IL-12hi Rapamycin-Conditioned Dendritic Cells Mediate IFN-γ–Dependent Apoptosis of Alloreactive CD4+ T Cells In Vitro and Reduce Lethal Graft-Versus-Host.

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IL-12hi Rapamycin-Conditioned Dendritic Cells Mediate IFN-γ–Dependent Apoptosis of Alloreactive CD4+ T Cells In Vitro and Reduce Lethal Graft-Versus-Host Disease Elizabeth O. Stenger, Brian R. Rosborough, Lisa R. Mathews, Huihui Ma, Markus Y. Mapara, Angus W. Thomson, Hēth R. Turnquist Biology of Blood and Marrow Transplantation Volume 20, Issue 2, Pages 192-201 (February 2014) DOI: 10.1016/j.bbmt.2013.11.007 Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 LPS-stimulated RAPA-DCs express high IL-12 despite low costimulatory molecule expression and induce apoptosis of alloreactive CD4+ T cells in an IFN-γ-dependent manner. C57BL/6 (B6; H-2b) and IL-12p40−/− (B6) myeloid DCs (mDC) were generated in 7-day culture with granulocyte-macrophage colony-stimulating factor and IL-4 alone (CTR-DC) or in the presence of 10 ng/mL RAPA (RAPA-DC). CD11c-purified mDCs were incubated for 18 hours in media alone or with 100 ng/mL LPS and then analyzed for cell surface molecule expression by flow cytometry. B6 mDCs were then used in 5-day MLRs to stimulate BALB/c (H2d) CD4+ T cells. (A) RAPA-DCs, especially after LPS exposure, express low levels of CD86 and high levels of IL-12 compared with LPS-exposed CTR-DCs (CD86loIL-12hi population). IL-12p40−/− LPS-stimulated RAPA-DCs lack a high IL-12 population but have a similar CD86lo population compared with wild-type. (B) The percentage of CD86hi IL-12lo, CD86hi IL-12hi, and CD86lo IL-12hi from 7 independent experiments was averaged. Data depict mean + 1 SD. (C) Compared with CTR-DCs, especially after LPS stimulation, RAPA-DCs induced increased apoptosis (Annexin V+7-AAD+) of alloreactive CD4+ T cells (12.7% ± 2.3% versus 7.3% ± .4%; +LPS: 28.5% ± 4.4% versus 15.4% ± 2.9%; both P < .05). Blocking the activity of IFN-γ in LPS-treated RAPA-DC cultures decreased levels of apoptosis to those of LPS-treated CTR-DCs (18.7% ± 1.0% versus 15.4% ± 2.9%; NS). Plots are representative of 3 experiments performed. (D) Average fold increase in CD4+ Annexin V+ 7-AAD+ relative to CTR-DCs on day 5 of MLRs. Error bars indicate mean + 1 SD. n = 3. *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 IL-12hi RAPA-DCs induce increased production of IFN-γ by CD4+ T cells. B6 myeloid DCs (mDC) were generated as described in Figure 1 and then used in 1- or 2-day MLRs to stimulate BALB/c CD4+ T cells. Plots are representative of 3 independent experiments performed. (A) CD4+ T cells exposed to either RAPA-DCs or LPS-stimulated RAPA-DCs produce increased IFN-γ compared with CTR groups (day 1: 3.19 ± .8 versus 10.6 ± .9; LPS: 6.1 ± 1.2 versus 10.6 ± 2.1, P < .05; day 2: 3.62 ± 2.1 versus 10.5 ± 5.9; LPS: 6.0 ± 3.1 versus 10.1 ± 3.4, P < .05). (B) Average fold increase in CD4+ IFN-γ+ relative to CTR-DCs on days 1 or 2 of MLRs. Error bars indicate mean + 1 SD. n = 3. *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Apoptosis induced by IL-12hi RAPA-DCs is dependent on T cell but not DC responses to IFN-γ. Wild type B6 or B6 IFN-γ-R−/− DC were generated then used in 5-day MLRs to stimulate wild-type BALB/c or IFN-γ-R−/− (H2d) CD4+ T cells. Plots are representative of 3 independent experiments performed. (A) IFN-γ-R−/− CD4+ T cells have decreased levels of apoptosis (Annexin V+7-AAD+) compared with wild-type T cells after exposure to LPS-treated IL-12hi RAPA-DCs (wild-type 5.5% ± 1.9% versus IFN-γ-R−/− 6.4% ± 3.1%; +LPS: 15.6% ± 3.6% versus 4.9% ± 1.1%; P < .05 for LPS). (B) Average fold increase in CD4+ Annexin V+ 7-AAD+ cells relative to CTR-DCs on day 5 of MLRs. Error bars indicate mean + 1 SD. n = 2. *P < .05. (C) IFN-γ-R−/− IL-12hi RAPA-DCs induce similar apoptosis (Annexin V+7-AAD+) of CD4+ T cells compared with wild-type (12.4% ± 7.6% versus 10.5% ± 7.6%, respectively; +LPS: 27.2% ± 11.9% versus 30.1% ± 16.3%; both NS). However, blocking IFN-γ significantly decreased apoptosis induced by LPS-stimulated IFN-γ-R−/− RAPA-DCs to levels similar to LPS-stimulated wild-type CTR-DC (18.0% ± 10.3% versus 21.9% ± 6.3%, P = NS). (D) Average fold increase in CD4+ Annexin V+ 7-AAD+ cells relative to wild-type CTR-DCs on day 5 of MLRs. Error bars indicate mean + 1 SD. n = 2. *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Apoptosis of alloreactive CD4+ T cells induced by IL-12hi RAPA-DCs is dependent on IL-12 expression. Wild-type B6 or B6 IL-12p40−/− myeloid DCs (mDC) were generated and then used in 5-day MLRs to stimulate BALB/c CD4+ T cells. Plots are representative of 3 independent experiments performed. (A) LPS-exposed IL-12p40−/− RAPA-DCs induce decreased apoptosis (Annexin V+7-AAD+) of alloreactive CD4+ T cells compared with wild-type (16.9% ± 8.9% versus 20.8% ± 10.0%; P < .05). Blocking IFN-γ further decreased apoptosis stimulated by LPS-exposed IL-12p40−/− RAPA-DCs (12.0% ± 6.1% versus 16.9% ± 8.9%, P < .05). (B) Average fold increase in CD4+ Annexin V+ 7-AAD+ cells relative to wild-type CTR-DCs on day 5 of MLRs. Error bars indicate mean + 1 SD. n = 3. *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Apoptosis of CD4+ T cells by induced IL-12hi RAPA-DCs is dependent on the Fas/FasL pathway and caspase 8. B6 were generated and then used in 1- or 2-day MLRs to stimulate BALB/c CD4+ T cells. Plots are representative of 3 to 4 independent experiments performed (n = 4 for 2-day MLRs for caspase 8). (A) After exposure to IL-12hi RAPA-DCs, CD4+ T cells increased expression of Fas compared with LPS-stimulated CTR-DCs, particularly after a 1-day exposure (day 1: 7.1 ± 1.4 versus 3.5 ± 1.0, P < .05; day 2: 6.6 ± 2.4 versus 3.1 ± 1.6, P = .05). (B) Average fold increase in CD4+ Fas+ cells relative to wild-type CTR-DCs on day 1 or 2 of MLRs. Error bars indicate mean + 1 SD. n = 3. *P < .05. (C) CD4+ T cells also up-regulate cleaved caspase 8 expression after exposure to IL-12hi RAPA-DC compared with CTR-DCs, particularly after a 2-day MLR exposure (day 1: 14.2 ± 2.4 versus 9.2 ± 4.7, P = .05; day 2: 10.9 ± 6.6 versus 6.2 ± 3.9, P < .05). (D) Average fold increase in CD4+ cleaved caspase 8+ cells relative to wild-type CTR-DCs on day 1 or 2 of MLRs. Error bars indicate mean + 1 SD. n = 3 (1 day) or 4 (2 day). *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 6 Autologous IL-12hi RAPA-DC demonstrate low costimulatory molecule expression and inhibit acute GVHD. BALB/c CTR- and RAPA-DCs were generated and then analyzed for cell surface marker expression using flow cytometry. (A) Compared with equivalent CTR-DC groups, unstimulated RAPA- and LPS-exposed RAPA-DCs showed decreased surface expression (MFI) of IAd, CD86, and CD80. (B) BALB/c LPS-stimulated RAPA-DCs demonstrate increased IL-12 expression relative to LPS-stimulated CTR-DCs (CD11c+ IL-12hi population 67.3% versus 16.3%). (C) Lethally irradiated BALB/c recipients were given 5 × 106 B6 bone marrow cells plus 1 × 106 purified B6 T cells alone (GVHD control) or with 1 × 106 BALB/c DCs (CTR-DC ± LPS or RAPA-DC ± LPS). Irradiated BALB/c mice injected with syngeneic BALB/c bone marrow (syngeneic) are also indicated. Although mice receiving CTR-DCs had survival comparable with the control GVHD group (without DCs) (median survival in days: GVHD, 17.5 days; CTR, 8 days; CTR-LPS, 11 days; all P = NS), IL-12hi RAPA-DCs significantly and markedly prolonged survival from GVHD (median survival in days: 38 days, P = .007). Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Supplemental Figure 1 Flow cytometric analysis of RAPA-DC demonstrates a similar cell surface phenotype to CTR-DC. B6 CTR-DC and RAPA-DC were generated, then analyzed for cell surface marker expression by flow cytometry. (A) DC were selected initially by forward scatter (FSC) and side scatter (SSC), then by CD11chi expression. By FSC, RAPA-DC are smaller than CTR-DC. (B) Like CTR-DC, RAPA-DC are CD11bhi and exhibit very low expression of CD4, CD8, and B220. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Supplemental Figure 2 RAPA-DCs exhibit lower expression of MHC class II, CD86, and CD80 compared with CTR-DCs. B6 CTR-DCs and RAPA-DCs were generated and then analyzed for cell surface marker expression by flow cytometry. Plots are representative of 4 or 5 (CD80) independent experiments performed. (A) Compared with equivalent CTR-DC groups, unstimulated RAPA- and LPS-exposed RAPA-DCs showed decreased surface expression (MFI) of MHC class II (IAd), CD86, and CD80. (B) Mean fold decrease in IAd+, CD86+, and CD80+ CD11c+ RAPA-DCs relative to wild-type CTR-DCs. RAPA-DCs display significantly decreased expression of IAd, CD86, and CD80 compared with CTR-DC, including after exposure to LPS. After exposure to LPS, both CD86 and MHC class II are significantly decreased, between RAPA-DCs and CTR-DCs. Because of varying expression of CD80 between experiments, decreases in expression of CD80 on IL-12hi RAPA-DCs compared with LPS-stimulated CTR-DCs did not reach statistical significance (P = .06). Error bars indicate means + 1 SD. n = 4 or 5 (CD80). *P < .05. Biology of Blood and Marrow Transplantation 2014 20, 192-201DOI: (10.1016/j.bbmt.2013.11.007) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions