Apoptosis is a form of cell death that eliminates compromised or superfluous cells. It is controlled by multiple signaling and effector pathways that mediate active responses to external growth, survival, or death factors. Cell cycle checkpoint controls are linked to apoptotic enzyme cascades, and the integrity of these and other links can be genetically compromised in many diseases, such as cancer. There are many books in print and hundreds of recent review articles about all aspects of apoptosis (e.g. 7, 11, 19, 24, 39, 42) and the methods for detecting it (e.g. 10, 32, 36).
Of all the aspects of apoptosis, the defining characteristic is a complete change in cellular morphology. As observed by electron microscopy, the cell undergoes shrinkage, chromatin margination, membrane blebbing, nuclear condensation and then segmentation, and division into apoptotic bodies which may be phagocytosed (11, 19, 24). The characteristic apoptotic bodies are short-lived and minute, and can resemble other cellular constituents when viewed by brightfield microscopy. DNA fragmentation in apoptotic cells is followed by cell death and removal from the tissue, usually within several hours (7). A rate of tissue regression as rapid as 25% per day can result from apparent apoptosis in only 2-3% of the cells at any one time (6). Thus, the quantitative measurement of an apoptotic index by morphology alone can be difficult.
DNA fragmentation is usually associated with ultrastructural changes in cellular morphology in apoptosis (26, 38). In a number of well-researched model systems, large fragments of 300 kb and 50 kb are first produced by endonucleolytic degradation of higher-order chromatin structural organization. These large DNA fragments are visible on pulsed-field electrophoresis gels (5, 43, 44). In most models, the activation of Ca2+-and Mg2+-dependent endonuclease activity further shortens the fragments by cleaving the DNA at linker sites between nucleosomes (3). The ultimate DNA fragments are multimers of about 180 bp nucleosomal units. These multimers appear as the familiar "DNA ladder" seen on standard agarose electrophoresis gels of DNA extracted from many kinds of apoptotic cells (e.g. 3, 7,13, 35, 44).
Another method for examining apoptosis via DNA fragmentation is by the TUNEL assay, (13) which is the basis of ApopTag® technology. The DNA strand breaks are detected by enzymatically labeling the free 3'-OH termini with modified nucleotides. These new DNA ends that are generated upon DNA fragmentation are typically localized in morphologically identifiable nuclei and apoptotic bodies. In contrast, normal or proliferative nuclei, which have relatively insignificant numbers of DNA 3'-OH ends, usually do not stain with the kit. ApopTag® Kits detect single-stranded (25) and double-stranded breaks associated with apoptosis. Drug-induced DNA damage is not identified by the TUNEL assay unless it is coupled to the apoptotic response (8). In addition, this technique can detect early-stage apoptosis in systems where chromatin condensation has begun and strand breaks are fewer, even before the nucleus undergoes major morphological changes (4, 8).
Apoptosis is distinct from accidental cell death (necrosis). Numerous morphological and biochemical differences that distinguish apoptotic from necrotic cell death are summarized in the following table (adapted with permission from reference 39). ApopTag® In Situ Apoptosis Detection Kits distinguish apoptosis from necrosis by specifically detecting DNA cleavage and chromatin condensation associated with apoptosis. However, there may be some instances where cells exhibiting necrotic morphology may stain lightly (14, 29) or, in rare instances, DNA fragmentation can be absent or incomplete in induced apoptosis (11). It is, therefore, important to evaluate ApopTag® staining results in conjunction with morphological criteria. Visualization of positive ApopTag® results should reveal focal in situ staining inside early apoptotic nuclei and apoptotic bodies. This positive staining directly correlates with the more typical biochemical and morphological aspects of apoptosis.
Since an understanding of cell morphology is critical for data interpretation and because of the potential for experimentally modifying or overcoming normal apoptotic controls, the following strategy is advised. When researching a new system, the staging and correlation of apoptotic morphology and DNA fragmentation should be characterized. In some tissues, cytoplasmic shrinkage may be indicated by a clear space surrounding the cell. The nuclear morphology of positive cells should be carefully observed at high magnification (400x-1000x). Early staged positive, round nuclei may have observable chromatin margination. Condensed nuclei of middle stages, and apoptotic bodies, usually are stained. Apoptotic bodies may be found either in the extracellular space or inside of phagocytic cells. It is highly recommended that less experienced observers should refer to illustrations of dying cells for comparison with new data (e.g. 11, 19, 24).
An additional, although far less sensitive, method of confirming ApopTag® staining results is the detection of DNA fragmentation on agarose gels. If a large percent of the cells in the tissue are apoptotic, then electrophoresis of extracted total genomic DNA and standard dye staining can be used to corroborate the in situ staining. However, the single-cell sensitivity of ApopTag® histochemistry is far higher than this method. DNA laddering data of comparable sensitivity may be obtained in several other ways. These include methods for selectively extracting the low molecular weight DNA (15), for preparing radiolabeled DNA (30, 40) in combination with resin-bed purification of DNA (12), and for DNA amplification by PCR (35).
The in situ staining of DNA strand breaks detected by the TUNEL assay and subsequent visualization by microscopy gives biologically significant data about apoptotic cells which may be a small percentage of the total population (13, 16). Apoptotic cells stained positive with ApopTag® Kits are easier to detect and their identification is more certain, as compared to the examination of simply histochemically stained tissues. Another feature of ApopTag® is that quantitative results can be obtained using flow cytometry, since end-labeling methodology detects apoptotic cells with a >10-fold higher sensitivity than necrotic cells (14,17). In addition, the occurrence of DNA fragmentation with regard to the cell cycle phase of apoptotic cells can be examined using the TUNEL assay and flow cytometry (16,18).