Programmed cell death ligand 2 regulates TH9 differentiation and induction of chronic airway hyperreactivity Jerome Kerzerho, PhD, Hadi Maazi, PhD, Anneliese.

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Programmed cell death ligand 2 regulates TH9 differentiation and induction of chronic airway hyperreactivity Jerome Kerzerho, PhD, Hadi Maazi, PhD, Anneliese O. Speak, PhD, Natacha Szely, MSc, Vincent Lombardi, PhD, Bryant Khoo, BSc, Stacey Geryak, RN, Jonathan Lam, PhD, Pejman Soroosh, PhD, Jacques Van Snick, PhD, Omid Akbari, PhD Journal of Allergy and Clinical Immunology Volume 131, Issue 4, Pages 1048-1057.e2 (April 2013) DOI: 10.1016/j.jaci.2012.09.027 Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Development of pulmonary TH9 cells after chronic exposure to Aspergillus fumigatus (A.f.). A, Protocol of immunization to induce chronic AHR by A fumigatus. Briefly, a group of naive BALB/c mice were immunized intranasally (i.n.) for 46 days with A fumigatus or PBS. B, On days 25, 32, 39, and 46, the percentages of cytokines (IL-9, IL-4, IL-13, IL-10, and IL-17a) secreting Teff cells in the lungs were then assessed by means of intracellular staining gated on the CD45+CD3+CD44+CD4+ population. Data are representative of 4 independent experiments (n = 5), with P values of less than .001 for IL-9 on days 39 and 46 between PBS- and A fumigatus–treated mice. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 PD-L2 regulates TH9 cell development in vitro. Purified CD4+DO11.10+ T cells were put in culture (1 × 105 cells per well) with OVA-loaded bone marrow–derived DCs (BM-DC) from WT and PD-L2−/− mice in the presence of IL-4 (10 ng/mL), TGF-β (1 ng/mL), and anti–IFN-γ antibodies (10 μg/mL) with or without anti–PD-1 blocking (α-PD1), anti–PD-L2 blocking (α-PD-L2), or isotype control antibodies (10 μg/mL). After 3 days of culture, production of IL-9, IL-1α, and IL-2 was measured by means of ELISA in the supernatant. Data are means ± SEMs of 3 experiments. *P < .05, WT isotype–treated versus WT anti–PD-L2–treated or PD-L2−/− mice. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 PD-L2 regulates TH9 cell differentiation in vivo. A, Protocol of immunization to induce chronic AHR by A fumigatus (A.f.). B, Purified lung CD45+ cells were cultured 24 hours after the last intranasal (i.n.) immunization overnight without any stimulation and analyzed for the percentage of cytokine-secreting Teff cells by means of intracellular staining gated on the CD45+CD3+CD44+CD4+ cells. Statistical analyses were performed by using the Student t test: *P < .05. Values are representative of 3 independent experiments (n = 5). Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Increased airway inflammation and AHR in PD-L2−/− mice. A, Groups of WT and PD-L2−/− BALB/c mice were immunized intranasally with A fumigatus (A.f.) or PBS, as described Fig 1, A. The mice were then assessed for AHR 24 hours after the last intranasal immunization by measuring RL and Cdyn. Data are means ± SEMs and representative of 3 separate experiments (n = 5). *P < .05 and **P < .03, Student t test. B, Bronchoalveolar lavage (BAL) fluid from the mice in Fig 4, A, was analyzed 24 hours after AHR measurement. Results are shown as the total number of cells in BAL fluid. *P < .05 and **P < .01, Student t test. Eos, Eosinophils; Lym, lymphocytes; Mac, monocyte/macrophage; PMN, neutrophils; Total, total cell number. C, Lung tissue from A fumigatus–sensitized PD-L2−/− or WT mice were stained with hematoxylin and eosin (H&E; upper panel) and analyzed for cell infiltration. Lung tissue from the same mice were stained with periodic acid–Schiff (PAS; lower panel) and analyzed for the presence of mucus. Arrows indicate the production of mucus in the lumen. Original magnification ×40 (inset, magnification ×100). D, Quantifications of lung histopathology shown as thickness of airway epithelium (left panel), number of inflammatory cells per 250 μm2 of lung tissue (middle panel), and number of goblet cells per 50 μm of epithelium at baseline (right panel). Data are shown as means ± SEMs (n = 5). *P < .05. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Variation of TGF-β production in lungs of PD-L2−/− mice. A, Protocol for A fumigatus (A.f.) immunization and preparation of lung lysate samples from WT and PD-L2−/− BALB/c mice. i.n., Intranasal. B, Concentrations of IL-9 and TGF-β, IL-13, IL-10, IL-4, IL-1α, and IL-17a were then assessed by means of ELISA in the whole-lung lysates, as described in the Methods section. Statistical analyses were performed with the Student t test. *P < .05 and **P < .01. Values are representative of 3 separate experiments (n = 5). Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 IL-9 regulates the severity of chronic AHR. A, Protocol of immunization of WT and PD-L2−/− mice with A fumigatus (A.f.) and antibodies. i.n., Intranasal. B, A group of WT and PD-L2−/− BALB/c mice were immunized intranasally according to our protocol in Fig 6, A. Twenty-four hours after the last immunization (day 46), mice were assessed for the development of AHR by measuring RL and Cdyn. Data are means ± SEMs and representative of 3 experiments (n = 5). *P < .05 and **P < .01, Student t test. C, Lung tissue from A fumigatus (A.f.)–sensitized PD-L2−/− or WT mice were stained with hematoxylin and eosin (H&E; upper panel) and periodic acid–Schiff (PAS; lower panel) and analyzed for cell infiltration and mucus production, respectively. Arrows indicate the production of mucus in the lumen. Original magnification ×40 (inset, original magnification ×100). D, Quantifications of lung histopathology shown as thickness of airway epithelium (left panel), number of inflammatory cells per 250 μm2 of lung tissue (middle panel), and number of goblet cells per 50 μm of epithelium at baseline (right panel). Data are shown as means ± SEMs (n = 5). *P < .05. E, Survival curves of PD-L2−/− and WT mice immunized as described in Fig 6, A. **P < .01, as determined by using a Mantel Cox test. Values are representative of 3 independent experiments starting with 10 mice per group. Ab, Antibody. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 A, Gating strategy for analysis of cytokine production by effector CD4+ T cells in the lungs. CD45+CD4+CD3+CD44+ cells were considered CD4+ Teff cells and analyzed for intracellular cytokine production in the lungs. The lymphocytes were initially selected based on forward scatter (FSC) and side scatter (SSC), followed by CD45, CD4, and CD3 gating. Finally, CD44+ cells were selected as CD4+ Teff cells and analyzed for the expression of cytokines. B, TH9 cells do not develop in the LNs after chronic exposure to A fumigatus (A.f.). A group of naive BALB/c mice were immunized intranasally for 46 days with A fumigatus (50 μg on weeks 1 and 2 and 20 μg on weeks 3-8 in 50 μL of saline solution) or PBS (negative control), as described in the protocol of immunization (Fig 1, A). On days 25, 32, 39, and 46, the percentage of cytokine (IL-9, IL-4, IL-13, and IL-10)–secreting Teff cells in the LNs was then assessed by means of intracellular staining gated on the CD45+CD44+CD4+ population. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Relative gene expression of the transcription factors IRF4, PU-1, STAT6, and GATA-3 in in vitro–primed CD4+ T cells. Purified CD4+DO11.10+ T cells were put in culture (1 × 105 cells per well) with OVA-loaded bone marrow–derived DCs from WT and PD-L2−/− mice (1:32 ratio) in the presence of IL-4 (10 ng/mL), TGF-β (1 ng/mL), and anti–IFN-γ antibodies (10 μg/mL). After 5 days of culture, relative gene expression of IRF4, PU-1, STAT6, and GATA-3 was analyzed by using quantitative real-time PCR. Data are means ± SEMs of 3 experiments. *P < .05, WT versus PD-L2−/− mice. Journal of Allergy and Clinical Immunology 2013 131, 1048-1057.e2DOI: (10.1016/j.jaci.2012.09.027) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions