A shown after the SHORT processing. Scale bar = 1 cm. Abbreviations: TDE = 2,2'-thiodiethanol; SHORT = SWITCH - H2O2 - Antigen Retrieval -TDE; PBS = phosphate-buffered saline. Please click here to view a larger version of this figure.

Figure 3. Representative LSFM images of a clarified slice labeled with four different markers. (A) Maximum intensity projection images (resolution of 3.3 x 3.3 x 3.3 µm3) showing a mesoscopic reconstruction of a SHORT-processed slice of Broca's area labeled for NeuN, Somatostatin, Calretinin, and the nuclear marker DAPI. On the right, the merged image (NeuN-SST-CR-DAPI) is shown. Scale bar = 0.5 cm. (B) Magnified insert of the merged image in A. Scale bar = 100 µm. (C) High resolution (0.55 x 0.55 x 3.3 µm) yz images from (B). Scale bar = 100 µm. Abbreviations: TDE = 2,2'-thiodiethanol; SHORT = SWITCH - H2O2 - Antigen Retrieval -TDE; LSFM = light-sheet fluorescence microscopy; NeuN = Neuronal Nuclear antigen; SST = somatostatin; CR = calretinin; DAPI = 4',6-diamidino-2-phenylindole. Please click here to view a larger version of this figure.

Figure 4: Representative LSFM images of multi-round staining in SHORT-processed slices. (A) Images of a human brain slice preclearing (in PBS) and after the multi-round labeling with refractive index matching (68% TDE). Scale bar = 1 cm. (B) Merging of the various channels acquired during three subsequent multi-rounds. The image shows both white and grey matter labeled with Vasoactive Intestinal Peptide, Somatostatin, Parvalbumin, Calretinin, Neuronal Nuclear antigen, Glial Fibrillary Acidic Protein, and Vimentin. High-resolution (resolution of 0.55 x 0.55 x 3.3 µm), single-channel images are shown on the right and below the image. Scale bar = 100 µm for all images, except for GFAP (scale bar 10 = µm). (C) Maximum intensity projection images of 500 µm-thick slice showing the signal from seven different antibodies used in three sequential rounds of immunostaining. Round 1: PV-SST-VIP; round 2: CR-SST-NeuN; round 3: VIM-SST-GFAP. Scale bar = 1 mm. This figure was modified from Pesce et al.18. Abbreviations: TDE = 2,2'-thiodiethanol; SHORT = SWITCH - H2O2 - Antigen Retrieval -TDE; LSFM = light-sheet fluorescence microscopy; NeuN = Neuronal Nuclear antigen; SST = somatostatin; CR = calretinin; PV = parvalbumin; GFAP = glial fibrillary acidic protein; VIM = vimentin; VIP = vasoactive intestinal peptide. Please click here to view a larger version of this figure.
Table 1: Representative time length of SHORT for samples with a range of areas and thickness. Specimens with different areas and thicknesses require a variable incubation time in clearing and antibody solutions, resulting in distinct time lengths for the whole SHORT pipeline. Please click here to download this Table.
Table 2: Antibodies compatible with SHORT. The table lists all the antibodies that were tested with the SHORT protocol and showed specific staining in 400-500 µm thick human brain specimens. The P/M column denotes polyclonal and monoclonal antibodies. Please click here to download this Table.