Annexin V may be co
njugated to fluorochromes including APC. This format retains its high affinity for phosphatidylserine (PS) and thus serves as a sensitive probe for flow cytometric analysis of cells that are undergoing apoptosis. Since externalization of PS occurs in the earlier stages of apoptosis, APC Annexin V staining can identify apoptosis at an earlier stage than assays ba
sed on nuclear changes such as DNA fragmentation. APC Annexin V staining precedes the loss of membrane integrity which accompanies the latest stages of cell death resulting from either apoptotic or necrotic processes. Therefore, staining with APC Annexin V is typically used in co
njunction with a vital dye such as propidium iodide (PI) or 7-Amino-Actinomycin (7-AAD) to allow the investigator to identify early apoptotic cells (7-AAD negative, APC Annexin V positive). Viable cells with intact membranes exclude 7-AAD, whereas the membranes of dead and damaged cells are permeable to 7-AAD. For example, cells that are co
nsidered viable are both APC Annexin V and 7-AAD negative while cells that are in early apoptosis are APC Annexin V positive and 7-AAD negative, while cells that are in late apoptosis or already dead are both APC Annexin V and 7-AAD positive. This assay does not distinguish between cells that have undergone apoptotic death versus those that have died as a result of a necrotic pathway because in either case, the dead cells will stain with both APC Annexin V and 7-AAD. However, when apoptosis is measured over time, cells can be often tracked from APC Annexin V and 7-AAD negative (viable, or no measurable apoptosis), to APC Annexin V positive and 7-AAD negative (early apoptosis, membrane integrity is present) and finally to APC Annexin V and 7-AAD positive (end stage apoptosis and death). The movement of cells through these three stages suggests apoptosis. In contrast, a single observation indicating that cells are both APC Annexin V and 7-AAD positive, in of itself, reveals less information a
bout the process by which the cells underwent their demise.