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The critical steps within the protocol are as follows. First, cells should be grown on the culture dish as a monolayer because conducting a morphological assessment of DAPI-stained nuclei is difficult for multilayered cells. To this end, in step 2.9, careful transfer of the culture dish to an incubator is recommended; shaking of the culture dish generates a swirl of suspended cells that leads to the concentration of cells at the center of the culture dish. In addition, overconfluence leading to multilayered cells should be avoided. To this end, in step 2.7, the number of cells seeded on the culture dish can be modified based on the population doubling time and the interval between irradiation and fixation. A confluence of approximately 80 at the time of fixation is recommended. Second, speed is important in fixation and DAPI staining (i.e., steps 4 and 5). Inter-sample inconsistency in regard to the time taken for these steps can lead to heterogeneity in DAPI signal intensity in the nuclei, which would obscure the morphological assessment.
In step 2.2, the number of cover slips in a single culture dish can be increased; a maximum of four cover slips can be placed in a 35 mm dish, and the number can be further increased using larger dishes. Placing multiple cover slips in each culture dish enables the efficient operation of time course assessment for a given treatment (i.e., the cover slips can be collected from a culture dish one by one at multiple time points of interest).
In step 3.2, the irradiation dose can be modified according to the researchers' interest. The application of a consistent dose to multiple cell lines enables the comparison of the sensitivity to each mode of clonogenic cell death among the cell lines. On the other hand, the use of iso-clonogenic survival doses for each cell line enables comparison of clonogenic cell death profiles among the cell lines. The iso-clonogenic survival dose can be determined by the clonogenic survival assay12. The D10 value, the dose that provides 10% clonogenic survival, is a common endpoint for the iso-clonogenic survival dose.
In step 3.3, the time from irradiation to fixation can be modified according to the researchers' interest; this is important because the peak time for IR-induced apoptosis, mitotic catastrophe, and cellular senescence varies according to cell line and treatment. In this article, we used 72 h after irradiation as the time point that would be most useful for the initial screening of clonogenic cell death profiles, based on multiple studies by our group and others described as follows1,2,3,4,8,9: (i) X-ray-induced apoptosis in cells established from solid tumors mostly occurs a few days after irradiation. (ii) X-ray-induced mitotic catastrophe in cancer cells occurs most prominently at the second or third mitosis after release from the temporary cell-cycle arrest induced by irradiation. The release usually occurs approximately 24 h after irradiation, followed by repeated mitoses at intervals of approximately 24 h. (iii) X-ray–induced cellular senescence becomes evident after an interval dependent upon the cell line in question: 2 days after irradiation for some early cases, and 7 days after irradiation for most cell lines. After obtaining an overall picture of the clonogenic cell death profiles from the initial screening, time course experiments will provide a more detailed elucidation of the peak time for each mode of clonogenic cell death in the specific cell line and/or condition of interest4.
It should be noted that the DAPI staining assay and the clonogenic survival assay, a gold standard method for radiation sensitivity assessment, are not interchangeable. Apoptosis and mitotic catastrophe only last for hours. Thus, the DAPI staining assay for a given time point detects apoptosis and mitotic catastrophe that occurs at the time point of the assessment. On the other hand, the results of the clonogenic survival assay at a given time point include the total amount of apoptosis and mitotic catastrophe that had occurred during the incubation period for typically 10 - 14 days after irradiation. Different from apoptosis and mitotic catastrophe, senescent cells remain on the culture dish; they accumulate gradually over time after irradiation. Therefore, the results of both the DAPI staining assay and the clonogenic survival assay reflect the total amount of senescence that occurred during the incubation period. Importantly, the proportion of apoptosis, mitotic catastrophe, and senescence induced by irradiation varies widely according to cell line and irradiation dose. Taken together, theoretically, the results of one assay cannot be translated directly into those of the other assay.
The DAPI staining assay has a few limitations. First, it remains controversial whether mitotic catastrophe is a distinct mode of cell death. In the field of radiation biology, mitotic catastrophe is considered a major mode of IR-induced cell death that is distinct from other mechanisms of clonogenic cell death1. On the other hand, others argue that mitotic catastrophe is not a distinct mode of cell death but rather a process that precedes cell death including apoptosis and necrosis13,14. Thus, apoptosis and mitotic catastrophe may overlap to some extent. Second, previous studies suggest that cellular senescence can occur in the absence of SAHF in some cell lines and treatment settings2. At present, other assays specifically designed for each clonogenic cell death mode should be used to increase the robustness of the conclusions of a given experiment. Third, the DAPI staining assay cannot assess modes of clonogenic cell death other than apoptosis, mitotic catastrophe, and cellular senescence (e.g., necrosis and autophagy). Fourth, the utility of the DAPI staining assay as a predictor of tumor response to radiotherapy has not been elucidated in the clinic. From this point of view, the clonogenic survival assay, which assesses the total amount of clonogenic cell death, is superior to the DAPI staining assay because a correlation has been established between SF2, the surviving fraction of cells irradiated with 2 Gy X-rays, and the tumor response to radiotherapy15. Nevertheless, it is noteworthy that the clonogenic survival assay is not utilized widely in the clinic, mainly due to the requirement for a high degree of expertise and a long period of time (i.e., 14 days) for data acquisition. By comparison, the procedure for the DAPI staining assay is simpler and takes significantly less time, approximately 3 - 4 days, to generate results. The utility of the DAPI staining assay as a predictor of tumor response to radiotherapy will be tested in the clinic in the near future.
In summary, the DAPI staining assay is a cost-effective one-step assay to simultaneously assess the three major modes of IR-induced clonogenic cell death. This approach allows one to easily screen for the modes of clonogenic cell death for various cell lines, treatment settings, and time points, with the goal of elucidating the mechanisms of cell death in the target cells and conditions of interest.