Puncture Wound Hemostasis and Preparation of Samples for Montaged Wide-Area Electron Microscopy Analysis

Summary

A puncture wound procedure for hemostatic thrombus formation is presented here. The formed thrombi are large and are hundreds of microns in diameter. Hence, volume imaging approaches are appropriate. We suggest montaged wide-area transmission electron microscopy as a high-resolution approach available to many and detail a preparative protocol.

Abstract

Hemostasis, the process of normal physiological control of vascular damage, is fundamental to human life. We all suffer minor cuts and puncture wounds from time to time. In hemostasis, self-limiting platelet aggregation leads to the formation of a structured thrombus in which bleeding cessation comes from capping the hole from the outside. Detailed characterization of this structure could lead to distinctions between hemostasis and thrombosis, a case of excessive platelet aggregation leading to occlusive clotting. An imaging-based approach to puncture wound thrombus structure is presented here that draws upon the ability of thin-section electron microscopy to visualize the interior of hemostatic thrombi. The most basic step in any imaging-based experimental protocol is good sample preparation. The protocol provides detailed procedures for preparing puncture wounds and platelet-rich thrombi in mice for subsequent electron microscopy. A detailed procedure is given for in situ fixation of the forming puncture wound thrombus and its subsequent processing for staining and embedding for electron microscopy. Electron microscopy is presented as the end imaging technique because of its ability, when combined with sequential sectioning, to visualize the details of the thrombus interior at high resolution. As an imaging method, electron microscopy gives unbiased sampling and an experimental output that scales from nanometer to millimeters in 2 or 3 dimensions. Appropriate freeware electron microscopy software is cited that will support wide-area electron microscopy in which hundreds of frames can be blended to give nanometer-scale imaging of entire puncture wound thrombi cross-sections. Hence, any subregion of the image file can be placed easily into the context of the full cross-section.

Introduction

The formation of a puncture wound thrombus that leads to bleeding cessation is one of the most essential events in life¹. Yet despite that essentiality, knowledge of what occurs structurally during thrombus formation, be it in a vein, an artery, an atherosclerotic event, or an occlusive clot, has been limited by resolution and imaging depth. Conventional light microscopy is limited in depth when compared to a fully formed puncture wound thrombus, 200 to 300 µm in Z¹, and in resolution level when compared to the size of platelet organelles and their spacing, often less than 30 nm². Two-photon light microscopy can yield the needed depth of imaging but does not improve resolution significantly. The most recent advances in light microscopy, for example, super-resolution techniques, are still resolution limited, in practice ~20 nm in XY and twice that in Z, and depth limited, no more than conventional light microscopy. Furthermore, super-resolution light microscopy, like much of research light microscopy, is based on fluorescence microscopy, a technique that is inherently biased to a small set of candidate proteins for which good antibodies exist or good tagged constructs³. In conclusion, conventional scanning electron microscopy can, at most, visualize the surface of the forming platelet-rich thrombus.

To overcome these technical limitations to characterizing thrombus structure, we had three goals. First, reproducibly produce a defined puncture wound in a mouse vein or artery that could then be readily stabilized in situ by chemical fixation. Second, apply a preparative procedure that emphasizes membrane preservation, a goal consistent with the aim of defining the position of individual platelets within the forming thrombus. Third, use an unbiased visualization technique that, in a single image, could be scaled between nanometer to near millimeter scale.

Montaged, wide-area electron microscopy was chosen as a major end visualization technique for a single important reason: in electron microscope imaging, one sees a vast array of features within a cell that outlines its organelles and features within the organelles. Small objects such as ribosomes can be recognized. This range of features is seen because the electron-dense heavy metal stains, uranyl, lead, and osmium, that are used for electron microscopy to yield contrast bind to a wide range of molecules. In an electron microscope image, one sees much of what is there, while with immunofluorescence and protein tagging approaches, one only sees what lights up. This means, for example, the antigen sites present on a given individual protein species. In the case of a tagged molecule, often a protein, it is the site(s) where that protein is. All other molecules are dark and not lit up. However, is this choice of electron microscopy practical? A puncture wound thrombus has a size of 300 by 500 µm and, at a pixel size of 3 nm, that is an image of 100,000 by 167,000 pixels. A high-quality electron microscope camera has 4000 by 4000 pixels. That means that approximately 1000 frames must be stitched/blended to give a single image. That is a possibility that has been present in most electron microscopes manufactured in the last 15 years. The microscope stage is computerized, and the images can be stitched together with a computer. That is the rationale that led to choices underlying the formulation of the presented protocol.

Conclusively, we present below a series of steps that give a reproducible wound in the vein or artery of mice that then, following in situ fixation steps and later embedding steps, can be visualized by montaged, wide-area transmission electron microscopy at nm scale and in the stitched image visualized at near mm scale, the scale of the actual in situ fixed thrombus. Scalability of this kind is required for understanding thrombus formation as both a problem in hematology/health and as a developmental biology system in which platelets are the major cell type. These advances deliver a major virtue of electron microscopy, namely, one sees what is there, not only what lights up. For a detailed protocol on the preparation of samples for serial block face scanning electron microscopy (SBF-SEM), the reader is directed to a recent article by Joshi et al.⁴.

Protocol

Experiments were reviewed and approved by the Institutional Animal Care and Use Committee (IACUC) at the University of Arkansas for Medical Sciences. Here, 8 – 12-week-old, wild-type male and female C57BL/6 mice were used. These mice are young adults with little accumulation of fat. The same procedures are applicable to mice mutants for various proteins important to hemostasis, such as von Willebrand factor or platelet glycoprotein VI (GPVI)5,6. All equipment, su…

Representative Results

Quantitation of drug effects on puncture wound bleeding time Puncture wound bleeding times provide a physiological model of a drug risk that can be readily carried out in mice. Outcomes that come from a puncture wound experiment are predictive. Here, we show a dabigatran dose-response bleeding curve. Dabigatran, a thrombin inhibitor, is used as an oral direct-acting anti-coagulant, a so-called DOAC12. The jugular vein puncture wound model was used to assess the risk inherent…

Discussion

We present a detailed puncture wound procedure for producing hemostatic thrombi in jugular veins and femoral arteries, their in situ perfusion fixation, and sample processing for montaged wide-area transmission electron microscopy. The overall procedures are useful for generating hemostatic thrombi for ultrastructural analysis and for comparing bleeding times in experimental mice, for example, mice treated with different types and dosages of pharmaceuticals. It is also useful for comparing bleeding times in cont…

Materials

0.9% Normal Saline Solution	Medline	BHL2F7123HH
27G x 3/4 EXELint scalp vein set	Medline	NDA26709
30G x 1/2 EXELint hypodermic needles	Medline	NDA264372
33G x 1/2 EXELint specialty hypodermic needles	Medline	NDA26393
50 mL Conical Tubes	Fisher Scientific	06-443-20
Alcohol Prep Pads (70% Isopropyl Alcohol)	Medline	MDS090670Z
Aluminum Foil	Fisher Scientific	01-213-100
Animal Heating Plate	Physitemp Instruments	HP-1M
Araldite GY 502	Electron Microscopy Sciences	10900
Axiocam 305 Color R2 Microscopy Camera	Carl Zeiss Microscopy	426560-9031-000
BD Luer-Lok Syringes, 20 mL	Medline	B-D303310Z
Calcium Chloride	Fisher Scientific	C79-500
Cell Culture Dishes 35mm x 10mm	Corning Inc.	430165
Cotton Tipped Applicators	Medline	MDS202055H
DMP-30 Activator	Electron Microscopy Sciences	13600
Dodecenyl Succinic Anhydride/ DDSA	Electron Microscopy Sciences	13700
Dressing Forceps, 5", curved, serrated, narrow tipped	Integra Miltex	6-100
Dressing Forceps, 5", standard, serrated	Integra Miltex	6-6
EMBED 812 Resin	Electron Microscopy Sciences	14900
Ethyl Alcohol, anhydrous 200 proof	Electron Microscopy Sciences	15055
Fisherbrand 4-Way Tube Rack	Fisher Scientific	03-448-17
Fisherbrand Digital Timer	Fisher Scientific	14-649-17
Fisherbrand Single Syringe Infusion Pump	Fisher Scientific	7801001
Gauze Sponges 2" x 2"- 4 Ply	Medline	NON26224H
Glutaraldehyde (10% Solution)	Electron Microscopy Sciences	16120
Isoflurane Liquid Inhalant Anesthesia, 100 mL	Medline	66794-017-10
Jeweler-Style Micro-Fine Forceps, Style 5F	Integra Miltex	17-305	Need 2 pairs.
L/S Pump Tubing, Silicone, L/S 15; 25 Ft	VWR	MFLX96410-15
L-Aspartic Acid	Fisher Scientific	BP374-100
Lead Nitrate	Fisher Scientific	L-62
Malachite Green 4	Electron Microscopy Sciences	18100
Masterflex L/S Easy-Load II Pump Head	VWR	MFLX77200-62
Masterflex L/S Variable Speed Digital Drive	VWR	MFLX07528-10
MSC Xcelite 5" Wire Cutters	Fisher Scientific	50-191-9855
Osmium Tetroxide 4% Aqueous Solution	Electron Microscopy Sciences	19150
Paraformaldehyde (16% Solution)	Electron Microscopy Sciences	15710
Physitemp Temperature Controller	Physitemp Instruments	TCAT-2LV
Potassium Ferrocyanide	Sigma-Aldrich	P-8131
Propylene Oxide, ACS Reagent	Electron Microscopy Sciences	20401
Pyrex Glass Beakers	Fisher Scientific	02-555-25B
Rectal Temperature Probe for Mice	Physitemp Instruments	RET-3
Scotch Magic Invisible Tape, 3/4" x 1000"	3M Company	305289
Sodium Cacodylate Buffer 0.2M, pH 7.4	Electron Microscopy Sciences	11623
SomnoFlo Low Flow Electronic Vaporizer	Kent Scientific	SF-01
SomnoFlo Starter Kit for Mice	Kent Scientific	SF-MSEKIT
Stainless Steel Minutien Pins	Fine Science Tools	26002-10
Stereomicroscope steREO Discovery.V12	Carl Zeiss Microscopy	495015-9880-010
Sylgard 184 Silicone Elastomer	World Precision Instruments	SYLG184	silicone mat
Tannic Acid	Electron Microscopy Sciences	21700
Thiocarbohydrazide (TCH)	Sigma-Aldrich	88535
Uranyl Acetate	Electron Microscopy Sciences	22400
Vannas Spring Micro Scissors	Fine Science Tools	15000-08
Von Graefe Eye Dressing Forceps, 2.75", Curved, Serrated	Integra Miltex	18-818	Need 2 pairs.
Wagner Scissors	Fine Science Tools	14068-12
Wahl MiniFigura Animal Trimmer	Braintree Scientific	CLP-9868
Zen Lite Software	Carl Zeiss Microscopy	410135-1001-000