Granzyme B is a serine proteinase that acts as a key effector of cell death mediated by cytotoxic T lymphocytes. The enzyme is transferred from the cytotoxic cell to the pathogenic target cell where it cleaves and activates a number of substrates involved in the induction of apoptosis. However, recent evidence implicates mitochondria as playing an important role in both the initiation of apoptosis and control of substrate cleavage by granzyme B in cytotoxic T lymphocyte induced death. This review focuses on current research in this rapidly expanding field, specifically the role of mitochondria in cell death induced by components of cytotoxic granules in particular granzyme B.