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2017 ; 114
(45
): E9618-E9625
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Necroptosis controls NET generation and mediates complement activation,
endothelial damage, and autoimmune vasculitis
#MMPMID29078325
Schreiber A
; Rousselle A
; Becker JU
; von Mässenhausen A
; Linkermann A
; Kettritz R
Proc Natl Acad Sci U S A
2017[Nov]; 114
(45
): E9618-E9625
PMID29078325
show ga
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)
constitutes life-threatening autoimmune diseases affecting every organ, including
the kidneys, where they cause necrotizing crescentic glomerulonephritis. ANCA
activates neutrophils and activated neutrophils damage the endothelium, leading
to vascular inflammation and necrosis. Better understanding of
neutrophil-mediated AAV disease mechanisms may reveal novel treatment strategies.
Here we report that ANCA induces neutrophil extracellular traps (NETs) via
receptor-interacting protein kinase (RIPK) 1/3- and mixed-lineage kinase
domain-like (MLKL)-dependent necroptosis. NETs from ANCA-stimulated neutrophils
caused endothelial cell (EC) damage in vitro. This effect was prevented by (i)
pharmacologic inhibition of RIPK1 or (ii) enzymatic NET degradation. The
alternative complement pathway (AP) was recently implicated in AAV, and C5a
inhibition is currently being tested in clinical studies. We observed that NETs
provided a scaffold for AP activation that in turn contributed to EC damage. We
further established the in vivo relevance of NETs and the requirement of
RIPK1/3/MLKL-dependent necroptosis, specifically in the bone marrow-derived
compartment, for disease induction using murine AAV models and in human kidney
biopsies. In summary, we identified a mechanistic link between ANCA-induced
neutrophil activation, necroptosis, NETs, the AP, and endothelial damage. RIPK1
inhibitors are currently being evaluated in clinical trials and exhibit a novel
therapeutic strategy in AAV.