Membrane cholesterol in the regulation of aminophospholipid asymmetry and phagocytosis in oxidized erythrocytes

Cholesterol is known to affect several membrane functions, including membrane susceptibility to oxidative stress. In order to gain a better understanding of the relationship between cholesterol contents, structural integrity, and degree of survival in oxidatively stressed erythrocytes, here we analyzed the transbilayer phospholipid distribution, the morphology, and the degree of clearance observed in cholesterol-modified (enriched or depleted) and unmodified (control) erythrocytes exposed to tert-butylhydroperoxide. We report that the modification of cholesterol contents in erythrocytes promotes the externalization of phosphatidylserine (PS) to the membrane surface, which is consistent with a concomitant inhibition of aminophospholipid translocase (APLT) and an increased uptake of modified erythrocytes by macrophages. Moreover, cholesterol depletion modifies the transbilayer aminophospholipid distribution induced by oxidative stress to a great extent, significantly increasing PS externalization, which is associated with the strongest decrease in APLT activity. The loss of normal PS asymmetry is positively correlated with enhanced phagocytosis, and an increase in echinocyte forms is observed in all oxidized erythrocytes. We envisage that PS externalization could be due, at least in part, to the decrease in APLT activity induced by oxidative stress, the activity of which is also dependent on membrane cholesterol contents.