Allergen endotoxins induce T-cell–dependent and non–IgE-mediated nasal hypersensitivity in mice Naruhito Iwasaki, MD, Kazufumi Matsushita, PhD, Ayumi.

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Allergen endotoxins induce T-cell–dependent and non–IgE-mediated nasal hypersensitivity in mice Naruhito Iwasaki, MD, Kazufumi Matsushita, PhD, Ayumi Fukuoka, PhD, Masakiyo Nakahira, MD, PhD, Makoto Matsumoto, MD, PhD, Shoko Akasaki, BPharm, Koubun Yasuda, PhD, Takeshi Shimizu, MD, PhD, Tomohiro Yoshimoto, MD, PhD Journal of Allergy and Clinical Immunology Volume 139, Issue 1, Pages 258-268.e10 (January 2017) DOI: 10.1016/j.jaci.2016.03.023 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Ec-OVA induces FcεRI-independent sneezing. A, Experimental schema. Fcer1a+/+ or Fcer1a−/− mice were i.p. immunized with OVA. B, Mice were then i.n. challenged with PBS or Ef-OVA. C, OVA-sensitized mice were i.n. challenged with PBS or Ec-OVA. B and C, Number of sneezes was counted for 10 minutes immediately after each i.n. challenge. Pooled data from 2 independent experiments are shown (mean, SEM, n = 5 [PBS groups], n = 8 [Ef-OVA groups], n = 7 [Ec-OVA groups]). N.S., Not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Nasal T-cell activation is required for Ec-OVA-induced sneezing. A, Experimental schema. B-D, WT mice were adoptively transferred with or without DO11.10-derived TH2 cells. Mice were then i.n. challenged with PBS or Ec-OVA. E-G, TH2-transferred mice were i.n. challenged with PBS, Ec-OVA, or Ef-OVA. B and E, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. C, D, F, and G, Frequency of OVA-TH2 cells (CD4+DO11.10TCR+ cells in CD45+ cells) (C and F) and eosinophils (CCR3+Siglec-F+ cells in CD45+ cells) (D and G) in nasal mucosa 24 hours after the final challenge was examined by FACS. H and I, Fcer1a+/+ or Fcer1a−/− (Fig 2, H), or Rag2+/+ or Rag2−/− mice (Fig 2, I) were adoptively transferred with DO11.10-derived TH2 cells and i.n. challenged with PBS or Ec-OVA. Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. Pooled data from 3 (Fig 2, B-G) or 2 (Fig 2, H and I) independent experiments are shown (mean, SEM, n = indicated in figure). N.S., Not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 TLR4-MyD88–signaling pathway is essential for Ec-OVA–induced sneezing. Tlr4+/+ or Tlr4−/− (A, C, and E), or Myd88+/+ or Myd88−/− (B, D, and F), mice were adoptively transferred with DO11.10-derived TH2 cells. Mice were then i.n. challenged with PBS or Ec-OVA. A and B, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. C-F, Frequency of OVA-TH2 cells (CD4+DO11.10TCR+ cells in CD45+ cells) (Fig 3, C and D) and eosinophils (CCR3+Siglec-F+ cells in CD45+ cells) (Fig 3, E and F) in nasal mucosa 24 hours after the final challenge was examined by FACS. Pooled data from 3 independent experiments are shown (mean, SEM, n = 5 [PBS groups], n = 12-13 (OVA groups in A, C, and E), n = 13-14 [OVA groups in B, D, F]). N.S., Not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 LPS triggers sneezing in T-cell–activated noses. A, Experimental schema. B, WT mice were adoptively transferred with DO11.10-derived TH2. Mice were then i.n. challenged with LPS (days 1-4), Ec-OVA (days 1-4), or Ef-OVA (days 1-2) followed by LPS (days 3-4). C, Mice i.n. challenged with Ef-OVA (days 1-2) were then i.n. challenged with variable concentrations of LPS (days 3-4). B and C, Number of sneezes at days 3 and 4 was counted for 10 minutes immediately after i.n. challenge. Pooled data from 3 (Fig 4, B) or 2 (Fig 4, C) independent experiments are shown (mean, SEM, n = indicated in figure). N.S., Not significant. ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Histamine mediates Ec-OVA–induced sneezing. WT mice adoptively transferred with DO11.10-derived TH2 cells were i.n. challenged with PBS or Ec-OVA in the presence or absence of diphenhydramine treatment (1 mg/dose), 90 minutes before each intranasal challenge. Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. Pooled data from 2 independent experiments are shown (mean, SEM, n = 4 [PBS groups], n = 8 [OVA groups]). **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Mast cells/basophils are dispensable for Ec-OVA–induced sneezing. A, Experimental schema. WT or Mas-TRECK mice were adoptively transferred with DO11.10-derived TH2 cells, i.p. injected with DT, and i.n. challenged with Ec-OVA. B, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. Pooled data from 2 independent experiments are shown (mean, SEM, n = 10 [WT], n = 11 [Mas-TRECK]). N.S., Not significant. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 Monocytes/macrophages are essential for Ec-OVA–induced sneezing. A, Experimental schema. WT mice adoptively transferred with DO11.10-derived TH2 cells were i.n. challenged with Ec-OVA. On day 3, 6 hours after the third nasal challenge, mice were i.p. injected with PBS or clodronate-containing liposome. B, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. C, Experimental schema. Fcer1a−/− (D) or WT (E and F) mice were i.p. immunized with OVA, then i.n. challenged with Ec-OVA (Fig 7, D and E) or Ef-OVA (Fig 7, F). On day 3, 6 hours after the third nasal challenge, mice were i.p. injected with PBS or clodronate-containing liposome. D-F, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. Pooled data from 2 independent experiments are shown (mean, SEM, n = indicated in figure). N.S., Not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Naive OVA-specific T cells do not mediate Ec-OVA–induced sneezing. WT mice were adoptively transferred with DO11.10-derived naive CD4+ or TH2 cells, and then i.n. challenged with Ec-OVA. Number of sneezes was counted for 10 minutes immediately after each intranasal challenge (mean, SEM, n = 3). **P < .01. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Memory OVA-specific TH2 cells mediate Ec-OVA–induced sneezing. WT mice were adoptively transferred with or without DO11.10-derived TH2 cells, and left untreated for 6 weeks. After the generation of memory TH2 cells, mice were i.n. challenged with PBS or Ec-OVA. Number of sneezes was counted for 10 minutes immediately after each intranasal challenge (mean, SEM, n = 2 [PBS groups], n = 3 [OVA groups]). **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Nasal accumulation of OVA-specific T cells and eosinophils in TH2-transferred and OVA-challenged mice. WT mice were adoptively transferred with or without DO11.10-derived TH2 cells. Mice were then i.n. challenged with PBS or Ec-OVA. Frequency of OVA-TH2 cells (CD4+DO11.10TCR+ cells in CD45+ cells) and eosinophils (CCR3+Siglec-F+ cells in CD45+ cells) in nasal mucosa 24 hours after the final challenge was examined by FACS. A, Gating strategy to analyze nasal CD45+ hematopoietic cells. B and C, Representative flow cytometry plots in Fig 2, C (B), and Fig 2, D (C). FSC-A, Forward scattered light-area; FSC-H, forward scattered light-height; FSC-W, forward scattered light-width; SSC-A, side scattered light-area; SSC-H, side scattered light-height; SSC-W, side scattered light-width. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 ILC2s do not expand in nasal mucosa in TH2- transferred and OVA-challenged mice. WT mice adoptively transferred with DO11.10-derived TH2 cells were i.n. challenged with PBS, Ec-OVA, or Ef-OVA. Frequency of ILC2s (Lin−ST2+CD90.2+ cells in CD45+ cells) in nasal mucosa 24 hours after the final challenge was examined by FACS. A, Gating strategy to analyze nasal ILC2s. B, Quantified graph of ILC2 frequency. Pooled data from 2 independent experiments are shown (mean, SEM, n = 8 [PBS and Ec-OVA groups], n = 7 [Ef-OVA group]). FSC-A, Forward scattered light-area; FSC-H, forward scattered light-height; FSC-W, forward scattered light-width; SSC-A, side scattered light-area; SSC-H, side scattered light-height; SSC-W, side scattered light-width; N.S., not significant. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 Delayed LPS challenge does not induce sneezing in nasally TH2-activated mice. A, Experimental schema. WT mice were adoptively transferred with DO11.10-derived TH2 cells. Mice were then i.n. challenged with Ec-OVA (days 1-4), Ef-OVA (days 1-2) followed by LPS (days 3-4), or Ef-OVA (days 1-2) followed by LPS only at day 4. B, Number of sneezes at days 3 and 4 was counted for 10 minutes immediately after intranasal challenge. Pooled data from 2 independent experiments are shown (mean, SEM, n = 5 [Ec-OVA group], n = 8 [LPS groups]). N.D., Not determined; N.S., not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E6 Histamine mediates Ec-OVA–induced sneezing. WT mice adoptively transferred with DO11.10-derived TH2 cells were i.n. challenged with PBS or Ec-OVA. Mice were i.p. injected with diphenhydramine (1 or 2 mg/dose) (A) or fexofenadine (5 mg/dose) (B) on day 4, 90 minutes before the final intranasal challenge. Number of sneezes at day 4 was counted for 10 minutes immediately after the intranasal challenge (mean, SEM, n = indicated in figure). N.S., Not significant. **P < .01; ***P < .001. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E7 DT treatment in Mas-TRECK mice depletes mast cell/basophil populations. A, Mice were treated as in Fig 6, A. Total RNAs were extracted from nasal mucosa and subjected to quantitative PCR analysis for the expression of Mcpt1, Mcpt2, Mcpt8, Hdc, and 18S. mRNA expression levels were normalized to 18S rRNA levels. B and C, WT or Mas-TRECK mice were i.p. immunized with OVA. Mice were then i.p. injected with DT and i.n. challenged with Ef-OVA. B, Experimental schema. C, Number of sneezes was counted for 10 minutes immediately after each intranasal challenge. Data representative of 2 independent experiments (A) and pooled data from 2 independent experiments are shown (C) (mean, SEM, n = 3-5 [A], n = 6-8 [C]). N.D., Not detected; N.S., not significant. *P < .05; **P < .01. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E8 Clodronate treatment depletes monocyte/macrophage populations. WT mice were i.p. injected with clodronate-containing liposome or PBS. Cells in the spleens were isolated 18 hours after the injection. Frequency of Ly-6ChighF4/80intCD11bhigh monocytes, F4/80highCD11bint macrophages, CD11c+MHC-IIhigh dendritic cells, and Ly-6G+CD11b+ neutrophils in CD45+ cells was examined by FACS. Representative flow cytometry plots from 2 independent experiments are shown. DC, Dendritic cells. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E9 Nasal accumulation of OVA-specific T cells and eosinophils is intact in clodronate-treated mice. WT mice adoptively transferred with DO11.10-derived TH2 cells were i.n. challenged with Ec-OVA for 4 days. On day 3, 6 hours after the third nasal challenge, mice were i.p. injected with PBS or clodronate-containing liposome. Frequency of OVA-TH2 cells (CD4+DO11.10TCR+ cells in CD45+ cells) (A) and eosinophils (CCR3+Siglec-F+ cells in CD45+ cells) (B) in nasal mucosa 60 minutes after the final nasal challenge was examined by FACS. Pooled data from 2 independent experiments are shown (mean, SEM, n = 8). N.S., Not significant. Journal of Allergy and Clinical Immunology 2017 139, 258-268.e10DOI: (10.1016/j.jaci.2016.03.023) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions