Traumatic brain injury (TBI) is one of the significant causes of death and
morbidity, and it is hence a focus of translational research. Apoptosis plays an essential part
in the pathophysiology of TBI, and its inhibition may help overcome TBI’s negative
consequences and improve functional recovery. Whereas physiological neuronal death is
necessary for appropriate embryologic development and adult cell turnover, it can also
drive neurodegeneration. Caspases are principal mediators of cell death due to apoptosis
and are critical to the required cleavage of intracellular proteins of cells committed to die.
Caspase-3 is the major executioner Caspase of apoptosis and is regulated by a range of
cellular components during physiological and pathological conditions. Activation of
Caspase-3 causes proteolyzation of DNA repair proteins, cytoskeletal proteins, and the
inhibitor of Caspase-activated DNase (ICAD) during programmed cell death, resulting in
morphological alterations and DNA damage that define apoptosis. Caspase-9 is an
additional crucial part of the intrinsic pathway, activated in response to several stimuli.
Caspases can be altered post-translationally or by modulatory elements interacting with the
zymogenic or active form of a Caspase, preventing their activation and activity. The
necessity of Caspase-9 and -3 in diverse apoptotic situations suggests that mammalian cells
have at least four distinct apoptotic pathways. Continued investigation of these processes is
anticipated to disclose new Caspase regulatory mechanisms with consequences far beyond
apoptotic cell death control. The present review discusses various Caspase-dependent
apoptotic pathways and the treatment strategies to inhibit the Caspases potentially.
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