In the different assays discussed below, the phagocytes must be incubated with a certain stimulus to activate the NADPH oxidase in these cells, because in resting phagocytes this enzyme is inactive. Frequently used stimuli are phorbol myristate acetate (PMA, a soluble, receptor-independent stimulus of protein kinase

C), serum-treated zymosan particles BIBW2992 in vivo (a particulate stimulus that binds to Fc-gamma receptors and complement receptor-3 on the cell surface) and the bacterial peptide formyl-methionyl-leucyl-phenylalanine (fMLP), binding to fMLP receptors on the cell surface and activating the NADPH oxidase when the cells have been ‘primed’ with platelet-activating factor (PAF). Oxygen consumption can be measured with an oxygen electrode [13], but this is a time-consuming and relatively insensitive method that is no longer used for CGD diagnostics. It is the most quantitative method of oxidase measurements, but for CGD diagnosis a simple yes (activity) or no (no activity) usually suffices. Assays for superoxide or Selleck Ensartinib hydrogen peroxide are generally employed instead. Superoxide generation can be measured by its ability to reduce ferricytochrome c, nitroblue tetrazolium, isoluminol

or lucigenin. The ferricytochrome c reduction is followed spectrophotometrically at 550 nm, because the difference in extinction coefficients of ferricytochrome c (0·89 × 104 M/cm) and its reduction product ferrocytochrome c (2·99 × 104 M/cm) is the largest at that wavelength. The contribution of superoxide to the reduction process must be quantified by adding superoxide dismutase (SOD). This enzyme catalyzes the second reaction shown above, JAK inhibitor and thus prevents superoxide

from reacting with ferricytochrome c. Any reduction of ferricytochrome c in the presence of SOD is superoxide-independent and must therefore be subtracted from the total reduction to obtain the superoxide-dependent contribution. The assay relies upon the excretion of superoxide by activated phagocytes because it takes place extracellularly, in the medium surrounding the cells. A detailed protocol for this reaction, with isolated neutrophils activated with PMA in a microtitre plate, can be found in [14]. Nitroblue tetrazolium (NBT) is a pale yellow dye that can be reduced by superoxide to the black, insoluble formazan. This reaction takes place inside activated phagocytes, thus leaving cells with an active NADPH oxidase stained by formazan deposits that cannot leave the cells. This property has made NBT an ideal agent to judge the oxidase activity of individual cells, which is especially useful for carrier detection of X-linked CGD (see section Oxidase activity or protein expression in single cells). CGD patients usually show no or very little formazan deposition in any cell [15].