Chlamydia pneumoniae Hijacks a Host Autoregulatory IL-1β Loop to Drive Foam Cell Formation and Accelerate Atherosclerosis

Pathogen burden accelerates atherosclerosis, but the mechanisms remain unresolved. Activation of the NLRP3 inflammasome is linked to atherogenesis. Herewe investigatedwhether Chlamydia pneumoniae (C. pn) infection engages NLRP3 in promoting atherosclerosis. C. pn potentiated hyperlipidemia-induced inflammasome activity in cultured macrophages and in foam cells in atherosclerotic lesions of Ldlr(-/-) mice. C. pn-induced acceleration of atherosclerosis was significantly dependent on NLRP3 and caspase-1. We discovered that C. pn-induced extracellular IL-1 beta triggers a negative feedback loop to inhibit GPR109a and ABCA1 expression and cholesterol efflux, leading to accumulation of intracellular cholesterol and foam cell formation. Gpr109a and Abca1 were both upregulated in plaque lesions in Nlrp3(-/-) mice in both hyperlipidemic and C. pn infection models. Mature IL-1 beta and cholesterol may compete for access to the ABCA1 transporter to be exported from macrophages. C. pn exploits this metabolic-immune crosstalk, which can be modulated by NLRP3 inhibitors to alleviate atherosclerosis.