[Understanding cell death: a challenge for biomedicine].

Apoptosis or programmed cell death (PCD) is a physiological process that constitutes the natural fate of end-stage differentiated cells. It is essential for tissue patterning during embryonic development and for maintenance of tissue homeostasis of the adult organism. The execution of the death programme is characterized by a sequence of morphological and biochemical changes. These include early mitochondrial alterations, cell shrinkage, chromatin condensation and nuclear fragmentation, membrane blebbing, caspase activation, the presentation of phosphatidylserine at the cell surface, and the formation of membrane bound vesicles termed apoptotic bodies . The apoptosis is evolutionary conserved. The main regulatory proteins involved include caspases and bcl-2 family proteins. Three groups of the Bcl-2 family proteins can be distinguished: the antiapoptotic proteins, like Bcl-2 and Bcl-x L, the pro-apoptotic members e.g., Bax, Bak and the BH3-only proteins. In apoptosis mitochondria have two essential functions. First, provide energy, in the form of ATP, which is required for cells to die by the apoptosis pathway. Second, to release pro-apoptotic proteins normally sequestered in the intermembrane space into the cytosol where they trigger downstream apoptotic signaling pathways. Mitochondrial dysfunction in apoptosis is related with specific permeabilization of the outer mitochondrial membrane to large molecules. They can be divided into two groups. First, cytochrome c, Smac/DIABLO and HtrA2/Omi, activates the caspase dependent mitochondrial pathway. The second group, endonuclease G and AIF translocate to the nucleus and induce DNA degradation in a caspase independent manner. Mitochondrial membrane potential (MMP), delta(phi)m, may control the permeability of the outer membrane and regulate cytochrome c release. When the mitochondria loss their delta(phi) undergo swelling, and release IMs proteins.