Role of Natural Killer Cells in Intravenous Immunoglobulin–Induced Graft-versus-Host Disease Inhibition in NOD/LtSz-scidIL2rg−/− (NSG) Mice Joëlle Gregoire-Gauthier,

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Role of Natural Killer Cells in Intravenous Immunoglobulin–Induced Graft-versus-Host Disease Inhibition in NOD/LtSz-scidIL2rg−/− (NSG) Mice Joëlle Gregoire-Gauthier, François Fontaine, Lionel Benchimol, Simon Nicoletti, Silvia Selleri, Mame Massar Dieng, Elie Haddad Biology of Blood and Marrow Transplantation Volume 21, Issue 5, Pages 821-828 (May 2015) DOI: 10.1016/j.bbmt.2015.01.006 Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Weekly IVIG treatment induces expansion of human NK cells. PBMC from PBS- (n = 10, empty circles) and IVIG-treated mice (n = 10, filled circles) were analyzed for percent (A) and (B) absolute numbers of NK cells. (C) PBMC isolated from PBS- and IVIG-treated mice and gated on hCD45+ cells were analyzed for CD3 and CD56 expression. Representative data of contour plots on day +14. Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Phenotype and function of IVIG-induced NK cells. (A) IVIG-treated xeno-GVHD mice were injected with 1 mg BrdU on day +10, and received additional BrdU in their drinking water until being sacrificed on day +14. Cells were collected from the blood, spleen, and liver of IVIG-treated mice and analyzed by flow cytometry for BrdU incorporation and expression of annexin V and 7-AAD. Because no NK cells were found in blood or tissues of PBS-treated mice, this experimental group was not included in the figure. Representative data of contour plots on day +14 (left quadrant: subG0-G1 phase; lower left quadrant: G0-G1 phase; upper quadrant: S phase; lower right quadrant: G2-M phase). (B) Percent of NK cells in the S phase of the cell cycle (n = 6). (C) Analysis of NK cells of blood and different tissue origin on day +14 for apoptosis (n = 5; black bars: live cells; dotted bars: early apoptotic cells; white bars: late apoptotic cells). Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 IVIG induce the functional activation of human NK cells. (A) NK cell–specific activation markers were analyzed on day +14 on cells isolated from the blood (white bars), spleen (dotted bars), and liver (black bars) of IVIG-treated mice (n = 5). (B) Splenocytes collected on day +10 from PBS- (empty circles) and IVIG-treated mice (filled circles) were used in cytotoxic assay against the K562 cells. Representative data (from 1 of 4 independent experiments) on cytotoxicity assay after a standard 4-hour 51chromium release assay. Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 IVIG treatment reduces the incidence of GVHD and mortality in mice injected with huPBMCs but not with NK-depleted huPBMCs. (A) Incidence of GVHD and (B) survival of PBS-treated and IVIG-treated (empty circles, n = 23; filled circles; n = 22, respectively) huPBMCs-injected mice, and PBS- and IVIG-treated NK-depleted (empty squares; n = 7; filled squares; n = 6, respectively) huPBMCs-injected mice. Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 IVIG must be administered by the same route and the same day as huPBMCs for effective expansion of human NK cells. (A) IVIG were administered i.p. and huPBMCs i.v. and PBMC on day +14 were isolated from PBS- (n = 10) and IVIG-treated (n = 10) mice, gated on hCD45+ cells, and analyzed for CD3 and CD56 expression. Representative data of contour plots on day +14. (B) Expansion of NK cells with initial IVIG treatment on day −1 (n = 33), day +7 (n = 6) (P = .04, .04, and .01 at days +7, +14, and +21 post-injection, respectively). (C) Incidence of GVHD in mice treated with IVIG from day -1 (dotted line; n = 33) or +7 (line; n = 6); P = .02. Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 6 T cells are required for IVIG-induced NK cell expansion in vivo. NK cell expansion was analyzed in IVIG-treated control (filled circles; n = 10), OKT3-treated (empty squares, n = 4), CsA-treated (filled triangles, n = 7), or T cell–depleted huPBMCs-injected mice (empty circles; n = 3). Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 7 Analysis of T cell proliferation and apoptosis in vivo in xeno-GVHD mice. A BrdU incorporation and an annexin V assays were performed on cells from the blood, spleen, and liver of xeno-GVHD mice that were sacrificed at day +14. (A) Proliferation, assessed by the percentage of T cells in the S phase of the cell cycle and (B) apoptosis of T cells in vivo in PBS-treated (n = 5, white) and IVIG-treated (n = 6, black) mice. Biology of Blood and Marrow Transplantation 2015 21, 821-828DOI: (10.1016/j.bbmt.2015.01.006) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions