Cheng-Chiu Huang, PhD, Yu Shin Kim, PhD, William P

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A histamine-independent itch pathway is required for allergic ocular itch Cheng-Chiu Huang, PhD, Yu Shin Kim, PhD, William P. Olson, BS, Fengxian Li, MD, Changxiong Guo, BA, Wenqin Luo, MD, PhD, Andrew J.W. Huang, MD, MPH, Qin Liu, PhD Journal of Allergy and Clinical Immunology Volume 137, Issue 4, Pages 1267-1270.e6 (April 2016) DOI: 10.1016/j.jaci.2015.08.047 Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Behavioral and cellular mechanisms of pruritogen-induced ocular itch. A, Behavioral distinction between ocular itch and pain in mice. B, Histamine-evoked scratching responses were reduced in TRPV1 KO mice (n = 5-9 per group). C, Chloroquine-induced scratching behavior was attenuated in TRPA1 KO mice (n = 6-13 per group). D, Serotonin evoked comparable number of scratching bouts among 3 genotypes (n = 7-14 per group). E, PBS elicited minimal and significantly less scratching responses than any group receiving pruritogen challenge (n = 5-9 per group). F, Imaging conjunctival nerve fiber activities using Pirt-GCaMP3 mouse. G, Whole-mount immunofluorescence of GCaMP3 signal in a PirtGCaMP3/+ conjunctiva. White arrow, GCaMP3+ sensory fiber. H-K, Responses of sensory fibers to pruritogens. Arrows in different colors indicate conjunctival fibers with differential receptivity to pruritogens. L, Percentage of GCaMP3+ conjunctival fibers activated by pruritogens among PirtGCaMP3/+, TRPA1 KO; PirtGCaMP3/+, and TRPV1 KO; PirtGCaMP3/+ mice (n ≥ 5 per group). Scale bar represents 100 μm. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Involvement of TRPA1 and TRPV1 in ocular itch of mast cell–dependent allergic conjunctivitis. A, Comparison of scratching behavior among OVA-sensitized WT, TRPA1 KO, and TRPV1 KO mice in response to conjunctival OVA challenge (n = 10-16 per group). B, Inflammatory cell infiltration and loss of goblet cell in allergic conjunctiva due to repeated OVA challenges. C, Pharmacological antagonism of TRPA1 and TRPV1 channels effectively attenuates ocular itch induced by allergic conjunctivitis (n = 6-9 per group). D, Comparison of scratching behavior in response to conjunctival prostaglandin E2 (PGE2) or PAF challenge (n = 6-12 per group). E, Topical Apafant alleviates allergic ocular itch (n = 8 per group). F, Synergistic activation of TRPA1 and TRPV1 by mast cell mediators confers ocular itch in allergic conjunctivitis. Scale bar represents 100 μm. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Sensory innervations of the mouse conjunctiva. A, Diagram of ocular itch pathway from conjunctival sensory fibers to brainstem nuclei (PrV/SpV). B-I, Detection of TRPA1 and TRPV1 mRNA expression by in situ hybridization. TG neurons innervating the conjunctiva are labeled by the retrograde tracer DiI. Yellow arrowheads indicate TRPA1+/DiI+ or TRPV1+/DiI+ neurons in the TG. J, Detection of TRPV1 protein in TG neurons innervating the conjunctiva by immunofluorescence. White arrows, TRPV1+/DiI+ TG neurons. K, Whole-mount histochemical staining of TRPV1-PLAP in mouse conjunctiva. Black arrow, TRPV1+ sensory fiber. L, Relation of TRPV1+ nerve terminals to conjunctival epithelium. Black arrows, TRPV1+ terminals. M, Whole-mount immunofluorescence of GFP signal in a TRPM8EGFPf/+ conjunctiva. White arrow, TRPM8+ sensory fiber. Epi, Epithelium; Str, stroma. Scale bars represent in B to I, 100 μm; J, 50 μm; K and M, 100 μm; L, 20 μm. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 TRPA1 and TRPV1 are not required for allergen-induced mast cell degranulation. A, No difference in conjunctival mast cell degranulation was observed among 3 genotypes. White arrows, OVA-sensitized conjunctival mast cells. Red arrows, activated conjunctival mast cells by OVA. Scale bars represent 100 μm; 20 μm in insets. B, Quantitative analysis of mast cell degranulation among 3 genotypes. N ≥ 3 mice and >200 mast cells were analyzed per group. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 TRPA1 is required for PAF-induced Ca2+ mobilization in sensory neurons. A, PAF activates a subset of TRPA1+ neurons from the TG. Increased Ca2+ mobility on PAF (10 μM) and allyl isothiocyanate (AITC, TRPA1 agonist, 100 μM) treatment in PirtGCaMP3/+ TG neurons. Arrows indicate neurons that are sensitive to both PAF and AITC. B, Calcium traces of TG neurons that responded to PAF and AITC in A. C, PAF-induced Ca2+ mobility in TG neurons was significantly attenuated in TRPA1 KO mice. N ≥ 3 mice and >400 TG neurons were analyzed per group. Scale bar represents 100 μm. *P < .05. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Behavioral responses of pruritogen-induced and allergy-induced skin itch. A, Scratching responses induced on the intradermal injection of OVA solution into the back skin in an allergic skin itch model. TRPA1 KO mice showed only marginally fewer scratching bouts than did the WT group, but did not differ from the TRPV1 KO mice (n = 9-14 per group). B, No difference in degranulation of skin mast cell was observed among 3 genotypes. N ≥ 3 mice and >500 mast cells were analyzed per group. C-E, Histamine-dependent itch was reduced in TRPV1 KO mice. Chloroquine-dependent itch was reduced in TRPA1 KO mice. No difference was shown among genotypes in serotonin-induced itch (n = 7-12 per group). Scale bars represent 50 μm; 10 μm in insets. ns, Not significant. ***P < .001. Journal of Allergy and Clinical Immunology 2016 137, 1267-1270.e6DOI: (10.1016/j.jaci.2015.08.047) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions