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Relationship: 993


The title of the KER should clearly define the two KEs being considered and the sequential relationship between them (i.e., which is upstream and which is downstream). Consequently all KER titles take the form “upstream KE leads to downstream KE”.  More help

Disruption, Lysosome leads to N/A, Mitochondrial dysfunction 1

Upstream event
Upstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help
Downstream event
Downstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help

Key Event Relationship Overview

The utility of AOPs for regulatory application is defined, to a large extent, by the confidence and precision with which they facilitate extrapolation of data measured at low levels of biological organisation to predicted outcomes at higher levels of organisation and the extent to which they can link biological effect measurements to their specific causes. Within the AOP framework, the predictive relationships that facilitate extrapolation are represented by the KERs. Consequently, the overall WoE for an AOP is a reflection in part, of the level of confidence in the underlying series of KERs it encompasses. Therefore, describing the KERs in an AOP involves assembling and organising the types of information and evidence that defines the scientific basis for inferring the probable change in, or state of, a downstream KE from the known or measured state of an upstream KE. More help

AOPs Referencing Relationship

This table is automatically generated upon addition of a KER to an AOP. All of the AOPs that are linked to this KER will automatically be listed in this subsection. Clicking on the name of the AOP in the table will bring you to the individual page for that AOP. More help
AOP Name Adjacency Weight of Evidence Quantitative Understanding Point of Contact Author Status OECD Status
Endocytic lysosomal uptake leading to liver fibrosis adjacent High Allie Always (send email) Under development: Not open for comment. Do not cite EAGMST Under Review

Taxonomic Applicability

Select one or more structured terms that help to define the biological applicability domain of the KER. In general, this will be dictated by the more restrictive of the two KEs being linked together by the KER. Authors can indicate the relevant taxa for this KER in this subsection. The process is similar to what is described for KEs (see pages 30-31 and 37-38 of User Handbook) More help
Term Scientific Term Evidence Link
human Homo sapiens High NCBI
mouse Mus musculus Moderate NCBI

Sex Applicability

Authors can indicate the relevant sex for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of the User Handbook). More help
Sex Evidence

Life Stage Applicability

Authors can indicate the relevant life stage for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of User Handbook). More help
Term Evidence
All life stages

Key Event Relationship Description

Provide a brief, descriptive summation of the KER. While the title itself is fairly descriptive, this section can provide details that aren’t inherent in the description of the KEs themselves (see page 39 of the User Handbook). This description section can be viewed as providing the increased specificity in the nature of upstream perturbation (KEupstream) that leads to a particular downstream perturbation (KEdownstream), while allowing the KE descriptions to remain generalised so they can be linked to different AOPs. The description is also intended to provide a concise overview for readers who may want a brief summation, without needing to read through the detailed support for the relationship (covered below). Careful attention should be taken to avoid reference to other KEs that are not part of this KER, other KERs or other AOPs. This will ensure that the KER is modular and can be used by other AOPs. More help

Disrupted lysosomal membrane release the content of lysosomes including cathepsins. Cathepsins take part in activation of BH3-only proteins, which directly or indirectly activate pro-apoptic Bax and Bak proteins. Once activated Bax and Bak form dimers and higher order oligomers, in order to form pores in outer mitochondrial membrane and cause mitochondrial injury.

Many evidences suggest that lysosomal disruption usually precedes mitochondrial injury (Guicciardi et al., 2000; Brunk et al., 2001; Zhao et al. 2003; Droga-Mazovec et al., 2008), with lysosomal proteases inducing mitochondrial dysfunction.

Zhao and colleagues have also proposed the existence of a positive feed-back mechanism between lysosomal damage and mitochondrial damage, in which early lysosomal rupture causes mitochondrial rupture and leakage of mitochondrial proteins that increase lysosomal damage and consequent apoptosis (Zhao et al., 2000).

The pathway between lysosomal membrane permeabilization (LMP) and mitochondrial membrane permeabilization (MMP) is regulated principally by Bcl-2 family of proteins. The family is subdivided into anti-apoptotic multidomain proteins (such as Bcl-2, Bcl-xl, Bcl-W, Mcl-1 and A1), pro-apoptotic multidomain proteins (Bax and Bak) and pro-apoptotic BH3-only proteins (such as Bid, Puma, Noxa, Bim, Bad, and Bik) (Fletcher and Huang, 2006; Youle and Strasser, 2008).

Cathepsins, released after lysosomal damage, have a role in the cell death through the cleavage of BH3-only proteins, such as Bid, to generate active tBid (truncated Bid) (Blomgran et al., 2007; Cirman et al., 2004; Droga-Mazovec et al., 2008; Houseweart et al., 2003; Stoka et al., 2001) and by degradation of the anti-apoptotic Bcl-2 molecules Bcl-2, Bcl-xl and Mcl-1 (Blomgran et al., 2007; Droga-Mazovec et al., 2008). However it was shown that though Bid is not the only substrate of lysosomal enzymes that induce cytochrome c release, it is the major one (Stoka et al., 2001). Droga-Mazovec and colleagues showed that Bid is cleaved by cathepsins in human liver carcinoma cells (HepG2) (Droga-Mazovec et al., 2008), while other study showed that particularly cathepsin B is active in hepatocytes (Guicciardi et al., 2000).

Bid is also cleaved by caspase 8, which represents a link between extrinsic and intrinsic (mitochondrial) pathway (Li et al., 1998).

Activated BH3-only proteins continue to activate pro-apoptic proteins Bax and Bak. Sarosiek et al. observed that Bid preferentially activates Bak, while Bim activates Bax (Sarosiek et al., 2013). The activation of Bax and Bak occurs after LMP, but before mitochondrial release of cytochrome c and caspase-3 activation (Boya et al., 2003). Currently there are two models describing activation of Bax and Bak proteins and the role of anti-apoptic and pro-apoptic multidomain proteins in it. In the indirect model, Bax and Bak are sequestered and inactivated by anti-apoptotic Bcl-2 proteins. The binding of pro-apoptotic BH3-only proteins to these Bcl-2 proteins triggers the release of Bax and Bak. The direct model proposes that Bax and Bak are activated by direct binding of pro-apoptotic BH3-only proteins, called the activators (Bid, Bim or Puma). However, these activators are normally sequestered by anti-apoptotic Bcl-2 proteins. In order to release the activators, other BH3-only proteins, called senzitizers, neutralize anti-apoptotic Bcl-2 proteins (Brenner and Mak, 2009; Willis et al., 2007).

Bak and Bax go under major conformational changes after binding of BH3 only proteins (as reviewed by Westphal et al., 2014). Once activated Bak or Bax molecules bind reciprocally to form symmetric homodimers. It is thought that homodimers of Bak or Bax must then associate to higher order oligomers to porate the mitochondrial outer membrane (Uren et al., 2017). Heterodimers form only a minor population compared with homodimers (Dewson et al., 2012; Mikhailov et al., 2003).

Bak and Bax shallow insertion into the outer leaflet of mitochondrial membrane (Westphal et al., 2014; Oh KJ et al., 2010) may destabilize the lamellar structure of the bilayer to induce lipidic pores in mitochondrial membrane. This induces release of proteins from the space between inner and outer mitochondrial membrane (Newmeyer et al., 2003).

Evidence Supporting this KER

Assembly and description of the scientific evidence supporting KERs in an AOP is an important step in the AOP development process that sets the stage for overall assessment of the AOP (see pages 49-56 of the User Handbook). To do this, biological plausibility, empirical support, and the current quantitative understanding of the KER are evaluated with regard to the predictive relationships/associations between defined pairs of KEs as a basis for considering WoE (page 55 of User Handbook). In addition, uncertainties and inconsistencies are considered. More help
Biological Plausibility
Define, in free text, the biological rationale for a connection between KEupstream and KEdownstream. What are the structural or functional relationships between the KEs? For example, there is a functional relationship between an enzyme’s activity and the product of a reaction it catalyses. Supporting references should be included. However, it is recognised that there may be cases where the biological relationship between two KEs is very well established, to the extent that it is widely accepted and consistently supported by so much literature that it is unnecessary and impractical to cite the relevant primary literature. Citation of review articles or other secondary sources, like text books, may be reasonable in such cases. The primary intent is to provide scientifically credible support for the structural and/or functional relationship between the pair of KEs if one is known. The description of biological plausibility can also incorporate additional mechanistic details that help inform the relationship between KEs, this is useful when it is not practical/pragmatic to represent these details as separate KEs due to the difficulty or relative infrequency with which it is likely to be measured (see page 40 of the User Handbook for further information).   More help

In the last decade there is a growing body of evidences about the strong functional link between lysosomes and mitochondria that play an important role in physiology and pathology. The evidences also showed link between lysosomal and mitochondrial damage, and that lysosomal damage precedes mitochondrial injury.

Uncertainties and Inconsistencies
In addition to outlining the evidence supporting a particular linkage, it is also important to identify inconsistencies or uncertainties in the relationship. Additionally, while there are expected patterns of concordance that support a causal linkage between the KEs in the pair, it is also helpful to identify experimental details that may explain apparent deviations from the expected patterns of concordance. Identification of uncertainties and inconsistencies contribute to evaluation of the overall WoE supporting the AOPs that contain a given KER and to the identification of research gaps that warrant investigation (seep pages 41-42 of the User Handbook).Given that AOPs are intended to support regulatory applications, AOP developers should focus on those inconsistencies or gaps that would have a direct bearing or impact on the confidence in the KER and its use as a basis for inference or extrapolation in a regulatory setting. Uncertainties that may be of academic interest but would have little impact on regulatory application don’t need to be described. In general, this section details evidence that may raise questions regarding the overall validity and predictive utility of the KER (including consideration of both biological plausibility and empirical support). It also contributes along with several other elements to the overall evaluation of the WoE for the KER (see Section 4 of the User Handbook).  More help

Repnik and colleagues showed that inhibition of cysteine cathepsins by E-64-d had little effect on LDH (cytosolic enzyme lactate dehydrogenase) release in medium in LLOMe treated cells (Repnik et al., 2017). They also detected that after exposure to LLOMe, cathepsins remain in lysosomes and are being degraded there which is in contradiction with most of the previous studies.

As stated earlier there are empirical evidences that incubation of cathepsin B with mitochondria and cytosolic factors increase mitochondrial permeabilization. However, in some studies pharmacological inhibition of cathepsin B, L and D didn't suppress Bid cleavage, suggesting that other lysosomal proteases might be responsible for Bid cleavage (Reiners et al., 2002).

The knockout of genes coding for cathepsins B, D, L and S failed to prevent induced MMP and cell death (Boya et al., 2003).

Housewert et al. showed that the amount of cerebellar granule cell apoptosis in cystatin B-deficient mice did not change when Bid was removed.  This indicates that cathepsins can use other mechanisms to initiate apoptosis. They concluded that another molecule may partially substitute for Bid when it is missing (Housewert et al., 2003). Willis and colleagues showed that neither Bim nor Bid are necessary for apoptosis, as their absences didn't stop apoptosis or prevented Bax activation (Willis et al., 2007).

Some  reports described Bax/Bak-independent mechanisms of cytochrome c release, involving either cyclosporine A sensitive mitochondrial membrane permeability (Wan et al., 2008) or a serine protease(s)-dependent mechanism (Mizuta et al., 2007).

Response-response Relationship
This subsection should be used to define sources of data that define the response-response relationships between the KEs. In particular, information regarding the general form of the relationship (e.g., linear, exponential, sigmoidal, threshold, etc.) should be captured if possible. If there are specific mathematical functions or computational models relevant to the KER in question that have been defined, those should also be cited and/or described where possible, along with information concerning the approximate range of certainty with which the state of the KEdownstream can be predicted based on the measured state of the KEupstream (i.e., can it be predicted within a factor of two, or within three orders of magnitude?). For example, a regression equation may reasonably describe the response-response relationship between the two KERs, but that relationship may have only been validated/tested in a single species under steady state exposure conditions. Those types of details would be useful to capture.  More help
This sub-section should be used to provide information regarding the approximate time-scale of the changes in KEdownstream relative to changes in KEupstream (i.e., do effects on KEdownstream lag those on KEupstream by seconds, minutes, hours, or days?). This can be useful information both in terms of modelling the KER, as well as for analyzing the critical or dominant paths through an AOP network (e.g., identification of an AO that could kill an organism in a matter of hours will generally be of higher priority than other potential AOs that take weeks or months to develop). Identification of time-scale can also aid the assessment of temporal concordance. For example, for a KER that operates on a time-scale of days, measurement of both KEs after just hours of exposure in a short-term experiment could lead to incorrect conclusions regarding dose-response or temporal concordance if the time-scale of the upstream to downstream transition was not considered. More help
Known modulating factors
This sub-section presents information regarding modulating factors/variables known to alter the shape of the response-response function that describes the quantitative relationship between the two KEs (for example, an iodine deficient diet causes a significant increase in the slope of the relationship; a particular genotype doubles the sensitivity of KEdownstream to changes in KEupstream). Information on these known modulating factors should be listed in this subsection, along with relevant information regarding the manner in which the modulating factor can be expected to alter the relationship (if known). Note, this section should focus on those modulating factors for which solid evidence supported by relevant data and literature is available. It should NOT list all possible/plausible modulating factors. In this regard, it is useful to bear in mind that many risk assessments conducted through conventional apical guideline testing-based approaches generally consider few if any modulating factors. More help
Known Feedforward/Feedback loops influencing this KER
This subsection should define whether there are known positive or negative feedback mechanisms involved and what is understood about their time-course and homeostatic limits? In some cases where feedback processes are measurable and causally linked to the outcome, they should be represented as KEs. However, in most cases these features are expected to predominantly influence the shape of the response-response, time-course, behaviours between selected KEs. For example, if a feedback loop acts as compensatory mechanism that aims to restore homeostasis following initial perturbation of a KE, the feedback loop will directly shape the response-response relationship between the KERs. Given interest in formally identifying these positive or negative feedback, it is recommended that a graphical annotation (page 44) indicating a positive or negative feedback loop is involved in a particular upstream to downstream KE transition (KER) be added to the graphical representation, and that details be provided in this subsection of the KER description (see pages 44-45 of the User Handbook).  More help

Domain of Applicability

As for the KEs, there is also a free-text section of the KER description that the developer can use to explain his/her rationale for the structured terms selected with regard to taxonomic, life stage, or sex applicability, or provide a more generalizable or nuanced description of the applicability domain than may be feasible using standardized terms. More help

Murine (Stoka et al., 2001; Zhang et al., 2009; Lindsten et al., 2000)

Human (Boya et al., 2003; Cirman et al., 2004)


List of the literature that was cited for this KER description using the appropriate format. Ideally, the list of references should conform, to the extent possible, with the OECD Style Guide (OECD, 2015). More help

Baixauli F, Acin-Perez R, Villarroya-Beltri C, Mazzeo C, Nunez-Andrade N, Gabande-Rodriguez E, Ledesma MD, Blázquez A, Martin MA, Falcón-Pérez JM, Redondo JM, Enríquez JA, Mittelbrunn M. Mitochondrial respiration controls lysosomal function during inflammatory T cell responses. Cell Metab. (2015) 22, 485–498.

Bidere N, Lorenzo HK,  Carmona S, Laforge M, Harper F, Dumont C, Senik A. Cathepsin D triggers Bax activation, resulting in selective AIF relocation in T lymphocytes entering the early commitment phase to apoptosis. J. Biol. Chem. (2003) 278:31401–31411.

Blomgran R, Zheng L, Stendah O. Cathepsin-cleaved Bid promotes apoptosis in human neutrophils via oxidative stress-induced lysosomal membrane permeabilization, J. Leukoc. Biol. (2007) 81 1213–1223.

Boya P, Andreau K, Poncet D, Zamzami N, Perfettini JL, Metivier D, Ojcius DM, Jäättelä M, Kroemer G. Lysosomal membrane permeabilization induces cell death in a mitochondrion-dependent fashion. J. Exp. Med. (2003) 197:1323–1334.

Brenner D, Mak TW. Mitochondrial cell death effectors.  Curr Opin Cell Biol. (2009) 21(6): 871–877.

Brunk UT, Dalen H, Roberg K, Hellquist HB. Photo-oxidative disruption of lysosomal membranes causes apoptosis of cultured human fibroblasts. Free Radicals Biol. Med. (1997) 23, 61 -626.

Cirman T, Orešić K, Mazovec GD, Turk V, Reed JC, Myers RM, Salvesen GS, Turk B. Selective disruption of lysosomes in HeLa cells triggers apoptosis mediated by cleavage of Bid by multiple papain-like lysosomal cathepsins, J. Biol. Chem. 279 (2004) 3578–3587.

Dewson G, Ma S, Frederick P, Hockings C, Tan I, Kratina T, Kluck RM. Bax dimerizes via a symmetric BH3:groove interface during apoptosis. Cell Death Differ. (2012) 19, 661–670.

Droga-Mazovec G, Bojič L, Petelin A, Ivanova S, Romih R, Repnik U, Salvesen GS, Stoka V, Turk V, Turk B. Cysteine cathepsins trigger caspase-dependent cell death through cleavage of bid and antiapoptotic Bcl-2 homologues, J. Biol. Chem. (2008)  283: 19140–19150.

Fernandez-Mosquera L, Diogo CV, Yambire KF, Santos GL, Luna Sanchez M, Benit P, Rustin P, Lopez LC, Milosevic I, Raimundo N. Acute and chronic mitochondrial respiratory chain deficiency differentially regulate lysosomal biogenesis. Sci. Rep. (2017) 7:45076.

Fletcher JI, Huang DC. BH3-only proteins: orchestrating cell death. Cell Death Differ. (2006) 13: 1268-1271.

Ghosh M, Carlsson F, Laskar A, Yuang XM, Li W. Lysosomal membrane permeabilization causes oxidative stress and ferritin induction in macrophages. FEBS Lett. (2011) 585(4): 623–629.

Gross A, Yin XM, Wang K, Wei MC, Jockel J, Milliman C, Erdjument-Bromage H, Tempst P, Korsmeyer SJ. Caspase cleaved BID targets mitochondrial and is required for cytochrome c release, while BCL-XL prevents this release but not tumor necrosis factor-R1/Fas death. J. Biol. Chem. (1999) 274: 1156 ± 1163.

Guicciardi ME,  Deussing J, Miyoshi H, Bronk SF, Svingen PA, Peters C, Kaufmann SH, Gores GJ. Cathepsin B contributes to TNF-alpha-mediated hepatocyte apoptosis by promoting mitochondrial release of cytochrome c. J. Clin. Invest. (2000) 106:1127–1137.

Houseweart MK, Vilaythong A, Yin XM, Turk B, Noebels JL, Myers RM. Apoptosis caused by cathepsins does not require Bid signaling in an in vivo model of progressive myoclonus epilepsy (EPM1). Cell Death and Differentiation, (2003): 10(12), 1329-1335.

Jürgensmeier JM, Xie Z, Deveraux Q, Ellerby L, Bredesen D, Reed JC.  Bax directly induces release of cytochrome c from isolated mitochondria. Proc Natl Acad Sci U S A. (1998) 95(9): 4997–5002.

Kagedal K, Zhao M, Svensson I, Brunk UT. Sphingosine-induced apoptosis is dependent on lysosomal proteases. The Biochemical journal.  (2001) 359: 335-43.

Korsmeyer SJ, Wei MC, Saito M, Weiler S, Oh KJ, Schlesinger PH. Pro-apoptotic cascade activates BID, which oligomerizes BAK or BAX into pores that result in the release of cytochrome c.  Cell Death Differ. (2000); 7(12): 1166–1173.

Li H, Zhu H, Xu CJ, Yuan J. Cleavage of BID by caspase 8 mediates the mitochondrial damage in the Fas pathway of apoptosis. Cell. (1998) 94(4): 491–501.

Lindsten T, Ross AJ, King A, Zong WX, Rathmell JC, Shiels HA, Ulrich E, Waymire KG, Mahar P, Frauwirth K, Chen Y, Wei M, Eng VM, Adelman DM, Simon MC, Ma A, Golden JA, Evan G, Korsmeyer SJ, MacGregor GR, Thompson  CB. The combined functions of proapoptotic Bcl-2 family members bak and bax are essential for normal development of multiple tissues. Mol. Cell. (2000) 6: 1389–1399.

Luo X, Budihardjo I, Zou H, Slaughter C, Wang X. Bid, aBcl2 interacting protein, mediates cytochrome c release from mitochondria in response to activation of cell surface death receptors. Cell (1998) 94: 481 - 490.

Mikhailov V, Mikhailova M, Degenhardt K, Venkatachalam MA, White E, Saikumar P. Association of Bax and Bak homo-oligomers in mitochondria. Bax requirement for Bak reorganization and cytochrome c release. J. Biol. Chem. (2003) 278: 5367–5376.

Mizuta T, Shimizu S, Matsuoka Y, Nakagawa T, Tsujimoto Y. A Bax/Bak-independent mechanism of cytochrome c release. J. Biol. Chem. (2007) 282, 16623–16630.

Newmeyer DD, Ferguson-Miller S. Mitochondria: releasing power for life and unleashing the machineries of death. Cell (2003) 112: 481–490.

Oh KJ, Singh P, Lee K, Foss K, Lee S, Park M, Lee S, Aluvila S, Park M, Singh P, Kim RS, Symersky J, Walters DE. Conformational Changes in BAK, a Pore-forming Proapoptotic Bcl-2 Family Member, upon Membrane Insertion and Direct Evidence for the Existence of BH3-BH3 Contact Interface in BAK Homo-oligomers. The Journal of Biological Chemistry. (2010) 285(37):28924-28937.

Palmieri M, Impey S, Kang H, di Ronza A, Pelz C, Sardiello M, Ballabio A. Characterization of the CLEAR network reveals an integrated control of cellular clearance pathways. Hum. Mol. Genet. (2011).  20: 3852–3866.

Reiners J, Caruso J, Mathieu P, Chelladurai B, Yin X-M, Kessel D. Release of cytochrome c and activation of pro-caspase-9 following lysosomal photodamage involves bid cleavage. Cell death and differentiation. (2002) 9(9):934-944.

Repnik U, Borg Distefano M,  Speth MT, Ng MYW, Progida C, Hoflack B, Gruenberg J, Griffiths G. L-leucyl-L-leucine methyl ester does not release cysteine cathepsins to the cytosol but inactivates them in transiently permeabilized lysosomes. J. Cell Sci. (2017) 130: 3124–3140.

Roberg K, Johansson U, Ollinger K. Lysosomal release of cathepsin D precedes relocation of cytochrome c and loss of mitochondrial transmembrane potential during apoptosis induced by oxidative stress. Free Radic Biol Med. (1999) 27(11-12): 1228–1237.

Roberg K, Kagedal K, Ollinger K. Microinjection of cathepsin d induces caspase-dependent apoptosis in fibroblasts. Am. J. Pathol. (2002) 161:89–96.

Sarosiek KA, Chi X, Bachman JA, Sims JJ, Montero J, Patel L, Flanagan A, Andrews DW, Sorger P, Letai A. BID preferentially activates BAK while BIM preferentially activates BAX, affecting chemotherapy response Mol Cell. Mol Cell. (2013) 51(6): 751–765.

Settembre C, Zoncu R, Medina DL, Vetrini F, Erdin S, Huynh T, Ferron M, Karsenty G, Vellard MC, Facchinetti V, Sabatini DM, Ballabio A. A lysosome-to-nucleus signalling mechanism senses and regulates the lysosome via mTOR and TFEB. EMBO J. (2012) 31, 1095–1108.

Stoka V, Turk B, Schendel SL, Kim TH, Cirman T, Snipas SL, Ellerby LM, Bredesen D, Freeze H, Abrahamson M, BroÈmme D, Krajewski S, Reed JC, Yin XM, Turk V, Salvesen GS. Lysosomal protease pathways to apoptosis: cleavage of Bid, not pro-caspases, is the most likely route. J. Biol. Chem. )2001) 276: 3149 - 3157.

Uren RT, Iyer S, Kluck RM. Pore formation by dimeric Bak and Bax: an unusual pore? Philosophical Transactions of the Royal Society B: Biological Sciences. (2017) 372(1726):20160218.

Wan KF, Chan S-L, Sukumaran SK, Lee M-C, Yu VC. Chelerythrine Induces Apoptosis through a Bax/Bak-independent Mitochondrial Mechanism. The Journal of Biological Chemistry. (2008) 283(13):8423-8433.

Wei MC, Lindsten T, Mootha VK, Weiler S, Gross A, Ashiya M, Thompson CB, Korsmeyer SJ. tBID, a membrane targeted death ligand, oligomerizes BAK to release cytochrome c. Genes Dev. (2000) 14: 2060 -2071.

Westphal D, Kluck RM, Dewson G. Building blocks of the apoptotic pore: how Bax and Bak are activated and oligomerize during apoptosis. Cell Death Differ. (2014) 21: 196–205.

Willis SN, Fletcher JI, Kaufmann T, van Delft MF, Chen L, Czabotar PE, Ierino H, Lee EF, Fairlie WD, Philippe Bouillet, Strasser A, Kluck RM, Adams JM, Huang DCS. Apoptosis initiated when BH3 ligands engage multiple Bcl-2 homologs, not Bax or Bak.  Science. (2007) 315(5813): 856–859.

Youle RJ, Strasser A. The BCL-2 protein family: opposing activities that mediate cell death.  Nat Rev Mol Cell Biol. (2008) 9(1): 47–59.

Zhang H, Zhong C, Shi L, Guo Y, Fan Z. Granulysin induces cathepsin B release from lysosomes of target tumor cells to attack mitochondria through processing of bid leading to Necroptosis. J Immunol. (2009) 182(11): 6993–7000.

Zhao M, Eaton J W, Brunk UT. Protection against oxidantmediated lysosomal rupture: a new anti-apoptotic activity of Bcl-2? FEBS Lett. (2000) 485: 104–108.

Zhao M, Antunes F, Eaton JW, Brunk UT. Lysosomal enzymes promote mitochondrial oxidant production, cytochrome c release and apoptosis. Eur. J. Biochem. (2003) 270: 3778–3786.