Distinguishing between apoptosis, necrosis, necroptosis and other cell death
modalities This issue of Methods contains a series of articles that cover the major techniques used to measure apoptosis, necrosis and varia- tions thereof, at the population, single cell, organelle and molecular level. Although we used to think of apoptosis as programmed or regulated cell death and necrosis as strictly non-programmed or unregulated cell death [1,2], data have emerged in recent years which suggest that the boundaries between these two modes of cell death can become blurred in certain situations [3,4]. To summarize, for those that are new to the eld, apoptosis is a mode of cell death that is characterized by a series of morpholog- ical and biochemical alterations to the cell architecture that pack- age a cell up for removal by cells with phagocytic capacity [5]. Crucially, apoptotic cells are recognized by phagocytes and are en- gulfed before they leak their contents. Thus, apoptosis ensures that when a cell needs to be removed from a tissue, this occurs in an or- derly fashion that minimizes disruption to neighboring cells. The major consideration during apoptosis is that intracellular contents do not leak into the extracellular space because this could (a) dam- age surrounding cells, and (b) trigger inammation through release of molecules with immune-activating activity, the so-called alar- mins [5]. Thus, apoptosis is largely concerned with avoiding dis- turbance to tissues in which there is ongoing homeostatic cell death. Most of the biochemical and morphological changes that typify apoptosis are the consequence of activation of a subset of the caspase family of proteases (caspases 3, 6, 7, 8 and 9) [1,5]. The latter caspases operate similar to a controlled demolition squad, coordinating the packaging and disposal of cells in a manner that minimizes damage to neighbors and the initiation of inam- mation [5]. Methods for measuring apoptosis typically rely on the detection of caspase-dependent events, such as exposure of plasma membrane phosphatidylserine [6], that precede uptake of vital dyes such as trypan blue or propidium iodide. Alternatively, the striking morphological features of apoptotic cells (such as com- paction and fragmentation of the cell nucleus), which are also ef- fected through caspase activation, are still highly relevant for methods for detecting this mode of cell death. In contrast to apoptosis, necrosis is generally uncontrolled and involves the sudden loss of membrane integrity, release of extra- cellular contents, leading to activation of the immune system and extensive inammation [2,4]. Necrosis is typically not associated with caspase activation, although the exception to this is where cell death follows aggressive activation of the inammatory subset of caspases (caspases 1, 4 and 5), a mode of cell death termed pyroptosis. Necrotic cell death bears none of the striking features that characterize apoptotic cells, such as extensive membrane blebbing and hypercondensation and fragmentation of the nucleus. Instead, necrotic cells undergo extensive organelle and cell swell- ing, leading to decondensation of nuclei which become markedly less stained with uorescent dyes such as DAPI or propidium io- dide. Thus, this mode of cell death is relatively easy to distinguish from apoptosis on the basis of morphological criteria. Necroptosis, which is a form of necrosis that appears to be dri- ven as a consequence of the deregulated activity of specic mole- cules, is under intensive investigation at present. This mode of cell death is typically seen in response to engagement of certain mem- bers of the death receptor subset of the TNF superfamily, particu- larly of the TNF receptor itself, when caspase activity is inhibited [7]. The caveat is that death receptor-induced necroptosis is only observed in cells that express the kinase, RIPK3. In cells lacking RIPK3, inhibition of caspase activity completely blocks TNF-in- duced cell death, but in RIPK3-expressing cells results in a necro- tic-like mode of cell death [4,8]. Necroptosis results from excessive recruitment of RIPK3 onto RIPK1, thereby promoting excessive RIPK1 kinase activity, which is cytotoxic. Thus, necropto- sis represents somewhat of a kinase bomb that is set off within the cell if the normal caspase wiring is interfered with. Under normal circumstances, caspase-8 restrains recruitment of RIPK3 onto RIPK1 in two ways, rst by cleaving RIPK1 and second by cleaving the deubiquitinating enzyme CYLD. CYLD negatively regulates the degree of RIPK1 ubiquitination that occurs in response to death receptor engagement, an event that is involved in assembling sig- naling complexes on RIPK1 to propagate death receptor-induced NFjB activation. However, untrammeled CYLD activity can lead to deubiquitination of RIPK1 and excessive recruitment of RIPK3 as a consequence. Thus, by cleaving RIPK1 and CYLD, caspase-8 ne-tunes the composition of the RIPK1/RIPK3 complex, which, if perturbed, deregulates the RIPK1/RIPK3 kinase complex, resulting in necroptosis. What is not clear at present is why. Moreover, the physiological relevance of this mode of cell death is currently de- bated but may occur upon infection with certain viruses that en- code caspase inhibitors. Irrespective of the precise physiological relevance of necroptosis, which is under investigation at present, the major means of distinguishing conventional necrosis from nec- roptosis is through probing for the involvement of RIPK1, or RIPK3, where cell death occurs in the absence of caspase involvement. This can be done either through knocking down expression of 1046-2023/$ - see front matter 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ymeth.2013.06.001 Methods 61 (2013) 8789 Contents lists available at SciVerse ScienceDirect Methods j our nal homepage: www. el sevi er . com/ l ocat e/ ymet h RIPK1 or RIPK3 using siRNA or shRNA or by means of the RIPK1 inhibitor necrostatin [7]. The issue begins with an overview of the morphological fea- tures of apoptosis by Henry et al. [9]. Morphological features of cell death still remain a key means of distinguishing apoptosis from necrosis, with the former typically associated with extensive cell shrinkage and plasma membrane blebbing and the latter typied by cell swelling and gross membrane rupture. Henry et al., also de- scribe ow cytometry-based methods for quantitating apoptosis based upon DNA fragmentation, caspase activation and phosphati- dylserine externalization, which are very well established methods in the eld [9]. This is followed by a comprehensive discussion of the differ- ences between apoptosis and necrosis by Vandenabeele and col- leagues [10], who also describe a variety of assays that can be used to discriminate between these different modes of cell death with particular emphasis on the L929 cell line that is widely used to study TNF-induced necroptosis. Bortoluci and colleagues de- scribe a novel form of cell death, called pyroptosis, that has fea- tures of apoptosis as well as necrosis and is induced through delivery of bacterial agellin into the cytoplasm of macrophages [11]. This form of cell death, which appears to be dependent on activation of inammatory caspases, such as caspase-1, is rapid and associated with the release of pro-inammatory cytokines [11]. Mitochondria have a central role in the initiation of apoptosis through releasing cytochrome c, which acts as a co-factor for the assembly of a key caspase-activating complex, called the apopto- some [1]. The Bcl-2 family of proteins regulate this cytochrome c release step in a positive and negative way, with opposing factions within this family ne-tuning the balance between life and death [1]. In response to diverse cytotoxic insults, members of the BH3- only subset of the Bcl-2 family can be mobilized to facilitate cyto- chrome c release by triggering opening of the Bax/Bak channel within the mitochondrial outer membrane. However, Bax/Bak channel assembly can be countered by the pro-survival subset of the Bcl-2 family, such as Bcl-2 and Bcl-xL. Mitochondrial outer membrane permeabilization (MOMP), as a result of Bax/Bak activa- tion represents a dening event where a cell commits to apoptosis [1]. Waterhouse and colleagues detail high-throughput ow cytometry-based methods to measure uptake of cationic dyes, as well as cytochrome c translocation, to distinguish healthy cells with intact mitochondria from dying cells where permeabilisation of mitochondria occurs [12]. Biochemical analysis of apoptosis- associated mitochondrial events, such as Bax/Bak activation, can also be conveniently studied using puried populations of isolated mitochondria, a topic which is covered by Chipuk and colleagues [13]. The proximity of a tumor cell to undergo MOMP, due to the interplay between members of the Bcl-2 family, may be one of the reasons why chemotherapeutic drugs are effective on some but not all cancers and is the topic of the article by Letai and col- leagues [14]. They describe an assay developed by the Letai lab, called BH3-proling, which utilizes peptides based on BH3 do- mains of BH3-only proteins to measure the proximity of mitochon- dria within specic tumor cell populations to MOMP and, by extension, apoptosis. Proling of tumor cell mitochondria in this way, prior to chemotherapy, may help to guide oncologists to- wards drugs or drug combinations that elicit favorable cell death responses, thereby sparing patients needless treatment cycles with drugs that are ineffective for their particular tumor. Along similar lines, it is also possible that responses to pertur- bations in the cell death machinery may be subject to computa- tional modeling in silico. Prehn and colleagues outline the use of signal transduction models to quantify and temporally analyze changes to particular proteins in response to apoptotic stimuli [15]. In situations where the concentrations of all members of a cell death pathway are known, useful predictions may be made con- cerning how best to engage or manipulate such pathways for ther- apeutic purposes. The assembly of large multi-protein complexes mediate many of the signaling events within a cell. Several of these complexes have been identied as key mediators of apoptotic and necrotic cell death including, the Death Inducing Signaling Complex (DISC) and the apoptosome, with the necrosome and RIPoptosome identied and extensively characterized in recent years. The precise compo- sition of these complexes is currently an area of intense research due to the increasing evidence that cell death outcomes are often determined by subtle compositional and stoichiometric changes within these complexes [4]. In this issue, MacFarlene and col- leagues provide a detailed range of methodologies to characterize the assembly of these complexes in vitro including afnity purica- tion, sucrose fractionation, size exclusion chromatography and reconstitution of the death-inducing complexes [16]. Moving onto methods used to evaluate cell death in vivo, Amar- ante-Mendes and colleagues detail a method for the assessment of cytotoxic T-lymphocyte (CTL) killing within the complex microen- vironment in which immune responses take place [17]. This is par- ticularly important given the conicting data published on CTL- mediated cytotoxicity arising from studies performed in vitro ver- sus in vivo. This is followed by an article by Derry and colleagues on the evaluation of cell death in the nematode worm C. elegans [18], a model system that has been exploited very successfully for the identication of many conserved components of cell death path- ways. Derry and colleagues utilize uorescent markers in conjunc- tion with RNAi screening to identify new genes and pathways that regulate apoptosis in the worm germline [18]. To complete this issue of Methods, we turn our attention to the use of genetically engineered mice in the study of cell death. There is no doubt that gene-targeted mice have become an indispensible resource in every area of biological research. The cell death eld is no exception to this and such models have provided key insights into the physiological roles and importance of many pro-apoptotic and anti-apoptotic proteins in vivo. Gain-of-function as well as loss-of-function gene mutations have helped to delineate cell death pathways, as well as tease out redundant and non-redun- dant functions of many apoptosis-related proteins. However, while much has been learned from studies using knockout mice and de- rived cell lines, Villunger and colleagues highlight the potential pit- falls of interpreting data generated from different genetic backgrounds [19]. While the use of knockouts clearly have their place, it is often meaningless to simply compare cell death re- sponses from cell lines derived from one genotype versus another. Such crude comparisons, while supercially sophisticated, are of- ten as crude as comparing one tumor cell line to another on the ba- sis that they differ by only one expressed gene. In conclusion, for those that wonder why it matters which way a cell dies, it is useful to consider why multicellular organisms have developed such complex strategies to regulate cell death. The ma- jor driving forces appear to be the avoidance of collateral damage to surrounding healthy neighbors, as well as the avoidance of inammation. Or conversely, where it is desirable that the immune system becomes activated, the exact opposite of this is true. Much like in daily life, it is important to know whether a death has oc- curred as a result of natural causes or foul play. Each scenario war- rants a very different response by those close to the recently deceased, as well as the authorities. References [1] R.C. Taylor, S.P. Cullen, S.J. Martin, Nat. Rev. Mol. Cell Biol. 9 (2008) 231241. [2] G. Kroemer, S.J. Martin, Nat. Med. 11 (2005) 725730. 88 Guest Editors Introduction / Methods 61 (2013) 8789 [3] A. Degterev, J. Yuan, Nat. Rev. Mol. Cell Biol. 9 (2008) 378390. [4] A. Kaczmarek, P. Vandenabeele, D.V. Krysko, Immunity 38 (2013) 209223. [5] S.J. Martin, C.M. Henry, S.P. Cullen, Mol. Cell. 46 (2012) 387397. [6] S.J. Martin, C.P.M. Reutelingsperger, J. Exp. Med. 182 (1995) 15451556. [7] A. Degterev, Z. Huang, M. Boyce, Y. Li, P. Jagtap, N. Mizushima, T.J. Mitchison, M.A. Mizushima, J. Yuan, Nat. Chem. Biol. 1 (2005) 112119. [8] P. Vandenabeele, L. Galluzzi, T. Vanden Berghe, G. Kroemer, Nat. Rev. Mol. Cell Biol. 11 (2010) 700714. [9] C.M. Henry, E. Hollville, S.J. Martin, Methods 61 (2013) 8895. [10] T. Vanden Berghe, S. Grootjans, V. Goossens, Y. Dondelinger, D.V. Krysko, N. Takahashi, Methods 61 (2013) 115127. [11] S.L. Lage, G.P. Amarante-Mendes, K.R. Bortoluci, Methods 61 (2013) 108114. [12] M.E. Christensen, E.S. Jansen, W. Sanchez, N.J. Waterhouse, Methods 61 (2013) 136143. [13] T.T. Renault, F.V. Floros, J.E. Chipuk, Methods 61 (2013) 144153. [14] J.A. Ryan, Methods 61 (2013) 154162. [15] M. Rehm, J.H.M. Prehn, Methods 61 (2013) 163171. [16] M.A. Hughes, C. Langlais, K. Cain, Methods 61 (2013) 98104. [17] T. Clemente, M.R. Dominguez, N.J. Vieira, M.M. Rodrigues, G.P. Amarante- Mendes, Methods 61 (2013) 103107. [18] B. Lant, W.B. Derry, Methods 61 (2013) 174182. [19] C. Manzl, F. Baumgartner, Methods 61 (2013) 128135. Seamus J. Martin Conor M. Henry Molecular Cell Biology Laboratory, Dept. of Genetics, Trinity College, Dublin 2, Ireland Fax: +353 1 679 8558. (S.J. Martin) E-mail address: martinsj@tcd.ie (S.J. Martin) Guest Editors Introduction/ Methods 61 (2013) 8789 89