Pentraxin 3 deletion aggravates allergic inflammation through a TH17-dominant phenotype and enhanced CD4 T-cell survival Jyoti Balhara, MSc, Lianyu Shan,

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Pentraxin 3 deletion aggravates allergic inflammation through a TH17-dominant phenotype and enhanced CD4 T-cell survival Jyoti Balhara, MSc, Lianyu Shan, MSc, Jingbo Zhang, PhD, Anik Muhuri, BSc, Andrew J. Halayko, PhD, Muhamad S. Almiski, MD, Diana Doeing, MD, John McConville, MD, Martin M. Matzuk, MD, PhD, Abdelilah S. Gounni, PhD Journal of Allergy and Clinical Immunology Volume 139, Issue 3, Pages 950-963.e9 (March 2017) DOI: 10.1016/j.jaci.2016.04.063 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Journal of Allergy and Clinical Immunology 2017 139, 950-963 Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 A, PTX3 concentrations are increased in the setting of asthma in human subjects and mice. PTX3 levels in BALF obtained from healthy subjects and patients with severe asthma were evaluated by means of ELISA. *P < .01. B, Schematic showing the protocol used for acute OVA sensitization/challenge in mice. IN, Intranasal; IP, intraperitoneal. C and D, PTX3 concentrations measured in the lungs (Fig 1, C) and BALF (Fig 1, D) of Ptx3+/+ mice in saline- and OVA-exposed conditions. *P < .01. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Disruption of PTX3 worsens airway and lung inflammation. A and B, Total (Fig 2, A) and differential (Fig 2, B) cell counts in BALF of OVA-sensitized/challenged and saline-exposed Ptx3+/+ and Ptx3−/− mice. C-H, Flow cytometric analysis of singlets (Fig 2, C) and granulocytes (Fig 2, D): eosinophils (Fig 2, E and F) and neutrophils (Fig 2, G and H) in the lungs of mice from both strains 48 hours after OVA challenge (n = 8-9 per group). *P < .01. FSC, Forward scatter; SSC, side scatter. I, Histologic examination of lung inflammation (×200 magnification). Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Total and OVA-specific IgE (A and B) and IgG2a (C and D) levels were assessed in sera of saline- and OVA-exposed Ptx3+/+ and Ptx3−/− mice by means of ELISA (n = 7-10 per group). *P < .01. ns, Not significant. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Deletion of PTX3 aggravates OVA-induced airway hyperreactivity and mucus gene expression. A, Airway resistance in OVA-sensitized/challenged Ptx3+/+ and Ptx3−/− mice, as determined by using the flexiVENT small-animal ventilator. ns, Not significant. B and C, Mucus production in the lungs was determined by using PAS staining (×200 magnification). D and E, mRNA expression of the mucus genes muc5ac (Fig 4, D) and muc5b (Fig 4, E) was assessed by using real-time PCR (n = 12 per group). *P < .01. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Absence of PTX3 induces enhanced IL-17A–dominant responses. A-F, Levels of proinflammatory cytokines in the lungs (Fig 5, A-C) and MLNs (Fig 5, D-F) were determined by means of ELISA (n = 8-10 mice per group). G-J, CD69 (Fig 5, G and H) and CD25 (Fig 5, I and J) expression on lung CD4 T cells (n = 5-6 mice per group). K-N, Characterization of effector lung CD4 T cells (Fig 5, K and L) and expression profile of IL-17A (Fig 5, M and N) by lung CD4 T cells in OVA-exposed Ptx3+/+ and Ptx3−/− mice (n = 10 mice per group). *P < .01. nd, Not determined; ns, not significant. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Ptx3−/− CD4 T cells show enhanced survival. A, Survival of lung CD4 T cells (CD3e+CD4+) was assessed by using Annexin V and 4′-6-diamisino-2-phenylindole dihydrochloride (DAPI) staining. Percentages of gated cells are presented as means ± SEMs (n = 8-10 per group). B-E, Expression of Bcl-2 (Fig 6, B and C) and IL-2 production (Fig 6, D and E) in OVA-exposed lung CD4 T cells were determined by means of flow cytometry. Quantification and statistical analysis of fluorescence-activated cell sorting data is shown as graphs (n = 5-10 per group). *P < .01. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 OVA exposure results in an increase in IL-6– and IL-23–producing DCs in Ptx3−/− mice. A-E, Lung CD11c+CD11b+ DCs from OVA-exposed Ptx3−/− and Ptx3+/+ mice (Fig 7, A) were assessed for the production of IL-6 (Fig 7, B and C) and IL-23 (Fig 7, D and E) by means of flow cytometry. FSC, Forward scatter; SSC, side scatter. F and G, Purified CFSE-labeled spleen naive CD4 T cells from PTX3+/+ mice were cocultured with lung DCs from OVA-exposed Ptx3−/− and Ptx3+/+ mice for 4 days, and numbers of IL-17A–producing CD4 T cells were quantified by using flow cytometry. H, IL-17A levels in these cocultures were detected by means of ELISA (n = 6-8 per group). *P < .01. I and J, lung DCs from OVA-exposed Ptx3−/− and Ptx3+/+ mice were cocultured with OTII mouse naive CD4 T cells, and the number of IL-17A–producing CD4 T cells was determined after 4 days (n = 3). Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 A-C, Fold increase in cytokine levels after exposure to OVA compared with respective saline control levels in Ptx3+/+ and Ptx3−/− mice. D-F, Concentrations of IL-5 (Fig E1, D), IL-12 (Fig E1, E), and IL-6 (Fig E1, F) in the lungs of Ptx3+/+ and Ptx3−/− mice, as determined by means of ELISA (n = 5-10 per group). *P < .01. G, mRNA level of IL-17A, as assessed by using real-time PCR, in the lungs of Ptx3+/+ and Ptx3−/− mice in saline- and OVA-exposed conditions (n = 8-12 per group). *P < .01. ns, Not significant. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Flow cytometric analysis of expression profiles of IL-17A (A and B) and IL-2 (C and D) by MLN CD4 T cells from OVA-exposed Ptx3+/+ and Ptx3−/− mice. Quantification and statistical analysis of fluorescence-activated cell sorting data is shown as graphs (n = 6-8/group). *P < .01. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 A-D, Flow cytometric analysis of expression profile of IL-4 (Fig E3, A and B), and IFN-γ (Fig E3, C and D) in lung CD4 T cells from OVA-exposed Ptx3+/+ and Ptx3−/− mice. E, STAT3 phosphorylation was assessed by means of Western blotting in lungs of naive and OVA-exposed Ptx3+/+ and Ptx3−/− mice (n = 3). F, Naive CD4 T cells were enriched from splenocytes and cultured in the presence of TH17 polarization cocktail for 5 days. G and H, IL-17A–producing CD4 T cells after TH17 polarization were assessed by means of flow cytometry. Quantification and statistical analysis of fluorescence-activated cell sorting data is shown as graphs (n = 5-6 per group). *P < .01. I and J, CD4 T cells were stimulated with 20 ng/mL IL-6, and STAT3 phosphorylation was detected by mean of Western blotting. The graph shows averages from 3 independent experiments. *P < .01. ns, Not significant. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Naive lung CD4 T cells from Ptx3+/+ and Ptx3 −/− mice were cultured for 3 days (A and B), and survival of CD4 T cells was assessed by using Annexin V and 4′-6-diamisino-2-phenylindole dihydrochloride (DAPI) staining (C and D; n = 8 per group). *P < .01. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 A and B, Bcl-2 expression was detected in naive CD4 T cells from Ptx3+/+ and Ptx3−/− mice by using Western blotting (n = 3). C, Enriched naive CD4 T cells were cultured in the presence of TH17 polarization cocktail for 5 days, and production of IL-2 by CD4 T cells from Ptx3+/+ and Ptx3−/− was assessed by means of flow cytometry (n = 5-6 per group). ns, Not significant. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E6 A and B, CD11c+CD11b+ DCs from MLNs of OVA-sensitized/challenged Ptx3+/+ and Ptx3−/− mice were assessed for intracellular IL-6 (A and B) and IL-23 (C and D) expression by using flow cytometry. The gating strategy is similar to that used in characterizing lung DCs (n = 6 per group). Quantitative analysis of IL-6 (E and F) and IL-23 (G and H) production is shown as graphs. Journal of Allergy and Clinical Immunology 2017 139, 950-963.e9DOI: (10.1016/j.jaci.2016.04.063) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions