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In vitro measurement of cell death with the annexin A5 affinity assay

Abstract

One of the hallmarks of cell death is the cell surface–expression of phosphatidylserine. Expression of phosphatidylserine at the cell surface can be measured in vitro with the phosphatidylserine-binding protein annexin A5 conjugated to fluorochromes. This measurement can be made by flow cytometry or by confocal scanning-laser microscopy. The annexin A5 affinity assay comprises the incubation of cells stimulated to execute cell death with fluorescence-labeled annexin A5 and propidium iodide. Living cells are annexin A5–negative and propidium iodide negative, cells in the early phases of cell death are annexin A5 positive–and propidium iodide–negative, and secondary necrotic cells are annexin A5–positive and propidium iodide–positive. The entire procedure takes about 30 minutes for flow cytometry and 45 minutes for confocal scanning-laser microscopy. Various precautions and considerations are discussed further in the protocol described here.

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Figure 1: Flow cytometry of apoptotic Jurkat cells with annexin A5–FP488 and propidium iodide.
Figure 2: CSLM analysis of apoptotic Jurkat cells with annexin A5–FP488 and propidium iodide.

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References

  1. Balasubramanian, K. & Schroit, A.J. Aminophospholipid asymmetry: a matter of life and death. Annu. Rev. Physiol. 65, 701–734 (2003).

    Article  CAS  Google Scholar 

  2. Savill, J., Dransfield, I., Gregory, C. & Haslett, C. A blast from the past: clearance of apoptotic cells regulates immune responses. Nat. Rev. Immunol. 2, 965–975 (2002).

    Article  CAS  Google Scholar 

  3. Vermes, I., Haanen, C., Steffens-Nakken, H. & Reutelingsperger, C. A novel assay for apoptosis. Flow cytometric detection of phosphatidylserine expression on early apoptotic cells using fluorescein labelled Annexin V. J. Immunol. Methods 184, 39–51 (1995).

    Article  CAS  Google Scholar 

  4. van Engeland, M., Nieland, L.J., Ramaekers, F.C., Schutte, B. & Reutelingsperger, C.P. Annexin V-affinity assay: a review on an apoptosis detection system based on phosphatidylserine exposure. Cytometry 31, 1–9 (1998).

    Article  CAS  Google Scholar 

  5. Kroemer, G. et al. Classification of cell death: recommendations of the Nomenclature Committee on Cell Death. Cell Death Differ. 12, 1463–1467 (2005).

    Article  CAS  Google Scholar 

  6. Corsten, M.F., Hofstra, L., Narula, J. & Reutelingsperger, C.P. Counting heads in the war against cancer: defining the role of annexin A5 imaging in cancer treatment and surveillance. Cancer Res. 66, 1255–1260 (2006).

    Article  CAS  Google Scholar 

  7. Martin, S.J. et al. Early redistribution of plasma membrane phosphatidylserine is a general feature of apoptosis regardless of the initiating stimulus: inhibition by overexpression of Bcl-2 and Abl. J. Exp. Med. 182, 1545–1556 (1995).

    Article  CAS  Google Scholar 

  8. Martin, S.J., Finucane, D.M., Amarante-Mendes, G.P., O'Brien, G.A. & Green, D.R. Phosphatidylserine externalization during CD95-induced apoptosis of cells and cytoplasts requires ICE/CED-3 protease activity. J. Biol. Chem. 271, 28753–28756 (1996).

    Article  CAS  Google Scholar 

  9. Foghsgaard, L. et al. Cathepsin B acts as a dominant execution protease in tumor cell apoptosis induced by tumor necrosis factor. J. Cell Biol. 153, 999–1010 (2001).

    Article  CAS  Google Scholar 

  10. Callahan, M.K. et al. Phosphatidylserine expression and phagocytosis of apoptotic thymocytes during differentiation of monocytic cells. J. Leukoc. Biol. 74, 846–856 (2003).

    Article  CAS  Google Scholar 

  11. Elliott, J.I. et al. Membrane phosphatidylserine distribution as a non-apoptotic signaling mechanism in lymphocytes. Nat. Cell Biol. 7, 808–816 (2005).

    Article  CAS  Google Scholar 

  12. Dillon, S.R., Constantinescu, A. & Schlissel, M.S. Annexin V binds to positively selected B cells. J. Immunol. 166, 58–71 (2001).

    Article  CAS  Google Scholar 

  13. Dias-Baruffi, M. et al. Dimeric galectin-1 induces surface exposure of phosphatidylserine and phagocytic recognition of leukocytes without inducing apoptosis. J. Biol. Chem. 278, 41282–41293 (2003).

    Article  CAS  Google Scholar 

  14. van den Eijnde, S.M. et al. Transient expression of phosphatidylserine at cell-cell contact areas is required for myotube formation. J. Cell Sci. 114, 3631–3642 (2001).

    CAS  PubMed  Google Scholar 

  15. Gerke, V., Creutz, C.E. & Moss, S.E. Annexins: linking Ca2+ signalling to membrane dynamics. Nat. Rev. Mol. Cell Biol. 6, 449–461 (2005).

    Article  CAS  Google Scholar 

  16. van Engeland, M., Ramaekers, F.C., Schutte, B. & Reutelingsperger, C.P. A novel assay to measure loss of plasma membrane asymmetry during apoptosis of adherent cells in culture. Cytometry 24, 131–139 (1996).

    Article  CAS  Google Scholar 

  17. Hughes, D. & Mehmet, H. Cell Proliferation and Apoptosis. 233–254, Ch. 9 (BIOS Scientific, Oxford, UK, 2003).

    Google Scholar 

  18. Pozarowski, P. et al. Interactions of fluorochrome-labeled caspase inhibitors with apoptotic cells: a caution in data interpretation. Cytometry A. 55, 50–60 (2003).

    Article  CAS  Google Scholar 

  19. Gavrieli, Y., Sherman, Y. & Ben-Sasson, S.A. Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation. J. Cell Biol. 119, 493–501 (1992).

    Article  CAS  Google Scholar 

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Correspondence to Chris Reutelingsperger.

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van Genderen, H., Kenis, H., Lux, P. et al. In vitro measurement of cell death with the annexin A5 affinity assay. Nat Protoc 1, 363–367 (2006). https://doi.org/10.1038/nprot.2006.55

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