a, CryoFM of MX04-labelled amyloid pathology targeted for cryoFIB-SEM lift-out showing in top left, top right, and lower left, reflection, MXO4 fluorescence and merged overview, respectively. Scale bar, 200 μm. Yellow rectangle in top right, closeup in bottom right. Scale bar, 20 μm. b-c, Alignment of cryoFM, FIB and SEM images to target lift-out in ZEN Connect. Images on left were aligned with middle image using fiducials indicated by open arrowheads. b, Alignment between cryoSEM normal overview and cryoSEM normal high-magnification image of MX04-labelled lift-out target. Scale bar, 200 μm. c, Alignment between cryoSEM normal high-magnification and cryoFIB normal image. Scale bar, 200 μm. Left and right, scale bar, 200 μm. Middle, scale bar, 100 μm. d, Alignment between cryoFIB normal image and cryoFIB high-magnification after cryoFIB milling trench. Left and right, scale bar, 100 μm. Middle, scale bar, 20 μm. e, Alignment between cryoFIB images before and after surface cleaning, sputter coating and cold deposition of platinum precursor. Scale bar, 20 μm. f, Alignment of cryoFIB images before and after trenches were milled in front, behind and to the right side to prepare tissue chunk for targeted lift-out. Scale bar, 20 μm. g, Images showing the result of alignments (from a to h) to target MX04-labelled tau for cryoFIB-SEM lift-out. Left, cryoFIB image of tissue chunk prepared for lift-out. Middle, confocal cryoFM of MX04-labelled amyloid plaque and tau tangles. Brown and yellow rectangles, left and right regions of serial chunk lift-out, respectively. Cyan line, location of lamella. Scale bar, 20 μm. h-l, CryoFIB-SEM lift-out of MX04-labelled post-mortem AD brain. Lines and rectangles tracing the tissue chunk during cryoFIB cuts and thinning were used for cryoCLEM. Red semi-transparent line, length of tissue chunk before lift-out. Green semi-transparent line, length of tissue chunk during lift-out. Brown rectangle, left tissue chunk. Yellow rectangle, right tissue chunk (lost during sample transfer from cryoFIB-SEM to cryoEM). Cyan line, region targeted for cryoFIB milling lamellae within tissue chunk. h, CryoFIB image of tissue chunk after final left side cut to detach tissue chunk. Magenta closed arrowhead, tissue chunk. Blue closed arrowhead, lift-out tool (copper block linking micromanipulator needle) attached to right side of tissue chunk. Scale bar, 10 μm. i, CryoSEM images showing attachment of the left tissue chunk to EM grid and cryoFIB cut between the left and right tissue chunks. Purple closed arrowhead, EM grid. Brown closed arrowhead, left tissue chunk. Yellow closed arrowhead, right tissue chunk. Blue closed arrowhead, lift-out tool. Scale bar, 10 μm. j, CryoFIB normal view image (56° stage tilt) of the tissue chunk after cryoFIB thinning to produce two 130–200 nm thick, ~8 μm wide, ~15 μm deep lamellae windows. Cyan closed arrowhead, lamella. Brown closed arrowhead, tissue chunk. Scale bar, 10 μm. k, CryoSEM showing serial attachment of the left and right tissue chunks. Yellow and brown closed arrowheads, left and right tissue chunks, respectively. Scale bar, 50 μm. Inset, overview image showing clipped half-moon Omniprobe EM grid. Scale bar, 0.5 mm. l, CryoEM overview showing left and right cryoFIB-milled tissue chunk attachment positions, left was lost and right remained during transfer cryoFIB to Krios TEM, respectively. Arrowheads, same as k. Scale bar, 50 μm.