Kathleen R. Bartemes, BA, Gail M. Kephart, BS, Stephanie J

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Enhanced innate type 2 immune response in peripheral blood from patients with asthma Kathleen R. Bartemes, BA, Gail M. Kephart, BS, Stephanie J. Fox, MD, Hirohito Kita, MD Journal of Allergy and Clinical Immunology Volume 134, Issue 3, Pages 671-678.e4 (September 2014) DOI: 10.1016/j.jaci.2014.06.024 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 IL-33 or IL-25 induce antigen-independent type 2 cytokine production by human PBMCs. PBMCs were cultured without antigen for 7 days with increasing concentrations of IL-33 (A) or IL-25 (B) in the presence or absence of 20 U/mL IL-2. IL-5 and IL-13 levels in the supernatants were determined by using ELISA. Data are the mean ± SEM of 30 subjects. *P < .05; **P < .01, compared with IL-2 alone or between groups as indicated by horizontal bars. C, PBMCs were cultured with medium, IL-33 alone (10 ng/mL), IL-25 alone (0.4 ng/mL), or in combination with IL-2 (20 U/mL), IL-7 (10 ng/mL), or TSLP (10 ng/mL). IL-5 levels in the supernatants were determined. Data are the mean ± SEM of 6 experiments. *P < .05 compared with IL-33 alone or IL-25 alone. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Lin− cells are necessary for IL-25- and IL-33–induced IL-13 production. PBMCs from subjects with AA and skin test-positive for house-dust mite (HDM) were separated into 2 fractions, the Lin+ with Lin− cell fraction and the Lin+ cell alone fraction. The Lin+ with Lin− cell fraction contained 82.0% Lin+ cells and 18.0% Lin− cells; the Lin+ cell alone fraction contained 99.5% Lin+ cells and 0.5% Lin− cells. The fractions were cultured with HDM extract (25 μg/mL), IL-25 or IL-33 (10 ng/mL) plus IL-2 (20 U/mL), or combinations of the HDM extract and cytokines for 7 days. A, IL-13 levels in cell-free supernatants of the Lin+ with Lin− cell fraction were determined. B, IL-13 levels in cell-free supernatants of the Lin+ cell alone fraction are presented as the ratio of the Lin+ cell alone fraction divided by the Lin+ with Lin− cell fraction from the same donor. Data are the mean ± SEM of 3 subjects. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Circulating ILC2s in peripheral blood respond to IL-33 ex vivo. A, Gating strategy to isolate ILC2s and other Lin− and Lin+ cell populations. Lin− lymphocytic cells were subdivided into 3 populations on the basis of CD127 and CRTH2 expression. Red boxes (labeled 1-4) indicate the sorted cells. B, Sorted cell populations from A were stimulated for 5 days with medium alone or IL-33 (10 ng/mL) plus IL-2 (20 U/mL). Levels of IL-5, IL-13, and IFN-γ in cell-free supernatants were measured using Milliplex. Data shown are the mean ± SEM of 3 independent experiments. **P < .01 compared with medium alone. C, ILC2s (Box 1 in A) were cultured for 5 days with IL-33 plus IL-2. Cell morphology is shown before and after culture by staining the cytospin preparations with Wright Giemsa. Scale bar = 10 μm. FSC, Forward scatter; SSC, side scatter. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 PBMCs from patients with AA show enhanced type 2 responses to IL-33 or IL-25. A, PBMCs from HC subjects, subjects with AR, or subjects with AA were cultured for 7 days with medium alone, IL-2 (20 U/mL) alone, IL-2 plus IL-33 (20 U/mL and 10 ng/mL, respectively), or IL-2 plus IL-25 (20 U/mL and 0.4 ng/mL, respectively). IL-5 (left) and IL-13 (right) levels in cell-free supernatants were determined using ELISA. Data shown are box and whisker plots (10th, 25th, 50th, 75th, and 90th percentile) of 14 or 15 subjects per group. *P < .05; **P < .01, between the groups indicated by horizontal bars. B, ILC2s in PBMCs were identified and enumerated using flow cytometry as described in Fig 2, A. Proportion of ILC2s in PBMCs and the total number of PBMCs per milliliter of blood are shown as the mean ± SEM (n = 6 per group). *P < .05, between the groups indicated by the horizontal bar. C, Total numbers of ILC2s per milliliter of blood were calculated. Each dot represents 1 patient, and horizontal bars indicate the mean for each group. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 CD3+ T cells are unnecessary for type 2 immune response to IL-25. Intact PBMCs (Intact) or PBMCs from which CD3+ cells had been magnetically depleted (CD3-depleted) were cultured with medium, IL-25 (10 ng/mL) alone, IL-2 (20 U/mL) alone, or IL-2 plus IL-25 for 5 days. IL-5 and IL-13 levels in cell-free supernatants were determined using ELISA. Data are the mean ± SEM of 2 to 5 independent experiments. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Blood ILC2s express the IL-33 receptor ST2 and respond to IL-33 in vitro. A, Gating strategy to identify ILC2s in PBMCs. In the histogram, anti-human ST2 staining (black line) and isotype control antibody staining (filled gray) are shown. B, PBMCs were cultured with medium alone or with IL-33 (10 ng/mL) plus IL-2 (20 U/mL) for 4 days. Brefeldin A was added for the last 12 hours. Top panels, Gating strategy for ILC2 identification. Bottom panels, Intracellular IL-5 staining in ILC2s cultured with medium alone (left panel, red line) or with IL-33 plus IL-2 (right panel, blue line) is shown. Gray-filled histograms depict isotype control staining for each culture condition. FSC, Forward scatter; SSC, side scatter. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Blood ILC2s from HC subjects and subjects with AA express comparable levels of ST2. PBMCs from the 2 subject groups were gated as described in Fig E2, and ST2 expression was analyzed. In the histogram, anti-human ST2 staining is indicated by the blue line and isotype control staining is depicted by the filled gray area. Representative data from 3 HC subjects and 3 subjects with AA are shown. Journal of Allergy and Clinical Immunology 2014 134, 671-678.e4DOI: (10.1016/j.jaci.2014.06.024) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions