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Neutrophil extracellular trap (NET) formation contributes to gout, autoimmune vasculitis, thrombosis, and atherosclerosis. The outside-in signaling pathway triggering NET formation is unknown. Here, we show that the receptor-interacting protein kinase (RIPK)-1-stabilizers necrostatin-1 or necrostatin-1s and the mixed lineage kinase domain-like (MLKL)-inhibitor necrosulfonamide prevent monosodium urate (MSU) crystal-or PMAinduced NET formation in human and mouse neutrophils. These compounds do not affect PMA-or urate crystal-induced production of ROS. Moreover, neutrophils of chronic granulomatous disease patients are shown to lack PMA-induced MLKL phosphorylation. Genetic deficiency of RIPK3 in mice prevents MSU crystal-induced NET formation in vitro and in vivo. Thus, neutrophil death and NET formation may involve the signaling pathway defining necroptosis downstream of ROS production. These data imply that RIPK1, RIPK3, and MLKL could represent molecular targets in gout or other crystallopathies. Additional supporting information may be found in the online version of this article at the publisher's web-site Keywords IntroductionNeutrophil extracellular trap (NET) formation was first described to enhance bacterial killing via the release of histones, ROS, and proteases [1,2], but also contributes to autoinflammatory Correspondence: Prof. Hans-Joachim Anders e-mail: hjanders@med.uni-muenchen.de and autoimmune disorders [3][4][5][6][7]. For example, monosodium urate (MSU) crystals trigger NET formation, which first drives massive inflammation and subsequently fosters the resolution of inflammation, explaining both gouty arthritis and tophusrelated immune energy [8]. MSU crystals, cytokines, and bacterial * These authors contributed equally to this work. Results and discussionPMA triggered death and NET formation of human neutrophils release around 50% of total DNA after 2 h (Supporting Information Fig. 1A). During these processes neutrophils release IL-1β (but not TNF-α) in time-dependent manner into the supernatant. However, pretreatment with IL-1R antagonist anakinra, TNF blocker etanercept or anti-TLR4 as well as lack of Fas (Fas lpr mice) had no effect on DNA release upon PMA or MSU stimulation as compared to their respective controls, which excludes their role in this process (Supporting Information Fig. 1B-F).In addition, neither zVAD-FMK nor ferrostatin-1 (Fer-1) had an effect (Fig. 1A), excluding caspase-mediated extrinsic apoptosis or pyroptosis, ferroptosis [12], respectively. In contrast, firstgeneration necrostatin (Nec)-1, Nec-1s, and the MLKL inhibitor necrosulfonamide (NSA) decreased overall cell death and NET formation as assessed by nuclear Sytox uptake, the release of DNA using PICO green dye, and chromatin release to induce NET structures. Nec-1 inhibits necroptosis via modulating RIPK1 and preventing RIPK3 and MLKL phosphorylation and necrosome formation [13][14][15][16]. Indeed, MSU-, LPS-, and PMA-induced cell death and NET formation of human neutrophils-induced RIPK3 expression and phospho...

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Severe GN involves local neutrophil extracellular trap (NET) formation. We hypothesized a local cytotoxic effect of NET-related histone release in necrotizing GN. In vitro, histones from calf thymus or histones released by neutrophils undergoing NETosis killed glomerular endothelial cells, podocytes, and parietal epithelial cells in a dose-dependent manner. Histone-neutralizing agents such as antihistone IgG, activated protein C, or heparin prevented this effect. Histone toxicity on glomeruli ex vivo was Toll-like receptor 2/4 dependent, and lack of TLR2/4 attenuated histone-induced renal thrombotic microangiopathy and glomerular necrosis in mice. Anti-glomerular basement membrane GN involved NET formation and vascular necrosis, whereas blocking NET formation by peptidylarginine inhibition or preemptive anti-histone IgG injection significantly reduced all aspects of GN (i.e., vascular necrosis, podocyte loss, albuminuria, cytokine induction, recruitment or activation of glomerular leukocytes, and glomerular crescent formation). To evaluate histones as a therapeutic target, mice with established GN were treated with three different histone-neutralizing agents. Anti-histone IgG, recombinant activated protein C, and heparin were equally effective in abrogating severe GN, whereas combination therapy had no additive effects. Together, these results indicate that NETrelated histone release during GN elicits cytotoxic and immunostimulatory effects. Furthermore, neutralizing extracellular histones is still therapeutic when initiated in established GN.

CKD associates with systemic inflammation, but the underlying cause is unknown. Here, we investigated the involvement of intestinal microbiota. We report that collagen type 4 α3-deficient mice with Alport syndrome-related progressive CKD displayed systemic inflammation, including increased plasma levels of pentraxin-2 and activated antigen-presenting cells, CD4 and CD8 T cells, and Th17- or IFNγ-producing T cells in the spleen as well as regulatory T cell suppression. CKD-related systemic inflammation in these mice associated with intestinal dysbiosis of proteobacterial blooms, translocation of living bacteria across the intestinal barrier into the liver, and increased serum levels of bacterial endotoxin. Uremia did not affect secretory IgA release into the ileum lumen or mucosal leukocyte subsets. To test for causation between dysbiosis and systemic inflammation in CKD, we eradicated facultative anaerobic microbiota with antibiotics. This eradication prevented bacterial translocation, significantly reduced serum endotoxin levels, and fully reversed all markers of systemic inflammation to the level of nonuremic controls. Therefore, we conclude that uremia associates with intestinal dysbiosis, intestinal barrier dysfunction, and bacterial translocation, which trigger the state of persistent systemic inflammation in CKD. Uremic dysbiosis and intestinal barrier dysfunction may be novel therapeutic targets for intervention to suppress CKD-related systemic inflammation and its consequences.

Phosphoinositides are small phospholipids that control diverse cellular downstream signaling events. Their spatial and temporal availability is tightly regulated by a set of specific lipid kinases and phosphatases. Congenital muscular dystrophies are hereditary disorders characterized by hypotonia and weakness from birth with variable eye and central nervous system involvement. In individuals exhibiting congenital muscular dystrophy, early-onset cataracts, and mild intellectual disability but normal cranial magnetic resonance imaging, we identified bi-allelic mutations in INPP5K, encoding inositol polyphosphate-5-phosphatase K. Mutations impaired phosphatase activity toward the phosphoinositide phosphatidylinositol (4,5)-bisphosphate or altered the subcellular localization of INPP5K. Downregulation of INPP5K orthologs in zebrafish embryos disrupted muscle fiber morphology and resulted in abnormal eye development. These data link congenital muscular dystrophies to defective phosphoinositide 5-phosphatase activity that is becoming increasingly recognized for its role in mediating pivotal cellular mechanisms contributing to disease.