Inflammasome-activated gasdermin D causes pyroptosis by forming membrane pores

Caspase-mediated cleavage of gasdermin D, previously shown to mediate pyroptosis, acts by inducing oligomerization and pore formation in cell membranes. Pyroptosis, an inflammatory form of programmed cell death that is part of the innate immune response, is triggered by caspase-mediated cleavage of the inflammasome protein gasdermin D. Judy Lieberman and colleagues examine the underlying molecular mechanism for gasdermin functioning in pyroptosis. They present evidence that caspase 11 cleavage of gasdermin D, previously shown to mediate pyroptosis, induces oligomerization of the N-terminal domain and pore formation. Also in this issue of Nature, Feng Shao and colleagues show that the N-terminal domains of gasdermins D, A and A3 are cytotoxic because they disrupt cell membranes in both mammalian cells and artificially transformed bacteria through the formation of membrane pores. Inflammatory caspases (caspases 1, 4, 5 and 11) are activated in response to microbial infection and danger signals. When activated, they cleave mouse and human gasdermin D (GSDMD) after Asp276 and Asp275, respectively, to generate an N-terminal cleavage product (GSDMD-NT) that triggers inflammatory death (pyroptosis) and release of inflammatory cytokines such as interleukin-1β1,2. Cleavage removes the C-terminal fragment (GSDMD-CT), which is thought to fold back on GSDMD-NT to inhibit its activation. However, how GSDMD-NT causes cell death is unknown. Here we show that GSDMD-NT oligomerizes in membranes to form pores that are visible by electron microscopy. GSDMD-NT binds to phosphatidylinositol phosphates and phosphatidylserine (restricted to the cell membrane inner leaflet) and cardiolipin (present in the inner and outer leaflets of bacterial membranes). Mutation of four evolutionarily conserved basic residues blocks GSDMD-NT oligomerization, membrane binding, pore formation and pyroptosis. Because of its lipid-binding preferences, GSDMD-NT kills from within the cell, but does not harm neighbouring mammalian cells when it is released during pyroptosis. GSDMD-NT also kills cell-free bacteria in vitro and may have a direct bactericidal effect within the cytosol of host cells, but the importance of direct bacterial killing in controlling in vivo infection remains to be determined.