Apoptosis represents a universal and exquisitely efficient cellular suicide pathway essential for a variety of normal biological processes ranging from embryonic development to ageing. In fact, tissue homeostasis is dependent on the perfect balance between positive and negative signals that determines the decision between life and death. Therefore, any imbalance can result in a wide range of pathologic disorders associated with unwanted apoptosis or cell growth. During the apoptotic process, the molecular players interact closely with each other in ways relevant to accelerate or interrupt the cellular death process. In addition, two major pathways of apoptosis activation have been recognized as the "intrinsic" mitochondrial pathway and the "extrinsic" death receptor pathway. Although these pathways act independently to initiate apoptosis, a delicate balance and cross-talk between the extrinsic and intrinsic pathways is thought to occur in many cell types. Interestingly, we have shown that ursodeoxycholic acid (UDCA), an endogenous hydrophilic bile acid, is a potent inhibitor of apoptosis by either stabilizing the mitochondrial membrane or modulating the expression of specific upstream targets. Herein, we review the main effectors involved in the death machinery, describe how they interact to regulate apoptosis, and discuss the main pathways that control cell death and survival. Further, we address multiple interesting targets as well as the potential application of UDCA as a therapeutic modality for apoptosis-related disorders.
IntroductionThe process of cell death typically follows one of two patterns: necrosis or apoptosis (Bayerdorffer et al., 1993). The first is the consequence of acute metabolic perturbation as it occurs in ischemia/reperfusion or acute drug-induced toxicity. In contrast, apoptosis represents the execution of a death program often initiated by specific stimuli. Nevertheless, it is important to note that, in certain occasions, rather than separate entities, apoptosis and necrosis are frequently the consequence of the same initiating factors and signaling pathways, representing extremes on a continuum of cell death (Bull et al., 1983;Hofmann, 2002).Apoptosis is an active mechanism by which metazoan organisms quickly eliminate cells in response 124 Solá et al.The molecular mechanisms of programmed cell death are highly conserved throughout evolution. Studies in Caenorhabditis elegans (C. elegans) have demonstrated that cell demise is carried out by specific cellular pathways (Hall et al., 1997), suggesting that it may be more "programmed" than initially thought. In fact, cell death in C. elegans is regulated only by three genes: ced-3, ced-4 and ced-9 (Fig. 1). Further, Egl-1 blocks the activity of Ced-9, an inhibitor of Ced-4 that complexes with and activates the cysteinic protease Ced-3 (Conradt and Horvitz, 1998).The apoptosis process can be subdivided into initiation, effector and degradation phases (Kroemer et al., 1995). In mammalian cells, the initiation stage depends on the ty...