Apoptosis in Tissue Injury

Given that apoptosis is delicately regulated by a balance of apoptotic activators (e.g., Bax) and apoptotic inhibitors (e.g., Bcl-2) that are continuously being synthesized, the decision of whether a cell dies or lives is constantly reevaluated. Disrupting that balance leads to apoptosis. Surface receptors that activate diverse signaling cascades or traumatic insults that disrupt intracellular structural integrity are involved in this decision-making process. By understanding the pathway for apoptosis, specifically the mechanistic steps, we may be able to deduce the initiating event. Having an understanding of the specific mechanisms of apoptosis is essential in developing approaches to analyzing consequences of programmed cell death. The consequences of apoptosis must be considered in forensic pathology as well because this may provide clues to the underlying pathological process. It will be important to determine whether the apoptosis is activated by receptor-mediated pathway or from an intrinsic pathway. The distribution of apoptotic cells will be important; for example, the level of apoptosis in a tumor may reflect whether it is a primary tumor or a secondary tumor. Thus, an appraisal of apoptosis may provide insight into the pathology of specimen.