Abstract
Pyroptosis is a lytic form of cell death executed by gasdermin pores. Through a CRISPR screen to uncover macrophage genes required for gasdermin D (GSDMD) pore activity, we identify the endosome adaptor Rabgef1 as a positive regulator of pore formation. Rabgef1 deficiency preserves NT-GSDMD membrane binding but prevents NT-GSDMD oligomerization and lytic death. Mechanistic analyses revealed that Rabgef1 deficiency is associated with an overabundance of cholesterol in the plasma membrane. Cholesterol depletion or redistribution through multiple approaches restores GSDMD oligomerization and pyroptosis. The Rabgef1-mediated control of membrane cholesterol and pore formation was found to be a general regulator of the gasdermin family. In cancer cells, organoids, and tumors, cholesterol reduction sensitizes resistant cells to GSDME pyroptosis driven by synthetic mRNAs, chemogenetic induction, and chemotherapy treatment. These results establish membrane cholesterol content as an endogenous checkpoint for gasdermin-mediated pyroptotic cell death during the execution phase, with implications for metabolic disease and cancer immunotherapy.