Many ways to die: passive and active cell death styles.

In multicellular organisms, cells may undergo passive, pathological death in response to various environmental injuries, or actively decide to self-destroy in order to ensure proper physiological morphogenesis, preserve tissue homeostasis and eliminate abnormal cells. While the passive cell demise occurs in an accidental, violent and chaotic way, corresponding to "necrosis", the active auto-elimination, defined "programmed cell death" (PCD), is executed in planned modalities. Different PCD pathways have been described, such as apoptosis, autophagic death, para-apoptosis and programmed necrosis. However, death patterns may overlap or integrate, providing a variety of cellular responses to various circumstances or stimuli. The consequences for the whole organism of necrosis and PCD are quite different. In the case of classical necrosis, cytosolic constituents chaotically spill into extracellular space through damaged plasma membrane and provoke an inflammatory response, while in most PCDs the cellular components are safely isolated by membranes, and then consumed by adjacent parenchymal cells and/or resident phagocytes without inflammation. Thus, whereas the necrotic cell removal induces and amplifies pathological processes, the elimination of PCD debris may remain virtually unnoticed by the body. Otherwise, alterations of PCD controls may be involved in human diseases, such as developmental abnormalities, or neurodegenerative, autoimmune and neoplastic affections, whose treatment implies the complete understanding of cell suicide processes. In this review, the cellular death patterns are focused and their significance discussed.