Chronic kidney disease (CKD) affects 13.4% of adults in America; and 38% in people aged 65 years or older[1]. In addition, cardiovascular disease (CVD) is the leading cause of death in CKD patients with end-stage kidney disease. CKD is associated with chronic inflammation, which contributes to the progression of CVD[2]. Furthermore, CKD alter apolipoprotein profile and elevate plasma lipid levels. It has been reported that 68.8% of CKD patients are associated with hyperlipidemia[3]. Therefore, hyperlipidemia is the critical risk factor for cardiovascular morbidity and mortality in CKD patients [4, 5]. In addition, trained immunity has been shown to play a critical role in chronic inflammatory diseases[6]. However, whether trained immunity promotes the inflammation in hyperlipidemia-CKD remains unclear. Circulating lipopolysaccharide (LPS) is significantly increased in atherosclerotic and CKD patients[7]. Clinical data indicates that circulating LPS is positively associated with the progression of CKD, and its levels even higher in patients with hemodialysis or dialysis[8]. Studies found that circulating LPS is delivered into cytosol for caspase-4/11 activation[9]. The Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) involving 10,061 patients found that targeting interleukin-1β (IL-1β) innate immunity pathway is significantly lowered the rate of recurrent cardiovascular events independent of lipid-level lowering[10]. Therefore, inhibiting the secretion of proinflammatory cytokine IL-1β has high potential to future development of novel therapeutics for hyperlipidemia-CKD accelerated CVD. Gasdermin D (GSDMD) is cleaved by inflammatory caspase-1 and caspase-4. N-terminal GSDMD binds to plasma membrane forming protein channel [11] and mediates the secretion of IL-1β[12, 13]. We found that caspase-1 activation was significantly decreased in caspase-4/11 deficient high-fat diet (HFD)-CKD mice, indicating that caspase-4 could regulate caspase-1 activation in HFD-CKD. Whether increased cytosolic LPS contribute to the increased vascular inflammation via caspase-4/11-GSDMD-IL-1β pathway remains unknown. In this study, we used HFD fed 5/6 nephrectomy CKD mice in vivo and cytosolic LPS stimulation in human aortic endothelial cell (HAECs) in vitro. We made the following results: 1) Inflammatory pathways are significantly increased in the aorta of HFD-CKD compared to HFD-Sham, normal diet (ND)-CKD, and ND-Sham. 2) Expression levels of endothelial cell activation markers (ICAM1 and VCAM1) are significantly increased in the aorta of HFD-CKD mice compared to HFD-Sham, ND-CKD, and ND-Sham. 3) Caspase-4 activation and N-GSDMD cleavage are significantly increased in the aorta of HFD-CKD mice compared to HFD-Sham, ND-CKD, and ND-Sham and in cytosolic LPS stimulated HAECs. 4) The increased inflammatory pathways and increased expression of adhesion molecules are decreased in the deficiency of caspase-4 in vivo and in the presence of caspase-4 inhibitor and N-terminal GSDMD cleavage inhibitor in vitro. 5) The increased mitochondrial ROS promote endothelial cell activation via caspase-4-GSDMD axis. Taken together, the caspase-4/11-GSDMD axis mediates endothelial cell activation and vascular inflammation in the aorta of HFD-CKD mice compared to controls. Furthermore, the increased endothelial cell activation and vascular inflammation are restored by caspase-4/11 deficiency in the aorta of HFD-CKD mice. These evidence indicate that inhibiting caspase-4/11-GSDMD axis could be a potential therapeutic target for inhibiting vascular inflammation associated with hyperlipidemia-CKD. / Biomedical Sciences

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The inflammasome complex is a multiprotein complex that may play a role in the pathogenesis of inflammatory bowel disease (IBD) by secreting the inflammatory cytokines interleukin (IL)-1β and IL-18, and inducing pyroptosis, as a response to signals through several inflammasome sensors. This study looked at the expression of several inflammasome components in the ileum and colon of patients suffering from IBD. The inflammasome sensors NLRP1, NLRP3, AIM2 and pyrin were upregulated in whole intestinal tissue of IBD patients, particularly in the colon. NLRP6 expression was increased in the colon of Crohn's disease patients, but not ulcerative colitis patients relative to colon of controls, and was reduced in the ileum of Crohn's disease patients compared to control ileum. Expression of caspase-1 and IL-1β, but not IL-18, were also increased in ileum and colon tissue from Crohn's patients. To identify the cell type where inflammasome expression was altered in Crohn’s disease, transcription of inflammasome subunits in intestinal tissue enriched for epithelial cells or lamina propria (LP) cells was analysed. These analyses indicated that LP cells have greater expression of the inflammasome sensors NLRP1, NLRP3, AIM2 and pyrin relative to epithelial cells, both during disease and in control tissue. Moreover, LP cells from Crohn’s patients have higher expression level of NLRP1, AIM2 and pyrin than LP cells from controls. In contrast the inflammasome sensor NLRP6 was more highly expressed by epithelial cells relative to LP cells in general, and NLRP6 expression in LP cells from IBD patients was lower than that observed in LP cells from controls. The observed differential expression of inflammasome components in controls versus IBD intestine and in different cellular fractions of intestinal tissue highlight the importance of understanding the role of the inflammasome in IBD and hints at the possibility of targeting the inflammasome pathway as a future treatment strategy.