A genotype-first approach reveals the molecular basis of pyrin inflammasome activation

Naoya Iwata1, Yoshihiko Kuchitsu2, Atsushi Hijikata3

  • 1Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Science Immunology
|August 7, 2026
PubMed

Insights

Genetic diagnosis of pyrin-associated autoinflammatory diseases (PAADs) is challenging due to many uncertain MEFV variants. This study identifies pathogenic variants and reveals distinct pathways for pyrin activation, advancing disease understanding.

Area of Science:

  • Genetics
  • Immunology
  • Molecular Biology

Background:

  • Pyrin-associated autoinflammatory diseases (PAADs) are linked to MEFV gene mutations, but most variants have uncertain significance, complicating diagnosis.
  • The molecular mechanisms of pyrin activation in PAADs are not fully understood.
  • Accurate genetic diagnosis and mechanistic insights are crucial for understanding and treating these inflammatory conditions.

Purpose of the Study:

  • To stratify MEFV variants using a pyroptosis assay and identify novel pathogenic variants.
  • To investigate the interaction between the pyrin B30.2 domain and CDC42 in pyrin activation.
  • To elucidate the distinct molecular pathways involved in pyrin activation by different MEFV variants.

Main Methods:

  • Utilized a cell-based pyroptosis assay to functionally characterize 265 missense MEFV variants.
  • Investigated the interaction between pyrin's B30.2 domain and CDC42.
  • Stratified variants based on their impact on pyrin activation and interaction with CDC42.

Main Results:

  • Identified previously uncharacterized pathogenic MEFV variants.
  • Demonstrated that familial Mediterranean fever (FMF)-related variants bind tightly to CDC42, causing pyrin hyperactivation.
  • Showed that non-FMF variants can hyperactivate pyrin independently of CDC42, suggesting multiple activation pathways.

Conclusions:

  • A functional pyroptosis assay can effectively stratify MEFV variants and identify pathogenic mutations.
  • Pyrin activation involves at least two distinct pathways: one dependent on CDC42 and another independent of it.
  • A genotype-first approach holds promise for advancing the understanding of PAADs and other complex genetic diseases.

Related Concept Videos