The granule pathway of programmed cell death.

The exocytosis of death-inducing granzymes stored in the granules of cytotoxic lymphocytes allows the immune system to rapidly eliminate intracellular pathogens and transformed cells. The membrane-disrupting protein perforin allows the entry of granzymes into a cell, where they induce apoptosis by cleaving target substrates in the cytoplasm and nucleus. Granzymes kill cells in a variety of ways. Recent work has demonstrated that granzymes induce mitochondrial dysfunction through caspase and caspase-independent pathways and destroy DNA and the integrity of the nucleus. Cytotoxic lymphocytes are susceptible to self-inflicted damage. Mice and humans defective in perforin and granzymes point to a role for self-inflicted damage in downregulating lymphocyte responses. Given the propensity for the granule pathway to inflict cellular damage, cytotoxic lymphocytes have developed a variety of mechanisms to protect themselves. In this regard, endogenous serine protease inhibitors have been suggested to protect cytotoxic lymphocytes from granzyme B. It would appear that certain viruses and possibly even tumor cells also use the same mechanism to escape destruction from the exocytosis pathway of programmed cell death.