Alpha-1 Antitrypsin Mediates Spontaneous Resolution of Acute Gouty Inflammation Via Inhibiting Caspase 3/GSDME-dependent Macrophage Pyroptosis

Research on spontaneous resolution of acute Gout remains limited. Macrophages pyroptosis is crucial for the inflammation of acute Gout, while current research mainly focus on Caspase 1/Gasdermin D axis. We aimed to investigate the involvement of other Gasdermin proteins in MSU crystal-induced Macrophages, and to explore the role of Caspase 3-interacting protein alpha-1 antitrypsin (AAT) in regulating macrophage Pyroptosis. Here, clinical evidence demonstrated elevated Gasdermin E (GSDME) in peripheral blood mononuclear cells (PBMCs) and CD68⁺ synovial Macrophages from patients with acute Gout. In THP-1-derived Macrophages, activated Caspase 3/GSDME axis was found after MSU crystals stimulation, and knockdown of Caspase 3 and GSDME significantly suppressed Pyroptosis. In vivo, the Caspase 3 Inhibitor effectively alleviated MSU crystal-induced acute gouty Arthritis in mice. Cytologically, Caspase 3 interacting protein AAT was identified using immunoprecipitation and mass spectrometry technology. Meanwhile, AAT was elevated in serum, PBMCs, synovial fluids, and CD68⁺ synovial Macrophages from patients with acute Gout. Furthermore, AAT inhibited Caspase 3/GSDME-dependent Pyroptosis axis by binding to Caspase 3 in MSU crystal-induced Macrophages. Additionally, AAT was internalized into Macrophages via low-density lipoprotein receptor-related protein-1. Collectively, elevated AAT in synovial fluids from patients with acute Gout attenuates macrophage Pyroptosis by inhibiting Caspase 3/GSDME axis, providing a novel explanation for the spontaneous resolution of acute Gout.