Inflammasomes and Childhood Autoimmune Diseases: A Review of Current Knowledge
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Inflammasomes and Childhood Autoimmune Diseases: A Review of Current Knowledge Chin‑An Yang1,2 · Bor‑Luen Chiang3,4 Accepted: 9 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Inflammasomes are multiprotein complexes capable of sensing pathogen-associated molecular patterns (PAMPs), dangerassociated molecular patterns (DAMPs), and cellular perturbations. Upon stimulation, the inflammasomes activate the production of the pro-inflammatory cytokines IL-1β and IL-18 and induce gasdermin D-mediated pyroptosis. Dysregulated inflammasome signaling could lead to hyperinflammation in response to environmental triggers, thus contributing to the pathogenesis of childhood autoimmune/autoinflammatory diseases. In this review, we group childhood rheumatic diseases into the autoinflammation to autoimmunity spectrum and discuss about the involvement of inflammasomes in disease mechanisms. Genetic mutations in inflammasome components cause monogenic autoinflammatory diseases, while inflammasome-related genetic variants have been implicated in polygenic childhood rheumatic diseases. We highlight the reported associations of inflammasome signaling-related genetic polymorphisms/protein levels with pediatric autoimmune disease susceptibility and disease course. Furthermore, we discuss about the use of IL-1 receptor antagonist as an adjunctive therapy in several childhood autoimmune diseases, including macrophage activation syndrome (MAS) and multisystem inflammatory syndrome in children (MIS-C) related to COVID-19. A comprehensive multi-cohort comparison on inflammasome gene expression profile in different pediatric rheumatic diseases is needed to identify patient subsets that might benefit from the adjunctive therapy of IL-1β inhibitors. Keywords Inflammasome · Pathogen-associated molecular patterns · Autoinflammation · Autoimmunity · Pediatric rheumatic disease
Introduction Dysregulated interactions between genes and environment have been suggested to result in human autoimmune diseases [1]. Inflammasomes are multi-protein complexes which play important roles in sensing pathogens and cellular * Bor‑Luen Chiang [email protected] 1
Division of Laboratory Medicine and Division of Pediatrics, China Medical University Hsinchu Hospital, Jubei, Hsinchu, Taiwan
2
College of Medicine, China Medical University, Taichung, Taiwan
3
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
4
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
perturbations, including pathogen-associated molecular patterns (PAMPs), danger-associated molecular patterns (DAMPs), and homeostasis-altering molecular processes (HAMPs) [2, 3]. Upon sensing of these molecular patterns/ processes, the inflammasome complexes assemble and function to cleave the inactive IL-1 family cytokine precursors and Gasdermin D (GSDMD). The resulting active IL-1β, IL-18, and GSDMD N-terminal cleavag
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