CRISPR-mediated regulation of apoptosis in cancer: Molecular targets, mechanisms, and translational challenges

The CRISPR/Cas system, owing to its high gene-editing efficiency and relatively low off-target effects, has emerged as a pivotal technological platform in cancer research. By precisely modulating oncogenic signaling pathways and apoptosis-related molecules, CRISPR provides a critical tool for elucidating and reprogramming the regulatory mechanisms of apoptosis in tumor cells. However, despite substantial progress in preclinical studies, achieving efficient and selective induction of apoptosis in tumor cells remains a major translational challenge. Increasing evidence indicates that CRISPR-based strategies can achieve more effective antitumor outcomes by reprogramming tumor cell sensitivity to apoptosis, rather than relying solely on single-gene editing. This review systematically summarizes the molecular targets and underlying mechanisms of CRISPR-mediated regulation of tumor cell apoptosis, with particular emphasis on key apoptotic signaling pathways and representative research advances. It highlights the pivotal role of targeting survival-associated genes in suppressing tumor progression and promoting apoptotic cell death. Furthermore, this review discusses the potential synergistic mechanisms of CRISPR in combination with chemotherapy or immunotherapy, as well as the value of CRISPR-based functional screening in identifying apoptosis-regulatory targets and drug resistance-associated mechanisms. Finally, we analyze the key challenges facing the clinical translation of CRISPR-mediated apoptosis regulation and propose future research directions and conceptual frameworks to optimize CRISPR-based anticancer strategies and facilitate their clinical application.