Published online before print June 3, 2004
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* CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain;
Investigation Unit, Industrial Farmacéutica Cantabria, Madrid, Spain;
Department of Immunology, Imperial College, London, United Kingdom;
Flow Cytometry Unit, Cancer Research Center and Department of Medicine, University of Salamanca, Spain; and
¶ Immune System Diseases and Oncology Service, University Hospital "Príncipe de Asturias," Alcalá de Henares, Madrid, Spain
1 Correspondence: Departamento de Medicina, Universidad de Alcalá, Carretera Madrid-Barcelona, Km 33.600, 28871 Alcalá de Henares (Madrid), Spain. E-mail: mams{at}tsai.es
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Key Words: FACS CD annexin V 7-amino actinomycin D physiological loss
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Along these lines, the reported increased apoptosis of lymphocytes with weak expression of LAgs such as CD56 or CD94 [15 , 16 ] has been interpreted in terms of specific lymphocyte subsets with increased susceptibility to this cell death mechanism. However, an alternative interpretation could be that apoptosis is physiologically associated with down-regulation in the expression of some LAgs. In support of these interpretations, two studies have shown that the expression of LAgs decreases during apoptosis in CD4+ and CD8+ T lymphocytes [17 , 18 ].
The aim of the present study was to analyze the relationship between apoptosis and LAg expression in lymphocytes. We studied the expression of different LAgs in negatively sorted, homogeneous cell population cultures under different experimental conditions. Furthermore, we analyzed this cellular behavior in a model of in vitro nonmanipulated, highly pure lymphocytes expressing a defined LAg (CD19) in peripheral blood mononuclear cells (PBMCs) from B chronic lymphocytic leukemia. The results show that loss of antigen expression occurs in different stages of apoptosis, the magnitude largely depending on the antigen analyzed. To simultaneously quantify the number of cells in each stage of apoptosis and to evaluate potential changes in the expression of LAgs expressed by these cells, we used a flow cytometry-based method to measure apoptosis, monitoring alterations in cell permeability and phosphatidylserine exposure [7 , 9 , 12 , 13 ]. Our group recently improved this technique [14 ].
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Fluorescence-activated cell sorting (FACS)
Lymphocyte subsets were purified by negative selection using flow cytometry cell sorting. For this, fresh PBMCs were incubated with different three- and four-color combinations of fluorescein isothiocyanate (FITC; green), phycoerythrin (PE; orange), peridinin chlorophyll protein conjugate (PerCP; red), and allophycocyanin (APC)-labeled monoclonal antibodies (mAb). To purify CD4+CD28+ cells, CD3+CD8+, and CD3+CD5+ T cell receptor (TCR)
ß+ T cells as well as B cells and natural killer (NK) cells, PBMCs were depleted of different cell subsets using the following combinations of mAb (FITC/PE/PerCP/APC): TCR
/CD14CD16CD56/CD8/CD19; TCR
/CD14CD16CD56/CD4/CD19; TCR
/CD14CD16CD56//CD19; /CD14CD16CD56/CD3/; /CD14/CD3/CD19, respectively. Anti-CD19-APC, anti-CD56-PE, anti-CD8-PerCP, anti-CD4-PerCP, anti-CD3-PerCP, and anti-TCR
-FITC were obtained from Becton Dickinson Biosciences, and anti-CD14-PE, anti-CD16-PE, and anti-CD45-FITC were purchased from Caltag Laboratories (San Francisco, CA).
All sorting experiments were performed in a FACSTARplus flow cytometer using CellQUEST software (Becton Dickinson Biosciences). A biparametric gate in a forward- versus side-scatter (FSC and SSC, respectively) dot plot was drawn around the lymphocyte population with low FSC and SSC characteristics, and no expression of any of the antigens specifically stained in each combination. The purity of the negatively sorted lymphocyte populations were as follows: CD4+CD28+, >98% for CD4 (>96% of these cells being CD28+); CD3+CD8+ T cells, >98% for CD3 (>96% of these cells also being CD8+); CD3+CD5+ T cells, >98% for CD3 (>98% of these cells also being CD5+); and NK cells, >97%. Given that negative FACS sorting of CD19+ B cells from healthy controls only provides low-level purity (>80%), we performed experiments with positively sorted, control CD19+ cells (purity >92%). The purity of CD19+ B cells from a B-CLL patient was always higher than 98%.
Induction of apoptosis in cultured, sorted cell populations
Highly purified, sorted lymphocytes were plated in 96-well, flat-bottomed culture plates at a density of 50,000 cells/well and cultured in triplicate in complete medium for 24 h. Spontaneous apoptosis was studied by culturing T cell subsets from healthy controls and B lymphocytes from B-CLL patients in the absence of any apoptosis inducer. In parallel experiments, phytohemagglutinin (PHA; 2 µg/ml, Difco Laboratories, Detroit, MI) [14
] or staurosporin (ST; 103 M, Sigma Chemical Co., St. Louis, MO) was used to bring about activation-induced cell death. Optimal doses of apoptosis inducers were determined in previous dose/response titrations (data not shown). In all cases, cell cultures were incubated at 37°C in a humidified atmosphere containing 5% CO2. Analysis of the distribution of cultured cells in the G0/G1, S, and G2/M cell-cycle phases was also performed as described previously [22
]. Tritiated thymidine uptake was also performed to demonstrate the absence of cell proliferation.
Analysis of apoptotic cells
Fresh or cultured lymphocytes were incubated and labeled with mAb (PE/APC) for 20 min at 4°C. The cells were then washed in 2 ml fresh, complete medium by centrifuging for 5 min at 300 g (4°C) and were resuspended in a Ca2+ binding buffer (HEPES 10 mM, NaCl 150 nM, MgCl2 1 mM, CaCl2 1.8 mM, and KCl 5 mM, pH adjusted to 7.4, Sigma Chemical Co.). They were then sequentially incubated with a solution containing annexin V-FITC (Bender MedSystem, Vienna, Austria) in Ca2+ binding buffer (10 min at 4°C) followed by a 3-min incubation with a 7-AAD solution (final concentration of 2.5 µg/ml, Sigma Chemical Co.) in the same buffer to identify early and late apoptotic cells, respectively. The following combinations of mAb (PE/APC) were used: CD5/CD19 for lymphocytes from B-CLL patients and CD28/CD4, CD3/CD8, or CD5/CD3 or CD56/ or CD5/CD19 for lymphocytes from healthy subjects. Control studies comprising unstained cells and cells incubated with isotype-matched, irrelevant PE- and APC-labeled mAb were performed in parallel with each experiment. For these procedures, anti-CD28-PE, anti-CD56-PE, anti-CD3-APC, anti-CD19-APC, and anti-CD4-APC mAb were obtained from Becton Dickinson Biosciences and anti-CD5-PE, anti-CD8-APC, and anti-CD3-PE, from Caltag Laboratories. In all cases, data acquisition and analysis were performed in a FACScalibur flow cytometer (Becton Dickinson Biosciences) using CellQUEST software.
The apoptotic index (AI) for each cell subset analyzed was calculated as the ratio between the percentage of antigen-positive apoptotic cells (annexin V+) and the overall percentage of cells expressing that antigen (annexin V+ plus annexin V cells).
The percentage of apoptotic cells that had completely lost the expression of the LAgs used for the identification of each cell subset was calculated according to the following equation: %ApoLAgloss = 100 x %ApoLAg/(%ApoLAg+%ApoLAg+), where %ApoLAgloss is the percentage of apoptotic cells that has lost the expression of LAg, %ApoLAg represents the percentage of apoptotic cells that has lost their LAgs over the total number of remaining cells, and %ApoLAg+ is the percentage of apoptotic cells that has maintained their LAg over the total number of remaining cells.
Statistical methods
To establish the statistical significance of the differences between the AIs for cell populations with different LAg expressions (strong, weak, or absent), the Wilcoxon matched-pairs signed-ranks test was used, using the Statistical Package for Social Sciences software v. 11.0 (Chicago, IL). Significance was set at P < 0.05.
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Figure 1. The intensity of CD19 expression decreases progressively over the apoptotic cycle in lymphocytes from B-CLL patients. (A) A representative bivariate dot plot of lymphocytes from a B-CLL patient after 24 h of serum-free culture for the definition of different stages of apoptosis by annexin V/7-AAD double-staining. V, Viable cells (annexin V/7-AAD); EA, early apoptotic cells (annexin V+/7-AAD); IA, intermediate apoptotic cells (annexin V+/7-AAD+lo), and LA, late apoptotic cells (annexin V+/7-AAD+hi). (B) Four different fluorescence intensities versus contour histograms corresponding to the four different stages of apoptosis inCD19+ leukemic cells. These include, from top to bottom: V, Viable cells; EA, early apoptotic cells; IA, intermediate apoptotic cells; LA, late apoptotic cells. Arrows indicate the geometric mean of CD19 fluorescence intensity for each histogram.
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Figure 2. Kinetics of loss of different LAgs over apoptosis in purified populations of normal lymphocytes. A dot plot analysis was used to define the four different gates that would enable the identification of the progressive, apoptotic stages in a bivariate dot plot of annexin V versus 7-AAD: viable cells (annexin V/7-AAD), early apoptotic cells (EA; annexin V+/7-AAD), intermediate apoptotic cells (IA; annexin V+/7-AAD+lo), and late apoptotic cells (LA; annexin V+/7-AAD+hi). (AF) MFI of the LAgs in each apoptotic stage from different sorted cell populations, (A) CD3+, (B) CD5+, (C) CD4+, (D) CD8+ (E) CD28+, and (F) CD56+. Sorted cell populations were cultured 24 h with no stimulation (), PHA ( ), or ST ( ). The coefficients of variation of MFI between replicated samples of all fractions of the antigens studied in all the conditions assayed were always lower than 10%.
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Figure 3. Patterns of loss of paired antigens coexpressed in the same cells during spontaneous in vitro apoptosis. (A) The percentage decrease in MFI of antigens expressed between the viable and early apoptotic cell stages in different sorted cell populations cultured in the medium alone (open bars), with PHA (hatched bars), or with ST (cross-hatched bars). The different apoptosis stages were determined in a bivariate annexin V versus 7-AAD dot plot. Their corresponding MFI values are represented by symbols: viable cells ( ), early apoptotic cells ( ), intermediate apoptotic cells ( ), and late apoptotic cells ( ). The mean values of expression of pairs of antigens in the same cell were obtained and are shown in (B) CD4 versus CD28, (C) CD3 versus CD8, and (D) CD3 versus CD5. (E and F) The covariation of the MFI of two LAgs coexpressed in the same cells against the FSC signal over the different stages of apoptosis. (E) CD3+CD8+ negatively sorted cell population: CD3 LAg (continuous line) and CD8 LAg (dotted line). (F) CD4+CD28+ negatively sorted cell population: CD4 LAg (continuous line) and CD28 LAg (dotted line). (A) The coefficients of variation of the percentages between replicated samples of all fractions of the antigens studied, in all conditions, were always lower than 5%. (BF) The coefficients of variation of mean intensity between replicated samples of all fractions of the antigens, studied in all conditions, were always lower than 10%.
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Different apoptotic indices are observed in cell fractions defined by the different degree of expression of LAgs
Purified lymphocyte subpopulations obtained by FACS were cultured in different experimental conditions to study the association between LAgs and spontaneous and induced apoptosis. After 24 h of culture and based on the degree of intensity of LAg expression, cells were classified into three different fractions: those with bright MFI signals (strong LAg expression), those with dim signals (weak LAg expression), and those with an undetectable signal (no LAg expression; Fig. 4A
). The AI obtained for each cell fraction is shown in Figure 4B
4C
4D
. Under all the experimental conditions assayed (spontaneous, PHA-induced, or ST-induced apoptosis) and for all the studied LAgs (CD5, CD3, CD8, CD4, CD28, CD56, CD19), the cell fraction with high LAg expression showed a lower AI than did the fractions with partial loss of their LAgs (dim MFI signal) or total loss (no MFI signal; no major differences were observed between the two latter fractions).
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Figure 4. Apoptotic indices of cell fractions defined by the degree of expression of their LAg. Representative histogram analyses of CD4 in the negatively sorted CD3+CD4+ population before starting the culture (A, upper) and after 24 h of culture in the presence of ST (A, lower). The intensity of expression of the CD4 LAg was divided into three fractions defined by degree of expression: M1 (Bright) represents the CD3+CD4+ cells with strong expression of CD4, M2 (Dim) represents the CD3+CD4+ cells with weak expression of CD4, and M3 (negative) represents the CD3+CD4+ cells lacking expression of CD4. (BD) The AIs of the three fractions of the different populations studied in which apoptosis was induced by the medium alone, by PHA, and by ST, respectively, are shown. The three bars represent the AI of the three different cell fractions defined: strong expression (open bars), with weak expression (shaded bars), and undetectable expression (solid bars). The coefficients of variation of the proportion of apoptotic cells between replicated samples of all fractions of the antigens studied, in all conditions, were always lower than 5%.
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Evidence of apoptotic cells with undetectable LAg expression
For all the antigens analyzed, except for CD19, and spontaneously or in the presence of PHA, more than 20% of apoptotic cells completely lost the expression of their LAgs to undetectable levels (Table 1
). Similar findings were observed in the presence of ST for the indicated LAgs except for CD3 and CD4. NK cells were those with the highest proportion of LAg-negative cells in the apoptotic populations.
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Table 1. Percentage of Apoptotic Cells That Completely Lost Detectable Expression of Their LAg
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Previous studies suggest that apoptosis preferentially occurs in cells from subsets with weak expression of LAgs such as CD56 or CD94 rather than in cells expressing the same antigens strongly [15 , 16 ]. Our findings ought to re-evaluate this suggested, special apoptosis susceptibility of lymphocytes with weak LAg expression. Our results show a generalized apoptotic lymphocyte behavior characterized by a decrease in the expression of specific LAgs by apoptotic cell, and consequently, the percentage of apoptotic lymphocytes increases as the intensity of expression of each LAg decreases. To elucidate the exact nature of the relationship between apoptosis and weak LAg expression, we specifically cultured negatively sorted homogeneous cell populations with strong expression of different LAgs. We observed the reduction in LAg expression as lymphocyte apoptosis progresses with a final stage of undetectable LAg levels. As this study shows that the apoptotic pathway itself is associated with reductions in the intensity of antigen expression, any analysis of apoptosis that defines cell subsets by the intensity of specific LAg expression should be interpreted with caution. Along these lines, once cells within a population begin to undergo apoptosis, if cells with strong LAg expression are selected, then, viable cells are being preferentially chosen. The opposite is true for weak LAg-expressing cells. Such arbitrary selection may lead to erroneous evaluation of the occurrence of apoptosis in specific subsets of lymphocytes, especially in those that rapidly lose expression of one or more antigens (as found for CD8 and CD28 antigens in CD3+CD8+ and CD4+CD28+ T lymphocytes, respectively).
Earlier studies have suggested in unpurified, heterogeneous cell preparations that the expression of some antigens (e.g., CD4, CD8, CD45RA, CD56) but not others (e.g., CD20) decreases in apoptotic lymphocytes without specific analysis of the different phases of this dynamic cellular process [17 , 18 ]. Our experimental approach has allowed demonstrating reductions of LAg expression to a final stage of undetectable levels and the loss of LAg expression in early stages of apoptosis. These apoptotic lymphocytes, which appear as LAg-negative, are usually ignored during evaluations of the frequency of apoptotic cells in phenotypically defined cell subsets.
An important issue is whether loss of LAg expression by apoptotic cells is a specific, active process associated with the transition of cells in the different stages of apoptosis or whether it simply reflects a general degradation of cell components. The observation that different markers have distinct loss of expression kinetics might suggest the former may be the case. This is further supported by the fact that antigens coexpressed in the same cells showed different degrees of loss in the different stages of apoptosis. Moreover, the kinetics of this loss was different in viable and early apoptotic cells. Overall, the existence of different rates of antigen loss could indicate that apoptotic cells have different ways of regulating the expression of different antigens.
A potential explanation for the decrease in the expression of surface LAgs is the partial loss of the cell membrane by early apoptotic cells. However, it should be noted that despite CD3+ and CD5+ cells showing decreased FSC signals in the early stages of apoptosis, the expression of both antigens was almost stable during this period. In addition, the patterns of loss of LAgs coexpressed in the same cell over the different stages of apoptosis were clearly different. A recent report has described that apoptosis induces early and active mRNA degradation [23 ]. mRNAs with different half-lives show similar apoptosis-induced degradation kinetics, indicating that this degradation is an active process induced by apoptosis. This suggests that a lack of LAg synthesis could be involved in the loss of LAg by apoptotic cells. Further studies are required regarding the physiological significance of this process.
Received March 18, 2004; accepted March 29, 2004.
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