Abstract 1115: Novel Mechanism For Extrahepatic Inflammation In Progressive Familial Intrahepatic Cholestasis 1

Abstract

Background: Human mutations in ATP8b1, a member of the P4-type ATPase family, cause Progressive Familial Intrahepatic Cholestasis I (PFIC1). PFIC1 patients often show extrahepatic inflammatory manifestations such as atherosclerosis, pancreatitis, and hearing loss. Even after liver transplantation, which rescues PFIC1 hepatic symptoms, the extrahepatic inflammatory symptoms persist. The mechanism of how ATP8b1 regulates inflammation is not clear. Pyroptosis executor Gasdermin D (GsdmD) plays a major role in promoting inflammation. GsdmD can be cleaved via a caspase-1/Nlrp3 dependent canonical inflammasome pathway, or a caspase-11 (in mice) or caspase-4/5 (in humans) dependent non-canonical inflammasome pathway. Goal: To decipher the mechanism for ATP8b1-mediated regulation of inflammasome activity in immune cells. Methods & Results: We employed Crispr-Cas9 generated homozygous ATP8b1 knockout human monocytes/macrophages to determine the status of inflammasome activity. Human monocytes/macrophages lacking ATP8b1 released significantly more IL-1β upon exposure to LPS (1μg/ml) + Nigericin (5 mM) vs. control cells (mean±SD, N=3-6, p<0.0001 by t-test.) Interestingly, ATP8b1 -/- cells showed GsdmD cleavage with LPS priming alone without a secondary signal, and markedly increased IL-1β release vs. WT cells (N=3-6, mean±SD, p<0.001). Mechanistically, LPS gained cytoplasmic access in ATP8b1 -/- immune cells, leading to cleavage of GsdmD in an NLRP3-independent, and caspase 4/5 dependent non-canonical inflammasome. The ATP8b1 -/- immune cells showed impaired lysosomal acidification, though the lysosomal number and lysosomal membrane integrity were not compromised. ATP8b1 -/- immune cells showed defects in inflammasome-resolving pathways such as phagocytosis and efferocytosis. Atomic force microscopy of ATP8b1 -/- cells showed a reduced order state of the plasma membrane with Young’s modulus of elasticity for THP-1 ATP8b1 -/- (Ey= 296±10.42 Pa) vs. WT macrophages (Ey =680±25.27 Pa, N =30, mean±SD, p<0.0001). Conclusions: ATP8b1 negatively regulates GsdmD cleavage via a non-canonical inflammasome pathway. GsdmD may serve as a therapeutic target for resolving inflammation in PFIC1 patients.