Early-life chlamydial lung infection enhances allergic airways disease through age- dependent differences in immunopathology Jay C. Horvat, PhD, Malcolm.

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Early-life chlamydial lung infection enhances allergic airways disease through age- dependent differences in immunopathology Jay C. Horvat, PhD, Malcolm R. Starkey, BBioMedSci(Hon), Richard Y. Kim, BBioMedSci(Hon), Simon Phipps, PhD, Peter G. Gibson, MBBS, Kenneth W. Beagley, PhD, Paul S. Foster, PhD, Philip M. Hansbro, PhD Journal of Allergy and Clinical Immunology Volume 125, Issue 3, Pages 617-625.e6 (March 2010) DOI: 10.1016/j.jaci.2009.10.018 Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Study protocols. Neonatal, infant, or adult mice were infected intranasally (IN) with C muridarum (Cmu) and 45 days later sensitized intraperitoneally (IP) and challenged IN with ovalbumin (Ova) to induce allergic airways disease. Key features of allergic airways disease were characterized 1 day after the final Ova challenge on day 61. Day 0, Infection at <24 hours (neonates), 3 weeks (infants), or 6 weeks (adults) of age. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Early-life infection increases airway mucus-secreting cells, IL-13 expression in lung tissue, and AHR in allergic airways disease in later life. A, Mucus-secreting cells surrounding the airway lumen. B, Relative abundance of IL-13 mRNA in lung tissue. C, AHR in terms of averaged peak airways resistance at the maximal methacholine dose (50 mg/mL) administered. For the entire dose response curves, see Fig E4. Black bars represent allergic groups, whereas white bars represent nonallergic groups. Results are representative of 2 or 3 independent experiments, and combined results are presented as means ± SEMs where n ≥ 8 individual mice. #Significant differences compared with uninfected, allergic (Ova) control; ∗significant differences compared with uninfected, nonallergic (Sham) control. #/∗P < .05; ##/∗∗P < .01; ###/∗∗∗P < .001. Group abbreviations: Ova, uninfected, allergic groups; Neo/Ova, Inf/Ova, and Ad/Ova, neonatal, infant, and adult infected, allergic groups, respectively; Sham, uninfected, nonallergic groups; Neo, Inf, and Ad, neonatal, infant, and adult infected, nonallergic groups, respectively. Uninfected controls (Ova and Sham) were 6 weeks old at the time of sensitization. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Early-life infection differentially affects pulmonary eosinophil influx and ovalbumin-specific cytokine responses in MLNs during allergic airways disease in later life. A, Eosinophil numbers within 100 μm of airway basement membrane. Ovalbumin-specific IFN-γ (B), IL-5 (C), IL-13 (D), and IL-10 (E) release in MLN culture supernatants. F, CD4+CD25+forkhead box protein 3+ Treg cell numbers in MLNs. Black bars represent allergic groups, whereas white bars represent nonallergic groups. Results are representative of 2 or 3 independent experiments, and combined results are presented as means ± SEMs where n ≥ 8 individual mice. #Significant differences compared with uninfected, allergic (Ova) control; ∗significant differences compared with uninfected nonallergic (Sham) control. #/∗P < .05; ##/∗∗P < .01; ###/∗∗∗P < .001. Group abbreviations: Ova, uninfected, allergic groups; Neo/Ova, Inf/Ova, and Ad/Ova, neonatal, infant, and adult infected, allergic groups, respectively; Sham, uninfected, nonallergic groups; Neo, Inf, and Ad, neonatal, infant, and adult infected, nonallergic groups, respectively. Uninfected controls (Ova and Sham) were 6 weeks old at the time of sensitization. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Early-life infection alters the numbers of activated mDCs in MLNs during allergic airways disease in later life. A-C, Number of activated (MHC II+) CD11c+CD11b+B220- mDCs in MLNs in neonatal, infant, and adult infected groups, respectively. Black bars represent allergic groups, whereas white bars represent nonallergic groups. Results are representative of 2 or 3 independent experiments, and combined results are presented as means ± SEMs where n ≥ 8 individual mice. #Significant differences compared with uninfected, allergic (Ova) control; ∗significant differences compared with uninfected, nonallergic (Sham) control. #P < .05; ###/∗∗∗P < .001. Group abbreviations: Ova, uninfected, allergic groups; Neo/Ova, Inf/Ova, and Ad/Ova, neonatal, infant, and adult infected, allergic groups, respectively; Sham, uninfected, nonallergic groups; Neo, Inf, and Ad, neonatal, infant, and adult infected, nonallergic groups, respectively. All controls are age-matched. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Early-life infection alters systemic DC function in later life. A-C, Systemic ovalbumin-peptide pulsed DC-induced IL-13 release by ovalbumin-peptide–specific CD4+ T cells; DCs were from infected nonallergic neonatal, infant, and adult groups, respectively. Results are representative of 2 or 3 independent experiments and combined results are presented as means ± SEMs where n ≥ 8 individual mice. ∗Significance compared with uninfected, nonallergic (Sham) control. Group abbreviations: Neo, Inf, and Ad, neonate, infant, and adult infected, nonallergic groups, respectively; Sham, uninfected, nonallergic groups. All controls are age-matched. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Neonatal infection increases alveolar size in later life. A, Photomicrographs of representative lung sections 9 weeks after infection (×40 magnification; scale bars represent 50 μm). B, Alveolar diameter of hematoxylin and eosin–stained lung sections. Black bars represent infected groups, whereas white bars represent uninfected groups. Results are representative of 2 or 3 independent experiments, and combined results are presented as means ± SEMs where n ≥ 8 individual mice. ∗Significance compared with uninfected, nonallergic (Sham) control. ∗∗∗P < .001. Group abbreviations: Neo, Inf, and Ad, neonatal, infant, and adult groups, respectively. Sham indicates uninfected control groups. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Infant C muridarum lung infection Infant C muridarum lung infection. Mice were infected at 3 weeks of age with 100 inclusion forming units (ifu) of C muridarum (Cmu), and pulmonary Cmu numbers and histopathology were determined over a 9-week period (A). Weight gain after infant (Inf) infection (B). Results are presented as means ± SEMs from n ≥ 4. Significant differences in Cmu numbers between days 0 and 10 and between days 15 and 20 are shown as #P <.05 and ##P <.01. Significant differences in histopathology between days 0 and 10 and days 10 and 45 are shown as ∗P <.05. Significant differences in rate of weight gain between days 8 and 10 of infected (Inf) compared with uninfected (Sham) infant mice are shown as ∗P <.05. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Age of sensitization does not affect airways mucus-secreting cell numbers, IL-13 expression in lung tissue, AHR, or eosinophil numbers in allergic airways disease. Mice were sensitized intraperitoneally and challenged intranasally with ovalbumin (Ova) to induce allergic airways disease in mice 6, 9, or 12 weeks old. Airways mucus-secreting cells (A), IL-13 expression in lung tissue (B), AHR in terms of averaged peak airways resistance (upper panel) and dynamic compliance (lower panel) in response to increasing doses of methacholine (C), and airways eosinophil numbers (D). Results are presented as means ± SEMs from n ≥ 4. ∗Significance compared with uninfected, nonallergic (Sham) controls. ∗P < .05; ∗∗P < .01. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Age of sensitization does not affect TH2-cytokine responses in allergic airways disease. Mice were sensitized intraperitoneally and challenged intranasally with ovalbumin to induce allergic airways disease in mice 6, 9, or 12 weeks old. Ovalbumin-specific IFN-γ (A), IL-5 (B), IL-13 (C), and IL-10 (D) release in MLN culture supernatants were determined. Results are presented as means ± SEMs from n ≥ 4. ∗P < .05. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Early-life infection enhances AHR in allergic airways disease in later life. AHR in terms of averaged peak airways resistance (upper panels) and dynamic compliance (lower panels) in response to increasing doses of methacholine and comparison of statistical differences across whole curves. Results are representative of 2 or 3 independent experiments, and combined results are presented as means ± SEMs where n ≥ 8 individual mice. ∗P < .05; ∗∗P < .01; ∗∗∗P < .001. Group abbreviations: Ova, Uninfected, allergic groups; Neo/Ova, Inf/Ova, and Ad/Ova, neonatal, infant, and adult infected, allergic groups, respectively; Sham, uninfected, nonallergic groups; Neo, Inf, and Ad, neonatal, infant, and adult infected, nonallergic groups, respectively. Uninfected controls (Ova and Sham) were 6 weeks old at the time of sensitization. Journal of Allergy and Clinical Immunology 2010 125, 617-625.e6DOI: (10.1016/j.jaci.2009.10.018) Copyright © 2010 American Academy of Allergy, Asthma & Immunology Terms and Conditions