Pain disorders of the temporomandibular joint and apical periodontitis affect approximately 5%36 and 30-70%37,38 of the general population, respectively. Primary sensory neurons detect noxious stimuli in the skin, oral mucosa, teeth, and periorbital regions, and their plasticity contributes to persistent pain. Cell culture and explants can be used to study neurons but are removed from their normal physiological context. Pirt-GCaMP3 calcium imaging after surgical exposure of the TG allows researchers to study primary sensory neurons in their normal physiological context by stimulating the face and head, including by the branch of the trigeminal nerve30. A major advantage of this calcium imaging method is the simultaneous monitoring of a large number of neurons. This method allows analysis of neuronal diameter and responses to hormones in control and pain model animals19,22,23,24.
Td-Tomato can be used to label specific types of neurons, which can be seen during imaging18,39,40. Another major advantage is the minimally invasive nature of this procedure, which requires a small incision, minimal muscle removal, and a small hole in the skull. Other applications include adapting the method to image other sensory ganglia, such as dorsal root ganglion14,15,16,17,18,20,21,26,41 and geniculate ganglion32,34. The protocol in this paper assumes the investigator is interested in examining the entire TG. Therefore, the sampling rate is low (each neuron gets sampled as few as 15x through the procedure), which provides only low resolution for transient analysis. However, an investigator can use a higher resolution objective and scan a smaller area of the TG at a higher sampling rate to examine transients in more detail or how nearby neurons interact18,42. Furthermore, the microscope manufacturer's software or cytoNet43 may also be helpful for analysis. StackReg is not required but is highly recommended. Other plugins such as TuboReg31 are available to help with alignment.
Preventing excessive bleeding and removing blood from the TG, using adequate anesthesia during imaging, leveling the TG, adjusting the optical slice thickness and focal field depth to ensure clarity and consistency between frames, and keeping the mouse's head still during stimulation are all critical for the success of the protocol. Excessive bleeding can affect how neurons respond to stimulation or prevent them from responding at all. Blood in the TG will block imaging. If the TG is not leveled properly, fewer neurons will be detected during imaging. Small movements can make it difficult or impossible to track neurons across the frame, and even if neurons can be tracked, transient analysis is impossible. Video 2 and Video 3 show what appear to be a line of neurons at the edge appearing and disappearing due to a few microns of movement. Anesthesia should be adequate to prevent nocifensive movements during stimuli.
Confocal microscopy excludes light generated outside the target area, so even in the absence of Ca2+ transients, movement of the TG can cause neurons at the margins of the excluded area to appear to become brighter or darker. Confocal microscopy only examines surface neurons, but deeper neurons may be sufficiently bright to contaminate the signal of surface neurons. Adjusting the aperture to a field depth of a typical diameter of primary sensory neurons (10-20 µm) is an essential step to greatly reduce signal contamination. For a Zeiss confocal scanning microscope, a pinhole of 1 airy unit is sufficient to prevent most signal contamination.
While this protocol applies stimuli in a fixed order, stimuli can be applied in a fixed or a random order. An advantage of using the order in this protocol is that desensitization of neurons may linger. Lighter stimuli usually activate fewer neurons, so there are fewer chances of lingering desensitization. In our experience, strong thermal stimuli activate the most neurons, so noxious thermal stimuli are applied last. A routine order of stimuli also reduces the chance that a stimulus is erroneously skipped. Random order can control for "priming" (where one test affects the result of a later test), but the numbers of animals used for in vivo imaging experiments are small, which means priming effects would be difficult to detect. Drugs often linger a long time and may be difficult or impossible to wash out and therefore, should be applied last.
The major limitations of this method include anesthesia artifact, the terminal nature of the procedure, and the inherent confounding of using Ca2+ transients as a surrogate for action potentials. Anesthesia is known to disrupt neuronal activity, rendering them less sensitive to stimulation33,44. Ketamine/xylazine anesthesia can reduce both the number of peripheral neurons activating and the amplitude of Ca2+ transients during imaging44. The terminal nature of this procedure precludes further testing of animals, so experiments requiring testing at multiple time points require a cohort of animals for each time point. Although the strength of Ca2+ transients is known to correlate with the number of action potentials15, any influx of Ca2+ into the cytoplasm can induce Ca2+ transients. This means that although similar methods can be used to directly study Ca2+ signals, researchers must be aware of Ca2+ artifacts. The authors were unable to find any literature reporting a non-action potential source of Ca2+ transients in primary sensory neurons, but it has been detected during Ca2+ imaging of spinal astrocytes45.
There are alternative genetically encoded Ca2+ indicators. GCaMP6 variants produce larger ΔF/F0Ca2+ transients than GCaMP342,46, and the GCaMP6f variant can detect single action potentials under the correct conditions15. NEMO-based Ca2+ indicators are potentially more sensitive than GCaMP indicators47. However, the baseline fluorescence of these indicators is low46,47, making it difficult to detect inactive cells and therefore, possibly unsuited to determining the proportion of neurons responding to a stimulus. Furthermore, confocal scanning microscopy does not penetrate deeply into the ganglion, meaning only superficial neurons can be imaged18. Two-photon microscopy allows deeper penetration48, although the overall performance using two-photon may be less stable15. Note that confocal versus two-photon has not been extensively tested side by side in primary sensory neurons.
In conclusion, Pirt-GCaMP3 TG imaging is a powerful method for studying nociceptive, somatosensory, and hormonal responses under normal and pathological conditions. Representative results from normal, control mice are presented here. Normal mice can be compared to mice with disease or injury models and to animals carrying mutations14,15,16,17,18,23,24,26,39,41,49. These methods can be applied to other genetically encoded Ca2+ indicators14,15,21and voltage imaging50,51,52,53.