Cell injuryadaptation 4

Editor's Notes

• #5: Apoptosis was initially recognized in 1972 by its distinctive morphology and named after the Greek designation for "falling off."[42] It occurs normally in many situations, and serves to eliminate unwanted or potentially harmful cells and cells that have outlived their usefulness. It is also a pathologic event when cells are damaged beyond repair, especially when the damage affects the cell's DNA; in these situations, the irreparably damaged cell is eliminated. ------------------------------------------------------------------------------------- "We are most grateful to Professor James Cormack of the Department of Greek, University of Aberdeen, for suggesting this term. The word "apoptosis" (Greek spelling of apoptosis) is used in Greek to describe the "dropping off" or "falling off" of petals from flowers, or leaves from trees. To show the derivation clearly, we propose that the stress should be on the penultimate syllable, the second half of the word being pronounced like "ptosis" (with the "p" silent), which comes from the same root "to fall", and is already used to describe the drooping of the upper eyelid."
• #6: Cell death is induced by a tightly regulated intracellular program in which cells destined to die activate enzymes that degrade the cells' own nuclear DNA and nuclear and cytoplasmic proteins.
• #7: Apoptosis is very essential for our survival: Embryogenesis, involution of corpus lutem et.c. Increased or decreased apoptosis is associated with diseases: Neurodegenerative diseases, Cancers.
• #8: Death by apoptosis is a normal phenomenon that serves to eliminate cells that are no longer needed, as, for example, during development, and to maintain a steady number of various cell populations in tissues. It is important in the following physiologic situations:   •    The programmed destruction of cells during embryogenesis, including implantation, organogenesis, developmental involution and metamorphosis. The term "programmed cell death" was originally coined to denote death of specific cell types at defined times during development.[43] Apoptosis is a generic term for this pattern of cell death, regardless of the context, but it is often used interchangeably with "programmed cell death."  •    Hormone-dependent involution in the adult, such as endometrial cell breakdown during the menstrual cycle, ovarian follicular atresia in the menopause, the regression of the lactating breast after weaning, and prostatic atrophy after castration.  •    Cell deletion in proliferating cell populations, such as intestinal crypt epithelia, in order to maintain a constant number.  •    Death of host cells that have served their useful purpose, such as neutrophils in an acute inflammatory response, and lymphocytes at the end of an immune response. In these situations, cells undergo apoptosis because they are deprived of necessary survival signals, such as growth factors.  •    Elimination of potentially harmful self-reactive lymphocytes, either before or after they have completed their maturation ( Chapter 6 ).  •    Cell death induced by cytotoxic T cells, a defense mechanism against viruses and tumors that serves to eliminate virus-infected and neoplastic cells. The same mechanism is responsible for cellular rejection of transplants.
• #10: Death by apoptosis is also responsible for loss of cells in a variety of pathologic states:   •    Cell death produced by a variety of injurious stimuli. For instance, radiation and cytotoxic anticancer drugs damage DNA, and if repair mechanisms cannot cope with the injury the cell kills itself by apoptosis. In these situations, elimination of the cell may be a better alternative than risking mutations and translocations in the damaged DNA, which may result in malignant transformation. These injurious stimuli, as well as heat and hypoxia, can induce apoptosis if the insult is mild, but large doses of the same stimuli result in necrotic cell death. Endoplasmic reticulum (ER) stress, which is induced by the accumulation of unfolded proteins, also triggers apoptotic death of cells (described later in the chapter).  •    Cell injury in certain viral diseases, such as viral hepatitis, in which loss of infected cells is largely because of apoptotic death.  •    Pathologic atrophy in parenchymal organs after duct obstruction, such as occurs in the pancreas, parotid gland, and kidney.  •    Cell death in tumors, most frequently during regression but also in actively growing tumors.
• #15: Morphology. The following morphologic features, some best seen with the electron microscope, characterize cells undergoing apoptosis ( Fig. 1-25 ).   •    Cell shrinkage. The cell is smaller in size; the cytoplasm is dense; and the organelles, although relatively normal, are more tightly packed.  •    Chromatin condensation. This is the most characteristic feature of apoptosis. The chromatin aggregates peripherally, under the nuclear membrane, into dense masses of various shapes and sizes. The nucleus itself may break up, producing two or more fragments.  •    Formation of cytoplasmic blebs and apoptotic bodies. The apoptotic cell first shows extensive surface blebbing, then undergoes fragmentation into membrane-bound apoptotic bodies composed of cytoplasm and tightly packed organelles, with or without nuclear fragments.  •    Phagocytosis of apoptotic cells or cell bodies, usually by macrophages. The apoptotic bodies are rapidly degraded within lysosomes, and the adjacent healthy cells migrate or proliferate to replace the space occupied by the now deleted apoptotic cell.
• #16: 7th edition: Figure 1-28  Mechanisms of apoptosis. Labeled (1) are some of the major inducers of apoptosis. These include specific death ligands (tumor necrosis factor [TNF] and Fas ligand), withdrawal of growth factors or hormones, and injurious agents (e.g., radiation). Some stimuli (such as cytotoxic cells) directly activate execution caspases (right). Others act by way of adapter proteins and initiator caspases, or by mitochondrial events involving cytochrome c. (2) Control and regulation are influenced by members of the Bcl-2 family of proteins, which can either inhibit or promote the cell's death. (3) Executioner caspases activate latent cytoplasmic endonucleases and proteases that degrade nuclear and cytoskeletal proteins. This results in a cascade of intracellular degradation, including fragmentation of nuclear chromatin and breakdown of the cytoskeleton. (4) The end result is formation of apoptotic bodies containing intracellular organelles and other cytosolic components; these bodies also express new ligands for binding and uptake by phagocytic cells.
• #17: 8th edition: FIGURE 1-24  Mechanisms of apoptosis. The two pathways of apoptosis differ in their induction and regulation, and both culminate in the activation of “executioner” caspases. The induction of apoptosis by the mitochondrial pathway involves the action of sensors and effectors of the Bcl-2 family, which induce leakage of mitochondrial proteins. Also shown are some of the anti-apoptotic proteins (“regulators”) that inhibit mitochondrial leakiness and cytochrome c–dependent caspase activation in the mitochondrial pathway. In the death receptor pathway engagement of death receptors leads directly to caspase activation. The regulators of death receptor–mediated caspase activation are not shown. ER, endoplasmic reticulum; TNF, tumor necrosis factor.
• #19: 7th edition Figure 1-25  Ultrastructural features of apoptosis. Some nuclear fragments show peripheral crescents of compacted chromatin, whereas others are uniformly dense.  (From Kerr JFR, Harmon BV: Definition and incidence of apoptosis: a historical perspective. In Tomei LD, Cope FO (eds): Apoptosis: The Molecular Basis of Cell Death. Cold Spring Harbor, NY, Cold Spring Harbor Laboratory Press, 1991, pp 5–29.)
• #20: 7th edition Figure 1-26  A, Apoptosis of epidermal cells in an immune-mediated reaction. The apoptotic cells are visible in the epidermis with intensely eosinophilic cytoplasm and small, dense nuclei. H&E stain. B, High power of apoptotic cell in liver in immune-mediated hepatic cell injury.  (Courtesy of Dr. Scott Granter, Brigham and Women's Hospital, Boston, AM.) (Courtesy of Dr. Dhanpat Jain, Yale University, New Haven, CT.) On histologic examination, in tissue stained with hematoxylin and eosin, apoptosis involves single cells or small clusters of cells. The apoptotic cell appears as a round or oval mass of intensely eosinophilic cytoplasm with dense nuclear chromatin fragments ( Fig. 1-26 ). Because the cell shrinkage and formation of apoptotic bodies are rapid and the fragments are quickly phagocytosed, considerable apoptosis may occur in tissues before it becomes apparent in histologic sections. In addition, apoptosis—in contrast to necrosis—does not elicit inflammation, making it more difficult to detect histologically.
• #21: 8th edition: FIGURE 1-22  Morphologic features of apoptosis. A, Apoptosis of an epidermal cell in an immune reaction. The cell is reduced in size and contains brightly eosinophilic cytoplasm and a condensed nucleus. B, This electron micrograph of cultured cells undergoing apoptosis shows some nuclei with peripheral crescents of compacted chromatin, and others that are uniformly dense or fragmented. C, These images of cultured cells undergoing apoptosis show blebbing and formation of apoptotic bodies (left panel, phase contrast micrograph), a stain for DNA showing nuclear fragmentation (middle panel), and activation of caspase-3 (right panel, immunofluorescence stain with an antibody specific for the active form of caspase-3, revealed as red color).  (B, From Kerr JFR, Harmon BV: Definition and incidence of apoptosis: a historical perspective. In Tomei LD, Cope FO (eds): Apoptosis: The Molecular Basis of Cell Death. Cold Spring Harbor, NY, Cold Spring Harbor Laboratory Press, 1991, pp 5–29; C, Courtesy of Dr. Zheng Dong, Medical College of Georgia, Augusta, GA.)
• #22: Apoptosis is a more orderly process of cell death in which there is individual cell necrosis, not necrosis of large numbers of cells. In this example, liver cells are dying individually (arrows) from injury by viral hepatitis. The cells are pink and without nuclei.
• #24: In this fetal thymus there is involution of thymic lymphocytes by the mechanism of apoptosis. Individual cells fragment and are consumed by phagocytes to give the appearance of clear spaces filled with cellular debris. Apoptosis is controlled by many mechanisms. Genes such as Bcl-2 are turned off and Bax genes turned on. Proteolytic enzymes called caspases produce much cellular breakdown.
• #25: Protein Cleavage: A specific feature of apoptosis is protein hydrolysis involving the activation of several members of a family of cysteine proteases named caspases.[45] Many caspases are present in normal cells as inactive pro-enzymes, and they need to be activated to induce apoptosis. Active caspases cleave many vital cellular proteins, such as lamins, and thus break up the nuclear scaffold and cytoskeleton; in addition, caspases activate DNAses, which degrade nuclear DNA. These changes underlie the nuclear and cytoplasmic structural alterations seen in apoptotic cells. DNA Breakdown: Apoptotic cells exhibit a characteristic breakdown of DNA into large 50- to 300-kilobase pieces.[46] Subsequently, there is internucleosomal cleavage of DNA into oligonucleosomes, in multiples of 180 to 200 base pairs, by Ca2+- and Mg2+-dependent endonucleases. The fragments may be visualized by agarose gel electrophoresis as DNA ladders ( Fig. 1-27 ). Endonuclease activity also forms the basis for detecting cell death by cytochemical techniques that recognize double-stranded breaks of DNA.[47] However, internucleosomal DNA cleavage is not specific for apoptosis. A "smeared" pattern of DNA fragmentation is thought to be indicative of necrosis, but this may be a late autolytic phenomenon, and typical DNA ladders may be seen in necrotic cells as well.[47] Phagocytic Recognition: Apoptotic cells express phosphatidylserine in the outer layers of their plasma membranes, the phospholipid having "flipped" out from the inner layers. (Because of these changes, apoptotic cells can be identified by binding of special dyes, such as Annexin V.) In some types of apoptosis, thrombospondin, an adhesive glycoprotein, is also expressed on the surfaces of apoptotic bodies, and other proteins secreted by phagocytes may bind to apoptotic cells and opsonize the cells for phagocytosis.[48] These alterations permit the early recognition of dead cells by macrophages, resulting in phagocytosis without the release of proinflammatory cellular components.[49] In this way, the apoptotic response disposes of cells with minimal compromise to the surrounding tissue.
• #26: Figure 1-27  Agarose gel electrophoresis of DNA extracted from culture cells. Ethidium bromide stain; photographed under ultraviolet illumination. Lane A, Control culture. Lane B, Culture of cells exposed to heat showing extensive apoptosis; note ladder pattern of DNA fragments, which represent multiples of oligonucleosomes. Lane C, Culture showing massive necrosis; note diffuse smearing of DNA. The ladder pattern is produced by enzymatic cleavage of nuclear DNA into nucleosome-sized fragments, usually multiples of 180–200 base pairs. These patterns are characteristic of but not specific for apoptosis and necrosis, respectively.  (From Kerr JFR, Harmon BV: Definition and incidence of apoptosis: a historical perspective. In Tomei LD, Cope FO [eds]: Apoptosis: The Molecular Basis of Cell Death. Cold Spring Harbor, NY, Cold Spring Harbor Laboratory Press, 1991, p 13.)
• #29: Figure 1-29  The extrinsic (death receptor-initiated) pathway of apoptosis, illustrated by the events following Fas engagement. The extrinsic (Death Receptor-Initiated) Pathway: This pathway is initiated by engagement of cell surface death receptors on a variety of cells.[51] Death receptors are members of the tumor necrosis factor receptor family that contain a cytoplasmic domain involved in protein-protein interactions that is called the death domain because it is essential for delivering apoptotic signals. (Some TNF receptor family members do not contain cytoplasmic death domains; their role in triggering apoptosis is much less established). The best-known death receptors are the type 1 TNF receptor (TNFR1) and a related protein called Fas (CD95), but several others have been described. The mechanism of apoptosis induced by these death receptors is well illustrated by Fas ( Fig. 1-29 ). When Fas is cross-linked by its ligand, membrane-bound Fas ligand (FasL), three or more molecules of Fas come together, and their cytoplasmic death domains form a binding site for an adapter protein that also contains a death domain and is called FADD (Fas-associated death domain). FADD that is attached to the death receptors in turn binds an inactive form of caspase-8 (and, in humans, caspase-10), again via a death domain. Multiple pro-caspase-8 molecules are thus brought into proximity, and they cleave one another to generate active caspase-8. The enzyme then triggers a cascade of caspase activation by cleaving and thereby activating other pro-caspases, the active enzymes mediate the execution phase of apoptosis (discussed below). This pathway of apoptosis can be inhibited by a protein called FLIP, which binds to pro-caspase-8 but cannot cleave and activate the enzyme because it lacks enzymatic activity.[52] Some viruses and normal cells produce FLIP and use this inhibitor to protect infected and normal cells from Fas-mediated apoptosis. The sphingolipid ceramide has been implicated as an intermediate between death receptors and caspase activation, but the role of this pathway is unclear and remains controversial.[53]
• #30: Figure 1-30  The intrinsic (mitochondrial) pathway of apoptosis. Death agonists cause changes in the inner mitochondrial membrane, resulting in the mitochondrial permeability transition (MPT) and release of cytochrome c and other pro-apoptotic proteins into the cytosol, which activate caspases (see text). The Intrinsic (Mitochondrial) Pathway: This pathway of apoptosis is the result of increased mitochondrial permeability and release of pro-apoptotic molecules into the cytoplasm, without a role for death receptors.[54][55] Growth factors and other survival signals stimulate the production of anti-apoptotic members of the Bcl-2 family of proteins.[56] This family is named after Bcl-2, which was identified as an oncogene in a B cell lymphoma and is homologous to the C. elegans protein, Ced-9. There are more than 20 proteins in this family, all of which function to regulate apoptosis; the two main anti-apoptotic ones are Bcl-2 and Bcl-x. These anti-apoptotic proteins normally reside in mitochondrial membranes and the cytoplasm. When cells are deprived of survival signals or subjected to stress, Bcl-2 and/or Bcl-x are lost from the mitochondrial membrane and are replaced by pro-apoptotic members of the family, such as Bak, Bax, and Bim. When Bcl-2/Bcl-x levels decrease, the permeability of the mitochondrial membrane increases, and several proteins that can activate the caspase cascade leak out ( Fig. 1-30 ). One of these proteins is cytochrome c, well known for its role in mitochondrial respiration. In the cytosol, cytochrome c binds to a protein called Apaf-1 (apoptosis activating factor-1, homologous to Ced-4 in C. elegans), and the complex activates caspase-9.[57] (Bcl-2 and Bcl-x may also directly inhibit Apaf-1 activation, and their loss from cells may permit activation of Apaf-1). Other mitochondrial proteins, such as apoptosis inducing factor (AIF), enter the cytoplasm, where they bind to and neutralize various inhibitors of apoptosis, whose normal function is to block caspase activation.[58] The net result is the initiation of a caspase cascade. Thus, the essence of this intrinsic pathway is a balance between pro-apoptotic and protective molecules that regulate mitochondrial permeability and the release of death inducers that are normally sequestered within the mitochondria.
• #31: Figure 54-6 Apoptotic pathways. The extrinsic pathway is activated by binding of a ligand to a death receptor protein, such as CD95, which signals through FADD to activate caspase-8 and subsequent members of the cascade. The intrinsic pathway is activated by mitochondrial permeability, releasing cytochrome c and other proteins that activate Apaf-1 and allow the cascade to proceed. The pathway is regulated by opposing actions of the pro-apoptotic proteins Bax and Bak, and the anti-apoptotic protein Bcl-2. The intrinsic pathway is also regulated by intracellular signals that activate Bcl-2 and prevent apoptosis, or activate Bak/Bax and facilitate apoptosis.REF: Hoffman’s Hematology
• #32: Figure 1-28  Mechanisms of apoptosis. Labeled (1) are some of the major inducers of apoptosis. These include specific death ligands (tumor necrosis factor [TNF] and Fas ligand), withdrawal of growth factors or hormones, and injurious agents (e.g., radiation). Some stimuli (such as cytotoxic cells) directly activate execution caspases (right). Others act by way of adapter proteins and initiator caspases, or by mitochondrial events involving cytochrome c. (2) Control and regulation are influenced by members of the Bcl-2 family of proteins, which can either inhibit or promote the cell's death. (3) Executioner caspases activate latent cytoplasmic endonucleases and proteases that degrade nuclear and cytoskeletal proteins. This results in a cascade of intracellular degradation, including fragmentation of nuclear chromatin and breakdown of the cytoskeleton. (4) The end result is formation of apoptotic bodies containing intracellular organelles and other cytosolic components; these bodies also express new ligands for binding and uptake by phagocytic cells.
• #36: TUNEL histochemical staining in murine liver, brown cell is apoptotic.
• #39: 8th edition: FIGURE 1-8  Schematic illustration of the morphologic changes in cell injury culminating in necrosis or apoptosis.