IL-6 Blockade Attenuates the Development of Murine Sclerodermatous Chronic Graft- Versus-Host Disease Doanh Le Huu, Takashi Matsushita, Guihua Jin, Yasuhito.

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IL-6 Blockade Attenuates the Development of Murine Sclerodermatous Chronic Graft- Versus-Host Disease Doanh Le Huu, Takashi Matsushita, Guihua Jin, Yasuhito Hamaguchi, Minoru Hasegawa, Kazuhiko Takehara, Manabu Fujimoto Journal of Investigative Dermatology Volume 132, Issue 12, Pages 2752-2761 (December 2012) DOI: 10.1038/jid.2012.226 Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Changes in serum inflammatory cytokines levels during development of sclerodermatous chronic graft-versus-host disease (Scl-cGVHD). BALB/c (H-2d) recipients were irradiated (800cGy) and transplanted with B10.D2 (H-2d) donor 10 × 106 T-cell-depleted bone marrow (TCD-BM) and 10 × 106 unfractionated splenocytes. (a) Serum samples were collected every 7 days after bone marrow transplantation (BMT). IL-12p70, tumor necrosis factor-α (TNF-α), IFN-γ, monocyte chemotactic protein-1 (MCP-1), IL-10, and IL-6 levels were measured by Cytometric Bead Array. (b) Allogeneic BMT recipients were treated with MR16-1 (anti-IL-6R mAb, □) or with control rat IgG (▪) on day 0 at a dose of 2mg per mouse. Seven days after BMT, serum IL-6, IL-10, MCP-1, IFN-γ, TNF- α, and IL-12p70 concentrations were measured by Cytometric Bead Array. Each value indicates mean (±SEM) results from three to four mice. **P<0.01. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 MR16-1 treatment attenuated chronic graft-versus-host disease (cGVHD) severity in a preventive model but did not alter in a therapeutic model. Preventive model: recipients were treated with MR16-1 (▵) or control (▪) on day 0 at a dose of 2mg per mouse and then weekly at a dose of 0.5mg per mouse. (a) Body mass changes and (b) skin scores were assessed every 3 days. (c) Representative photographs were taken on day 42 after bone marrow transplantation (BMT). (d) Plasma TGF-β1 level was measured by ELISA 42 days after BMT. Therapeutic model: recipients were treated with MR16-1 (▵) or control (▪) on day 25 at a dose of 2mg per mouse and then weekly at a dose of 0.5mg per mouse. (e) Body mass changes and (f) skin scores were assessed every 3 days. Each value indicates mean (±SEM) results from five mice. *P<0.05. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Improved fibrosis scores in MR16-1-treated animals in the preventive model. Slides were scored and skin soluble collagen was measured as described in Materials and Methods. (a) Representative photomicrographs of histopathological changes from syngeneic (BALB/c → BALB/c), control, and MR16-1-treated groups. Sections were stained with hematoxylin and eosin (H&E) or Masson's trichome. Arrows indicate the dermal thickness. Bar=100μm. Histopathological scores were analyzed at the end time point from (b) preventive and (c) therapeutic models. (d, e) Skin fibrosis was compared by determining dermal thickness, (f) soluble collagen, and trichrome area/total area. (g) Lung and liver fibrosis was estimated by the ratio of trichrome area/total area. Each value indicates mean (±SEM) results from four to five mice. *P<0.05, **P<0.01. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Elevated regulatory T cell (Treg) numbers in MR16-1-treated animals in the preventive model. Tregs in each experimental group. Total splenic cellularity, absolute number of splenic CD4+ T cells, and Tregs are shown (a) 14 days and (b) 42 days following bone marrow transplantation (BMT) in the preventive model, and (c) 57 days after BMT in the therapeutic model. CD1dhiCD5+CD19+ B cells in each experimental group. Absolute number of splenic CD19+ B cells and CD1dhiCD5+CD19+ B cells (e) 14 days and (f) 42 days after BMT in the preventive model, and (g) 57 days after BMT in the therapeutic model. Each value indicates mean (±SEM) results from four mice. *P<0.05. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 A decrease in tumor necrosis factor-α (TNF-α)-producing CD4+ T cells and low levels of TNF-α, IFN-γ, IL-6, IL-18, TGF-β1, CCL2, CCL3, and CCL5 mRNA in the preventive model. Splenic single-cell suspensions were stimulated as described in Materials and Methods. Percentages of IL-10-producing CD19+ B cells from (a) preventive and (b) therapeutic models. (c) From the CD4+ T-cell gate, results represent one mouse from the MR16-1-treated group or control group, indicating the percentages of TNF-α-producing CD4+ T cells with/without stimulation. (d) Cytokine production by CD4+ T cells in the preventive model. (e) Expression of cytokine/chemokines was measured by real-time quantitative reverse transcriptase (RT–PCR) analysis. Each value indicates mean (±SEM) results from four to five mice. *P<0.05, **P<0.01. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 Anti-CD25 mAb treatment inhibited MR16-1's attenuation in sclerodermatous chronic graft-versus-host disease (Scl-cGVHD). According to the preventive model described in Materials and Methods, MR16-1-treated recipients were injected intraperitoneally with 250μg per mouse of anti-CD25 mAb at days 0, 7, 21, and 35. (a) Body mass changes and (b) skin scores were assessed every 3 days. (c) Histopathological skin score, dermal thickness, skin trichrome area/total area, and skin soluble collagen were analyzed 42 days post bone marrow transplantation (BMT). (d) Representative of CD4+CD25+FoxP3+ regulatory T cells (Tregs) and CD4+CD25+ T cells in each experimental group. (e) Absolute number of splenic CD4+ T cells, (CD4+CD25+FoxP3+) Tregs, CD4+CD25+ T cells, and CD4+FoxP3+ T cells are shown. Each value indicates mean (±SEM) results from four to six mice. *, #P<0.05, **, ##P<0.01. Journal of Investigative Dermatology 2012 132, 2752-2761DOI: (10.1038/jid.2012.226) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions