Pyroptosis is a highly inflammatory form of Lysis programmed cell death that occurs most frequently upon infection with intracellular pathogens and is likely to form part of the antimicrobial response. This process promotes the rapid clearance of various bacterial, viral, fungal and protozoan infections by removing intracellular replication niches and enhancing the host's defensive responses. Pyroptosis can take place in and is also reported to occur in keratinocytes and some .
The process is initiated by formation of a large supramolecular complex termed the inflammasome (also known as a pyroptosome) upon intracellular danger signals. The inflammasome activates a different set of caspases as compared to apoptosis, for example, caspase-1/4/5 in humans and caspase-11 in mice. These caspases contribute to the maturation and activation of the pro-inflammatory IL-1β and IL-18, as well as the pore-forming protein GSDMD. Formation of pores causes cell membrane rupture and release of cytokines, as well as various damage-associated molecular pattern (DAMP) molecules such as HMGB-1, ATP and DNA, out of the cell. These molecules recruit more immune cells and further perpetuate the inflammatory cascade in the tissue.
However, in pathogenic chronic diseases, the inflammatory response does not eradicate the primary stimulus. A chronic form of inflammation ensues that ultimately contributes to tissue damage. Pyroptosis is associated with diseases including autoinflammatory, metabolic, and cardiovascular diseases, as well as cancer and neurodegeneration. Some examples of pyroptosis include the cell death induced in Salmonella-infected and abortively HIV-infected T helper cells.
The Greek pyro refers to fire and ptosis means falling. The compound term of pyroptosis may be understood as "fiery falling", which describes the bursting of pro-inflammatory chemical signals from the dying cell. Pyroptosis has a distinct morphology and mechanism compared to those of other forms of cell death.
It has been suggested that microbial infection was the main evolutionary pressure for this pathway.
Inflammasome formation was initially thought to be required for the induction of pyroptosis, but in 2013, the caspase-11 dependent noncanonical pathway was discovered, suggesting lipopolysaccharides (LPS) can trigger pyroptosis and subsequent inflammatory responses independent of toll-like receptor 4 (TLR4). In 2015, GSDMD (GSDMD) was identified as the effector of pyroptosis that forms pores in the cell membrane. In 2021, the high-resolution structure of the GSDMD pore was solved by cryo-electron microscopy (cryo-EM). Also in 2021, an additional molecule, NINJ1, was found to be required for the plasma membrane rupture during pyroptosis.
In terms of mechanism, pyroptosis is activated by inflammatory caspases, including caspase-1/4/5 in humans and caspase-11 in mice. Caspase-8 can act as an upstream regulator of inflammasome activation in context-dependent manners. Caspase-3 activation can take place in both apoptosis and pyroptosis.
Although both pyroptosis and necroptosis are triggered by membrane pore formation, pyroptosis is more controlled. Cells that undergo pyroptosis exhibit membrane blebbing and produce protrusions known as pyroptotic bodies, a process not found in necroptosis. Also, necroptosis works in a caspase-independent fashion. It is proposed that both pyroptosis and necroptosis may act as defence systems against pathogens when apoptotic pathways are blocked.
Canonical inflammasomes mostly contain three components: a sensor protein (PRRs), an adaptor (PYCARD) and an effector (caspase-1). Generally, inflammasome-forming NLR proteins share a similar structure, several leucine-rich repeat (LRR) domains, a central nucleotide-binding and oligomerization domain (NBD) and an N-terminal pyrin domain (PYD). NLRP3, for example, recruits ASC adaptor protein via PYD-PYD interaction. Both pro-caspase-1 and ASC contain a caspase activation and recruitment domain (CARD), and this homotypic CARD-CARD interaction enables autocatalytic cleavage and reassembly of procaspase-1 to form active caspase-1. Alternatively, NLRC4 can directly recruit pro-caspase-1, as it has a CARD instead of a PYD. In addition to their formation as a complex to induce pyroptosis, inflammasomes can also be integral components of larger cell death-inducing complexes called PANoptosomes to induce PANoptosis, another inflammatory form of cell death.
Activated caspase-1 is responsible for cleavage of pro-IL-1β and pro-IL-18. These cytokines, once processed, will be in their biologically active form ready to be released from the host cells. In addition, caspase-1 also cleaves the cytosolic GSDMD. GSDMD can be cleaved to produce an N-terminal domain (GSDMD-N) and a C-terminal domain (GSDMD-C). GSDMD-N can oligomerize and form transmembrane pores that have an inner diameter of 10-14 nm. The pores allow secretion of IL-1β and IL-18 and various cytosolic content to extracellular space, and they also disrupt the cellular ionic gradient. The resulting increase in osmotic pressure causes an influx of water followed by cell swelling and bursting. Notably, GSDMD-N is autoinhibited by GSDMD C-terminal domain before cleavage to prevent cell lysis in normal conditions. Also, GSDMD-N can only insert itself into the inner membrane with specific lipid compositions, which limits its damage to neighbour cells. Downstream of GSDMD, NINJ1 is now thought to be required for the plasma membrane rupture during pyroptosis.
In a healthy cell, caspase-1 activation helps to fight infection caused by Salmonella and Shigella by introducing cell death to restrict pathogen growth. When the "danger" signal is sensed, the quiescent cells will be activated to undergo pyroptosis and produce inflammatory cytokines IL-1β and IL-18. IL-18 will stimulate IFNγ production and initiates the development of TH1 responses. (TH1 responses tend to release cytokines that direct an immediate removal of the pathogen.)
The cell activation results in an increase in cytokine levels, which will augment the consequences of inflammation and this, in turn, contributes to the development of the adaptive response as infection progresses. The ultimate resolution will clear pathogens.
In contrast, persistent inflammation will produce excessive immune cells, which is detrimental. If the amplification cycles persist, metabolic disorder, autoinflammatory diseases and liver injury associated with chronic inflammation will occur.
Recently, pyroptosis and downstream pathways were identified as promising targets for treatment of severe COVID-19-associated diseases.
In gastric cancer cells, presence of GSDMD can inhibit cyclin A2/CDK2 complexes, leading to cell cycle arrest and thus inhibit tumour development. Also, cellular concentration of GSDME increases when gastric cancer cells are treated with certain chemotherapy drugs. GSDME then activates caspase-3 and triggers pyroptotic cell death.
Cervical cancer can be caused by human papillomavirus (HPV) infection. AIM2 protein can recognise viral DNA in cytoplasm and form AIM2 inflammasome, which then triggers by a caspase-1 dependent canonical pyroptosis pathway. HPV infection causes the upregulation of sirtuin 1 protein, which disrupts the transcription factor for AIM2, RelB. Knockdown of sirtuin 1 upregulates AIM2 expression and triggers pyroptosis.
Mechanism
The canonical inflammasome pathway
The noncanonical inflammasome pathway
Caspase-3-dependent cell death pathway
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Clinical relevance
Infection
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Cerebrovascular disease
Cancer
Metabolic disorder
Cryopyrinopathies
HIV and AIDS
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