Altered cellular membrane integrity is one of the earliest signs of apoptosis.1,2 One key change during this event is the movement of phosphatidylserine (PS) from the inner leaflet of the cell membrane towards the cell surface. This process, due to the inactivation of flippase- and activation of scramblase-enzymes, is inducible, reversible and dependent upon calcium release from the endoplasmic reticulum.1 Exposure of PS acts as an "eat me" signal, prompting phagocytosis of apoptotic cells.3 In the absence of PS exposure during apoptosis, dying cells would escape the immune system ensuing an inflammatory response.2 Thus, PS externalization has emerged as a useful event and target for monitoring the progression of apoptosis in real-time.
The discovery of a natural ligand, Annexin A5, which binds reversibly, selectively and with high-affinity to exposed PS prompted its development as a biological tool for the...