Regulated in development and DNA damage responses 1 (REDD1) links stress with IL- 1β–mediated familial Mediterranean fever attack through autophagy-driven.

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Regulated in development and DNA damage responses 1 (REDD1) links stress with IL- 1β–mediated familial Mediterranean fever attack through autophagy-driven neutrophil extracellular traps  Panagiotis Skendros, MD, PhD, Akrivi Chrysanthopoulou, PhD, François Rousset, MSc, Konstantinos Kambas, PhD, Athanasios Arampatzioglou, MSc, Alexandros Mitsios, BSc, Veronique Bocly, BSc, Theocharis Konstantinidis, MD, Philippe Pellet, BSc, Iliana Angelidou, MSc, Eirini Apostolidou, MD, Dimitrios Ritis, MSc, Victoria Tsironidou, BSc, Sotiris Galtsidis, PhD, Charalampos Papagoras, MD, PhD, Dimitrios Stakos, MD, PhD, Georgios Kouklakis, MD, PhD, Vasiliki Dalla, MD, PhD, Maria Koffa, PhD, Ioannis Mitroulis, MD, PhD, Ioannis Theodorou, MD, PhD, Konstantinos Ritis, MD, PhD  Journal of Allergy and Clinical Immunology  Volume 140, Issue 5, Pages 1378-1387.e13 (November 2017) DOI: 10.1016/j.jaci.2017.02.021 Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Journal of Allergy and Clinical Immunology 2017 140, 1378-1387 Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 REDD1 overexpression during FMF attacks. A and B, Transcriptomic (Fig 1, A) and heat map (Fig 1, B; false discovery rate < 0.05) analysis between neutrophils from patients with FMF attacks and neutrophils from patients in remission (n = 3). In Fig 1, A, β-tubulin (TUBB) is displayed as a negative control. C and D, REDD1 mRNA levels (Fig 1, C; n = 6) and REDD1 or p62/SQSTM1 immunoblotting (Fig 1, D; n = 4) in neutrophils from patients with FMF attacks in comparison with neutrophils from patients in FMF remission and those from control subjects. In Fig 1, A and C, data are presented as means ± SDs. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 REDD1 induction leads to autophagy-mediated NET release. A, Induction of REDD1 in neutrophils from patients in FMF remission compared with neutrophils from control subjects. B and C, REDD1-induced autophagy assessed with LC3B staining (red, LC3B; blue, 4′,6-diamidino-2-phenylindole [DAPI]/DNA; Fig 2, B) or p62/SQSTM1 immunoblotting (Fig 2, C). D and E, REDD1-induced NET release is autophagy mediated. F, Induction of NET release in neutrophils from patients in FMF remission compared with those from control subjects. G, REDD1 expression in neutrophils from control subjects compared with those from patients in FMF remission treated with sera from patients with FMF attacks. H, Induction of NET release in neutrophils from patients in FMF remission. Fig 2, D and H, Green, neutrophil elastase (NE); red, CitH3. In Fig 2, A-H, n = 6. Bars show means ± SDs. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 The microenvironment in patients with FMF attacks is required for IL-1β expression on REDD1-induced NETs. Neutrophils from patients in FMF remission were treated with REDD1 inducer, sera from patients with FMF attacks, and a combination of these, as assessed by means of confocal microscopy (green, IL-1β, red, neutrophil elastase [NE]; A) and immunoblotting of purified NET proteins (B; n = 4). Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Regulation of IL-1β bioactivity by REDD1-induced autolysosomes in neutrophils. A-C, Neutrophils from control subjects (Fig 4, A) or neutrophils from patients in FMF remission (Fig 4, B) treated with sera from patients with FMF attacks in the presence of REDD1 inducer (10 μmol/L) and ex vivo isolated neutrophils from patients with FMF attacks (Fig 4, C; magenta, REDD1; green, pyrin or NALP3; red, LysoTracker). D and E, IL-1β expression in purified NET proteins (Fig 4, D) or on isolated NET structures from neutrophils from control subjects or neutrophils from patients in FMF remission on treatment with sera from patients with FMF attacks in the presence of REDD1 inducer (10 μmol/L; Fig 4, E). F, IL-1β protein expression in PBMCs from control subjects treated with NET structures generated by double-stimulated neutrophils from patients in FMF remission or control subjects. Fig 4, A-F, n = 4. Data are presented as means ± SDs. IOD, Integrated optical density. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Effect of epinephrine in neutrophils from patients in FMF remission. A, REDD1 expression levels in neutrophils treated with epinephrine (1 nmol/L; mean ± SD). B, NET release from neutrophils treated with epinephrine (1 nmol/L) in the presence or absence of sera from patients with FMF attacks (green, IL-1β; red, neutrophil elastase [NE]). Fig 5, A and B, n = 4. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 REDD1 expression in patients with inflammatory diseases. A and B, REDD1 expression in neutrophils from patients with FMF attacks, active AOSD, or acute bacterial infections compared with healthy control subjects (Fig 6, A) and in neutrophils from control subjects treated with corresponding serum (Fig 6, B). Data are presented as means ± SDs. n.s., Not significant. ∗P < .05. C, Heat map analysis of REDD1 expression between neutrophils from selected similarly aged patients (FMF, AOSD, infections) with attack and those from the same patients in remission and after in vitro stimulation of neutrophils from control subjects with corresponding serum. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 Neutrophil IL-1β/CitH3 expression in patients with inflammatory diseases. Representative scatter plots (A) and data from flow cytometry of CitH3-positive and/or IL-1β–positive ex vivo isolated neutrophils from patients with autoinflammatory diseases compared with those from patients with infections or healthy control subjects (B-D). In Fig 7, B and C, data are presented as means ± SDs. n.s., Not significant. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Differentially expressed genes between patients with FMF in remission and control subjects (cutoff false discovery rate < 0.05). β-Tubulin (TUBB) is displayed as a negative control and has no difference of expression. Data are presented as means ± SDs. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Increase in the autophagy level of neutrophils from patients in FMF remission in the presence of a high dose of REDD1 inducer. Autophagy induction assessed with LC3B staining in neutrophils from patients in FMF remission treated with different doses of REDD1 inducer are shown (confocal microscopy; red, LC3B; blue, 4′,6-diamidino-2-phenylindole [DAPI]/DNA; n = 6). Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 IL-1β protein expression in PBMCs from control subjects treated with NET structures derived from neutrophils from control subjects on treatment with sera from patients with FMF attacks in the presence of REDD1 inducer (10 μmol/L; n = 4). Anakinra was used as an inhibitor of IL-1β signaling. GAPDH, Glyceraldehyde-3-phosphate dehydrogenase. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Expression of IL-1β on NETs released from neutrophils obtained from patients with AOSD. Localization of IL-1β in NETs from patients with AOSD during active disease compared with those released from patients with bacterial infections is shown (confocal microscopy; green, IL-1β; red, neutrophil elastase [NE]; blue, 4′,6-diamidino-2-phenylindole [DAPI]/DNA; n = 5). Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 IL-1β/CitH3 expression in neutrophils from control subjects stimulated in vitro with sera from patients with FMF attacks or sepsis or healthy control sera. Representative scatter plots (A) and data from flow cytometry of CitH3- or IL-1β–positive neutrophils (B and C) are shown. In Fig E5, B and C, data are presented as means ± SDs. Fig E5, B and C, n = 5. ∗P < .05. Journal of Allergy and Clinical Immunology 2017 140, 1378-1387.e13DOI: (10.1016/j.jaci.2017.02.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions