Filaggrin-null mutations are associated with increased maturation markers on Langerhans cells Claire S. Leitch, MBChB (Hons), MMed Sci, Eenass Natafji,

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Filaggrin-null mutations are associated with increased maturation markers on Langerhans cells Claire S. Leitch, MBChB (Hons), MMed Sci, Eenass Natafji, MBChB, MMed Sci, Cunjing Yu, MSc, Sharizan Abdul-Ghaffar, BM, Nayani Madarasingha, MBBS, MD, MMedSci, Zoë C. Venables, MBChB, MMed Sci, Roland Chu, BSc (Hons), MBChB, PhD, Paul M. Fitch, BSc (Hons), PhD, Andrew J. Muinonen-Martin, MBChB, PhD, Linda E. Campbell, BSc, W.H. Irwin McLean, DSc, FRS, Jürgen Schwarze, MD, Sarah E.M. Howie, PhD, Richard B. Weller, MD, FRCP (Ed) Journal of Allergy and Clinical Immunology Volume 138, Issue 2, Pages 482-490.e7 (August 2016) DOI: 10.1016/j.jaci.2015.11.040 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 FLG-null subjects with and without AD have a higher proportion of CD11chi epidermal APCs than WT subjects. A, Scatter plot comparing the percentage of CD11chi cells among the different subject groups. P = .009, Kruskal-Wallis test. *P < .05, Dunn multiple comparison posttest P values. B, Scatter plot comparing the percentage of CD11chi cells in all WT subjects versus all FLG-null subjects. P values were calculated by using the Mann-Whitney test, as shown on the graph. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Confocal microscopy confirms increased CD11c expression in LCs in FLG-null subjects with and without AD. A, CD1a+ (red) and langerin (white) measurement. B, Scatter plot comparing the mean volume of CD11c staining per LC in all WT subjects versus all FLG-null subjects. P values were calculated by using the Mann-Whitney test. C, Scatter plot comparing the mean number of CD83+ LCs per 100 LCs in all WT subjects versus all FLG-null subjects. P values were calculated by using the Mann-Whitney test. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Skin barrier function is reduced in FLG-null subjects with but not without AD. A, Comparison of mean resting TEWL in all subject groups. P = .02, FLG-null subjects with AD versus WT subjects with AD, Mann-Whitney test. Lines show minimum to maximum values. B, Plot showing the number of tape strips required to reach a TEWL of greater than 20 g/h/m2 in all subject groups. P ≤ .0001, Dunn multiple comparison posttest values shown on graph. *P < .05 and ****P < .0001. Lines show minimum to maximum values. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Cis-UCA reduces costimulatory molecule expression in unstimulated MDCCs. MDCCs were cultured for 7 days in the presence of cis-UCA (c-UCA) or trans-UCA (t-UCA). Culture with 100 μg/mL cis-UCA caused a significant reduction in CD86 (A), PD-L1 (B), HLA-DR (C), and CD40 (D) MFI. Statistical analysis was done with repeated-measures ANOVA (Friedman test with Dunn multiple comparison posttest). **P < .01, ***P < .001, and ****P < .0001. Lines show medians and interquartile ranges. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Cis-UCA reduces costimulatory molecule expression in LPS-stimulated MDCCs. MDCCs cultured for 7 days in the presence of cis-UCA (c-UCA) or trans-UCA (t-UCA) were stimulated with 1 ng/mL LPS for 24 hours. Conditioning with 100 μg/mL cis-UCA caused a significant reduction in CD86 (A) and PD-L1 (B) MFI. Statistical analysis was done with repeated-measures ANOVA (Friedman test with Dunn multiple comparison posttest). *P < .05 and **P < .01. Lines show medians and interquartile ranges. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Cis-UCA–conditioned MDCCs induce more cells with a regulatory T-cell phenotype. A, Proliferation of CD4 T cells in coculture. B, Induction of cells with a regulatory T-cell phenotype after coculture. ns, Not significant. *P < .05, Kruskal-Wallis test with the Dunn multiple comparison posttest. C, Similar proportion of CD25+ cells after coculture with trans-UCA– and cis-UCA–conditioned MDCCs. D, More CD25+FoxP3+CD127− cells after coculture with cis-UCA–conditioned MDCCs. In Fig 6, A, C, and D, Representative plots from 1 donor are shown. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Gating strategy for single-cell suspensions created from epidermal suction blister roofs. Representative FlowJo cytometry plots are shown. A, Forward scatter (FSC)–A, side scatter (SSC)–A plot gated to exclude subcellular debris. B, SYTOX Blue SSC-A plot gated on live cells. C, HLA-DR: percentage of the maximum histogram showing all epidermal cells gated on HLA-DR positivity. D, CD1a: percentage of the maximum histogram showing HLA-DR+ cells gated on CD1a positivity. E, CD11c: percentage of the maximum histogram showing HLA-DR+ and CD1a+ cells gated on CD11c positivity. F, CD11c expression was divided into low and high groups to reflect the normal low expression of CD11c by LCs. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Epidermal thickness of suction blister roof samples. The number of 1.01-μm z-stack slices needed to visualize each blister roof specimen was calculated as a proxy measure of epidermal thickness. This scatter dot plot shows mean values for each volunteer averaged from counts from 3 different stacks. Lines show means and SDs. P = .34, Kruskal-Wallis test. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 CD83 and HLA-DR staining of epidermal suction blister roofs. Intact suction blister roofs from nonlesional skin were incubated with antibodies to CD1a, CD11c, CD83, HLA-DR, and langerin/CD207. A, HLA-DR staining of epidermal dendritic cells (red) in a representative sample. Note that occasional cells express more HLA-DR (arrows). B, CD83 staining showing occasional CD83+ cells in the same sample (green, arrows). C, Merged image showing that cells expressing more HLA-DR are also CD83+ (arrows). Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Gating strategy for cultured cells. A, Representative FlowJo cytometry plots show that forward scatter (FSC) versus side scatter (SSC) was used to draw a gate around the cells. B, Single cells were gated by plotting FSC height against FSC area to exclude doublets. C, Viable cells were gated by excluding dead cells stained with Ef780 dye. D, Single viable cells were then analyzed for individual markers, including HLA-DR (lighter line), overlaid with their isotype controls. See Table E1 for full phenotypic details. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 Concentration of UCA isomers in suction blister fluid. A, Bar chart comparing mean levels of UCA (cis-UCA and trans-UCA isomers combined) in suction blister fluid between different subject groups. The narrow bar shows SEMs. P = .66, Kruskal-Wallis test. B, Dot plot comparing mean levels of cis-UCA between different subject groups. Bars show means ± SEMs. P = .65, Kruskal-Wallis test. C, Dot plot comparing mean levels of trans-UCA between different subject groups. Bars show means ± SEMs. P = .66, Kruskal-Wallis test. Note the approximately 200-fold difference between cis- and trans-UCA concentrations. Journal of Allergy and Clinical Immunology 2016 138, 482-490.e7DOI: (10.1016/j.jaci.2015.11.040) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions