Imaging dermal blood flow through the intact rat skin with an optical clearing method

Delivery and kinetics of immersion optical clearing agents in tissues: Optical imaging from ex vivo to in vivo

Advanced optical imaging provides a powerful tool for the structural and functional analysis of tissues with high resolution and contrast, but the imaging performance decreases as light propagates deeper into the tissue. Tissue optical clearing technique demonstrates an innovative way to realize deep-tissue imaging and have emerged substantially in the last two decades. Here, we briefly reviewed the basic principles of tissue optical clearing techniques in the view of delivery strategies via either free diffusion or external forces-driven advection, and the commonly-used optical techniques for monitoring kinetics of clearing agents in tissue, as well as their ex vivo to in vivo applications in multiple biomedical research fields. With future efforts on the even distribution of both clearing agents and probes, excavation of more effective clearing agents, and automation of tissue clearing processes, tissue optical clearing should provide more insights into the fundamental questions in biological events clinical diagnostics.

Advancing DIEP Flap Monitoring with Optical Imaging Techniques: A Narrative Review

OBJECTIVES

This review aims to explore recent advancements in optical imaging techniques for monitoring the viability of Deep Inferior Epigastric Perforator (DIEP) flap reconstruction. The objectives include highlighting the principles, applications, and clinical utility of optical imaging modalities such as near-infrared spectroscopy (NIRS), indocyanine green (ICG) fluorescence angiography, laser speckle contrast imaging (LSCI), hyperspectral imaging (HSI), dynamic infrared thermography (DIRT), and short-wave infrared thermography (SWIR) in assessing tissue perfusion and oxygenation. Additionally, this review aims to discuss the potential of these techniques in enhancing surgical outcomes by enabling timely intervention in cases of compromised flap perfusion.

MATERIALS AND METHODS

A comprehensive literature review was conducted to identify studies focusing on optical imaging techniques for monitoring DIEP flap viability. We searched PubMed, MEDLINE, and relevant databases, including Google Scholar, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ProQuest Dissertations & Theses, among others, using specific keywords related to optical imaging, DIEP flap reconstruction, tissue perfusion, and surgical outcomes. This extensive search ensured we gathered comprehensive data for our analysis. Articles discussing the principles, applications, and clinical use of NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR in DIEP flap monitoring were selected for inclusion. Data regarding the techniques' effectiveness, advantages, limitations, and potential impact on surgical decision-making were extracted and synthesized.

RESULTS

Optical imaging modalities, including NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation in DIEP flap reconstruction. These techniques provide objective and quantitative data, enabling surgeons to monitor flap viability accurately. Studies have demonstrated the effectiveness of optical imaging in detecting compromised perfusion and facilitating timely intervention, thereby reducing the risk of flap complications such as partial or total loss. Furthermore, optical imaging modalities have shown promise in improving surgical outcomes by guiding intraoperative decision-making and optimizing patient care.

CONCLUSIONS

Recent advancements in optical imaging techniques present valuable tools for monitoring the viability of DIEP flap reconstruction. NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation, enabling accurate evaluation of flap viability. These modalities have the potential to enhance surgical outcomes by facilitating timely intervention in cases of compromised perfusion, thereby reducing the risk of flap complications. Incorporating optical imaging into clinical practice can provide surgeons with objective and quantitative data, assisting in informed decision-making for optimal patient care in DIEP flap reconstruction surgeries.

Semi-automated protocol to quantify and characterize fluorescent three-dimensional vascular images

The microvasculature facilitates gas exchange, provides nutrients to cells, and regulates blood flow in response to stimuli. Vascular abnormalities are an indicator of pathology for various conditions, such as compromised vessel integrity in small vessel disease and angiogenesis in tumors. Traditional immunohistochemistry enables the visualization of tissue cross-sections containing exogenously labeled vasculature. Although this approach can be utilized to quantify vascular changes within small fields of view, it is not a practical way to study the vasculature on the scale of whole organs. Three-dimensional (3D) imaging presents a more appropriate method to visualize the vascular architecture in tissue. Here we describe the complete protocol that we use to characterize the vasculature of different organs in mice encompassing the methods to fluorescently label vessels, optically clear tissue, collect 3D vascular images, and quantify these vascular images with a semi-automated approach. To validate the automated segmentation of vascular images, one user manually segmented one hundred random regions of interest across different vascular images. The automated segmentation results had an average sensitivity of 83±11% and an average specificity of 91±6% when compared to manual segmentation. Applying this procedure of image analysis presents a method to reliably quantify and characterize vascular networks in a timely fashion. This procedure is also applicable to other methods of tissue clearing and vascular labels that generate 3D images of microvasculature.

Visualization of regenerating and repairing hearts

With heart failure continuing to become more prevalent, investigating the mechanisms of heart injury and repair holds much incentive. In contrast with adult mammals, other organisms such as teleost fish, urodele amphibians, and even neonatal mammals are capable of robust cardiac regeneration to replenish lost or damaged myocardial tissue. Long-term high-resolution intravital imaging of the behaviors and interactions of different cardiac cell types in their native environment could yield unprecedented insights into heart regeneration and repair. However, this task remains challenging for the heart due to its rhythmic contraction and anatomical location. Here, we summarize recent advances in live imaging of heart regeneration and repair, discuss the advantages and limitations of current systems, and suggest future directions for novel imaging technology development.

Optical clearing of tissues: Issues of antimicrobial phototherapy and drug delivery

This review presents principles and novelties in the field of tissue optical clearing (TOC) technology, as well as application for optical monitoring of drug delivery and effective antimicrobial phototherapy. TOC is based on altering the optical properties of tissue through the introduction of immersion optical cleaning agents (OCA), which impregnate the tissue of interest. We also analyze various methods and kinetics of delivery of photodynamic agents, nanoantibiotics and their mixtures with OCAs into the tissue depth in the context of antimicrobial and antifungal phototherapy. In vitro and in vivo studies of antimicrobial phototherapies, such as photodynamic, photothermal plasmonic and photocatalytic, are summarized, and the prospects of a new TOC technology for effective killing of pathogens are discussed.

TISSUE CLEARING

Tissue clearing of gross anatomical samples was first described over a century ago and has only recently found widespread use in the field of microscopy. This renaissance has been driven by the application of modern knowledge of optical physics and chemical engineering to the development of robust and reproducible clearing techniques, the arrival of new microscopes that can image large samples at cellular resolution and computing infrastructure able to store and analyze large data volumes. Many biological relationships between structure and function require investigation in three dimensions and tissue clearing therefore has the potential to enable broad discoveries in the biological sciences. Unfortunately, the current literature is complex and could confuse researchers looking to begin a clearing project. The goal of this Primer is to outline a modular approach to tissue clearing that allows a novice researcher to develop a customized clearing pipeline tailored to their tissue of interest. Further, the Primer outlines the required imaging and computational infrastructure needed to perform tissue clearing at scale, gives an overview of current applications, discusses limitations and provides an outlook on future advances in the field.

Tissue optical clearing for 3D visualization of vascular networks: A review

Reconstruction of the vasculature of intact tissues/organs down to the capillary level is essential for understanding the development and remodeling of vascular networks under physiological and pathological conditions. Optical imaging techniques can provide sufficient resolution to distinguish small vessels with several microns, but the imaging depth is somewhat limited due to the high light scattering of opaque tissue. Recently, various tissue optical clearing methods have been developed to overcome light attenuation and improve the imaging depth both for ex-vivo and in-vivo visualizations. Tissue clearing combined with vessel labeling techniques and advanced optical tomography enables successful mapping of the vasculature of different tissues/organs, as well as dynamically monitoring vessel function under normal and pathological conditions. Here, we briefly introduce the commonly-used labeling strategies for entire vascular networks, the current tissue optical clearing techniques available for various tissues, as well as the advanced optical imaging techniques for fast, high-resolution structural and functional imaging for blood vessels. We also discuss the applications of these techniques in the 3D visualization of vascular networks in normal tissues, and the vascular remodeling in several typical pathological models in clinical research. This review is expected to provide valuable insights for researchers to study the potential mechanisms of various vessel-associated diseases using tissue optical clearing pipeline.

Stokes polarization imaging applied for monitoring dynamic tissue optical clearing

We propose a continuous Stokes imaging system with a refresh rate of several seconds, instead of a traditional Mueller measurement setup, to quickly track the microstructural changes of tissues during the optical clearing process. The effectiveness of this fast Stokes imaging applied in monitoring the dynamic process is first validated by three designed experiments with a polarization state that changes continuously and rapidly, and is further confirmed by gradual changes in polarization image contrast and resolution with clearing. By comparison with experiments from different tissue samples with the same agent, the fast Stokes response curve can improve the analysis ability of photon polarization behavior connected with the complicated changes of tissue characteristics.

Tissue Optical Clearing for Biomedical Imaging: From In Vitro to In Vivo

Tissue optical clearing technique provides a prospective solution for the application of advanced optical methods in life sciences. This chapter firstly gives a brief introduction to mechanisms of tissue optical clearing techniques, from the physical mechanism to chemical mechanism, which is the most important foundation to develop tissue optical clearing methods. During the past years, in vitro and in vivo tissue optical clearing methods were developed. In vitro tissue optical clearing techniques, including the solvent-based clearing methods and the hydrophilic reagents-based clearing methods, combined with labeling technique and advanced microscopy, can be applied to image 3D microstructure of tissue blocks or whole organs such as brain and spinal cord with high resolution. In vivo skin or skull optical clearing, promise various optical imaging techniques to detect cutaneous or cortical cell and vascular structure and function without surgical window.

In vivo detection of human cutaneous beta-carotene using computational optical clearing

The content of dermal beta-carotene can be a good indicator showing the body health. Because, it is involved in production of vitamin A maintaining healthy skin and mucous membranes. Also, it reduces the risk of cardiovascular diseases and its antioxidant capacity prevents the formation of cancerous cells. In this work, we use Raman spectroscopy and a low-cost diffuse reflectance spectroscopy (DRS) to detect the dermal beta-carotene spectra. We apply computational optical clearing (OC) method to in vivo evaluation the concentration of this chromophore. The results show that Raman spectroscopy is a good tool for in vitro detection of carotenoids but is not able to clearly discriminate the individual carotenoids in skin tissue in vivo. The results also show that using OC enhances the ability of low-cost diffuse reflection spectroscopy for in vivo detection of dermal beta-carotene in humans. This method can be used as a low-cost and portable device to screening the concentration of chromophores such as melanin and carotenoid molecules for oncological studies.

Chronic Brain Imaging Across a Transparent Nanocrystalline Yttria-Stabilized-Zirconia Cranial Implant

Repeated non-diffuse optical imaging of the brain is difficult. This is due to the fact that the cranial bone is highly scattering and thus a strong optical barrier. Repeated craniotomies increase the risk of complications and may disrupt the biological systems being imaged. We previously introduced a potential solution in the form of a transparent ceramic cranial implant called the Window to the Brain (WttB) implant. This implant is made of nanocrystalline Yttria-Stabilized Zirconia (nc-YSZ), which possesses the requisite mechanical strength to serve as a permanent optical access window in human patients. In this present study, we demonstrate repeated brain imaging of n = 5 mice using both OCT and LSI across the WttB implant over 4 weeks. The main objectives are to determine if the WttB implant allows for chronic OCT imaging, and to shed further light on the question of whether optical access provided by the WttB implant remains stable over this duration in the body. The Window to the Brain implant allowed for stable repeated imaging of the mouse brain with Optical Coherence Tomography over 28 days, without loss of signal intensity. Repeated Laser Speckle Imaging was also possible over this timeframe, but signal to noise ratio and the sharpness of vessels in the images decreased with time. This can be partially explained by elevated blood flow during the first imaging session in response to trauma from the surgery, which was also detected by OCT flow imaging. These results are promising for long-term optical access through the WttB implant, making feasible chronic in vivo studies in multiple neurological models of brain disease.

Research Techniques Made Simple: Optical Clearing and Three-Dimensional Volumetric Imaging of Skin Biopsies

Skin histology is traditionally carried out using two-dimensional tissue sections, which allows for rapid staining, but these sections cannot accurately represent three-dimensional structures in skin such as nerves, vasculature, hair follicles, and sebaceous glands. Although it may be ideal to image skin in a three-dimensional manner, it is technically challenging to image deep into tissue because of light scattering from collagen fibrils in the dermis and refractive index mismatch owing to the presence of differing biological materials such as cytoplasm, and lipids in the skin. Different optical clearing methods have been developed recently, making it possible to render tissues transparent using different approaches. Here, we discuss the steps involved in tissue preparation for three-dimensional volumetric imaging and provide a brief overview of the different optical clearing methods as well as different imaging modalities for three-dimensional imaging.

Penetration-enhanced optical coherence tomography angiography with optical clearing agent for clinical evaluation of human skin

BACKGROUND

Optical coherence tomography angiography (OCTA) is an emerging imaging technique which shows its advantages over visualizing microcirculation with free label. However, its shortcomings in imaging depth limit its development in dermatological field. Nowadays, the newly optical clearing agent (OCA) designed for skin optical imaging demonstrates its potential. In our study, whether this OCA can improve the imaging ability of OCTA in healthy human skin and whether the combination of them is beneficial to compare the lesions and the contralateral normal skins in the patients with port wine stains (PWS) have been investigated.

METHODS

Five healthy volunteers and 3 PWS patients were recruited in this study. In terms of healthy people, the opisthenar area which has same structure information as facial skin was taken for investigating the OCA's ability of enhancing OCTA imaging depth on healthy human skin, besides, in order to verifying whether the exists of skin corneum interfere OCA's function, we compared the effect of only using OCA with that of comprehensive using pre-processing skin and OCA. There are one physical removing corneum method by using medical tape to strip opisthenar skin for over 20-time and one chemical way through applying exfoliating cream. For PWS patient, the combining using OCA and OCTA was applied at the lesion area and the contralateral normal area for the purpose of verifying their ability to provide the information of vessels.

RESULTS

This novel OCA had excellent efficacy to increase the penetration depth of human opisthenar skin for the OCTA imaging by approximately 0.16 ± 0.03 mm. Pre-processing of stratum corneum with an exfoliating cream or medical tape stripping did not further benefit the penetrating efficacy of the OCA. Moreover, according to a comprehensive analysis of the OCTA images enhanced by the OCA, the PWS lesions usually have larger density and diameter of the vessels which located in deep layers (beyond 0.21 mm) than the contralateral normal skin.

CONCLUSIONS

The OCTA imaging depth and contrast were significantly improved by the OCA. The OCA application is a simple and efficient clinical procedure for OCTA enhancement. Moreover, it demonstrated great clinical value to compare the normal skin and the PWS lesions in the patients by the enhanced OCTA imaging.

In-vivo and ex-vivo optical clearing methods for biological tissues: review

Every optical imaging technique is limited in its penetration depth by scattering occurring in biological tissues. Possible solutions to overcome this problem consist of limiting the detrimental effects of scattering by reducing optical inhomogeneities within the sample. This can be achieved either by using physical methods (such as refractive index matching solutions) or by chemical methods (such as the removal of scatterers), based on tissue transformation protocols. This review provides an overview of the current state-of-the-art methods used for both ex-vivo and in-vivo optical clearing of biological tissues. We start with a brief history of the development of the most widespread clearing methods across the new millennium, then we describe the working principles of both physical and chemical methods. Clearing methods are then reviewed, pointing the attention of the reader on both physical and chemical methods, classified based on the tissue size and type for each specific application. A small section is reserved for methods that have already found in-vivo applications at the research level. Finally, a detailed discussion highlighting both the most relevant results achieved and the new ongoing developments in this field is reported in the last part, together with future perspectives for the clearing methodology.

Comparison of cerebral and cutaneous microvascular dysfunction with the development of type 1 diabetes

Rationale: Diabetes can lead to cerebral and cutaneous vascular dysfunction. However, it is still unclear how vascular function changes with the development of diabetes and what differences exist between cerebral and cutaneous vascular dysfunction. Thus, it is very important to monitor changes in cerebral and cutaneous vascular function responses in vivo and study their differences during diabetes development. Methods: With the assistance of newly developed skull and skin optical clearing techniques, we monitored the responses of sodium nitroprusside (SNP)- and acetyl choline (ACh)-induced cerebral and cutaneous vascular blood flow and blood oxygen in diabetic mice in vivo during the development of type 1 diabetes (T1D) by combining laser speckle contrast imaging with hyperspectral imaging. We then compared the differences between cerebral and cutaneous vascular responses and explored the reasons for abnormal changes induced in response to different vascular beds. Results: In the early stage of diabetes (T1D-1 week), there were abnormal changes in the cerebral vascular blood flow and blood oxygen responses to SNP and ACh as well as cutaneous vascular blood oxygen. The cutaneous vascular blood flow response also became abnormal from T1D-3 weeks. Additionally, the T1D-induced abnormal blood flow response was associated with changes in vascular myosin light chain phosphorylation and muscarinic acetylcholine receptor M3 levels, and the aberrant blood oxygen response was related to an increase in glycated hemoglobin levels. Conclusion: These results suggest that the abnormal cutaneous vascular blood oxygen response occurred earlier than the blood flow response and therefore has the potential to serve as a good assessment indicator for revealing cerebrovascular dysfunction in the early stage of diabetes.

Optical Access to Arteriovenous Cerebral Microcirculation Through a Transparent Cranial Implant

BACKGROUND AND OBJECTIVE

Microcirculation plays a critical role in physiologic processes and several disease states. Laser speckle imaging (LSI) is a full-field, real-time imaging technique capable of mapping microvessel networks and providing relative flow velocity within the vessels. In this study, we demonstrate that LSI combine with multispectral reflectance imaging (MSRI), which allows for distinction between veins and arteries in the vascular flow maps produced by LSI. We apply this combined technique to mouse cerebral vascular network in vivo, comparing imaging through the skull, to the dura mater and brain directly through a craniectomy, and through a transparent cranial "Window to the Brain" (WttB) implant.

STUDY DESIGN/MATERIALS AND METHODS

The WttB implant used in this study is made of a nanocrystalline Yttria-Stabilized-Zirconia ceramic. MSRI was conducted using white-light illumination and filtering the reflected light for 560, 570, 580, 590, 600, and 610 nm. LSI was conducted using an 810 nm continuous wave near-infrared laser with incident power of 100 mW, and the reflected speckle pattern was captured by a complementary metal-oxide-semiconductor (CMOS) camera.

RESULTS

Seven vessel branches were analyzed and comparison was made between imaging through the skull, craniectomy, and WttB implant. Through the skull, MSRI did not detect any vessels, and LSI could not image microvessels. Imaging through the WttB implant, MSRI was able to identify veins versus arteries, and LSI was able to image microvessels with only slightly higher signal-to-noise ratio and lower sharpness than imaging the brain through a craniectomy.

CONCLUSIONS

This study demonstrates the ability to perform MSRI-LSI across a transparent cranial implant, to allow for cerebral vascular networks to be mapped, including microvessels. These images contain additional information such as vein-artery separation and relative blood flow velocities, information which is of value scientifically and medically. The WttB implant provides substantial improvements over imaging through the murine cranial bone, where microvessels are not visible and MSRI cannot be performed. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

In Vivo Experimental Study on the Enhancement of Optical Clearing Effect by Laser Irradiation in Conjunction with a Chemical Penetration Enhancer

The penetration of optical clearing agents (OCAs) is restricted by the natural barrier function of the stratum corneum (SC) of the skin, which can be breached by physical and chemical methods to enhance the transcutaneous delivery of OCAs. To breach the barrier function of SC, we carried out the in vivo experimental study to enhance the optical clearing effect of PEG-400 by laser irradiation in conjunction with a chemical penetration enhancer thiazone. We compared the reflectance spectra of skin without laser irradiation or thiazone. Mono-treatment of thiazone could not significantly enhance the optical clearing efficacy of the skin. After 60 min, the reflectance spectrum decreased by only approximately 10%. With the combined treatment, the reflectance spectrum decreased by approximately 30% after 10 min. Subsequently, the effect of laser dose on the enhancement of optical clearing efficacy was studied. The optimal irradiation dose was determined. The reflectance of skins irradiated by a laser dose at 0.7 J/cm2 decreased by approximately 10% and were 20% lower than those at 0.5 and 0.9 J/cm2. The laser at 0.5 J/cm2 could not damage the SC completely, whereas the laser at 0.9 J/cm2 influenced the epidermis and dermis; thus, the reflectance of skin samples irradiated by 0.9 J/cm2 did not decrease.

Spectral contrast optical coherence tomography angiography enables single-scan vessel imaging

Optical coherence tomography angiography relies on motion for contrast and requires at least two data acquisitions per pointwise scanning location. We present a method termed spectral contrast optical coherence tomography angiography using visible light that relies on the spectral signatures of blood for angiography from a single scan using endogenous contrast. We demonstrate the molecular sensitivity of this method, which enables lymphatic vessel, blood, and tissue discrimination.

Confocal Raman microscopy combined with optical clearing for identification of inks in multicolored tattooed skin in vivo

Raman measurements applied on freshly tattooed porcine skin ex vivo showed a possibility of obtaining the ink pigment related information in the skin. Based on these results, confocal Raman microscopy was used to identify the tattoo ink pigments of different colors in multicolored tattooed human skin in vivo. The Raman signatures of tattoo ink pigments were unique. Therefore, it could be shown that the applied method is successful for the identification of the tattoo ink pigments in human skin in vivo down to depths of approx. 50 μm, which is sufficient to screen the entire epidermis and the top of the papillary dermis area on the forearm and leg skin sites. Additional application of the optical clearing technique in vivo by topical application of glycerol, combined with tape stripping removal of the uppermost stratum corneum layers and defatting allows the extension of depths of investigation in tattooed skin down to approx. 400 μm, i.e. to cover the entire papillary dermis and a large part of the reticular dermis. Thus, the tattoo ink pigments were identified in vivo and depth-dependently in human tattooed skin confirming their presence in the papillary and reticular dermis. The proposed non-invasive in vivo Raman screening combined with optical clearing for identifying the tattoo pigments in the dermis can be an important task preceding a laser-based tattoo removal procedure and for determining the optimal laser parameters.

Evaluation of a transparent cranial implant as a permanent window for cerebral blood flow imaging

Laser speckle imaging (LSI) of mouse cerebral blood flow was compared through a transparent nanocrystalline yttria-stabilized zirconia (nc-YSZ) cranial implant over time (at days 0, 14, and 28, n = 3 mice), and vs. LSI through native skull (at day 60, n = 1 mouse). The average sharpness of imaged vessels was found to remain stable, with relative change in sharpness under 7.69% ± 1.2% over 28 days. Through-implant images of vessels at day 60 appeared sharper and smaller on average, with microvessels clearly visible, compared to through-skull images where vessels appeared blurred and distorted. These results suggest that long-term imaging through this implant is feasible.

Combination of analytical and experimental optical clearing of rodent specimen for detecting beta-carotene: phantom study

Recently, compression optical clearing (OC) was applied to detect dermal carotenoid using reflection spectroscopy. To enhance the precision and accuracy of reflection spectroscopy to better detect the spectral absorption of beta-carotene inside biological phantom, here, we simultaneously use compression and immersion OC using dimethyl sulfoxide. In addition, we analytically extract the absorption coefficient of beta-carotene using diffuse reflectance spectroscopy (as an analytical OC). Our results show that the presented analytical OC can be applied alone as a noninvasive method to measure cutaneous chromophores at deep tissues. Finally, we also improve the ability of the analytical clearing method mediated with experimental OC. Our result demonstrates that the combination of analytical and experimental clearing methods enhance the ability of diffuse reflection spectroscopy for extracting the absorption coefficient of beta-carotene as one of the chromospheres inside biological phantom.

Visualization of skin microvascular dysfunction of type 1 diabetic mice using in vivo skin optical clearing method

To realize visualization of the skin microvascular dysfunction of type 1 diabetic mice, we combined laser speckle contrast imaging and hyperspectral imaging to simultaneously monitor the noradrenaline (NE)-induced responses of vascular blood flow and blood oxygen with the development of diabetes through optical clearing skin window. The main results showed that venous and arterious blood flow decreased without recovery after injection of NE; furthermore, the decrease of arterious blood oxygen induced by NE greatly weakened, especially for 2- and 4-week diabetic mice. This change in vasoconstricting effect of NE was related to the expression of α1-adrenergic receptor. This study demonstrated that skin microvascular function was a potential research biomarker for early warning in the occurrence and development of diabetes. The in vivo skin optical clearing method provides a feasible solution to realize visualization of cutaneous microvessels for monitoring microvascular reactivity under pathological conditions. In addition, visual monitoring of skin microvascular function response has guiding significance for early diagnosis of diabetes and clinical research.

Visualization of skin microvascular dysfunction of type 1 diabetic mice using in vivo skin optical clearing method

To realize visualization of the skin microvascular dysfunction of type 1 diabetic mice, we combined laser speckle contrast imaging and hyperspectral imaging to simultaneously monitor the noradrenaline (NE)-induced responses of vascular blood flow and blood oxygen with the development of diabetes through optical clearing skin window. The main results showed that venous and arterious blood flow decreased without recovery after injection of NE; furthermore, the decrease of arterious blood oxygen induced by NE greatly weakened, especially for 2- and 4-week diabetic mice. This change in vasoconstricting effect of NE was related to the expression of α1-adrenergic receptor. This study demonstrated that skin microvascular function was a potential research biomarker for early warning in the occurrence and development of diabetes. The in vivo skin optical clearing method provides a feasible solution to realize visualization of cutaneous microvessels for monitoring microvascular reactivity under pathological conditions. In addition, visual monitoring of skin microvascular function response has guiding significance for early diagnosis of diabetes and clinical research.

Measurement of tissue optical properties in the context of tissue optical clearing

Nowadays, dynamically developing optical (photonic) technologies play an ever-increasing role in medicine. Their adequate and effective implementation in diagnostics, surgery, and therapy needs reliable data on optical properties of human tissues, including skin. This paper presents an overview of recent results on the measurements and control of tissue optical properties. The issues reported comprise a brief review of optical properties of biological tissues and efficacy of optical clearing (OC) method in application to monitoring of diabetic complications and visualization of blood vessels and microcirculation using a number of optical imaging technologies, including spectroscopic, optical coherence tomography, and polarization- and speckle-based ones. Molecular modeling of immersion OC of skin and specific technique of OC of adipose tissue by its heating and photodynamic treatment are also discussed.

Recent progress in tissue optical clearing for spectroscopic application

This paper aims to review recent progress in optical clearing of the skin and over naturally turbid biological tissues and blood using this technique in vivo and in vitro with multiphoton microscopy, confocal Raman microscopy, confocal microscopy, NIR spectroscopy, optical coherence tomography, and laser speckle contrast imaging. Basic principles of the technique, its safety, advantages and limitations are discussed. The application of optical clearing agent on a tissue allows for controlling the optical properties of tissue. Optical clearing-induced reduction of tissue scattering significantly facilitates the observation of deep-located tissue regions, at the same time improving the resolution and image contrast for a variety of optical imaging methods suitable for clinical applications, such as diagnostics and laser treatment of skin diseases, mucosal tumor imaging, laser disruption of pathological abnormalities, etc.

In vivo imaging the motility of monocyte/macrophage during inflammation in diabetic mice

Diabetes, as a chronic metabolic disease, can impair the immune function of monocytes/macrophages (MMs). However, it is unclear how MM immune response to inflammation with the development of diabetes, and whether immune response around the inflammatory foci depends on the depth in tissue. Footpad provides a classical physiological site for monitoring cellular behavior during inflammation, but limited to the superficial dermis due to the strong scattering of footpad. Herein, we used confocal microscopy to monitor the motility of MMs in deeper tissue around inflammatory foci with the development of type 1 diabetic (T1D) mice through a switchable footpad skin optical clearing window. Delayed-type hypersensitivity (DTH) model was elicited on the footpad of T1D. Results demonstrated that progressive T1D led to the gradually potentiated MM recruitment and increased expression of monocyte chemoattractant protein-1 during DTH, but MM migration displacement, motion velocity and motility coefficient were significantly attenuated. Besides, MMs from the deeper dermis had a much larger migration displacement than those from superficial dermis at early stages of DTH but an opposite tendency at late stages for non-T1D, while progressive T1D obscured this difference gradually. This study will be helpful for investigating the influences of progressive metabolic diseases on immune response. MM motion trajectory at depth of superficial dermis and the deeper dermis at AOVA (heat-aggregated ovalbumin)-4 hours and AOVA-72 hours on non-T1D (A) and T1D-4 weeks (B). Mean motility coefficient (C) at the 2 depths. Data were pooled from 6 mice per group. *P < .05 and **P < .01 compared among different T1D disease durations. #P < .05 compared between different depths.

Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study

Port-wine stain (PWS) birthmark is a congenital microvascular malformation of the skin. A 1064-nm Nd:YAG laser can achieve a deeper treatment, but the weak absorption by blood limits its clinical application. Multiple laser pulses (MLPs) are a potential solution to enhance the curative effect of a Nd:YAG laser. To reduce the pulse number (p_n) required for the thermal destruction of the blood vessel, the effect of glucose in conjunction with MLP was investigated. In vivo experiments were performed on a dorsal skin chamber model. Different concentrations (20, 25, 30, and 40%) of glucose were applied to the sub-dermal side of the hamster skin before laser irradiation. Identical vessels with diameters of 200 ± 30 and 110 ± 20 μm were chosen as representatives of typical PWS vessels. Instant thermal responses of the blood vessel were recorded by a high-speed camera. The required p_n for blood vessel damage was compared with that without glucose pretreatment. Results showed that the use of glucose with a concentration of 20% combined with MLP Nd:YAG laser to damage blood vessels is more appropriate because severe hemorrhage or carbonization easily appeared in blood vessels at higher glucose concentration of 25, 30, and 40%. When 20% glycerol is pretreated on the sub-dermal hamster skin, the required p_n for blood vessel damage can be significantly decreased for different power densities. For example, p_n can be reduced by 40% when the power density is 57 J/cm². In addition, generation of cavitation and bubbles in blood vessels is difficult upon pretreatment with glucose. The combination of glucose with MLP Nd:YAG laser could be an effective protocol for reducing the p_n required for blood vessel damage. Randomized controlled trial (RCT) and human trials will be conducted in the future.

Optical clearing for multiscale biological tissues

Three-dimensional reconstruction of tissue structures is essential for biomedical research. The development of light microscopes and various fluorescent labeling techniques provides powerful tools for this motivation. However, optical imaging depth suffers from strong light scattering due to inherent heterogeneity of biological tissues. Tissue optical clearing technology provides a distinct solution and permits us to image large volumes with high resolution. Until now, various clearing methods have been developed. In this study, from the perspective of the end users, we review in vitro tissue optical clearing techniques based on the sample features in terms of size and age, enumerate the methods suitable for immunostaining and lipophilic dyes and summarize the combinations with various imaging techniques. We hope this review will be helpful for researchers to choose the most suitable clearing method from a variety of protocols to meet their specific needs.

A useful way to develop effective in vivo skin optical clearing agents

Skin optical clearing has shown tremendous potential in improving various optical imaging performances, but there is some certain blindness in screening out high-efficiency in vivo optical clearing methods. In this work, three optical clearing agents: sucrose (Suc), fructose (Fruc) and PEG-400 (PEG), and two chemical penetration enhancers: propylene glycol (PG) and thiazone (Thiaz) were used. PEG was firstly mixed with the two penetration enhancers, respectively, and then mixed with Fruc and Suc, respectively, to obtain six kinds of skin optical clearing agents (SOCAs). Optical coherence tomography angiography was applied to monitor SOCAs-induced changes in imaging performances, skin optical properties, refractive index mismatching extent, and permeability rate. Experimental results demonstrated that PEG+Thiaz+Suc has the optimal capacity in enhancing the imaging performances, decreasing the scattering and the refractive index mismatching since Thiaz is superior to PG, and Suc is superior to Fruc. This study indicates that the optimal SOCA can be obtained directly by means of additionally adding or replacing the similar category substance in preexisting SOCAs with some more effective reagents. It not only provides an optimal SOCA, but also provides a useful way to develop more effective SOCAs. Cross-section skin structural texture (a), reconstructed blood flow distribution information (b), before or after treated with different SOCAs.

Lookup-table-based inverse model for mapping oxygen concentration of cutaneous microvessels using hyperspectral imaging

Hyperspectral imaging combining with skin optical clearing technique provides a possible way to non-invasively monitor hemodynamics of cutaneous microvessels. In order to estimate microvascular blood oxygen saturation, in this work, a lookup-table-based inverse model was developed to extract the microvascular optical and physiological properties using hyperspectral analysis. This approach showed a higher fitting degree than currently existing hyperspectral analysis methods (i.e. multiple linear regression and non-negative least square fit) in estimating blood oxygen saturation. Hypoxic stimulation experiment showed that calculated results were in accordance with physiological changes, and the relative changes of estimated oxygen saturation indicated this method appeared to be more sensitive to blood oxygen fluctuation. And a simulated blood model was used for verification here, indicating this method also showed a good accuracy in determining oxygen saturation from the simulated spectra.

Study of the inhibition effect of thiazone on muscle optical clearing

We investigated the effect of thiazone, a widely used penetration enhancer, on in vitro porcine skin and muscle tissue by single-integrating sphere technique during optical clearing (OC) treatment. The results showed that thiazone induced an increase on the total transmittance of skin which led to a reduction in that of muscle in the spectral range from 400 to 800 nm. Small particles crystalized out from the thiazone-treated muscle were observed by microscopy imaging. With the help of x-ray diffraction measurement, we ascertained that the crystal was a single-crystal of thiazone, which mainly induced an increase of the scattering. Contrast transmittance measurements carried on the mixture of water, thizaone–propylene glycol solution showed that the free water in muscle could be the main reason for the thiazone crystallization. Therefore, during OC treatment of thiazone, the remarkable effect on skin and the noticeable inhibition effect on subcutaneous muscle tissue after penetrating into the skin should be considered. The experimental results provide such a reference for the choice of penetration enhancer.

Enhanced in vivo visualization of the microcirculation by topical application of fructose solution confirmed with correlation mapping optical coherence tomography

Changes within the microcirculation can provide an early indication of the onset of a plethora of ailments. Various techniques have thus been developed that enable the study of microcirculatory irregularities. Correlation mapping optical coherence tomography (cmOCT) is a recently proposed technique, which enables mapping of vasculature networks at the capillary level in a noninvasive and noncontact manner. This technique is an extension of conventional optical coherence tomography (OCT) and is therefore likewise limited in the penetration depth of ballistic photons in biological media. Optical clearing has previously been demonstrated to enhance the penetration depth and the imaging capabilities of OCT. In order to enhance the achievable maximum imaging depth, we propose the use of optical clearing in conjunction with the cmOCT technique. We demonstrate in vivo a 13% increase in OCT penetration depth by topical application of a high-concentration fructose solution, thereby enabling the visualization of vessel features at deeper depths within the tissue.

Optical clearing for luminal organ imaging with ultrahigh-resolution optical coherence tomography

The imaging depth of optical coherence tomography (OCT) in highly scattering biological tissues (such as luminal organs) is limited, particularly for OCT operating at shorter wavelength regions (such as around 800 nm). For the first time, the optical clearing effect of the mixture of liquid paraffin and glycerol on luminal organs was explored with ultrahigh-resolution spectral domain OCT at 800 nm. Ex vivo studies were performed on pig esophagus and bronchus, and guinea pig esophagus with different volume ratios of the mixture. We found that the mixture of 40% liquid paraffin had the best optical clearing effect on esophageal tissues with a short effective time of ∼ 10 min, which means the clearing effect occurs about 10 min after the application of the clearing agent. In contrast, no obvious optical clearing effect was identified on bronchus tissues.

A survey of clearing techniques for 3D imaging of tissues with special reference to connective tissue

For 3-dimensional (3D) imaging of a tissue, 3 methodological steps are essential and their successful application depends on specific characteristics of the type of tissue. The steps are 1° clearing of the opaque tissue to render it transparent for microscopy, 2° fluorescence labeling of the tissues and 3° 3D imaging. In the past decades, new methodologies were introduced for the clearing steps with their specific advantages and disadvantages. Most clearing techniques have been applied to the central nervous system and other organs that contain relatively low amounts of connective tissue including extracellular matrix. However, tissues that contain large amounts of extracellular matrix such as dermis in skin or gingiva are difficult to clear. The present survey lists methodologies that are available for clearing of tissues for 3D imaging. We report here that the BABB method using a mixture of benzyl alcohol and benzyl benzoate and iDISCO using dibenzylether (DBE) are the most successful methods for clearing connective tissue-rich gingiva and dermis of skin for 3D histochemistry and imaging of fluorescence using light-sheet microscopy.

Enhancement of OCT imaging by blood optical clearing in vessels – A feasibility study

The results of a feasibility study of the application of PEG-300 and fructose as two independent optical clearing agents for the reduction of light scattering in biological tissues are presented.

An OCT system operating at 1300 nm was used to study optical clearing effects. In

The intradermal injection of fructose in combination with the intravenous injection of PEG-300 led to a rapid optical clearing effect. In the experiments on mice

The experiments on mice have clearly demonstrated that intradermal and intravenous injections of optical clearing agents enhanced light transport through the skin and blood vessels.

Accessing to arteriovenous blood flow dynamics response using combined laser speckle contrast imaging and skin optical clearing

Laser speckle contrast imaging (LSCI) shows a great potential for monitoring blood flow, but the spatial resolution suffers from the scattering of tissue. Here, we demonstrate the capability of a combination method of LSCI and skin optical clearing to describe in detail the dynamic response of cutaneous vasculature to vasoactive noradrenaline injection. Moreover, the superior resolution, contrast and sensitivity make it possible to rebuild arteries-veins separation and quantitatively assess the blood flow dynamical changes in terms of flow velocity and vascular diameter at single artery or vein level.

Optical clearing in dense connective tissues to visualize cellular connectivity in situ

Visualizing the three-dimensional morphology and spatial patterning of cells embedded deep within dense connective tissues of the musculoskeletal system has been possible only by utilizing destructive techniques. Here we utilize fructose-based clearing solutions to image cell connectivity and deep tissue-scale patterning in situ by standard confocal microscopy. Optical clearing takes advantage of refractive index matching of tissue and the embedding medium to visualize light transmission through a broad range of bovine and whole mount murine tissues, including cartilage, bone, and ligament, of the head and hindlimb. Using non-destructive methods, we show for the first time intercellular chondrocyte connections throughout the bulk of cartilage, and we reveal in situ patterns of osteocyte processes and the lacunar-canalicular system deep within mineralized cortical bone. Optical clearing of connective tissues is expected to find broad application for the study of cell responses in normal physiology and disease pathology.

Optical clearing agents improve photoacoustic imaging in the optical diffusive regime

Acoustic resolution photoacoustic microscopy (AR-PAM) takes advantage of weak acoustic scattering to image fine structures, such as the subcutaneous microvasculature, providing a spatial resolution on the order of tens of micrometers. However, the amplitude of AR-PAM deteriorates sharply with depth, as a result of light scattering and acoustic attenuation caused by structures such as the skin. Optical clearing techniques can enhance optical transmittance by decreasing the scattering of light through tissues. However, it is unknown whether optical clearing agents (OCAs) can be used to improve AR-PAM. We applied different types of OCAs to rat dorsal skin in an ex vivo study to determine the effects of OCAs on photoacoustic detection. We identified three OCAs that improved the photoacoustic amplitude for further in vivo testing. With the use of an appropriate penetration enhancer, PEG-400 significantly improved the photoacoustic amplitude for detection of deep-sealed blood vessels, while glycerol alone improved the image quality of shallow vessels. In contrast, DMSO application resulted in decreased photoacoustic amplitude in the in vivo trials.

Recent progress in tissue optical clearing

Tissue optical clearing technique provides a prospective solution for the application of advanced optical methods in life sciences. This paper gives a review of recent developments in tissue optical clearing techniques. The physical, molecular and physiological mechanisms of tissue optical clearing are overviewed and discussed. Various methods for enhancing penetration of optical-clearing agents into tissue, such as physical methods, chemical-penetration enhancers and combination of physical and chemical methods are introduced. Combining the tissue optical clearing technique with advanced microscopy image or labeling technique, applications for 3D microstructure of whole tissues such as brain and central nervous system with unprecedented resolution are demonstrated. Moreover, the difference in diffusion and/or clearing ability of selected agents in healthy versus pathological tissues can provide a highly sensitive indicator of the tissue health/pathology condition. Finally, recent advances in optical clearing of soft or hard tissue for in vivo imaging and phototherapy are introduced. [Formula: see text].

Optical clearing-aided photoacoustic microscopy with enhanced resolution and imaging depth

Due to strong light scattering in tissue, both the spatial resolution and maximum penetration depth of optical-resolution photoacoustic microscopy (OR-PAM) deteriorate sharply with depth. To reduce tissue scattering, we propose to use glycerol as an optical clearing agent in OR-PAM. Our results show that the imaging performance of OR-PAM can be greatly enhanced by optical clearing both in vitro and in vivo.

Signal and depth enhancement for in vivo flow cytometer measurement of ear skin by optical clearing agents

The in vivo flow cytometry (IVFC) has shown a great potential for detecting circulating tumor cells quantitatively in the bloodstream. However, the detection depth suffers from the strong light scattering of tissue. In this study, an innovative ear skin optical clearing agent (ESOCA) is employed to improve the signal quality of the IVFC. Our results show that compared with commonly used glycerol, topical application of ESOCA can enhance the transmittance of rat ear significantly in vivo. The labeled red blood cells can be detected by the IVFC with higher signal quality and greater detection depth. This study is very helpful for potential tumor metastasis studies by the IVFC in deep tissues.

Enhanced optical clearing of skin in vivo and optical coherence tomography in-depth imaging

The strong optical scattering of skin tissue makes it very difficult for optical coherence tomography (OCT) to achieve deep imaging in skin. Significant optical clearing of in vivo rat skin sites was achieved within 15 min by topical application of an optical clearing agent PEG-400, a chemical enhancer (thiazone or propanediol), and physical massage. Only when all three components were applied together could a 15 min treatment achieve a three fold increase in the OCT reflectance from a 300 μm depth and 31% enhancement in image depth Z(threshold).

Tissue optical immersion clearing

In this article, we discuss the optical immersion method based on refractive index matching of scatterers (e.g., collagen, elastin fibers, cells and cell compartments) and the ground material (interstitial fluid and/or cytoplasm) of tissue and blood under the action of exogenous optical clearing agents. We analyze the optical clearing of fibrous and cell-structured tissues and blood from the point of view of receiving more valuable, normally hidden, information from spectroscopic and polarization measurements, confocal microscopy, optical coherence and optical projection tomography, as well as from nonlinear spectroscopies, such as two-photon fluorescence and second-harmonic generation techniques. Some important applications of the immersion technique to glucose sensing, drug delivery monitoring, improvements of image contrast and imaging depth, nondistortive delivery of laser radiation and precision tissue laser photodisruption, among others, are also described.

ASSESSMENT OF TISSUE OPTICAL CLEARING AS A FUNCTION OF GLUCOSE CONCENTRATION USING OPTICAL COHERENCE TOMOGRAPHY

One of the major challenges in imaging biological tissues using optical techniques, such as optical coherence tomography (OCT), is the lack of light penetration due to highly turbid structures within the tissue. Optical clearing techniques enable the biological samples to be more optically homogeneous, allowing for deeper penetration of light into the tissue. This study investigates the effect of optical clearing utilizing various concentrations of glucose solution (10%, 30%, and 50%) on porcine skin. A gold-plated mirror was imaged beneath the tissue and percentage clearing was determined by monitoring the change in reflected light intensity from the mirror over time. The ratio of percentage clearing per tissue thickness for 10%, 30% and 50% glucose was determined to be 4.7 ± 1.6% mm(-1) (n = 6), 10.6 ± 2.0% mm(-1) (n = 7) and 21.8 ± 2.2% mm(-1) (n = 5), respectively. It was concluded that while higher glucose concentration has the highest optical clearing effect, a suitable concentration should be chosen for the purpose of clearing, considering the osmotic stress on the tissue sample.