Dendritic cells from X-linked hyper-IgM patients present impaired responses to Candida albicans and Paracoccidioides brasiliensis  Otavio Cabral Marques,

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Dendritic cells from X-linked hyper-IgM patients present impaired responses to Candida albicans and Paracoccidioides brasiliensis  Otavio Cabral Marques, MSc, Christina Arslanian, BSc, Rodrigo Nalio Ramos, MSc, Mariana Morato, MSc, LenaFriederike Schimke, MD, Paulo Vitor Soeiro Pereira, MSc, Sonia Jancar, MD, PhD, Janaíra Fernandes Ferreira, MD, Cristina Worm Weber, MD, Gisele Kuntze, MD, Nelson Augusto Rosario-Filho, MD, PhD, Beatriz Tavares Costa Carvalho, MD, Patricia Cruz Bergami-Santos, PhD, Mary J. Hackett, BSc, Hans D. Ochs, MD, Troy R. Torgerson, MD, PhD, Jose Alexandre Marzagão Barbuto, MD, PhD, Antonio Condino-Neto, MD, PhD  Journal of Allergy and Clinical Immunology  Volume 129, Issue 3, Pages 778-786 (March 2012) DOI: 10.1016/j.jaci.2011.10.026 Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Normal expression and secretion of pattern recognition receptors by iDCs from patients with X-HIGM. Flow cytometric analysis of iDCs derived from peripheral blood monocytes (PBMs) in the presence of GM-CSF and IL-4 showed the expected CD14 downregulation (A). X-HIGM iDCs demonstrate normal expression of TLR2 and TLR4 (B) and secrete normal amounts of PTX3 compared with normal controls (C) (P < .05; n = 5, Mann-Whitney test). MFI, Mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 DCs from CD40L-deficient patients express reduced CD80, CD86, and HLA-DR levels that can be restored to normal levels by stimulation with sCD40L. Flow cytometric analysis of iDCs showing that cells from patients with X-HIGM express reduced levels of HLA-DR, CD80, and CD86 (A and B). mDCs incubated with sCD40L show expression of costimulatory and HLA-DR molecules at levels similar to those in normal controls (Fig 2, A and B). mDCs incubated with C albicans and P brasiliensis exhibit reduced expression of HLA-DR and CD80 but normal levels of CD86 (C) relative to normal controls. Significant differences are denoted by asterisk (P < .05; n = 5, Mann-Whitney test). MFI, Mean fluorescence intensity. Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 DCs from CD40L-deficient patients induced normal TH17 cell generation. Patients with X-HIGM showed a percentage of TH17 cells similar to that in normal controls after stimulation of T cells with iDCs, phorbol 12-myristate 13-acetate plus ionomycin, or C albicans–pulsed mDCs (A). The levels of IL-17 in cocultures of T cells with C albicans– or P brasiliensis–pulsed mDCs from patients with X-HIGM were also similar to those of normal controls (B) (P > .05 in all situations; n = 5, Mann-Whitney test). PMA, Phorbol 12-myristate 13-acetate. Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 IL-12 and IL-10 production by X-HIGM mDCs. mDCs from patients with X-HIGM secrete decreased IL-12 but increased IL-10 in response to P brasiliensis and C albicans. After sCD40L stimulation of X-HIGM mDCs, IL-12 and IL-10 secretions were restored to a pattern similar to that observed in healthy controls (A and B). Significant differences are denoted by asterisk (P < .05; n = 5, Mann-Whitney test). Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 X-HIGM DCs induce normal CD4+ and CD8+ T-cell proliferation in coculture. iDCs and P brasiliensis– or C albicans–pulsed mDCs from patients with X-HIGM (blue) showed a normal capacity to induce CD4+ and CD8+ T-cell proliferation compared with healthy control cells (red) (A and B) (P > .05 in all situations; n = 5, Mann-Whitney test). CFSE, 5,6-Carboxyfluorescein diacetate succinimidyl ester. Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 In cocultures, mDCs from CD40L-deficient patients skew T-cell response to a TH2 pattern. Lower levels of IFN-γ and higher IL-4 and IL-5 production (A-C) were detected in cells from patients with X-HIGM. This was reversed to a pattern similar to that in normal controls when X-HIGM mDCs were matured in the presence of sCD40L. Significant differences are denoted by asterisk (P < .05; n = 5, Mann-Whitney test). Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 The imbalanced production of IFN-γ and IL-4 is reversed by exogenous sCD40L. Supernatants of T cells cocultured with C albicans–pulsed mDCs from patients with X-HIGM showed reduced level of IFN-γ, which was upregulated by exogenous sCD40L (A), while increased level of IL-4 was downregulated (B). Significant differences are denoted by asterisk (P < .05; n = 5, Mann-Whitney test). Journal of Allergy and Clinical Immunology 2012 129, 778-786DOI: (10.1016/j.jaci.2011.10.026) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions