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Updated: Aug 11, 2026

Quantification of Efferocytosis by Single-cell Fluorescence Microscopy
Published on: August 18, 2018
Annexin A5 inhibits engulfment through internalization of PS-expressing cell membrane patches
Heidi Kenis1, Hugo van Genderen, Niko M Deckers
1Department of Biochemistry, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
Abstract:
Apoptosis and subsequent clearance of apoptotic cells are important for the prevention of diseases. Therefore, it is essential to understand the mechanisms underlying the biology of phagocytic clearance of apoptotic cells. The best characterized "eat me" signal on the surface of apoptotic cells is phosphatidylserine (PS). Recently, we demonstrated that annexin A5 mediates the internalization of PS-expressing membrane patches and down regulates surface expression of tissue factor. Here, we investigated the role of PS in the phagocytosis of apoptotic cells using annexin A5. Using a novel flow cytometric-based phagocytosis assay, we observed that engulfment was inhibited with 20% if annexin A5 was added to PS-expressing cells that had completed apoptosis. The inhibition increased to more than 50% if annexin A5 was added during the apoptotic process. This inhibition is specific for annexin A5, since the mutant M23 and annexin A1 did not further increase the inhibition of phagocytosis when added during the apoptotic process. Interestingly, cells with internalized annexin A5 still express PS at their surface. We conclude that other ligands within the PS-expressing membrane patch act together with PS as an "eat me" signal.
Insights
Phosphatidylserine (PS) is a key "eat me" signal on apoptotic cells. Annexin A5 binding during apoptosis significantly inhibits phagocytosis, suggesting other signals cooperate with PS for efficient cell clearance.
Area of Science:
- Cell Biology
- Immunology
- Biochemistry
Background:
- Apoptosis and efficient clearance of apoptotic cells are crucial for preventing disease.
- Phosphatidylserine (PS) is the best-characterized
- eat me
- signal on apoptotic cells.
- Annexin A5 binds PS and has been shown to mediate internalization of PS-expressing membrane patches.
Purpose of the Study:
- To investigate the role of phosphatidylserine (PS) in the phagocytosis of apoptotic cells using annexin A5.
- To determine how annexin A5 affects the phagocytic clearance of apoptotic cells expressing PS.
Main Methods:
- Utilized a novel flow cytometry-based phagocytosis assay.
- Administered annexin A5 to apoptotic cells at different stages (post-apoptosis vs. during apoptosis).
- Compared the inhibitory effects of annexin A5 with a mutant (M23) and annexin A1.
Main Results:
- Annexin A5 addition inhibited phagocytosis by 20% when added to cells after apoptosis completion.
- Inhibition increased to over 50% when annexin A5 was added during the apoptotic process.
- Internalized annexin A5 did not prevent surface PS expression, and annexin A1 did not enhance inhibition.
Conclusions:
- Annexin A5 binding during apoptosis significantly impairs phagocytic clearance of PS-expressing cells.
- The results suggest that other ligands within the PS-expressing membrane patch, in addition to PS itself, function as "eat me" signals.
- This highlights a complex interplay of signals in the efficient removal of apoptotic cells.
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