Neutrophils in antiretroviral therapy–controlled HIV demonstrate hyperactivation associated with a specific IL-17/IL-22 environment  Laure Campillo-Gimenez,

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Neutrophils in antiretroviral therapy–controlled HIV demonstrate hyperactivation associated with a specific IL-17/IL-22 environment  Laure Campillo-Gimenez, PhD, Sarah Casulli, PhD, Yasmine Dudoit, MS, Sophie Seang, MD, Guislaine Carcelain, MD, PhD, Sidonie Lambert-Niclot, PharmD, PhD, Victor Appay, PhD, Brigitte Autran, MD, PhD, Roland Tubiana, MD, Carole Elbim, MD, PhD  Journal of Allergy and Clinical Immunology  Volume 134, Issue 5, Pages 1142-1152.e5 (November 2014) DOI: 10.1016/j.jaci.2014.05.040 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Highly activated circulating PMNs from HIV-infected patients. A and B, Expression of cell-surface molecules on resting PMNs was studied on whole-blood samples maintained at 4°C. One histogram representative of CD62L, CD11b, and CD16b expression at the surface of PMNs from HCs (black) and HIV-infected patients (white) is shown; the isotype control is shown in gray (Fig 1, A). Average mean fluorescence intensity (MFI) in each group is shown in Fig 1, B. C, Production of ROS by unstimulated PMNs. D, Spontaneous PMN death was measured by incubating whole-blood samples with PBS for 20 hours at 37°C; results are expressed as percentages of apoptotic (left) and necrotic (right) PMNs. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Lack of monocyte activation in HIV-infected patients. A, Surface expression of CD44 and CD11b on monocytes was evaluated as mean fluorescence intensity (MFI) on total CD14+ cells; HLA-DR expression on monocytes was estimated by the percentage of CD14+ cells that highly expressed HLA-DR. B, Serum level of sCD14. C, Average percentages of classical, intermediate, and proinflammatory monocytes among total CD14+ cells in each group. D, Percentage of proinflammatory monocytes that expressed the MDC-8 marker. E, ROS production by unstimulated monocytes. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Higher level of PMN activation in HIV-infected patients with a history of inflammatory diseases than in the HIV-infected patients without inflammatory diseases. A, Expression of cell-surface molecules (CD62L, CD11b, and CD16b) on resting PMNs. B, ROS production by unstimulated PMNs. C, Percentages of apoptotic and necrotic PMNs. All measurements were made in HCs and patients from the HIV(I) and HIV(NI) groups. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Similar level of monocyte and T-cell activation in HIV-infected patients with a history of inflammatory diseases and HIV-infected patients without inflammatory diseases. A-D, CD44, CD11b, and HLA-DR expression on monocytes (Fig 4, A); serum level of sCD14 (Fig 4, B); ROS production by unstimulated monocytes (Fig 4, C); and percentages of proinflammatory monocytes that expressed the MDC-8 marker (Fig 4, D). E and F, Percentage of memory CD3+CD8+ cells (left) or CD3+CD4+ cells (right) that expressed both CD38 and HLA-DR (Fig 4, E) or CD57 (Fig 4, F) markers. All measurements were made in HCs and patients in the HIV(I) and HIV(NI) groups. **P < .01 and ***P < .001. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Specific cytokine environment in HIV-infected patients. A-C, Serum levels of IL-18 (left), TGF-β (middle), and IL-22 (right; Fig 5, A) and percentages of total IL-17+ (Fig 5, B) and IL-22+ (Fig 5, C) cells in HCs (n = 22) and HIV-infected patients (n = 60). D-F, Percentage of IL-17+ (Fig 5, D) or IL-22+ (Fig 5, E) cells among PBMCs and serum IL-22 concentration (Fig 5, F) in HCs and patients in the HIV(I) and HIV(NI) groups. G, Correlation between the percentage of total IL-17+ cells and CD11b (left) or CD62L (middle) expression on resting PMNs and ROS production by unstimulated PMNs (right). *P < .05 and **P < .01. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Model for HIV-associated PMN hyperactivation. HIV-1 activates the inflammasome, leading to production of IL-18, which, combined with TGF-β, plays a role in the expansion of IL-17–producing cells. IL-17 production in tissue leads to IL-8 secretion by endothelial cells, which in turn induces massive recruitment and activation of PMNs. IL-18 might also activate PMNs directly; this in turn might produce IL-18. Cytotoxic contents released by activated and necrotic PMNs lead to tissue injury. Vascular and tissue lesions might be counteracted by IL-22, depending on the level of this cytokine. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Normal functional capacities of PMNs from HIV-infected patients depending on the agonist. A and B, CD62L (Fig E1, A) and CD11b (Fig E1, B) expression on the PMN surface was measured after incubation of whole-blood samples for 45 minutes with PBS, TLR1/2 agonist, TLR4 agonist, or TNF-α. C, ROS production by PMNs was measured after pretreatment of whole-blood samples for 45 minutes with PBS, TLR1/2 agonist, TLR4 agonist, or TNF and stimulation for 5 minutes with formyl-methionyl-leucyl-phenylalanine (fMLP). D, PMN survival was analyzed by incubating whole-blood samples with PBS, TLR1/2 agonist, or TLR4 agonist for 20 hours at 37°C; the percentage of apoptotic PMNs was determined, as described in the legend of Fig 1. All measurements were taken in HCs and HIV-infected patients. Values are means ± SEMs. ***P < .001. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Levels of T-cell activation and immunosenescence. A, Percentage of memory CD3+CD8+ (upper panel) or CD3+CD4+ (lower panel) cells that express both CD38 and HLA-DR markers. B, Percentage of memory CD3+CD8+ (upper panel) or CD3+CD4+ (lower panel) cells that express the CD57 marker. Memory cells were defined by means of Boolean gating with Kaluza Software (CD4+ or CD8+ and not naive cells). C, Correlation between markers of T-lymphocyte activation and T-lymphocyte immunosenescence. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Cytokine quantification in HIV-infected patients. Multiple cytokines and chemokines were quantified in serum from HCs and HIV-infected patients. IL-23, IL-21, and IL-1β levels were measured by means of ELISA, whereas IL-17A/F, monocyte chemoattractant protein 1 (MCP-1), IL-8, IL-6, TNF-α, IL-10, IFN-α, and GM-CSF were detected by using the Cytometric Bead Array. *P < .05. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Intracellular cytokine analysis. A, Gating process. Cells were first gated on the basis of forward-scatter (FS) and side-scatter (SS) characteristics (gate A). Then only singlets (gate B) and live cells (defined by the Fixable Viability marker eF450) were included in the analysis. B, Representative dot plots of IL-17+ cells after incubation without (NS) or with staphylococcal enterotoxin B (SEB) in 1 HC and one HIV-infected patient. The negative control used isotype fluorochrome-conjugated antibodies (Iso) corresponding to anti–IL-17 fluorochrome-conjugated antibody. C, Percentage of total IL-17+ (left) and IL-22+ (right) cells among PBMCs after SEB stimulation in HC and HIV-infected patients with (HIV[I]) or without (HIV[NI]) inflammatory diseases. D, After gating on total IL-17+ or IL-22+ cells, phenotype analyses were performed. We used the expression of CD3 and CD4 markers to define T helper cells, the CD14 marker to define monocytes, and the iNKT (TCRVα24-Vβ11) and Tγδ (TCRγδ) markers. Each selected dot plot represents 1 HIV-infected patient. Journal of Allergy and Clinical Immunology 2014 134, 1142-1152.e5DOI: (10.1016/j.jaci.2014.05.040) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions