Programmed cell death: necrosis versus apoptosis.

Cell death remains poorly understood, despite its obvious importance in every organ and tissue in a wide variety of biological processes, including, of course, the many pathological. The past few years have seen an amazing expansion of interest in cell death in normal development and maturation, in the pathogenesis of many acute and chronic diseases, and in the therapy of some diseases, especially malignant neoplastic diseases and some hyperplastic diseases such as psoriasis. This expansion has included an unusual interest in a supposedly new form of cell death, a "programmed cell death," designated "apoptosis." This is proposed as a hitherto undescribed form of cell death in contrast to the classical cell death, necrosis. Apoptosis is considered by some, especially by nonpathologists, to represent quite a different type of cell death. A review of the literature on on apoptosis, programmed cell death, necrosis, etc. indicates that there is no field of basic cell biology and cell pathology that is more confusing and more unintelligible than the area of apoptosis versus necrosis. If any degree of clarity is to develop in our understanding of the fundamental principles underlying cell death of any type, it is incumbent upon us to rethink "from square one" the scientific analysis of how cells die and how can we assess cell death in a reasonably rational manner.