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Phosphatidylserine in Non-Apoptotic Cell Death Inbar Shlomovitz1, Mary Speir2,3 and Motti Gerlic1*

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Phosphatidylserine in Non-Apoptotic Cell Death Inbar Shlomovitz1, Mary Speir2,3 and Motti Gerlic1* Shlomovitz et al. Cell Communication and Signaling (2019) 17:139 https://doi.org/10.1186/s12964-019-0437-0 REVIEW Open Access Flipping the dogma – phosphatidylserine in non-apoptotic cell death Inbar Shlomovitz1, Mary Speir2,3 and Motti Gerlic1* Abstract The exposure of phosphatidylserine (PS) on the outer plasma membrane has long been considered a unique feature of apoptotic cells. Together with other “eat me” signals, it enables the recognition and phagocytosis of dying cells (efferocytosis), helping to explain the immunologically-silent nature of apoptosis. Recently, however, PS exposure has also been reported in non-apoptotic forms of regulated inflammatory cell death, such as necroptosis, challenging previous dogma. In this review, we outline the evidence for PS exposure in non-apoptotic cells and extracellular vesicles (EVs), and discuss possible mechanisms based on our knowledge of apoptotic-PS exposure. In addition, we examine the outcomes of non-apoptotic PS exposure, including the reversibility of cell death, efferocytosis, and consequent inflammation. By examining PS biology, we challenge the established approach of distinguishing apoptosis from other cell death pathways by AnnexinV staining of PS externalization. Finally, we re- evaluate how PS exposure is thought to define apoptosis as an immunologically silent process distinct from other non-apoptotic and inflammatory cell death pathways. Ultimately, we suggest that a complete understanding of how regulated cell death processes affect the immune system is far from being fully elucidated. Keywords: Cell death, Inflammation, Apoptosis, Necroptosis, Phosphatidylserine, AnnexinV, Phagocytosis, Extracellular vesicles, ESCRT, Efferocytosis Plain English summary and tumorigenesis [1]. Originally, cell death was divided For a long time, it has been considered that when cells into two basic forms, termed apoptosis (programmed are programed to die via a mechanism known as apop- cell death) and necrosis (accidental cell death), which tosis, they alarm neighboring cells using “eat me” signals were distinguished primarily by their morphology as to facilitate their clearance from our body. Recently, it observed by pathologists. In the last two decades, how- has been reported that even when cells die via a regu- ever, the cell death field has expanded to include lated but non-apoptotic pathway (termed necroptosis) upwards of 10 distinct, although sometimes overlapping, they still possess similar “eat me” signals to apoptotic pathways [2]. cells. In this review, we outline the evidence for these “eat me” signals in non-apoptotic cell death, and discuss the possible mechanisms and implications of such Apoptosis signals. Defined in 1972, apoptosis was the first form of regu- lated cell death (RCD) to be discovered [3]. Apoptosis is executed either by intrinsic or extrinsic pathways, which Background ultimately lead to the activation of a family of cysteine- Cell death is central to physiological homeostasis; the dependent aspartate-specific proteases called caspases balance between cellular differentiation, proliferation, [4–6]. In the extrinsic pathway, ligation of death ligands and death underpins all aspects of biology, including (e.g., TNF-related apoptosis-inducing ligand (TRAIL) embryogenesis, organ function, immune responsivity, [7], tumor necrosis factor (TNF) [8], or Fas ligand (FASL) [9]) to their respective death receptors recruits * Correspondence: [email protected] 1 and activates the initiator caspases-8 and -10 in an inter- Department of Clinical Microbiology and Immunology, Sackler Faculty of – Medicine, Tel Aviv University, Tel Aviv, Israel action mediated by death domain containing adaptor Full list of author information is available at the end of the article proteins, e.g., Fas-associated protein with death domain, © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Shlomovitz et al. Cell Communication and Signaling (2019) 17:139 Page 2 of 12 FADD [10]. In the intrinsic, or mitochondrial, pathway, FLICE (FADD-like IL-1β-converting enzyme)-inhibitory cellular stress modifies the balance between pro- and protein (c-FLIP), cleaves and inactivates RIPK1 and RIPK3 anti-apoptotic B-cell lymphoma-2 (Bcl-2) family members, [30–36]. Once caspase-8 activity is blocked, however, releasing pro-apoptotic BAX and BAK to induce mito- extra- and intracellular signals trigger auto- and trans- chondrial outer membrane permeabilization (MOMP). phosphorylation between RIPK1 and RIPK3, leading to Cytochrome-c release following mitochondrial damage the aggregation and phosphorylation of MLKL by RIPK3 activates the initiator caspase-9 [11, 12], which then [31, 37–39]. This culminates in the translocation of phos- cleaves the effector caspases-3, − 6, and − 7toexecute phorylated MLKL (pMLKL) to the plasma membrane apoptosis [13, 14]. Hallmarks of apoptotic cell death are where it compromises membrane integrity, resulting in cell shrinkage, chromatin condensation (pyknosis) [15], necroptosis [40–42](Fig.1). As with necrosis, necrop- DNA fragmentation [16], plasma membrane blebbing tosis is characterized by cell swelling and membrane [17], and the shedding of apoptotic bodies [18–20]. permeabilization resulting in the release of danger asso- Another main feature is the exposure of phosphatidylser- ciated molecular patterns (DAMPs) and consequent ine (PS) on the outer plasma membrane, which, among inflammation [25, 28, 43, 44]. Necroptosis can be pre- other “eat me” signals, results in the phagocytosis and vented genetically by the depletion of RIPK3 or MLKL, clearance of apoptotic cells and bodies without the release as well as chemically by the inhibition of RIPK1 kinase of pro-inflammatory molecules [21]. Hence, apoptosis has activity [45, 46], RIPK3 kinase activity [47], or MLKL always been classified as an immunologically silent form necroptotic activity [40, 48]. of cell death [22]. Similar to apoptosis, necroptosis is also important in host immune defense against various pathogens. Thus, it Necrosis is not surprising that some viruses have developed fac- The term necrosis was originally used by Rudolf Virchow tors that inhibit necroptosis as part of their virulence to describe tissue breakdown while configuration was strategy [49]. Among these are vaccinia virus [50], cyto- conserved [23]. Necrosis is now considered to be a trauma- megalovirus (CMV) [51, 52], Epstein-Barr virus (EBV) induced form of accidental cell death (ACD) [2]. Morpho- [53], and Influenza A virus [54, 55]. Herpes simplex logically, necrosis is characterized by the swelling of the cell virus (HSV)-1 and − 2 inhibit necroptosis in human cells (oncosis) and its organelles, as well as by permeabilization [56], while inducing necroptosis in murine cells, which of the plasma membrane that releases cellular contents into are not their natural host [57, 58]. Bacteria, such as the extracellular space to trigger inflammation [20]. While Salmonella enterica [59], Mycobacterium tuberculosis originally considered to be unprogrammed, necrosis is now [60], and Staphylococcus aureus [61–63] induce necrop- understood to also be a regulated process that can be tosis, while the enteropathogenic Escherichia coli (EPEC)- genetically and chemically manipulated. Many pathways of effector, EspL, directly degrades components of necroptotic regulated necrosis have now been discovered, including signaling [64]. Both the complex role and the relevance of necroptosis, pyroptosis, mitochondrial permeability transi- necroptosis in host-pathogen interactions are currently an tion (MPT)-driven necrosis, ferroptosis, parthanatos, and area of intensive study [43, 65–67]. NETosis [2]. While these pathways represent a huge and Necroptosis has also been suggested to play a role in vari- ongoing field of investigation, this review will focus primar- ous inflammatory pathologies, such as atherosclerosis [68], ily on necroptosis within the context of PS biology. ischemia-reperfusion renal injury [69], cerulein-induce acute pancreatitis [31], neurodegenerative diseases, such as amyo- Necroptosis trophic lateral sclerosis (ALS) [70], multiple sclerosis (MS) Necroptosis is the most characterized form of regulated ne- [71], and Alzheimer’s disease (AD) [72, 73], as well as many crosis. Necroptosis was originally defined in the year 2000 others. In most cases, it is still unclear whether the non- as a receptor-interacting serine/threonine-protein kinase 1 necroptotic roles of RIPK1 and RIPK3, rather than their exe- (RIPK1)-dependent, caspase-independent form of cell death cution of cell death, underlie disease pathology [74, 75]. [24]. However, since a RIPK1-independent necroptotic pathway was latter discovered [25–27], necroptosis is now Cell death and inflammation defined as a receptor-interacting serine/threonine-protein While the Roman Cornelius Celsus defined the four car- kinase 3 (RIPK3)−/mixed lineage kinase domain-like dinal signs of inflammation (heat, redness, swelling, and (MLKL)-dependent,
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