Apoptosis and age-related disorders: role of caspase-dependent and caspase-independent pathways

The execution of the apoptotic program involves a relatively limited number of pathways that converge on the activation of the caspase family of proteases. However, there is increasing evidence that other protease families may contribute to produce apoptotic-like features. This has posed the question as to whether caspase inhibitors may then be used to treat diseases characterised by an excess apoptosis. In several neurodegenerative diseases including acute neuronal loss as in stroke or slowly developing diseases at least two major events contribute to neurodegeneration: the loss of neuronal connectivity and cell loss. In many of these conditions, mitochondrial dysfunction and the resulting ATP depletion may preclude caspase activation, and consequently switch execution of cell death towards necrosis. A block or partial inhibition of the typical apoptotic demise may have profound implications in vivo, as persistence within the nervous system of damaged, but 'undead' cells, followed by delayed lysis may favour neuroinflammatory reactions. Furthermore, caspases may be involved in loss of neurons, but not in the loss of connectivity that seems to initiate degenerative processes in the nervous system. Some recent findings, which suggest that degenerating neurons may use multiple execution pathways will be discussed. (C) 2002 Published by Elsevier Science Ireland Ltd.