Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease in the Western world. Twenty percent of NAFLD individuals develop chronic hepatic inflammation (non-alcoholic steatohepatitis, NASH) associated with cirrhosis, portal hypertension and hepatocellular carcinoma, yet causes of progression from NAFLD to NASH remain obscure. Here, we show that the NLRP6 and NLRP3 inflammasomes and the effector protein IL-18 negatively regulate NAFLD/NASH progression, as well as multiple aspects of metabolic syndrome via modulation of the gut microbiota. Different animal models reveal that inflammasome deficiency-associated changes in the configuration of the gut microbiota are associated with exacerbated hepatic steatosis and inflammation through influx of TLR4 and TLR9 agonists into the portal circulation, leading to enhanced hepatic TNF-α expression that drives NASH progression. Furthermore, co-housing of inflammasome-deficient animals to wild type mice results in exacerbation of hepatic steatosis, glucose intolerance, and obesity. Thus, altered interactions between the gut microbiota and the host, produced by defective NLRP3 and NLRP6 inflammasome sensing, may govern the rate of progression of multiple metabolic syndrome-associated abnormalities, highlighting the central role of the microbiota in the pathogenesis of heretofore seemingly unrelated systemic auto-inflammatory and metabolic disorders.

The current model of apoptosis holds that upstream signals lead to activation of downstream effector caspases. We generated mice deficient in the two effectors, caspase 3 and caspase 7, which died immediately after birth with defects in cardiac development. Fibroblasts lacking both enzymes were highly resistant to both mitochondrial and death receptor-mediated apoptosis, displayed preservation of mitochondrial membrane potential, and had defective nuclear translocation of apoptosis-inducing factor (AIF). Furthermore, the early apoptotic events of Bax translocation and cytochrome c release were also delayed. We conclude that caspases 3 and 7 are critical mediators of mitochondrial events of apoptosis.Mitochondria play a central role in apoptosis. Mitochondrial outer membrane permeabilization (MOMP) leads to release of proapoptotic factors such as cytochrome c and AIF (1). Furthermore, loss of mitochondrial membrane potential (Δψ m ) is thought to contribute to cell death by disruption of normal mitochondrial function (2, 3). Interaction of members of the Bcl-2 family of proteins regulates MOMP, the key event of cytochrome c release into the cytoplasm (3, 4). What is less clear, however, is the precise role of caspase proteases in mitochondrial events of apoptosis. Although upstream caspases, such as caspase 2 and caspase 8, affect mitochondrial events in both death-receptor and mitochondrial pathways of apoptosis, either directly or through interaction with Bcl-2 family members, the role of presumed downstream "effector" caspases in this process is less clear (5, 6). Therefore, we studied the two highly related effectors, caspase 3 and caspase 7, to elucidate their functions in apoptosis.* To whom correspondence should be addressed. richard.flavell@yale.edu. We generated caspase 7 −/− mice ( fig. S1), which were born in ratios consistent with Mendelian inheritance. They had normal appearance, organ morphology, and lymphoid development. When caspase 7 −/− mouse embryonic fibroblasts (MEFs) were treated with inducers of apoptosis, they exhibited a slight survival advantage as compared with wild-type MEFs. Apoptosis caused by a range of insults in other caspase 7 −/− cells proceeded normally, however, including the death of activated T cells following stimulation of the T cell receptor, thymocyte apoptosis, Fas-mediated death of B cells, and Fas-mediated death of hepatocytes ( fig. S2). Supporting Online MaterialCaspase 3, which is structurally similar to caspase 7, might compensate for the lack of caspase 7, which would lead to this relatively mild antiapoptotic phenotype (7,8). Thus, we bred caspase 7 −/− mice to caspase 3 −/− mice previously described by our laboratory (9). The embryonic stem cells containing the mutation were from the 129/SvJ genetic background. Mice derived from these embryonic stem cells were backcrossed six generations onto the C57BL/6 background. We obtained no live caspase 3 −/− /caspase 7 −/− double-knockout (DKO) mice when progeny were genotyped at an age of 10 to 14 days. DKO mic...

Hepatocyte death results in a sterile inflammatory response that amplifies the initial insult and increases overall tissue injury. One important example of this type of injury is acetaminophen-induced liver injury, in which the initial toxic injury is followed by innate immune activation. Using mice deficient in Tlr9 and the inflammasome components Nalp3 (NACHT, LRR, and pyrin domain-containing protein 3), ASC (apoptosis-associated specklike protein containing a CARD), and caspase-1, we have identified a nonredundant role for Tlr9 and the Nalp3 inflammasome in acetaminophen-induced liver injury. We have shown that acetaminophen treatment results in hepatocyte death and that free DNA released from apoptotic hepatocytes activates Tlr9. This triggers a signaling cascade that increases transcription of the genes encoding pro-IL-1β and pro-IL-18 in sinusoidal endothelial cells. By activating caspase-1, the enzyme responsible for generating mature IL-1β and IL-18 from pro-IL-1β and pro-IL-18, respectively, the Nalp3 inflammasome plays a crucial role in the second step of proinflammatory cytokine activation following acetaminophen-induced liver injury. Tlr9 antagonists and aspirin reduced mortality from acetaminophen hepatotoxicity. The protective effect of aspirin on acetaminophen-induced liver injury was due to downregulation of proinflammatory cytokines, rather than inhibition of platelet degranulation or COX-1 inhibition. In summary, we have identified a 2-signal requirement (Tlr9 and the Nalp3 inflammasome) for acetaminophen-induced hepatotoxicity and some potential therapeutic approaches.

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