“It’s a technique that could have very broad application,” says Boyden, an associate professor of biological engineering and brain and cognitive sciences at MIT. He is also a member of MIT’s Media Lab and McGovern Institute for Brain Research, and an HHMI-Simons Faculty Scholar.
In a paper appearing in the 17 July issue of Nature Biotechnology, Boyden and his colleagues used this technique to distinguish early-stage breast lesions with high or low risk of progressing to cancer — a task that is challenging for human observers. This approach can also be applied to other diseases: In an analysis of kidney tissue, the researchers found that images of expanded samples revealed signs of kidney disease that can normally only be seen with an electron microscope.
“Using expansion microscopy, we are able to diagnose diseases that were previously impossible to diagnose with a conventional light microscope,” says Octavian Bucur, an instructor at Harvard Medical School, Beth Israel Deaconess Medical Center (BIDMC), and the Ludwig Center at Harvard, and one of the paper’s lead authors.
MIT postdoc Yongxin Zhao is the paper’s co-lead author. Boyden and Andrew Beck, a former associate professor at Harvard Medical School and BIDMC, are the paper’s senior authors.
“A few chemicals and a light microscope”
Boyden’s original expansion microscopy technique is based on embedding tissue samples in a dense, evenly generated polymer that swells when water is added. Before the swelling occurs, the researchers anchor to the polymer gel the molecules that they want to image, and they digest other proteins that normally hold tissue together.
This tissue enlargement allows researchers to obtain images with a resolution of around 70 nanometers, which was previously possible only with very specialized and expensive microscopes.
In the new study, the researchers set out to adapt the expansion process for biopsy tissue samples, which are usually embedded in paraffin wax, flash frozen, or stained with a chemical that makes cellular structures more visible.
The MIT/Harvard team devised a process to convert these samples into a state suitable for expansion. For example, they remove the chemical stain or paraffin by exposing the tissues to a chemical solvent called xylene. Then, they heat up the sample in another chemical called citrate. After that, the tissues go through an expansion process similar to the original version of the technique, but with stronger digestion steps to compensate for the strong chemical fixation of the samples.
During this procedure, the researchers can also add fluorescent labels for molecules of interest, including proteins that mark particular types of cells, or DNA or RNA with a specific sequence.
“The work of Zhao et al. describes a very clever way of extending the resolution of light microscopy to resolve detail beyond that seen with conventional methods,” says David Rimm, a professor of pathology at the Yale University School of Medicine, who was not involved in the research.
The researchers tested this approach on tissue samples from patients with early-stage breast lesions. One way to predict whether these lesions will become malignant is to evaluate the appearance of the cells’ nuclei. Benign lesions with atypical nuclei have about a fivefold higher probability of progressing to cancer than those with typical nuclei.
However, studies have revealed significant discrepancies between the assessments of nuclear atypia performed by different pathologists, which can potentially lead to an inaccurate diagnosis and unnecessary surgery. An improved system for differentiating benign lesions with atypical and typical nuclei could potentially prevent 400,000 misdiagnoses and hundreds of millions of dollars every year in the United States, according to the researchers.
After expanding the tissue samples, the MIT/Harvard team analyzed them with a machine learning algorithm that can rate the nuclei based on dozens of features, including orientation, diameter, and how much they deviate from true circularity. This algorithm was able to distinguish between lesions that were likely to become invasive and those that were not, with an accuracy of 93 percent on expanded samples compared to only 71 percent on the pre-expanded tissue.
“These two types of lesions look highly similar to the naked eye, but one has much less risk of cancer,” Zhao says.
The researchers also analyzed kidney tissue samples from patients with nephrotic syndrome, which impairs the kidneys’ ability to filter blood. In these patients, tiny finger-like projections that filter the blood are lost or damaged. These structures are spaced about 200 nanometers apart and therefore can usually be seen only with an electron microscope or expensive super resolution microscopes.
When the researchers showed the images of the expanded tissue samples to a group of scientists that included pathologists and nonpathologists, the group was able to identify the diseased tissue with 90 percent accuracy overall, compared to only 65 percent accuracy with unexpanded tissue samples.
“Now you can diagnose nephrotic kidney disease without needing an electron microscope, a very expensive machine,” Boyden says. “You can do it with a few chemicals and a light microscope.”