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Review
. 2021 May;18(5):1106-1121.
doi: 10.1038/s41423-020-00630-3. Epub 2021 Mar 30.

Necroptosis, pyroptosis and apoptosis: an intricate game of cell death

Damien Bertheloot  1 , Eicke Latz  2   3   4 , Bernardo S Franklin  5
Affiliations
Review

Necroptosis, pyroptosis and apoptosis: an intricate game of cell death

Damien Bertheloot et al. Cell Mol Immunol. 2021 May.

Abstract

Cell death is a fundamental physiological process in all living organisms. Its roles extend from embryonic development, organ maintenance, and aging to the coordination of immune responses and autoimmunity. In recent years, our understanding of the mechanisms orchestrating cellular death and its consequences on immunity and homeostasis has increased substantially. Different modalities of what has become known as 'programmed cell death' have been described, and some key players in these processes have been identified. We have learned more about the intricacies that fine tune the activity of common players and ultimately shape the different types of cell death. These studies have highlighted the complex mechanisms tipping the balance between different cell fates. Here, we summarize the latest discoveries in the three most well understood modalities of cell death, namely, apoptosis, necroptosis, and pyroptosis, highlighting common and unique pathways and their effect on the surrounding cells and the organism as a whole.

Keywords: Apoptosis; Inflammation; Necroptosis; Pyroptosis; Survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Necroptosis is triggered downstream of death domain receptors (e.g., TNFR and Fas) and Toll-like receptor (TLR)-4 or TLR3. Upon activation, these receptors recruit the adapter proteins FADD, TRADD, and TRIF, which interact with RIPK1 and caspase-8 or -10. First, RIPK1 is ubiquitylated by IAPs, keeping it nonfunctional and enabling proinflammatory downstream activity via NFκB. After detection of a “death signal”, RIPK1 is deubiquitylated by CYLD and can thus recruit RIPK3. The RIPK1/RIP3 complex recruits and phosphorylates MLKL. In the presence of highly phosphorylated inositol phosphate (IP6), phosphorylated MLKL oligomerizes, thus forming the necrosome. MLKL oligomers translocate to phosphatidylinositol phosphate (PIP)-rich patches in the plasma membrane and form large pores. Ultimately, MLKL pores lead to necroptotic cell death by allowing ion influx, cell swelling, and membrane lysis followed by the uncontrollable release of intracellular material. The cytosolic nucleic acid sensors RIG-I and cGAS/STING also contribute to necroptotic cell death, as they induce IFN-I and TNFα and thus promote necroptosis via an autocrine feedback loop. Downstream of TNFR or TLR engagement, active caspase-8 cleaves the cytokine blocker N4BP1, thus promoting an increase in cytokine release. Once activated, RIPK3 phosphorylates the pyruvate dehydrogenase complex (PDC) in mitochondria and promotes aerobic respiration and mitochondrial ROS production. In the presence of cytosolic DNA released from infecting microbes, DNA-dependent activator of IFN regulatory factor (DAI) recruits RIPK3 and thus bypasses RIPK1 for activation of MLKL and formation of the necrosome complex
Fig. 2
Fig. 2
Pyroptosis is an inflammatory form of cell death triggered by intracellular sensors such as NLRP3 (used here as an example) that detect DAMPs, PAMPs, membrane disturbances, osmotic imbalances, and ion efflux, among other stimuli. Upon activation, these sensors recruit the adapter ASC, forming a micron-sized structure called the inflammasome. These oligomeric structures act as platforms for the activation of caspase-1. Active caspase-1 cleaves proforms of the interleukin-1 family cytokines IL-1β and IL-18. Caspase-1 also activates gasdermin D (GSDMD), unmasking the N-terminal domain, which forms pores in the plasma membrane, in turn enabling the release of mature IL-1β and IL-18 and causing cell swelling (a “ballooning effect”) and pyroptosis. In addition, intracellular recognition of LPS can result in pyroptosis: guanylate-binding proteins (GBPs) bind to the surface of bacteria and assemble a caspase-4/11-activating platform composed of GBP1, 2, 3, and 4, and the cytosolic precursors of caspase-4 and -11. Active caspase-4 and -11 cleave GSDMD, leading to pyroptosis. Notably, caspase-4 can additionally induce proteolytic cleavage of IL-18. As an inherently inflammatory form of cell death, pyroptosis has several layers of regulation. Expression of NLRP3 and the cytokine IL-1 requires priming via stimulation of TLRs, TNFR or IL-1R followed by NFκB activation. Inflammasome sensors are heavily regulated through posttranslational modifications, such as phosphorylation and ubiquitylation (indicated in the box) or by cleavage
Fig. 3
Fig. 3
Apoptosis is triggered through two major pathways referred to as the intrinsic and extrinsic pathways. The intrinsic pathway is activated by oligomerization of the B-cell lymphoma-2 (BCL-2) family proteins BAK and BAX. BAK/BAX oligomers form pores in the mitochondrial outer membrane, leading to the release of cytochrome c into the cytosol. Activation of BAK/BAX is regulated by proapoptotic (e.g., BAD and BID) or antiapoptotic (e.g., BCL-2) BCL-2 family proteins. Cytochrome c binds to Apaf-1, which recruits procaspase-9, forming the apoptosome. In the apoptosome, caspase-9 is activated by autoproteolytic cleavage, initiating the caspase-processing cascade. The extrinsic pathway is activated by engagement of membrane receptors such as Tumor necrosis factor (TNF) receptor 1 (TNFR1), death receptors, or Toll-Like Receptors (TLRs). These proteins induce the formation of signaling complexes involving TNFR1-associated death domain protein (TRADD) or Fas-associated death domain protein (FADD), receptor-interacting serine/threonine protein kinase 1 (RIPK1) and procaspase-8. Ubiquitylation of RIPK1 by cellular inhibitors of apoptosis (cIAPs) stabilizes the complex and induces the activation of the transcription factor NFκB. FLIP, also present in the DISC, limits caspase-8 activity while promoting cell survival, cell proliferation, and the production of proinflammatory cytokines. Imbalances in this pathway, such as those imposed by cellular stress, allow the activation of caspase-8 and caspase-10, which in turn triggers the caspase activation cascade. Once active, executioner caspases (i.e., caspase-2, -6, -8 and -10) bring about programmed apoptotic death. Apoptotic cells release messengers in the form of nucleosomal structures, shed receptors, anti-inflammatory metabolites or molecules packaged in apoptotic extracellular vesicles (ApoEVs). Phosphatidylserine (PS) molecules exposed on the outer surface of the plasma membrane function as “eat me” signals for phagocytes
Fig. 4
Fig. 4
Crossing lines of programmed cell death. The different cell fates are balanced by an intricate game between pro- and antisurvival factors in which caspase-8 seems to be the central referee
See this image and copyright information in PMC

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