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Gadolinium-based compounds induce NLRP3-dependent IL-1β production and peritoneal inflammation
  1. Christian Schmidt-Lauber1,
  2. Lukas Bossaller2,
  3. Hani H Abujudeh3,
  4. Gregory I Vladimer2,
  5. Anette Christ2,
  6. Katherine A Fitzgerald2,
  7. Eicke Latz2,4,
  8. Ellen M Gravallese1,
  9. Ann Marshak-Rothstein1,
  10. Jonathan Kay1
  1. 1Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  3. 3Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  4. 4Institute of Innate Immunity, University of Bonn and German Center of Neurodegenerative Diseases (DZNE), Bonn, Germany
  1. Correspondence to Professor Jonathan Kay, Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Rheumatology Center, Memorial Campus, 119 Belmont Street, Worcester, MA 01605, USA; jonathan.kay{at}


Objective Nephrogenic systemic fibrosis (NSF) is a progressive fibrosing disorder that may develop in patients with chronic kidney disease after administration of gadolinium (Gd)-based contrast agents (GBCAs). In the setting of impaired renal clearance of GBCAs, Gd deposits in various tissues and fibrosis subsequently develops. However, the precise mechanism by which fibrosis occurs in NSF is incompletely understood. Because other profibrotic agents, such as silica or asbestos, activate the nucleotide-binding oligomerisation domain (NOD)-like receptor protein 3 (NLRP3) inflammasome and initiate interleukin (IL)-1β release with the subsequent development of fibrosis, we evaluated the effects of GBCAs on inflammasome activation.

Methods Bone marrow derived macrophages from C57BL/6, Nlrp3−/− and Asc−/− mice were incubated with three Gd-containing compounds and IL-1β activation and secretion was detected by ELISA and western blot analysis. Inflammasome activation and regulation was investigated in IL-4- and interferon (IFN)γ-polarised macrophages by ELISA, quantitative real time (qRT)-PCR and NanoString nCounter analysis. Furthermore, C57BL/6 and Nlrp3−/−mice were intraperitoneally injected with GBCA and recruitment of inflammatory cells to the peritoneum was analysed by fluorescence-activated cell sorting (FACS).

Results Free Gd and GBCAs activate the NLRP3 inflammasome and induce IL-1β secretion in vitro. Gd-diethylenetriaminepentaacetic acid also induces the recruitment of neutrophils and inflammatory monocytes to the peritoneum in vivo. Gd activated IL-4-polarised macrophages more effectively than IFNγ-polarised macrophages, which preferentially expressed genes known to downregulate inflammasome activity.

Conclusions These data suggest that Gd released from GBCAs triggers a NLRP3 inflammasome-dependent inflammatory response that leads to fibrosis in an appropriate clinical setting. The preferential activation of IL-4-differentiated macrophages is consistent with the predominantly fibrotic presentation of NSF.

  • Inflammation
  • Cytokines
  • Magnetic Resonance Imaging

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