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It has been known for several decades that plasma membrane repair after mechanical injury is a Ca2+-dependent process1,2. Later studies showed that Ca2+ influx through the wound triggers a vigorous process of exocytosis of intracellular vesicles at the site of injury, which is required for resealing3,4. The rate of loss of a fluorescent dye loaded into the cytoplasm of cells was used to assess the speed of repair, and concluded that resealing was completed within <30 sec after injury5. Two models were initially proposed to explain the requirement for exocytosis in plasma membrane repair: 1) the "patch" model, which suggested that Ca2+ influx through the lesion triggers initially homotypic fusion of intracellular vesicles, forming a large "patch" that would then be applied to the plasma membrane to reseal the wound6 and 2) the tension reduction model, which proposed that membrane added by Ca2+-dependent exocytosis in the vicinity of the wound would reduce plasma membrane tension, facilitating resealing of the bilayer7. The role of Ca2+-triggered exocytosis in plasma membrane repair was further reinforced by studies showing that lysosomes contain a Ca2+ sensor molecule, synaptotagmin VII, which facilitates their exocytosis and plasma membrane repair in injured cells8,9,10,11.
However, additional evidence has indicated that exocytosis alone was not sufficient to promote plasma membrane repair. In addition to mechanical tears on the plasma membrane, a frequent form of cell injury is permeabilization by pore-forming toxins produced by bacteria12,13 or immune cells14,15. Unlike mechanical tears, pore-forming proteins insert themselves on the plasma membrane forming a stable, protein-lined pore that cannot be resealed simply by applying a membrane "patch" or by reducing membrane tension. Intriguingly, studies revealed that mammalian cells have an efficient mechanism to repair their plasma membrane after permeabilization with pore-forming proteins, and this process also requires the presence of extracellular Ca2+ 12. This finding raised the question of whether transmembrane pore removal from the cell surface was also a rapid process, as observed with mechanical wounds5. Surprisingly, our recent studies revealed that the resealing of cells permeabilized with pore-forming toxins has very similar properties to the repair of mechanical wounds: the process requires extracellular Ca2+, and is completed within ~30 sec. Investigating this process in more detail, we recently learned that in addition to Ca2+-regulated exocytosis of lysosomes, plasma membrane repair involves a rapid form of endocytosis, which is triggered by release of the lysosomal enzyme acid sphingomyelinase (ASM) and is essential not only for the removal of transmembrane pores, but also for the repair of mechanical wounds16.
To determine the kinetics of cell resealing after permeabilization with pore-forming proteins, in our laboratory we adapted a live imaging methodology that had been used previously to assess resealing of laser-injured isolated muscle fibers17. This assay relies on properties of the lipophilic dye FM1-43, which stably intercalates into the outer leaflet of lipid bilayers increasing in fluorescence intensity. When the plasma membrane bilayer is disrupted extracellular dye gains access to intracellular membranes, providing a sensitive assay to detect plasma membrane injury and repair18,16,19,20. To adapt this assay for the assessment of cell resealing after permeabilization with pore-forming proteins, we pre-incubated cells at 4 °C with the bacterial toxin streptolysin O (SLO), which binds to membrane cholesterol21. Synchronous cell permeabilization can then be easily achieved by moving the cells from ice to warm medium in a heated microscope stage, which activates the oligomerization and change in conformation that leads to transmembrane pore formation. An advantage of this approach, over the previously published assays using laser wounding, is that a larger number of cells can be analyzed simultaneously in a microscopic field, providing better sampling of the cell population. Given the mechanistic similarities between the cell resealing process seen after mechanical injury and permeabilization with pore-forming toxins, the assay we describe here provides a very versatile and powerful method for dissecting factors involved in the fundamental process of plasma membrane repair. As an example, we show that it is possible to use this assay to identify Ca2+ dependent and independent steps of the repair process.