Department of Pharmacy, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
The Center for Basic Research and Innovation of Medicine and Pharmacy (MOE), School of Pharmacy, Naval Medical University/Second Military Medical University, Shanghai, China.
Nat Commun. 2024 Aug 5;15(1):6640. doi: 10.1038/s41467-024-50996-5.
Immune checkpoint inhibitor (ICI)-induced myocarditis involves intensive immune/inflammation activation; however, its molecular basis is unclear. Here, we show that gasdermin-E (GSDME), a gasdermin family member, drives ICI-induced myocarditis. Pyroptosis mediated by GSDME, but not the canonical GSDMD, is activated in myocardial tissue of mice and cancer patients with ICI-induced myocarditis. Deficiency of GSDME in male mice alleviates ICI-induced cardiac infiltration of T cells, macrophages, and monocytes, as well as mitochondrial damage and inflammation. Restoration of GSDME expression specifically in cardiomyocytes, rather than myeloid cells, in GSDME-deficient mice reproduces ICI-induced myocarditis. Mechanistically, quantitative proteomics reveal that GSDME-dependent pyroptosis promotes cell death and mitochondrial DNA release, which in turn activates cGAS-STING signaling, triggering a robust interferon response and myocardial immune/inflammation activation. Pharmacological blockade of GSDME attenuates ICI-induced myocarditis and improves long-term survival in mice. Our findings may advance the understanding of ICI-induced myocarditis and suggest that targeting the GSDME-cGAS-STING-interferon axis may help prevent and manage ICI-associated myocarditis.
免疫检查点抑制剂(ICI)诱导的心肌炎涉及强烈的免疫/炎症激活;然而,其分子基础尚不清楚。在这里,我们表明,gasdermin-E(GSDME),一种 gasdermin 家族成员,驱动 ICI 诱导的心肌炎。GSDME 介导的细胞焦亡,而不是经典的 GSDMD,在患有 ICI 诱导的心肌炎的小鼠和癌症患者的心肌组织中被激活。GSDME 在雄性小鼠中的缺失缓解了 ICI 诱导的心脏 T 细胞、巨噬细胞和单核细胞浸润,以及线粒体损伤和炎症。在 GSDME 缺陷型小鼠中特异性地在心肌细胞而不是髓样细胞中恢复 GSDME 的表达,再现了 ICI 诱导的心肌炎。从机制上讲,定量蛋白质组学揭示了 GSDME 依赖性细胞焦亡促进细胞死亡和线粒体 DNA 释放,进而激活 cGAS-STING 信号通路,引发强烈的干扰素反应和心肌免疫/炎症激活。GSDME 的药理学阻断可减轻 ICI 诱导的心肌炎,并提高小鼠的长期存活率。我们的发现可能有助于深入了解 ICI 诱导的心肌炎,并提示靶向 GSDME-cGAS-STING-干扰素轴可能有助于预防和管理 ICI 相关的心肌炎。
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