Apoptosis is a process characterized by typical morphological features such as plasma membrane blistering, cell shrinkage, chromatin condensation, and fragmentation. It is a type of programmed cell death regulated by the Bcl-2 family and caspase enzymes (
1,
2). Apoptosis occurs in multicellular organisms and, if inhibited, can lead to uncontrolled cell division and potential tumor formation. Disruptions in the apoptosis process are linked to cancer, autoimmune disorders, and neurodegenerative diseases (
3).
Caspases, many of which are the primary mediators of programmed cell death including apoptosis, necroptosis, and pyroptosis, are enzymes belonging to a family of proteases. The name "caspase" derives from their function, featuring a unique cysteine protease activity where a cysteine in their active site acts as a nucleophile to cleave target proteins at aspartic acid residues. This family of enzymes includes fourteen members in mammals, eleven of which are human enzymes, playing crucial roles by breaking down specific substrates from the sequence H
3N
+…Asp
xxa…COOH (
4,
5).
These enzymes are synthesized as inactive precursors known as procaspases. The proteolytic processing of procaspases yields a tetrameric active caspase enzyme composed of two repeating heterotypic subunits. Caspases are categorized into two groups based on substrate specificity and procaspase structure: Initiator and executioner. Initiator caspases (caspase-8 and 9) activate executioner caspases (caspase-3 and 7) in response to specific cell death signals, which then cleave various cellular proteins to drive apoptosis (
6). Actin, vimentin, keratin, and cadherin serve as suitable substrates for caspase enzymes (
7,
8).
Caspase-3, comprising two subunits of 17 and 12 kDa, is activated by caspase-8, caspase-9, and caspase-10, and subsequently activates caspase-6 and caspase-7.
Caspase-7, also known as "apoptosis-associated cysteine peptidase," is encoded by the CASP7 gene. This enzyme, in its precursor form, is activated by caspase-3, caspase-9, and caspase-10 (
9). Caspases are involved in apoptosis through two main pathways: The extrinsic pathway, triggered by death receptors, and the intrinsic pathway, activated by cellular damage and stress.
Various factors influence the regulation, activation, and inhibition of caspases, and consequently apoptosis. These include the levels of intracellular calcium ions, the p53 molecule, adapter molecules, cytochrome c released due to the permeability of the mitochondrial outer membrane, Apaf-1 (apoptotic protease activating factor), and IAP (Inhibitor of Apoptosis Protein) (
10-
14).
Caspases are activated intrinsically due to cellular damage and stress, involving mitochondrial cooperation. Since platelets contain mitochondria, they can initiate the intrinsic or mitochondrial pathway of apoptosis. This process involves the permeabilization of the mitochondrial outer membrane and the transfer of cytochrome c, AIF (apoptosis-inducing factor), or Smac, leading to caspase-dependent or independent cytosolic signaling that activates caspase (
15). During intrinsic activation, cytochrome c from mitochondria works together with caspase-9, Apaf-1, and ATP to activate caspase-3. Permeabilization of the mitochondrial outer membrane involves proteins from the Bcl-2 superfamily, which includes anti-apoptotic members (Bcl-2, Bcl-xL, Bcl-w) and pro-apoptotic members (Bid, Bad, Bak, Bax, and Bim). The presence of apoptotic stimuli promotes the accumulation and oligomerization of Bak/Bax in the mitochondrial outer membrane, forming a permeable transport pore (PTP) (
16).
Although it is well understood that most nucleated cells can undergo caspase-dependent apoptosis, the functions of apoptosis regulatory molecules in anucleated cells like platelets remain largely unexplored.