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Noreen Muhammad Naguib Mosaad 
5212322 
Group:11 
Dentistry
Apoptosis 
Apoptosis is the process of programmed cell 
death (PCD) that may occur in multicellular 
organisms. Biochemical events lead to characteristic cell 
changes (morphology) and death. These changes 
include blebbing, cell 
shrinkage, nuclear fragmentation, chromatin 
condensation, and chromosomal DNA fragmentation. 
In contrast to necrosis, which is a form of traumatic cell 
death that results from acute cellular injury, in general 
apoptosis confers advantages during an organism's 
lifecycle. For example, the separation of fingers and toes 
in a developing humanembryo occurs because cells 
between the digits apoptose. Unlike necrosis, apoptosis 
produces cell fragments called apoptotic bodies that 
phagocytic cells are able to engulf and quickly remove 
before the contents of the cell can spill out onto 
surrounding cells and cause damage. 
Between 50 and 70 billion cells die each day due to 
apoptosis in the average human adult. For an average 
child between the ages of 8 and 14, approximately 20 
billion to 30 billion cells die a day. 
Research in and around apoptosis has increased 
substantially since the early 1990s. In addition to its 
importance as a biological phenomenon, defective 
apoptotic processes have been implicated in an extensive 
variety of diseases. Excessive apoptosis causes atrophy, 
whereas an insufficient amount results in uncontrolled cell 
proliferation, such as cancer. 
Process: 
A cell initiates intracellular apoptotic signaling in response 
to a stress, which may bring about cell suicide. The
binding of nuclear receptors 
by glucocorticoids, heat,[13] radiation,[13] nutrient 
deprivation,[13] viral infection,[13] hypoxia[13] and increased 
intracellularcalcium concentration, for example, by 
damage to the membrane, can all trigger the release of 
intracellular apoptotic signals by a damaged cell. A 
number of cellular components, such as poly ADP ribose 
polymerase, may also help regulate apoptosis. 
Before the actual process of cell death is precipitated by 
enzymes, apoptotic signals must cause regulatory 
proteins to initiate the apoptosis pathway. This step allows 
apoptotic signals to cause cell death, or the process to be 
stopped, should the cell no longer need to die. Several 
proteins are involved, but two main methods of regulation 
have been identified: targeting mitochondria functionality, 
or directly transducing the signal via adaptor proteins to 
the apoptotic mechanisms. Another extrinsic pathway for 
initiation identified in several toxin studies is an increase in 
calcium concentration within a cell caused by drug activity, 
which also can cause apoptosis via a calcium binding 
protease calpain. 
Steps: 
-Mitochondrial regulation 
-Direct signal transduction 
-TNF path 
-FAS path 
-common components 
-Caspases 
-Caspase-independent apoptotic pathway 
-Execution 
-Removal of dead cells
Methods for distinguishing apoptotic from 
necrotic (necroptotic) cells 
In order to perform analysis of apoptotic versus necrotic 
(necroptotic) one can do analysis of morphology by time-lapse 
microscopy, flow fluorocytometry, and transmission 
electron microscopy. There are also various biochemical 
techniques for analysis of cell surface markers 
(phosphatidylserine exposure versus cell permeability by 
flow fluorocytometry), cellular markers such as DNA 
fragmentation (flow fluorocytometry), caspase activation, 
Bid cleavage, and cytochrome c release (Western 
blotting). It is important to know how primary and 
secondary necrotic cells can be distinguished by analysis 
of supernatant for caspases, HMGB1, and release of 
cytokeratin 18. However, no distinct surface or 
biochemical markers of necrotic (necroptotic) cell death 
have been identified yet, and only negative markers are 
available. These include absence of apoptotic parameters 
(caspase activation, cytochrome c release, and 
oligonucleosomal DNA fragmentation) and differential 
kinetics of cell death markers (phosphatidylserine 
exposure and cell membrane permeabilization). A 
selection of techniques that can be used to 
distinguish apoptosis from necroptotic cells could be found 
in these references 
Implication in disease: 
Defective pathways 
The many different types of apoptotic pathways contain a 
multitude of different biochemical components, many of 
them not yet understood.[40] As a pathway is more or less 
sequential in nature, it is a victim of causality; removing or 
modifying one component leads to an effect in another. In 
a living organism, this can have disastrous effects, often in
the form of disease or disorder. A discussion of every 
disease caused by modification of the various apoptotic 
pathways would be impractical, but the concept overlying 
each one is the same: The normal functioning of the 
pathway has been disrupted in such a way as to impair 
the ability of the cell to undergo normal apoptosis. This 
results in a cell that lives past its "use-by-date" and is able 
to replicate and pass on any faulty machinery to its 
progeny, increasing the likelihood of the cell's becoming 
cancerous or diseased. 
A recently described example of this concept in action can 
be seen in the development of a lung cancer called NCI-H460.[ 
41] The X-linked inhibitor of apoptosis protein (XIAP) 
is overexpressed in cells of the H460 cell line. XIAPs bind 
to the processed form of caspase-9, and suppress the 
activity of apoptotic activator cytochrome c, therefore 
overexpression leads to a decrease in the amount of 
proapoptotic agonists. As a consequence, the balance of 
anti-apoptotic and proapoptotic effectors is upset in favour 
of the former, and the damaged cells continue to replicate 
despite being directed to die. 
Treatments 
The main method of treatment for death signaling-related 
diseases involves either increasing or decreasing the 
susceptibility of apoptosis in diseased cells, depending on 
whether the disease is caused by either the inhibition of or 
excess apoptosis. For instance, treatments aim to restore 
apoptosis to treat diseases with deficient cell death, and to 
increase the apoptotic threshold to treat diseases involved 
with excessive cell death. To stimulate apoptosis, one can 
increase the number of death receptor ligands (such as 
TNF or TRAIL), antagonize the anti-apoptotic Bcl-2 
pathway, or introduce Smac mimetics to inhibit the 
inhibitor (IAPs). The addition of agents such as Herceptin, 
Iressa, or Gleevec works to stop cells from cycling and
causes apoptosis activation by blocking growth and 
survival signaling further upstream. Finally, adding p53- 
MDM2 complexes displaces p53 and activates the p53 
pathway, leading to cell cycle arrest and apoptosis. Many 
different methods can be used either to stimulate or to 
inhibit apoptosis in various places along the death 
signaling pathway. 
Apoptosis is a multi-step, multi-pathway cell-death 
programme that is inherent in every cell of the body. In 
cancer, the apoptosis cell-division ratio is altered. Cancer 
treatment by chemotherapy and irradiation kills target cells 
primarily by inducing apoptosis. 
Pictures of apoptosis:
Apoptosis

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Apoptosis

  • 1. Noreen Muhammad Naguib Mosaad 5212322 Group:11 Dentistry
  • 2. Apoptosis Apoptosis is the process of programmed cell death (PCD) that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation. In contrast to necrosis, which is a form of traumatic cell death that results from acute cellular injury, in general apoptosis confers advantages during an organism's lifecycle. For example, the separation of fingers and toes in a developing humanembryo occurs because cells between the digits apoptose. Unlike necrosis, apoptosis produces cell fragments called apoptotic bodies that phagocytic cells are able to engulf and quickly remove before the contents of the cell can spill out onto surrounding cells and cause damage. Between 50 and 70 billion cells die each day due to apoptosis in the average human adult. For an average child between the ages of 8 and 14, approximately 20 billion to 30 billion cells die a day. Research in and around apoptosis has increased substantially since the early 1990s. In addition to its importance as a biological phenomenon, defective apoptotic processes have been implicated in an extensive variety of diseases. Excessive apoptosis causes atrophy, whereas an insufficient amount results in uncontrolled cell proliferation, such as cancer. Process: A cell initiates intracellular apoptotic signaling in response to a stress, which may bring about cell suicide. The
  • 3. binding of nuclear receptors by glucocorticoids, heat,[13] radiation,[13] nutrient deprivation,[13] viral infection,[13] hypoxia[13] and increased intracellularcalcium concentration, for example, by damage to the membrane, can all trigger the release of intracellular apoptotic signals by a damaged cell. A number of cellular components, such as poly ADP ribose polymerase, may also help regulate apoptosis. Before the actual process of cell death is precipitated by enzymes, apoptotic signals must cause regulatory proteins to initiate the apoptosis pathway. This step allows apoptotic signals to cause cell death, or the process to be stopped, should the cell no longer need to die. Several proteins are involved, but two main methods of regulation have been identified: targeting mitochondria functionality, or directly transducing the signal via adaptor proteins to the apoptotic mechanisms. Another extrinsic pathway for initiation identified in several toxin studies is an increase in calcium concentration within a cell caused by drug activity, which also can cause apoptosis via a calcium binding protease calpain. Steps: -Mitochondrial regulation -Direct signal transduction -TNF path -FAS path -common components -Caspases -Caspase-independent apoptotic pathway -Execution -Removal of dead cells
  • 4. Methods for distinguishing apoptotic from necrotic (necroptotic) cells In order to perform analysis of apoptotic versus necrotic (necroptotic) one can do analysis of morphology by time-lapse microscopy, flow fluorocytometry, and transmission electron microscopy. There are also various biochemical techniques for analysis of cell surface markers (phosphatidylserine exposure versus cell permeability by flow fluorocytometry), cellular markers such as DNA fragmentation (flow fluorocytometry), caspase activation, Bid cleavage, and cytochrome c release (Western blotting). It is important to know how primary and secondary necrotic cells can be distinguished by analysis of supernatant for caspases, HMGB1, and release of cytokeratin 18. However, no distinct surface or biochemical markers of necrotic (necroptotic) cell death have been identified yet, and only negative markers are available. These include absence of apoptotic parameters (caspase activation, cytochrome c release, and oligonucleosomal DNA fragmentation) and differential kinetics of cell death markers (phosphatidylserine exposure and cell membrane permeabilization). A selection of techniques that can be used to distinguish apoptosis from necroptotic cells could be found in these references Implication in disease: Defective pathways The many different types of apoptotic pathways contain a multitude of different biochemical components, many of them not yet understood.[40] As a pathway is more or less sequential in nature, it is a victim of causality; removing or modifying one component leads to an effect in another. In a living organism, this can have disastrous effects, often in
  • 5. the form of disease or disorder. A discussion of every disease caused by modification of the various apoptotic pathways would be impractical, but the concept overlying each one is the same: The normal functioning of the pathway has been disrupted in such a way as to impair the ability of the cell to undergo normal apoptosis. This results in a cell that lives past its "use-by-date" and is able to replicate and pass on any faulty machinery to its progeny, increasing the likelihood of the cell's becoming cancerous or diseased. A recently described example of this concept in action can be seen in the development of a lung cancer called NCI-H460.[ 41] The X-linked inhibitor of apoptosis protein (XIAP) is overexpressed in cells of the H460 cell line. XIAPs bind to the processed form of caspase-9, and suppress the activity of apoptotic activator cytochrome c, therefore overexpression leads to a decrease in the amount of proapoptotic agonists. As a consequence, the balance of anti-apoptotic and proapoptotic effectors is upset in favour of the former, and the damaged cells continue to replicate despite being directed to die. Treatments The main method of treatment for death signaling-related diseases involves either increasing or decreasing the susceptibility of apoptosis in diseased cells, depending on whether the disease is caused by either the inhibition of or excess apoptosis. For instance, treatments aim to restore apoptosis to treat diseases with deficient cell death, and to increase the apoptotic threshold to treat diseases involved with excessive cell death. To stimulate apoptosis, one can increase the number of death receptor ligands (such as TNF or TRAIL), antagonize the anti-apoptotic Bcl-2 pathway, or introduce Smac mimetics to inhibit the inhibitor (IAPs). The addition of agents such as Herceptin, Iressa, or Gleevec works to stop cells from cycling and
  • 6. causes apoptosis activation by blocking growth and survival signaling further upstream. Finally, adding p53- MDM2 complexes displaces p53 and activates the p53 pathway, leading to cell cycle arrest and apoptosis. Many different methods can be used either to stimulate or to inhibit apoptosis in various places along the death signaling pathway. Apoptosis is a multi-step, multi-pathway cell-death programme that is inherent in every cell of the body. In cancer, the apoptosis cell-division ratio is altered. Cancer treatment by chemotherapy and irradiation kills target cells primarily by inducing apoptosis. Pictures of apoptosis: