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GSDME-mediated pyroptosis promotes inflammation and fibrosis in obstructive nephropathy


Renal tubular cell (RTC) death and inflammation contribute to the progression of obstructive nephropathy, but its underlying mechanisms have not been fully elucidated. Here, we showed that Gasdermin E (GSDME) expression level and GSDME-N domain generation determined the RTC fate response to TNFα under the condition of oxygen-glucose-serum deprivation. Deletion of Caspase-3 (Casp3) or Gsdme alleviated renal tubule damage and inflammation and finally prevented the development of hydronephrosis and kidney fibrosis after ureteral obstruction. Using bone marrow transplantation and cell type-specific Casp3 knockout mice, we demonstrated that Casp3/GSDME-mediated pyroptosis in renal parenchymal cells, but not in hematopoietic cells, played predominant roles in this process. We further showed that HMGB1 released from pyroptotic RTCs amplified inflammatory responses, which critically contributed to renal fibrogenesis. Specific deletion of Hmgb1 in RTCs alleviated caspase11 and IL-1β activation in macrophages. Collectively, our results uncovered that TNFα/Casp3/GSDME-mediated pyroptosis is responsible for the initiation of ureteral obstruction-induced renal tubule injury, which subsequentially contributes to the late-stage progression of hydronephrosis, inflammation, and fibrosis. This novel mechanism will provide valuable therapeutic insights for the treatment of obstructive nephropathy.

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Fig. 1: UUO- induced Casp3/GSDME activation and renal tubular cell necrosis increased in the kidney.
Fig. 2: Gsdme deficiency alleviated renal tubular damage, hydronephrosis, and fibrogenesis in the UUO model.
Fig. 3: Bone marrow-derived cells with Gsdme deficiency did not reduce renal tubular damage and renal fibrosis progression after UUO.
Fig. 4: Real tubular damage and fibrogenesis were reduced in UUO mice with specific deletion of Casp3 in renal tubules, but not in hematopoietic cells.
Fig. 5: Gsdme and Casp3 deficiency improved renal function and inhibited fibrosis progression in the kidney with reversible unilateral ureteral obstruction (R-UUO).
Fig. 6: Gsdme−/−, Casp3−/− and Ksp-cre Casp3fl/fl mice displayed a reduction of renal tubulointerstitial inflammation post-UUO.
Fig. 7: Specific deletion Hmgb1 in renal tubular cells reduced fibrosis progression and inflammatory cells infiltration in the R-UUO model.
Fig. 8: Caspase3 cleaved GSDME in over-expressing GSDME of renal tubular cells (RTCs) in vitro to induce cell death and release HMGB1.


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We are grateful to Pro. Feng Shao (Beijing National Institute of Biological Sciences) and Jiahuai Han (Xiamen University) for research information and experimental materials.

Funding statement

This work was supported by grants from National Natural Science Foundation of China (No. 82070720, No. 81870472 and No. 81700596), Joint Funds for the Innovation and Natural Science Foundation of Science and Technology of Fujian province (No. 2019Y9019 and No. 2020J02020), Fujian Province finance project (2020B009) and Startup Fund for Scientific Research of Fujian Medical University (No. 2019QH2037).

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YX, TWM, and HYL conceived and designed the research. YL, YY, ZXH, HC, KL, HBM, and ZC performed animal experiments. YL, YY, RL, ZW, ZC, and HBM performed all in vitro experiments. RL, HC, ZZ, and YX performed histologic analysis and flow cytometry. YL, KL, HC, ZZ, HYL, and YX analyzed the data. TWM and YX supervised the research. YL, YY, and YX wrote the original draft. TWM and YX performed writing-review and editing. All authors read and approved the final paper.

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Correspondence to Tak W. Mak or Yanfang Xu.

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The authors declare no competing interests.

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The manuscript reporting studies did not involve human participants, human data or human tissue. The animal experiments were accomplished in compliance with ethical standards. All the animal experiments were performed with the approval of the Laboratory Animal Management and Ethics Committee of Fujian Medical University, according to the Chinese Guidelines on the Care and Use of Laboratory Animals.

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Li, Y., Yuan, Y., Huang, Zx. et al. GSDME-mediated pyroptosis promotes inflammation and fibrosis in obstructive nephropathy. Cell Death Differ 28, 2333–2350 (2021).

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