Heme-Induced Activation of the TLR3/TRIF-IFN-I-CCL2 Pathway Contributes to Kidney Injury in Sickle Cell Disease Available to Purchase

• Heme triggers kidney inflammation through a TLR3/TRIF–IFN-I–CCL2 pathway

• Targeting IFN-I/CCL2 pathway may offer therapeutic benefit in sickle cell nephropathy

Sickle cell nephropathy (SCN) is a major clinical complication in sickle cell disease (SCD), yet its underlying mechanisms remain incompletely defined. Hemolysis, a hallmark of SCD, has been implicated in SCN pathogenesis, but the downstream inflammatory pathways are not fully understood. We previously demonstrated that hemolysis triggers type I interferon (IFN-I) responses, leading to upregulation of the chemokine CCL2 and recruitment of classical monocytes that differentiate into monocyte-derived macrophages (MoMϕ) within livers in SCD. In this study, we show that IFN-I and CCL2 levels are elevated in the plasma of SCD patients with abnormal urine albumin-creatinine ratio (uACR) and in the kidneys of Townes SCD mouse model. Using IFN-I receptor (Ifnar1)-/- and CCL2 receptor (Ccr2)-/- mouse models of SCD, we demonstrate that loss of IFN-I or CCL2 signaling reduces MoMϕ accumulation, renal inflammation, and renal injury. Mechanistically, we identify that hemin-induced IFN-I production occurs via the TLR3/TRIF signaling axis, independent of MyD88, MAVS, or STING. These findings uncover a previously unrecognized heme-TLR3/TRIF-IFN-I-CCL2 pathway that contributes to renal pathology in SCD and suggest that targeting this axis may offer therapeutic benefit.