Food Allergy Herbal Formula-2 silences peanut-induced anaphylaxis for a prolonged posttreatment period via IFN-γ–producing CD8+ T cells Kamal D. Srivastava,

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Food Allergy Herbal Formula-2 silences peanut-induced anaphylaxis for a prolonged posttreatment period via IFN-γ–producing CD8+ T cells Kamal D. Srivastava, MPhil, Chunfeng Qu, MD, PhD, Tengfei Zhang, PhD, Joseph Goldfarb, PhD, Hugh A. Sampson, MD, Xiu-Min Li, MD Journal of Allergy and Clinical Immunology Volume 123, Issue 2, Pages 443-451 (February 2009) DOI: 10.1016/j.jaci.2008.12.1107 Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Experimental design. C3H/HeJ mice were subjected to weekly intragastric peanut (PN) sensitization from week 0 through week 5 and boosted thereafter at weeks 6 and 8. Peanut-allergic mice were treated with FAHF-2 (32 mg, twice a day), or water beginning at week 8 (at which time peanut hypersensitivity is fully established15) and continued daily for 7 weeks. Mice were challenged at week 14 (first challenge) and 6 subsequent peanut challenges at the intervals indicated. Sham: peanut-sensitized and boosted mice receiving water treatment (n = 13 at first through sixth challenges and n = 12 at the seventh challenge); FAHF-2: peanut-sensitized and boosted mice receiving FAHF-2 treatment (n = 8); naive: neither sensitized nor treated. Twenty naive mice served as controls. Because naive mice do not respond to peanut challenge,15 only 5 naive mice at week 14 and 5 at week 18 received peanut challenge. The remaining 10 mice were not challenged until week 50 to maintain naive status; however, plasma and serum samples were collected at the time of each challenge (weeks 22-40) and body temperatures were recorded to generate normal control data. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 FAHF-2 treatment prevented a decrease in body temperature, histamine release, and mast cell degranulation. A, Postchallenge body temperatures. Body temperatures were measured immediately after evaluation of symptom scores. Data are means ± SEMs. The numbers of mice are as follows: sham (12-13), FAHF-2 (8), naive (5-10). ∗∗∗P < .001 vs sham. B, Plasma histamine levels. Blood was collected immediately after scores and temperatures were recorded after each posttherapy challenge, and plasma was obtained. Histamine levels were measured by using an enzyme immunoassay. Data points indicate group means ± SEMs, n = same as indicated in A. The scale of the x-axis is not linear. C, Illustration of mast cell degranulation. Ear tissue samples were taken 40 minutes after seventh challenge and stained with toluidine blue. Mast cells were considered degranulated if at least 5 granules appeared outside the cell body. Arrows indicate deregulated mast cells. D, Percent of degranulated mast cells. Mast cells were counted using light microscopy at ×100. A total of 500 cells were counted from 3 sections of each ear sample for calculation of the percentage of degranulated cells. Data points indicate group means ± SEMs, n = 4-5 mice/group from 1 set of experiments. ∗∗P < .01; ∗∗∗P < .001 vs sham; ###P < .001 vs naive. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 FAHF-2 treatment produced prolonged reduction in serum peanut (PN)–specific IgE and increased IgG2a levels. Sera were harvested after blood collection by retro-orbital bleeding at indicated time points. Serum peanut-specific IgE levels (A) and specific IgG2a levels (B) were determined by ELISA. Data points indicate group means ± SEMs, n as indicated in Fig 1. ∗P < .05; ∗∗P < .01; ∗∗∗P < .001 vs sham. The scale of the x-axis is not linear. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 FAHF-2 treatment reduced TH2 cytokine levels and increased IFN-γ secretion by specific modulation of CD4+ and CD8+ T cells. MLN cells and splenocytes were collected from each group of mice immediately after evaluation of clinical effect and blood drawing after the seventh challenge (week 50). MLN cells and splenocytes were prepared and stimulated with CPE for 72 hours. Cytokines in MLN culture supernatants (A) and splenocyte culture supernatants (B) were measured by ELISA. Data are shown as means ± SEMs of pooled cultures from a representative 1 of 2 experiments measured in triplicate (n = 5 mice per group). C-F, Cytokine production by isolated CD4+(solid bars) and CD8+ T cells (open bars) after the seventh challenge. Splenic CD8+ or CD4+ T cells isolated from each group of mice after final challenge were restimulated with irradiated syngeneic splenocytes and CPE for 72 hours. Cytokines in culture supernatants were measured by ELISA. Data shown are means ± SEMs of pooled cultures measured in triplicate (N = 5 mice/group). ∗∗P < .01; ∗∗∗P < .001 vs sham. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 IFN-γ is necessary for FAHF-2 suppression of TH2 responses and anaphylaxis. A, Serum peanut (PN)–specific IgE levels. Blood was collected by retro-orbital bleed 1 day before treatment (week 8) and first and second posttherapy challenges (weeks 14 and 18). Serum peanut-specific IgE was measured by ELISA. Data include group means ± SEMs from 5 mice/group. B, IL-4 levels in splenocyte cultures. splenocytes were prepared as in Fig 4 after the week 14 challenge. Cells were cultured in the presence or absence of CPE for 3 days. IL-4 levels were measured by ELISA. IL-4 is undetectable in unstimulated cell culture (data not shown). Data include group means ± SEMs, n = 5 mice/group. C, Anaphylaxis scores. Signs were visually assessed 25 to 30 minutes after the second challenge as described in the legend for Table I. Symbols indicate individual mice, and lines indicate group medians. D, Plasma histamine levels. Plasma was obtained after the second challenge immediately after anaphylactic score assessment. Histamine levels were measured by using an enzyme immunoassay. Symbols indicate individual mice. Lines indicate group means, n = 5/group. ∗P < .05; ∗∗P < .01; ∗∗∗P < .001 vs sham; #P < .05 and ##P < .01 vs FAHF-2. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 CD8+ T cells are important contributors to FAHF-2 inhibition of anaphylaxis and TH2 responses. A, Peanut (PN)–specific IgE. Blood was collected by retro-orbital puncture 1 day before treatment (week 8) and first and second posttherapy challenges (weeks 14 and 18). Serum peanut-specific IgE was measured by ELISA. Data include group means ± SEMs, n = 5 mice/group. B, Anaphylaxis scores. Anaphylactic signs were visually assessed 25 to 30 minutes after the second challenge as in Table I. C, Plasma histamine levels. Histamine level measured by enzymatic assay in plasma obtained after the second challenge immediately after assessment of anaphylaxis. Symbols indicate individual mice. Lines indicate group medians for anaphylactic scores and group means for histamine, n = 5/group. ∗P < .05; ∗∗P < .01; ∗∗∗P < .001 vs sham; #P < .05 and ##P < .01 vs FAHF-2. Journal of Allergy and Clinical Immunology 2009 123, 443-451DOI: (10.1016/j.jaci.2008.12.1107) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions