An activating NLRC4 inflammasome mutation causes autoinflammation with recurrent macrophage activation syndrome
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Open Access
- 14 September 2014
- journal article
- case report
- Published by Springer Science and Business Media LLC in Nature Genetics
- Vol. 46 (10), 1140-1146
- https://doi.org/10.1038/ng.3089
Abstract
Scott Canna and colleagues report the identification of a de novo mutation in a conserved region of NLRC4 by whole-exome sequencing of an individual presenting with macrophage activation syndrome. Functional studies confirm that the mutation leads to constitutive inflammasome activation. Inflammasomes are innate immune sensors that respond to pathogen- and damage-associated signals with caspase-1 activation, interleukin (IL)-1β and IL-18 secretion, and macrophage pyroptosis. The discovery that dominant gain-of-function mutations in NLRP3 cause the cryopyrin-associated periodic syndromes (CAPS) and trigger spontaneous inflammasome activation and IL-1β oversecretion led to successful treatment with IL-1–blocking agents1. Herein we report a de novo missense mutation (c.1009A>T, encoding p.Thr337Ser) affecting the nucleotide-binding domain of the inflammasome component NLRC4 that causes early-onset recurrent fever flares and macrophage activation syndrome (MAS). Functional analyses demonstrated spontaneous inflammasome formation and production of the inflammasome-dependent cytokines IL-1β and IL-18, with the latter exceeding the levels seen in CAPS. The NLRC4 mutation caused constitutive caspase-1 cleavage in cells transduced with mutant NLRC4 and increased production of IL-18 in both patient-derived and mutant NLRC4–transduced macrophages. Thus, we describe a new monoallelic inflammasome defect that expands the monogenic autoinflammatory disease spectrum to include MAS and suggests new targets for therapy.Keywords
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