The in vivo evidence for regulated necrosis

  • Wulf Tonnus
    Division of Nephrology Department of Internal Medicine III University Hospital Carl Gustav Carus at the Technische Universität Dresden Dresden Germany
  • Andreas Linkermann
    Division of Nephrology Department of Internal Medicine III University Hospital Carl Gustav Carus at the Technische Universität Dresden Dresden Germany

Abstract

<jats:title>Summary</jats:title><jats:p>Necrosis is a hallmark of several widespread diseases or their direct complications. In the past decade, we learned that necrosis can be a regulated process that is potentially druggable. <jats:styled-content style="fixed-case">RIPK</jats:styled-content>3‐ and <jats:styled-content style="fixed-case">MLKL</jats:styled-content>‐mediated necroptosis represents by far the best studied pathway of regulated necrosis. During necroptosis, the release of damage‐associated molecular patterns (<jats:styled-content style="fixed-case">DAMP</jats:styled-content>s) drives a phenomenon referred to as necroinflammation, a common consequence of necrosis. However, most studies of regulated necrosis investigated cell lines in vitro in a cell autonomous manner, which represents a non‐physiological situation. Conclusions based on such work might not necessarily be transferrable to disease states in which synchronized, non‐cell autonomous effects occur. Here, we summarize the current knowledge of the pathophysiological relevance of necroptosis in vivo, and in light of this understanding, we reassess the morphological classification of necrosis that is generally used by pathologists. Along these lines, we discuss the paucity of data implicating necroptosis in human disease. Finally, the in vivo relevance of non‐necroptotic forms of necrosis, such as ferroptosis, is addressed.</jats:p>

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