AIM2-NLRP3 Inflammasome Dual Inhibitor on hsCRP

Despite advances in contemporary preventive and therapeutic strategies, coronary heart disease (CHD) remains a leading cause of morbidity and mortality worldwide. Residual inflammatory risk (RIR) persists in a substantial proportion of patients despite guideline-directed medical therapy and contributes to recurrent cardiovascular events, including myocardial infarction, stroke, and cardiovascular death. Accumulating evidence has established inflammation as a key driver of atherosclerotic cardiovascular disease, highlighting the need for targeted anti-inflammatory therapies to address this unmet clinical need. Notably, two large-scale randomized controlled trials, COLCOT and LoDoCo2, demonstrated that low-dose colchicine reduces cardiovascular events in patients with coronary artery disease, providing compelling clinical evidence for the therapeutic potential of targeting inflammation. These findings subsequently led to the approval of colchicine by the US Food and Drug Administration (FDA) for the reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease.

The anti-inflammatory effects of colchicine are thought to involve the disruption of microtubule dynamics and the suppression of NLRP3 inflammasome activation, thereby attenuating downstream interleukin (IL)-1β and IL-6 signaling and reducing high-sensitivity C-reactive protein (hsCRP) levels. Among the inflammasomes implicated in cardiovascular diseases, NLRP3 and AIM2 have emerged as important contributors to inflammatory signaling in atherosclerotic disease. However, whether effective attenuation of residual inflammatory risk requires simultaneous targeting of multiple inflammasome pathways remains unclear. In our previous studies, we evaluated three pharmacological inhibitors of the NLRP3 inflammasome in patients with CHD. Notably, only colchicine, a nonselective inhibitor of NLRP3 inflammasome activation, significantly reduced hsCRP levels, whereas the more selective NLRP3 inhibitors tranilast and oridonin did not produce a comparable effect. Given that colchicine can also suppress AIM2 inflammasome activation, these findings raise the possibility that its clinical anti-inflammatory efficacy may extend beyond NLRP3 inhibition. We therefore hypothesized that concomitant inhibition of the NLRP3 and AIM2 inflammasomes may represent a more effective therapeutic strategy for mitigating residual inflammatory risk in patients with CHD.

To explore this hypothesis and identify clinically available therapeutic alternatives, we performed an integrated drug-repurposing strategy combining molecular docking-based virtual screening with functional validation in a THP-1 cell-based model of dual NLRP3 and AIM2 inflammasome activation. By integrating inhibitory efficacy against both inflammasome pathways with clinically achievable plasma drug concentrations, we identified the candidate drugs with IL-1β inhibitory activity exceeding that of colchicine: leflunomide, eplerenone, and artesunate. These findings provide a rationale for further investigating dual inflammasome inhibition as a potential therapeutic approach to targeting residual inflammatory risk in CHD.