Pulmonary sarcoidosis is associated with exosomal vitamin D–binding protein and inflammatory molecules  Maria-Jose Martinez-Bravo, PhD, Casper J.E. Wahlund,

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Pulmonary sarcoidosis is associated with exosomal vitamin D–binding protein and inflammatory molecules  Maria-Jose Martinez-Bravo, PhD, Casper J.E. Wahlund, MSc, Khaleda Rahman Qazi, PhD, Robert Moulder, PhD, Ana Lukic, MSc, Olof Rådmark, PhD, Riitta Lahesmaa, PhD, Johan Grunewald, MD, PhD, Anders Eklund, MD, PhD, Susanne Gabrielsson, PhD  Journal of Allergy and Clinical Immunology  Volume 139, Issue 4, Pages 1186-1194 (April 2017) DOI: 10.1016/j.jaci.2016.05.051 Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Protein profiles of BALF exosomes captured by anti–MHC class II–coated latex beads and analyzed by using flow cytometry. A and B, Exosome markers tetraspanin CD63 and CD9. C and D, Expression of HLA-DR and CD54 on exosomes. MFI, Mean fluorescence intensity normalized to isotype controls. Open circles indicate patients with Löfgren syndrome, and solid circles represent patients with chronic sarcoidosis. **P < .01, Mann-Whitney or Kruskal-Wallis test (the latter for patients with Löfgren syndrome/patients with non-Löfgren disorders/healthy subjects). Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Summary of the biological processes affected in BALF exosomes from patients with sarcoidosis compared with those from healthy control subjects, as measured by using iTRAQ. DAVID, a functional annotation clustering tool, was used to group related biological processes. Annotation clusters with an upregulated and downregulated expression score of greater than 2 are shown. Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Activating and inhibiting proteins involved in the complement cascade show a different profile in BALF exosomes from patients with sarcoidosis and healthy control subjects, as measured by using iTRAQ. Abundance of proteins is related to the internal control. Bars represent relative linear protein abundance in patients with sarcoidosis and healthy control subjects. Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 CD55 levels are lower in BALF exosomes from patients than in those from healthy control subjects, as measured by using iTRAQ and flow cytometry. A, Relative abundance of CD55 compared with a pooled reference, as measured by using iTRAQ in patients with sarcoidosis and healthy control subjects. B, CD55 levels on exosomes bound to anti-CD63–coated beads and measured by using flow cytometry adjusted to isotype-matched control. Open circles indicate patients with Löfgren syndrome, and solid circles indicate patients with chronic sarcoidosis. **P < .01, Mann-Whitney or Kruskal-Wallis test (the latter for patients with Löfgren syndrome/patients with non-Löfgren disorders/healthy subjects). Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 BALF exosomes from patients carry more complement C3 than those of healthy control subjects. A, Relative abundance of C3 compared with an internal pooled reference measured by using iTRAQ in patients with sarcoidosis and healthy control subjects. B, C3 levels on exosomes bound to CD63-coated beads and measured by using flow cytometry adjusted to isotype-matched controls. C, Western Blot analysis of C3 in protein isolates from BALF exosomes of patients with sarcoidosis (P1-P6) and healthy control subjects (H1-H5). Before transfer, the gel was scanned for total protein contents; relative intensities correlating with protein amounts are plotted in percentage of the strongest sample. MW, Molecular weight marker. Open circles indicate patients with Löfgren syndrome, and solid circles indicate patients with chronic sarcoidosis. **P < .01, Mann-Whitney or Kruskal-Wallis test (the latter for patients with Löfgren syndrome/patients with non-Löfgren disorders/healthy subjects). Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 BALF exosomes carry LT pathway enzymes. A, LTA4H in BALF exosomes detected by using iTRAQ in patients with sarcoidosis and healthy subjects. Open circles indicate patients with Löfgren syndrome, and solid circles indicate patients with chronic sarcoidosis. B, Western blot analysis of 5-LO and LTA4H in patients (S) and healthy control subjects (H). C, Quantitative analysis of LTA4H Western blot band intensities. *P < .05, Mann-Whitney or Kruskal-Wallis test (the latter for patients with Löfgren syndrome/patients with non-Löfgren disorders/healthy subjects). Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 VDBP is present on exosomes and is enriched in patients compared with healthy control subjects. A, Relative abundance of VDBP on BALF exosomes, as detected by using iTRAQ relative to a pooled reference. B, VDBP on BALF exosomes from healthy control subjects and patients with sarcoidosis, as measured by using ELISA. In the sarcoidosis group open circles indicate patients with Löfgren syndrome, and solid circles indicate patients with chronic disease. C, VDBP measured in plasma of patients and healthy control subjects by using ELISA. D, VDBP levels on exosomes isolated from plasma, as measured by using ELISA. *P < .05 and **P < .01, Mann-Whitney or Kruskal-Wallis test (the latter for patients with Löfgren syndrome/patients with non-Löfgren disorders/healthy subjects). Journal of Allergy and Clinical Immunology 2017 139, 1186-1194DOI: (10.1016/j.jaci.2016.05.051) Copyright © 2016 American Academy of Allergy, Asthma & Immunology Terms and Conditions