Department of Pediatrics, University of California San Diego, La Jolla, CA
Rady Children's Hospital of San Diego, San Diego, CA
Address reprint requests to: Ariel E. Feldstein, M.D., Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, MC 0715, La Jolla, CA. 92037-0715. E-mail: firstname.lastname@example.org; fax: 858-966-8917.
Potential conflict of interest: Dr. Hoffman is a consultant for Sobi, Regeneron, and Novartis. He advises, is on the speakers' bureau for, and received grants from Novartis and Sobi.
The work was funded by the National Institutes of Health (DK076852 and DK082451 [to A.E.F.] and AI52430 [to H.M.H.]) and the German Research Foundation (DFG grant no. 173/2-1; to A.W.). The monoclonal alpha-tubulin antibody, developed by J. Frankel and E.M. Nelsen, was obtained from the Developmental Studies Hybridoma Bank developed under the auspices of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and maintained by the Department of Biology at The University of Iowa (Iowa City, IA).
See Editorial on Page 761
Inflammasome activation plays a central role in the development of drug-induced and obesity-associated liver disease. However, the sources and mechanisms of inflammasome-mediated liver damage remain poorly understood. Our aim was to investigate the effect of NLRP3 inflammasome activation on the liver using novel mouse models. We generated global and myeloid cell-specific conditional mutant Nlrp3 knock-in mice expressing the D301N Nlrp3 mutation (ortholog of D303N in human NLRP3), resulting in a hyperactive NLRP3. To study the presence and significance of NLRP3-initiated pyroptotic cell death, we separated hepatocytes from nonparenchymal cells and developed a novel flow-cytometry–based (fluorescence-activated cell sorting; FACS) strategy to detect and quantify pyroptosis in vivo based on detection of active caspase 1 (Casp1)- and propidium iodide (PI)-positive cells. Liver inflammation was quantified histologically by FACS and gene expression analysis. Liver fibrosis was assessed by Sirius Red staining and quantitative polymerase chain reaction for markers of hepatic stellate cell (HSC) activation. NLRP3 activation resulted in shortened survival, poor growth, and severe liver inflammation; characterized by neutrophilic infiltration and HSC activation with collagen deposition in the liver. These changes were partially attenuated by treatment with anakinra, an interleukin-1 receptor antagonist. Notably, hepatocytes from global Nlrp3-mutant mice showed marked hepatocyte pyroptotic cell death, with more than a 5-fold increase in active Casp1/PI double-positive cells. Myeloid cell-restricted mutant NLRP3 activation resulted in a less-severe liver phenotype in the absence of detectable pyroptotic hepatocyte cell death. Conclusions: Our data demonstrate that global and, to a lesser extent, myeloid-specific NLRP3 inflammasome activation results in severe liver inflammation and fibrosis while identifying hepatocyte pyroptotic cell death as a novel mechanism of NLRP3-mediated liver damage. (Hepatology 2014;59:898–910)
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Inflammasomes are multiprotein cytoplasmic complexes that serve as pattern recognition receptors. They intersect with a wide variety of immune and cell death pathways. NLRP3, the most well studied Nod-like receptor, forms a complex comprised of adaptor proteins, such as apoptosis-associated speck-like protein (ASC), and the serine protease caspase-1 (Casp1). NLRP3 inflammasome activation governs the cleavage and activation of Casp1, resulting in maturation of effector proinflammatory cytokines, such as pro-interleukin (IL)−1β and pro-IL-18.[2-4]
Casp1 is activated from a 45-kDa inactive precursor that contains a 15-kDa N-terminal subunit, a central 20-kDa subunit and a 10-kDa c-terminal subunit.[5, 6] The active Casp1 is comprised of a tetramer consisting of two 20-kDa fragments and two 10-kDa fragments. Once activated, Casp1 is then able to cleave a variety of protein precursors affecting the cytoskeleton of the cell, glycolysis, mitochondrial function, and inflammation.[8, 9] Other studies indicate that Casp1 may be important in promoting survival upon pathogen attack, as well as having a more general role as a regulator of lipid metabolism. Casp1 activation can also directly induce a distinct form of programmed cell death, called pyroptosis.[11, 12] Although pyroptosis has been well described in vitro, its relevance in vivo has remained unclear and supported mainly by indirect reports demonstrating Casp1-mediated effects independent of IL-1β and IL-18 secretion. As in apoptotic cell death, cells undergoing pyroptosis incur DNA damage and become positive in the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. However, in contrast to apoptosis, pyroptosis is also associated with cell swelling, the release of proinflammatory intracellular contents, and pore formation in the cell membrane, thereby becoming positive for propidium iodide (PI) staining.[13, 14]
We, and others, have recently shown that hepatic Casp1 activation occurs in both bone-marrow–derived Kupffer cells (macrophages) and hepatocytes during the development of nonalcoholic steatohepatitis (NASH) and alcoholic steatohepatitis (ASH) and this activation appears to be mediated through the NLRP3 inflammasome.[15-17] These studies demonstrate that Casp1 plays an important role in inflammation and fibrosis during NASH and ASH development.[15, 18] Furthermore, treatment with an IL-1 receptor (IL-1R) antagonist has been shown to ameliorate ASH in mice. However, the specific contribution of persistent NLRP3 inflammasome activation in hepatic parenchymal versus nonparenchymal cells to liver pathology in vivo and the molecular mechanisms involved in this process remain incompletely understood. To address these issues, we have generated two novel mouse models with global, or myeloid-specific, expression of a mutant hyperactive NLRP3 inflammasome.[19, 20]
Materials and Methods
Generation of Nlrp3 Knock-in Mice
We generated, as previously described, an Nlrp3 knock-in (KI) mouse strain with an aspartate 301–to-asparagine (D301N) substitution, which corresponds to the D303N mutation observed in human cryopyrin-associated periodic syndrome. This point mutation is thought to cause a conformational change that confers ligand-independent activation of the mutated NLRP3 inflammasome. Briefly, the targeting construct, pPNTlox2PNlrp3D301N, was created by cloning 4-7-kilobase regions directly up- and downstream of a targeted position in intron 2 of Nlrp3 around the neoR antibiotic resistance cassette in plasmid pPNTlox2P (Fig. 1). Because of the presence of an intronic floxed neomycin resistance cassette, the expression of the mutation does not occur unless the Nlrp3 KI mice (Nlrp3D301NneoR) are first bred with mice expressing Cre recombinase. Floxed mice were bred to mice expressing Cre recombinase under control of zona pelucida 3 (CreZ: universal expression of D301N mutant Nlrp3) or lysozyme (CreL: D301N expression in myeloid lineage cells only).
The Nlrp3D301NneoR mice used in this study are now available from The Jackson Laboratory (Bar Harbor, ME) as B6N.129-Nlrp3tm3Hhf/J. Strains C57BL/6-Tg(Zp3-cre)93Knw/J and B6.129P2-Lyz2tm1(cre)Ifo/J were both acquired from The Jackson Laboratory. Mice were cared for in accord with appropriate institutional guidelines. Experimental protocols were approved by the University of California San Diego (San Diego, CA) Institutional Animal Care and Use Committee.
To assess the role of IL-1R signaling within the generated mouse models, we treated Nlrp3 CreZ KI mice with an IL-1R antagonist (anakinra). The drug or saline injections at a comparable volume were subcutaneously injected daily at a dose of 300 mg/kg from day 2 to 13.
Liver Sample Preparation
Nlrp3 CreZ mice were sacrificed at days 12-14 after birth, whereas the mother remained on a normal diet. Liver tissue was harvested under deep anesthesia and divided as follows: (1) A representative section was fixed in 10% formalin for 24 hours and embedded in paraffin; (2) another representative section was snap-frozen in isopentane, submerged in liquid nitrogen, and embedded in optimal cutting temperature compound; (3) samples of 50 μg were placed in 0.5 mL of RNAlater Solution (Life Technologies, Carlsbad, CA); and (4) the remainder of the liver tissue was quickly frozen in liquid nitrogen and stored at −80°C.
Liver Histology and Immunostaining
Tissue sections (5 μm) were prepared and routinely stained for hematoxylin and eosin. Steatosis, inflammation, and ballooning were scored on the basis of the nonalcoholic fatty liver disease (NAFLD) activity score. Liver fibrosis was assessed with Sirius Red staining. Therefore, liver sections were incubated for 2 hours at room temperature with an aqueous solution of saturated picric acid containing 0.1% Fast Green FCF and 0.1% Direct Red. TUNEL assay was performed according to the manufacturer's instructions (ApopTag Peroxidase In Situ Apoptosis Detection Kit; Millipore, Billerica, MA) and quantitated as previously described. Immunohistochemistry (IHC) staining for myeloperoxidase (Myeloperoxidase Ab-1; Thermo Scientific, Waltham, MA) was performed in formalin-fixed, paraffin-embedded livers according to the manufacturer's instruction. Receptor-interacting protein kinases 1 and 3 (RIP1 and RIP3: RIP1, BD610458; Becton Dickinson, Franklin Lakes, NJ; RIP3, sc47364; Santa Cruz Biotechnology, Inc., Santa Cruz, CA) were visualized in 5-μm-thick liver sections by simultaneous double-staining immunofluorescence (IF).
For immunoblotting analysis, 50-mg whole-liver lysate was resolved by a 4%-20% gradient gel or 18% gel, transferred to nitrocellulose membrane, and blotted with appropriate primary antibodies (Abs). Membranes were incubated with peroxidase-conjugated secondary Ab (dilution, 1:10,000; GeneTex, Irvine, CA), and protein bands were visualized with the enhanced chemiluminescence reagent and digitized using a CCD camera (ChemiDoc; Bio-Rad, Hercules, CA). Expression intensity was quantified by ImageLab (Bio-Rad). Anti-transforming growth factor beta (TGF-β) Ab (dilution, 1:1,000; Cell Signaling Technology, Danvers, MA), anti-Casp1 p10 (dilution, 1:500), anti-IL-18 (dilution, 1:500; both Santa Cruz Biotechnology), and anti-IL-1β (dilution, 1:1,000; Abcam, Cambridge, MA) were used. Protein load was verified with an α-tubulin Ab (dilution, 1:10,000; Hybridoma Bank; University of Iowa, Iowa City, IA; kindly provided by M. Kaulich). IL-1β was quantified in whole-liver samples using a mouse IL-1β enzyme-linked immunosorbent assay (R&D Systems, Minneapolis, MN), according to the manufacturer's instruction.
Real-Time Polymerase Chain Reaction
Total RNA was isolated from liver tissue using an RNeasy Tissue Mini kit (Qiagen, Valencia, CA). The reverse transcript (complementary DNA; cDNA) was synthesized from 1 μg of total RNA using the iScript cDNA Synthesis kit (Bio-Rad). Real-time polymerase chain reaction (PCR) quantification was performed using Sybr-Green and the CFX96 Thermal Cycler (from Bio-Rad). Briefly, 10 μL of reaction mix contained cDNA, KAPA SYBR FAST quantitative PCR (qPCR) master mix, and primers at final concentrations of 200 nmol. Sequences of primers used for qPCR are given in Supporting Table 1.
Table 1. Effects of NLPR3 Inflammasome in Global (CreZ) and Myeloid Cell-Specific (CreL) Mutant Mouse Models on Hepatocytes and HSCs
Stellate Cell Activation
Abbreviations: CreL/CreZ, Cre recombinase under control of lysozyme/zona pelucida 3; n.t., not tested.
Nlrp3 CreZ anakinra treatment
For detailed characterization of the inflammatory infiltrate within the livers of Nlrp3-mutant mice, we separated livers and analyzed samples by flow cytometry (FCM). Whole livers were force filtered through a 70 μm nylon cell strainer (Becton Dickinson) with phosphate-buffered saline (PBS). The solution was centrifuged for 1 minute at 8˚C with 500 rpm, producing a pellet of parenchymal cells and a supernatant incorporating the infiltrating cells. The supernatant was applied to Ficoll (Ficoll-Paque PLUS; GE Healthcare, Upsalla, Sweden) and centrifuged at 3,000 rpm for 25 minutes at room temperature. The layer of mononuclear cells was recovered, incubated with red blood cell lysis buffer (eBioscience, San Diego, CA), and washed with PBS by centrifugation. Infiltrating cells were classified by multicolor analysis after incubation with CD45 (Becton Dickinson), CD11b (eBioscience), CD11c (eBioscience), CD11b (eBioscience), F4/80 (AbD serotec, Kidlington, UK), and CD4 (eBioscience) for 30 minutes on ice and washed with 3% fetal bovine serum/PBS. Analysis of RIP1 and RIP3 expression was performed in whole-liver lysates of Nlrp3 CreZ mutants utilizing RIP1 (Becton Dickinson) and RIP3 (Santa Cruz) Abs. Cells were analyzed by FCM (BD LRS II; Becton Dickinson).
Determination of Pyroptotic Cell Death in Hepatocytes
To assess pyroptosis in vivo, we designed the following strategy. Active Casp1 was measured in parenchymal cell suspensions with FLICA 660-YVAD-FMK (FLICA 660 in vitro Active Caspase-1 Detection Kit; ImmunoChemistry Technologie, Bloomington, MN), according to the manufacturer's instructions and with PI to mark cells with membrane pores (Life Technologies). To determine rate of pyroptotic cell death in hepatocytes, we excluded monomorphic cells based on size and positive staining for F4/80 and CD11b from the analysis.
Analyses were performed with GraphPad software (version 5.03; GraphPad Software Inc., La Jolla, CA). FCM data were analyzed using FlowJo software (version 10.0.5; TreeStar, Inc., Ashland, OR). Significance level was set at α = 5% for all comparisons. Wilcoxon's rank-sum tests, unpaired t tests, and Kruskal-Wallis' test were used for comparison of continuous variables. Unless otherwise stated, data are expressed as mean ± standard error of the mean or as median and range/quartiles for continuous variables and as absolute number or percentage for categorical variables.
Mutant NLRP3 Leads to Growth Retardation and Impaired Survival
Nlrp3 CreZ KI pups were born at the expected Mendelian frequency (Fig 1). Although often indistinguishable from wild-type (WT) siblings at birth, Nlrp3 CreZ KI mice exhibited growth retardation and significantly lower body weight that was obvious by postbirth day 5.20 Moreover, Nlrp3 KIs developed cutaneous inflammation with concomitant hair loss (Fig 1). Nlrp3 CreZ mice usually died at 2-3 weeks. WT mice showed significantly more weight at time of sacrifice: median weight of WT, 9.1 g (minimum, 7.38 g; maximum, 11.4 g); Nlrp3 CreZ, 3.12 g (minimum, 2.45 g; maximum, 3.52 g; Fig. 1). Notably, Nlrp3 mutants showed significantly higher liver weight as a percentage of body weight than age-matched WTs (Nlrp3 CreZ median: 6.3%; WT, 3.5%; Fig. 1).
Active NLPR3 Inflammasome Results in Severe Liver Inflammation With Neutrophil Infiltration
Liver histology of Nlrp3 CreZ mutants revealed severe inflammation with many inflammatory foci composed predominantly of polymorphonuclear cells and areas of cell death (Fig. 2). Analysis of messenger RNA (mRNA) showed that Nlrp3 mutants exhibit significantly higher levels of pro-IL-1β (Nlrp3 CreZ 6.6-fold change to WT; P < 0.05), ASC (3.3-fold; P < 0.05), Casp1 (3.2-fold; P < 0.05), and tumor necrosis factor alpha (TNF-α; 4.0-fold; P < 0.05), compared to WT controls (Fig. 2). Whole-liver lysates showed a marked increase in IL-1β (8.0-fold; P < 0.05) and IL-18 (2.0-fold, P = not significant [NS]) protein expression (Fig. 2). To perform a detailed characterization of the inflammatory cell infiltrate in Nlrp3 mutants, we separated residential from infiltrating cells in the liver. Infiltrating cells showed high intensity of CD45 and CD11b staining, compared to WT controls; no difference was observed in CD11c, CD4, and CD8 staining; and Nlrp3 CreZ mutants showed less F4/80 intensity (Fig. 2). Analysis of whole-liver lysates showed no significant difference in F4/80 mRNA levels in Nlrp3 mutants, although monocyte chemoattractant protein 1 (MCP-1) was significantly elevated. This result, indicating that neutrophils are the most prevalent infiltrating cell population, was further confirmed by myeloperoxidase (MPO) IHC of liver sections (Fig. 2). Neutrophil leukocyte recruitment was mediated by a marked increase in chemoattractant (chemokine [C-X-C motif] ligand [CXCL]1, CXCL2, and CXCL5), whereas endothelium-expressed leukocyte adhesion molecules (CD47, intercellular adhesion molecule 1 [ICAM1], and platelet endothelial cell adhesion molecule 1 [PECAM1]) did not show significant alterations in mutant mice (Fig. 2).
To explore whether necroptosis was increased in mutant mice, we assessed the expression and activation of kinases RIP1 and RIP3, which have been shown to be required for necroptosis. Livers of Nlrp3 CreZ mice and WT littermates were harvested and stained with RIP1 and RIP3 Abs and analyzed by FCM. Whole-liver lysates of Nlrp3 CreZ mutants showed a slight increase in RIP1-positive cells and no detectable difference in RIP3-positive cells, when compared to WT littermates (Supporting Fig. 1). To detect RIP1-3 complex formations, required for initiation of nercroptosis, we performed double IF staining that demonstrated a lack of colocalization of RIP1 and RIP3 in mutant mice, similar to controls (Supporting Fig. 1).
NLRP3 Activation Results in Hepatocyte Pyroptosis
Several forms of cell death, including oncosis (or necrotic cell death), apoptosis, programmed necrosis (or necroptosis), and autophagic cell death, have been recognized to have roles in various acute and chronic liver pathologies. Pyroptosis, a term coined a decade ago by Cookson and Brannan, is a novel form of programmed cell death that differs from other types of cell death in that it is dependent on Casp1 activation, results in DNA damage with positivity for TUNEL staining, develops pore formation in cell membrane resulting in cell swelling, and shows positivity for PI staining. Currently, pyroptosis, as an additional mechanism to Casp1-dependent processing and activation of proinflammatory cytokines, has not been characterized in liver pathologies nor has its relevance to in vivo models been fully elucidated. It has been suggested that pyroptosis may occur in cells (such as hepatocytes) that are not well equipped for secretion of cytokines after inflammasome-mediated Casp1 activation.
We initially observed a significant increase in TUNEL-positive cells in livers of Nlrp3-mutant mice (Nlrp3 CreZ 2.2-fold change to WT; P < 0.05; Fig. 3), suggesting that either apoptosis or pyroptosis was playing a role in liver pathology. We hypothesized that pyroptotic cell death was occurring in hepatocytes with a hyper activated NRLP3 inflammasome. Pyroptosis was defined by the presence of both active Casp1 and PI positivity, two key features that define pyroptotic cell death, and measured as aforementioned by FCM. Notably, hepatocyte cell fractions from Nlrp3 CreZ mice showed a marked increase (more than 20-fold) in the number of Casp1 and PI double-positive cells, compared to WT animals (Fig. 3). Increased Casp1 expression was confirmed by analyzing liver lysates of Nlrp3-mutant mice. Mice with global mutant NLRP3 inflammasome expression showed an 8-fold increase of cleaved Casp1 (P < 0.05).
NLRP3 Inflammasome Induces Hepatic Stellate Cell Activation and Collagen Deposition
The differential findings observed in Nlrp3-mutant mice, which included several aspects of hepatocyte viability and inflammatory signaling, two events that have been linked to hepatic stellate cell (HSC) activation, led us to further examine the role of the NLRP3 inflammasome in fibrogenesis and fibrosis in the liver. Indeed, Nlrp3 CreZ mutants showed increased collagen deposition, visualized by Sirius Red staining in close proximity to inflammatory hot spots (Fig. 4). Moreover, Nlrp3 CreZ mutants displayed significantly higher connective tissue growth factor (CTGF) and tissue inhibitor of matrix metalloproteinase 1 (TIMP1) mRNA levels, compared to WT mice (Fig. 4). TGF-β precursor protein, as well as mature TGF-β, also showed higher values in Nlrp3 CreZ mice, in comparison to WT littermates.
Liver Inflammation, but Not HSC Activation Is Attenuated by IL-1R Antagonist Treatment in Nlrp3-Mutant Mice
To assess the role of IL-1R signaling in liver inflammation and activation of HSCs, we treated Nlrp3 CreZ mutants with an IL-1R antagonist (anakinra; Fig. 5). Treatment with anakinra resulted in an improvement in liver inflammation and a reduction of TUNEL-positive cells. Correspondingly, mRNA levels of TNF-α, pro-IL-1β, and pro-Casp1 were significantly decreased in anakinra-treated mutants, when compared to saline-injected controls. Notably, markers of HSC activation (CTGF and TIMP1) were not significantly reduced and collagen deposition, as assessed by Sirus red staining, was unchanged in anakinra-treated mice (Fig. 5).
Myeloid Cell-Specific Mutant Mice Exhibit a Less-Severe Liver Phenotype
To characterize the source of the described NLRP3 effects and, in particular, the role of inflammatory cell-derived NLRP3 inflammasome activation in the liver injury observed in global Nlrp3 mutants, we next generated myeloid cell-specific Nlrp3 mutants. To achieve this aim, we bred intronic Nlrp3 floxed mice to mice expressing Cre recombinase under control of the lysozyme promoter (CreL), generating mice that only express mutant NLRP3 in cells of myeloid lineage. Phenotypically, Nlrp3 CreZ and Nlrp3 CreL mice were similar, although Nlrp3 CreL mice gained more weight and died usually at a slightly older age than global Nlrp3 mutants (Fig. 6). Characterization of the liver changes in Nlrp3 CreL mice showed an increase in inflammatory activity, fibrogenesis, and fibrosis, when compared to WT animals. However, we detected that liver pathology was less severe than that observed in global Nlrp3-mutant mice. Protein levels of mature IL-1β and TGF-β precursors as well as mature TGF-β were raised in comparison to WT mice, but were lower than levels in CreZ mice. To examine potential mechanisms involved in differences observed between Nlrp3 CreZ and Nlrp3 CreL mice, we next examined the presence of DNA breakdown by TUNEL assays. We observed significantly less TUNEL-positive cells in myeloid-specific mutants, compared to global mutants (Fig. 6). Moreover, fractionation of livers, followed by FCM for quantitation of pyroptosis as aforementioned, demonstrated that hepatocyte pyroptosis occurs at a much lower rate in myeloid–specific, compared to global, mutants (Fig. 6). Correspondingly, levels of cleaved Casp1 p10 fragments were lower in Nlrp3 CreL mutants (3-fold increase to WT; NS), compared to Nlrp3 CreZ mutants (8-fold increase; P < 0.05).
The principal findings of this study relate to the role of cell-specific NLRP3 inflammasome activation and pyroptotic cell death in liver injury and fibrosis. These results demonstrate that unrestrained NLRP3 activation results in shortened survival, severe liver inflammation, characterized by a predominantly neutrophilic infiltrate, and HSC activation with collagen deposition in the liver. These effects were partially mediated through IL-1R signaling and associated with the presence of hepatocyte pyroptosis. Myeloid cell-derived NLRP3 activation resulted in a less-severe liver phenotype in the absence of detectable pyroptotic liver cell death. These results identify NLRP3 inflammasome activation and NLRP3-dependent hepatocyte pyroptotic cell death as novel mechanisms of liver injury and fibrosis.
Our current data demonstrate, for the first time, the presence of pyroptotic cell death in hepatocytes with a hyper activated NLRP3 inflammasome. Casp1-induced pyroptosis in macrophages has been previously shown to be important in intracellular bacteria clearance in vivo independently of IL-1β and IL-18. In addition, Masters et al. discovered pyroptosis in infection-induced cytopenias by studying inflammasome activation in hematopoietic progenitor cells. Using a novel FCM approach, we were able to demonstrate that isolated hepatocytes from mice with a globally activated NLRP3 inflammasome showed a marked increase in the number of cells with active Casp1 and cell membrane pores, two central features that define and differentiate pyroptotic cell death from other forms of cell death, such as apoptosis and oncosis. Mice with myeloid-specific activation of NLRP3 display an absence of pyroptotic hepatocyte cell death and a less-severe liver phenotype while still having increased levels of IL-1β. It is possible that elevated levels of IL-1β could contribute to cell death by other mechanisms, such as TNF-α induced cell death, as previously reported in hepatocytes. These results strongly suggest an important contribution of pyroptotic hepatocyte cell death to the liver injury and fibrosis observed in Nlrp3 CreZ mutants. Additionally, treatment with an IL-1R antagonist only partially attenuated liver inflammation in CreZ mice, whereas fibrogenesis was unchanged. Future studies to further characterize the presence and relevance of pyroptotic cell death in liver pathologies using the approach described in this study are warranted.
As shown earlier and confirmed in our study, activation of the NLRP3 inflammasome leads to neutrophilia in the blood and many tissues with high levels of serum inflammatory mediators.[19, 20] In the present study, we found a marked increase in leukocyte chemoattractants, whereas markers for leukocyte adhesion did not show significant alterations in mutant mice. Neutrophilia could be the result, in part, of reduced pyroptosis because recent studies have shown that neutrophils undergo pyroptotic cell death at a much lower rate than other cells. Neutrophilic infiltration also reveals the main feature of the concept of sterile inflammation, which is a major component of a wide range of liver diseases, including ASH, NASH, drug-induced liver injury, and ischemia/reperfusion injury.[30, 31] In addition, sterile inflammation leads to the release of toxic mediators that contribute to pathogenesis of these liver diseases.[32-34] IL-1β, the most widely recognized downstream mediator of the NLRP3 inflammasome, has been shown to stimulate collagen expression in a dose-dependent manner in fibroblasts. Moreover, transient expression of IL-1β in airway epithelial cells promoted a significant increase in TGF-β and associated deposition of collagen in the lung. Furthermore, HCSs, the myofibroblasts of the liver, can be activated either by IL-1β or IL-18 to induce collagen deposition. HSCs are known as the major source of CTGF in damaged liver, and fully activated HSCs are known to release TIMP1, strongly suggesting a key role for HSC activation in the fibrosis observed in our models.[38, 39] We found enhanced collagen deposition and increased expression of CTGF and TIMP1 in Nlrp3 CreZ-mutant mice with early signs of liver fibrosis, which was not reversed with anakinra treatment, suggesting a role for mediators other than IL-1β in liver fibrosis. These results are supported by the recent finding that inflammasome components in HSC lines were found to be important in the regulation of various HSCs functions. Furthermore, NLRP3 inflammsome deficiency was associated with protection against carbon-tetrachloride– or thioacetamide-induced liver fibrosis and was found to reduce mortality and liver injury after acetaminophen administration. Future studies to dissect the importance of cell-specific activation of the NLRP3 inflammasome and the role of IL-1-independent NLRP3 pathways contributing to liver inflammation, cell death, and fibrosis are warranted.
In summary, the current studies uncover the role of NLRP3 activation in liver inflammation and fibrosis. The results support a model in which various liver pathologies, such as NASH and ASH, resulting from NLRP3 inflammasome activation in hepatocytes and nonparenchymal cells results in induction of proinflammatory signaling, hepatocyte pyroptotic cell death, and HSC activation, which are then responsible for collagen deposition and fibrosis (Fig. 7). These data provide new insights into the pathogenesis of liver damage and identify potential novel molecular targets for therapeutic intervention for these common, potentially serious diseases.