OP0106 A NOVEL KNOCK-IN MOUSE MODEL OF CAPS THAT DEVELOPS AMYLOIDOSIS: THERAPEUTIC EFFICACY OF PROTON PUMP INHIBITORS
Authors: Arinna Bertoni, Sonia Carta, Chiara Baldovini, Federica Penco, Enrica Balza, Silvia Borghini, Marco DI Duca, Emanuela Ognio, Paolo Nozza, Francesca Schena, Patrizia Castellani, Claudia Pastorino, Carola Perrone, Laura Obici, Alberto Martini, Isabella Ceccherini, Marco Gattorno, Anna Rubartelli, Sabrina Chiesa
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Cryopyrin associated periodic syndromes (CAPS) are a group of autoinflammatory diseases linked to gain-of-function mutations in the NLRP3 gene that cause uncontrolled IL-1β secretion. CINCA syndrome is the most severe CAPS disease characterized by central nervous system disabilities with a long-term risk of secondary amyloidosis. Proton pump inhibitors (PPIs), commonly used as inhibitors of gastric acid production, also display anti-inflammatory properties, making them promising drugs in sepsis and in inflammatory disorders. <h3>Objectives</h3> To develop a novel NLRP3 knock-in (KI) mouse model of CAPS to evaluate amyloid deposition and to test alternative therapeutic approaches. <h3>Methods</h3> We generated KI mice by engineering N475K mutation associated with CAPS phenotype into mouse <i>Nlrp3</i> gene. KI and Wild Type (WT) mice received PPIs or PBS intraperitoneally and were analyzed for survival, inflammation, cytokine secretion, and amyloidosis development. Cytokines secretion from bone marrow derived dendritic cells (BMDCs) and peritoneal macrophages (PMs) was evaluated by ELISA. Hystological analysis of all organs was evaluated by hematoxylin and eosin staining. Amyloid deposition was quantified through Congo Red staining. <h3>Results</h3> Mutant NLRP3 KI mice displayed features that recapitulates the immunological and clinical phenotype of CAPS. These mice had systemic inflammation, with high levels of serum pro-inflammatory cytokines compared to WT controls. Hystological analysis revealed the presence of acute and chronic inflammatory cell infiltrates and amyloid deposits in spleen, liver and kidneys. As in CAPS monocytes, BMDCs and PM from KI mice showed a strong increase in IL-1β, IL-18, and IL-1α secretion and decreased levels in interleukin-1 receptor antagonist (IL-1Ra), the naturally occurring IL-1b inhibitor. PPIs treatment of KI mice showed a clear clinical impact with improvement of inflammatory conditions and regression of amyloid deposits. Remarkably, BMDCs and PMs from PPI-treated mice presented reduced secretion of pro-inflammatory cytokines and re-established the levels of IL-1RA. <h3>Conclusion</h3> NLRP3 KI mice display a CAPS phenotype with many characteristics of autoinflammation, including amyloidosis. The therapeutic effectiveness associated with lack of toxicity indicates that PPIs could represent relevant adjuvants to the anti-IL-1 drugs in IL-1 driven diseases. <h3>References</h3> [1] Gattorno M, Martini A. Beyond the NLRP3 inflammasome: autoinflammatory diseases reach adolescence. Arthritis Rheum. 2013; [2] Brydges SD, Mueller JL, McGeough MD, Pena CA, Misaghi A, Gandhi C Putnam CD, et al. Inflammasome-mediated disease animal models reveal roles for innate but not adaptive immunity. Immunity. 2009; [3] Balza E, Piccioli P, Carta S, Lavieri R, Gattorno M, Semino Cet al. Proton pump inhibitors protect mice from acute sistemic inflammation and induce long-term cross-tolerance. Cell Death Dis. 2016. <h3>Disclosure of Interests</h3> Arinna Bertoni: None declared, Sonia Carta: None declared, Chiara Baldovini: None declared, Federica Penco: None declared, Enrica Balza: None declared, Silvia Borghini: None declared, Marco Di Duca: None declared, Emanuela Ognio: None declared, Paolo Nozza: None declared, Francesca Schena: None declared, Patrizia Castellani: None declared, Claudia Pastorino: None declared, Carola Perrone: None declared, Laura Obici: None declared, Alberto Martini Consultant for: I do not have any conflict of interest to declare since starting from 1 March 2016 I became the Scientific Director of the G. Gaslini Hospital; therefore, my role does not allow me to render private consultancies resulting in personal income. I perform consultancy activities on behalf of the Gaslini Institute for the companies listed below: AbbVie, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, EMD Serono, Janssen, Novartis, Pfizer, R-Pharm. The money received for these activities are directly transferred to the Gaslini Institute's bank account. Before March 2016, I was the head of the Pediatric Rheumatology Department at the G. Gaslini Hospital, where the PRINTO Coordinating Centre is located. For the coordination activity of the PRINTO network, the Gaslini Hospital received contributions from the industries listed in this section. This money has been reinvested for the research activities of the hospital in fully independent manners besides any commitment with third parties., Isabella Ceccherini: None declared, Marco Gattorno Grant/research support from: MG has received unrestricted grants from Sobi and Novartis, Anna Rubartelli: None declared, Sabrina Chiesa: None declared