Analysis of apoptotic pathways by multiparametric flow cytometry: application to HIV infection.

Flow cytometry analysis of apoptosis allows the detection, at the single cell level, of essential features of apoptotic cells. They include alterations in plasma membrane integrity, detected with the 7-aminoactinomycin D assay, translocation of phosphatidylserine from the inner to the outer layer of the plasma membrane analyzed with the annexin-V/PI assay, DNA strand breaks in apoptotic nuclei measured with the in situ nick translation and terminal deoxynucleotidyl transferase dUTP-mediated nick end labeling assays, and morphological modifications evidenced with FSC/SSC criteria. In addition, mitochondrial events such as the drop in transmembrane potential DeltaPsi(m) can be detected with the cationic lipophilic dye 3,3'-dihexyloxacarbocyanine iodide and downregulation of the Bcl-2 molecule by specific intracellular staining. Multiparametric flow cytometry combines all these approaches for a thorough sequential analysis of apoptosis, especially for heterogenous populations such as human peripheral mononuclear cells. Several examples of combined staining of apoptotic cells are shown on peripheral blood lymphocytes from chronically HIV-infected patients, prone to undergo premature apoptosis.