Programmed necrosis in inflammation: Toward identification of the effector molecules

Until recently, programmed cell death was conceived of as a single set of molecular pathways. We now know of several distinct sets of death-inducing mechanisms that lead to differing cell-death processes. In one of them--apoptosis--the dying cell affects others minimally. In contrast, programmed necrotic cell death causes release of immunostimulatory intracellular components after cell-membrane rupture. Defining the in vivo relevance of necrotic death is hampered because the molecules initiating it such as receptor-interacting protein kinase-1 (RIPK1), RIPK3, or caspase-1 also serve other functions. Proteins that participate in late events in two forms of programmed necrosis mixed lineage kinase domain-like protein (MLKL) in necroptosis and gasdermin-D in pyroptosis were recently discovered, bringing us closer to identifying molecules that strictly serve in death mediation, thereby providing probes for better assessing its role in inflammation.