Genetically determined NLRP3 inflammasome activation associates with systemic inflammation and cardiovascular mortality

• Published in: European heart journal Vol. 42; no. 18; pp. 1742 - 1756
• Main Authors: Schunk, Stefan J, Kleber, Marcus E, März, Winfried, Pang, Shichao, Zewinger, Stephen, Triem, Sarah, Ege, Philipp, Reichert, Matthias C, Krawczyk, Marcin, Weber, Susanne N, Jaumann, Isabella, Schmit, David, Sarakpi, Tamim, Wagenpfeil, Stefan, Kramann, Rafael, Boerwinkle, Eric, Ballantyne, Christie M, Grove, Megan L, Tragante, Vinicius, Pilbrow, Anna P, Richards, A Mark, Cameron, Vicky A, Doughty, Robert N, Dubé, Marie-Pierre, Tardif, Jean-Claude, Feroz-Zada, Yassamin, Sun, Maxine, Liu, Chang, Ko, Yi-An, Quyyumi, Arshed A, Hartiala, Jaana A, Tang, W H Wilson, Hazen, Stanley L, Allayee, Hooman, McDonough, Caitrin W, Gong, Yan, Cooper-DeHoff, Rhonda M, Johnson, Julie A, Scholz, Markus, Teren, Andrej, Burkhardt, Ralph, Martinsson, Andreas, Smith, J Gustav, Wallentin, Lars, James, Stefan K, Eriksson, Niclas, White, Harvey, Held, Claes, Waterworth, Dawn, Trompet, Stella, Jukema, J Wouter, Ford, Ian, Stott, David J, Sattar, Naveed, Cresci, Sharon, Spertus, John A, Campbell, Hannah, Tierling, Sascha, Walter, Jörn, Ampofo, Emmanuel, Niemeyer, Barbara A, Lipp, Peter, Schunkert, Heribert, Böhm, Michael, Koenig, Wolfgang, Fliser, Danilo, Laufs, Ulrich, Speer, Thimoteus
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 07.05.2021
• Subjects: Basic Medicine; Cardiology and Cardiovascular Disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Clinical Medicine; Clinical Research; Coronary artery disease; Humans; Inflammasome; Inflammasomes - genetics; Inflammation; Inflammation - genetics; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Leukocytes, Mononuclear; Medical and Health Sciences; Medical Genetics and Genomics (including Gene Therapy); Medicin och hälsovetenskap; Medicinsk genetik och genomik (Här ingår: Genterapi); Medicinska och farmaceutiska grundvetenskaper; NLR Family, Pyrin Domain-Containing 3 Protein - genetics; NLRP3; NLRP3; Inflammation; Inflammasome; Cardiovascular diseases; Coronary artery disease
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehab107

Abstract Aims Inflammation plays an important role in cardiovascular disease (CVD) development. The NOD-like receptor protein-3 (NLRP3) inflammasome contributes to the development of atherosclerosis in animal models. Components of the NLRP3 inflammasome pathway such as interleukin-1β can therapeutically be targeted. Associations of genetically determined inflammasome-mediated systemic inflammation with CVD and mortality in humans are unknown. Methods and results We explored the association of genetic NLRP3 variants with prevalent CVD and cardiovascular mortality in 538 167 subjects on the individual participant level in an explorative gene-centric approach without performing multiple testing. Functional relevance of single-nucleotide polymorphisms on NLRP3 inflammasome activation has been evaluated in monocyte-enriched peripheral blood mononuclear cells (PBMCs). Genetic analyses identified the highly prevalent (minor allele frequency 39.9%) intronic NLRP3 variant rs10754555 to affect NLRP3 gene expression. rs10754555 carriers showed significantly higher C-reactive protein and serum amyloid A plasma levels. Carriers of the G allele showed higher NLRP3 inflammasome activation in isolated human PBMCs. In carriers of the rs10754555 variant, the prevalence of coronary artery disease was significantly higher as compared to non-carriers with a significant interaction between rs10754555 and age. Importantly, rs10754555 carriers had significantly higher risk for cardiovascular mortality during follow-up. Inflammasome inducers (e.g. urate, triglycerides, apolipoprotein C3) modulated the association between rs10754555 and mortality. Conclusion The NLRP3 intronic variant rs10754555 is associated with increased systemic inflammation, inflammasome activation, prevalent coronary artery disease, and mortality. This study provides evidence for a substantial role of genetically driven systemic inflammation in CVD and highlights the NLRP3 inflammasome as a therapeutic target. Graphical Abstract rs10754555 associates with higher NLRP3 mRNA expression and NLRP3 inflammasome activation, which induces the release of IL-1β and IL-18. This leads to systemic inflammation, higher risk for coronary artery disease, and cardiovascular mortality.