APOPTOSIS: PROGRAMMED CELL DEATH AND ITS CLINICAL IMPLICATIONS

Abstract

The fact that cell death is not ultimately a bad thing came as a surprise to many researchers. Physiological cell death has been observed in various multicellular organisms. Apoptosis or programmed cell death is the predominant form of physiological cell death by which the organism eliminates unnecessary or damaged single cells. It is a major component of normal development and disease. Apoptosis is characterized by membrane blobbing, shrinkage of the cell, nuclear fragmentation and chromatin condensation. Organelles are preserved almost intact. Cell surface molecules change to assure that apoptotic cells will be immediately recognized and engulfed by neighboring cells or phagocytes leading to little or no inflammation. A wide variety of physiological and pathological stimuli can initiate apoptosis. They act via receptor mechanisms, through biochemical agents, or cause DNA and cell membrane damage. Death receptors that initiate apoptosis include the Fas receptor and the TNF receptor systems. After an appropriate stimulus, the first stage of apoptosis or decision phase is the genetic control point of cell death. This is followed by the second stage or execution phase, which is responsible for the morphological change in apoptosis. The third stage is engulfment of the dying cell followed by degradation of the engulfed cell DNA. There are two overlapping signaling pathways leading to apoptosis, termed the intrinsic and extrinsic pathways. In the intrinsic, various stimuli, such as oxidative stress, lead to mitochondrial dysfunction and the release of pro-apoptotic factors. Ligand binding to cell surface death receptors, such as Fas, activates the extrinsic pathway. During the last decades the molecular mechanisms involved in disordered apoptosis were unraveled, suggesting that cancer, chronic disease, and fetal developmental abnormalities can occur as a result of disordered apoptosis.