Aggregated neutrophil extracellular traps limit inflammation by degrading cytokines and chemokines

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1 CORRECTION NOTICE Nat. Med. doi: /nm.3547; corrected online 25 August 2014 Aggregated neutrophil extracellular traps limit inflammation by degrading cytokines and chemokines Christine Schauer, Christina Janko, Luis E Munoz, Yi Zhao, Deborah Kienhöfer, Benjamin Frey, Michael Lell, Bernhard Manger, Jürgen Rech, Elisabeth Naschberger, Rikard Holmdahl, Veit Krenn, Thomas Harrer, Ivica Jeremic, Rostyslav Bilyy, Georg Schett, Markus Hoffmann & Martin Herrmann In the version of this file posted online, the captions for the supplementary videos were incorrect. The caption for Supplementary Video 1 should read Untreated isolated human neutrophils do not undergo NETosis. Isolated human neutrophils ( cells ml 1 ) were stained with Hoechst 33342, incubated with PBS as control, and analyzed by time-lapse video microscopy. The original length of the video is 70 minutes. The caption for Supplementary Video 2 should be Generation of NETs by neutrophils. Isolated human neutrophils ( cells ml 1 ) were stained with Hoechst 33342, incubated with monosodium urate crystals, and analyzed by time-lapse video microscopy. Video shows neutrophils rearranging their internal structures and finally forming NETs in a rapid disintegration process. The original length of the video is 70 minutes. The error has been corrected in this file as of 25 August 2014.

2 Supplementary Figure 1: In vitro-generated aggregates share characteristics of NETs. Representative immunofluorescence images of cryosections prepared from aggregates developing from human neutrophils cultured at cells ml -1 together with 1 mg/ml MSU-crystals. Negative controls stained with only PI and FITC-conjugated secondary antibody are depicted in the lower panels. Scale bars, 100 µm. MPO, myeloperoxidase.

3 Supplementary Figure 2: Formation of aggnets is dependent on ROS. Representative images of isolated human PMN cultured in high density ( cells ml -1 ) together with MSU-crystals and with or without the ROS-inhibitors diphenylene iodonium (DPI), N-acetylcysteine (NAC), butylated hydroxyanisole (BHA), or ascorbic acid. Scale bars, 2 mm.

4 Supplementary Figure 3: Dose-response curve of the effect of MSUcrystals on isolated human neutrophils. (a and b) Neutrophils cultured at low and high densities with concentrations of MSU-crystals ranging from 0 to 5000 µg ml -1. (a) Representative light microscopy images. Scale bars, 3 mm. (b) Means ± S.E.M. of aggnet-areas plotted against concentration of MSU-crystals in 3 donors. * P < 0.05, ** P < 0.01, *** P < of cells vs

5 cells, as determined by Student s t-test. Of note, since non-digested MSU-crystals are woven into the structure of the aggnets, the sizes of the in vitro formed aggnets depended on the amount of added MSUcrystals. (c) 10 7 human neutrophils were incubated with varying amounts of autologous PBMCs. Addition of PBMCs did not change the size of the developing aggnet. Under conditions of varying concentrations of both PMNs and PBMCs, the size of the formed aggregates only depended on the amount of PMNs in the culture. (d) Human neutrophils were incubated with MSU-crystals and autologous peripheral blood mononuclear cells (PBMC) and the size of the developing aggnets was evaluated. Figure shows representative images from cells of one out of 3 independent blood donors.

6 Supplementary Figure 4: Morphological changes induced in neutrophils by inducers of NETosis and necrosis. (a) Representative immunofluorescence images of human neutrophils ( cells ml -1 ) incubated without stimulant or exposed to 1 mg ml -1 MSU-crystals, 1 mg ml -1 zymosan, heat (70 C, 5 min), 10 µm melittin, 1 mm HgCl 2, or 0.05% Triton. Cytospins were prepared and stained with DAPI and an antibody against human NE. The merged pictures show co-

7 localization of DNA- and NE-specific staining. Scale bars, 100 µm (b) Quantitative evaluation of changes in nuclear morphology. Upper panel: dot plot of nuclei analyzed for mean area and circularity index. One dot represents the mean from one blood donor. Lower panel: means ± SEM of maximal coherent PI-positive area in samples from 4-6 donors. All groups were compared to MSU-treated group. *** P < as determined by Student s t-test with Dunnett s post-hoc test.

8 Supplementary Figure 5: murine aggnets can be visualized in DECT. C57BL/6 mice were pre-treated with 2 ml of 2% thioglycolate solution. Four days later, 20 mg MSU-crystals were injected intraperitoneally. Amorphous aggregates (aggnets) formed after injection of MSUcrystals can be detected by DECT (green, depicted by arrow).

9 Supplementary Figure 6: AggNETs formed in human blood and mouse air pouches depend on ROS. (a) Quantitative analysis of aggnet-formation in neutrophils isolated from the blood of oxidative burst-deficient subjects with chronic granulomatous disease (CGD) and normal healthy controls (NHD). One dot shows the area of the largest aggnet from one blood donor. ** P < 0.01 as determined by Mann-Whitney U test. (b) Quantification of total area covered by aggnets in the air pouches of wild type and Ncf1** mice after MSU-injection. One dot represents one mouse. ** P < 0.01 as determined by Mann-Whitney U test. (c) Co-localization of extranuclear DNA (DAPI) and NE on cryosections from murine aggregates from air pouches was analyzed. A control without primary antibody is displayed in the right panel. Scale bars, 100 µm.

10 Supplementary Figure 7: IL-8 and IL-1RA are released from aggregated NETs. Preformed aggregated NETs from neutrophils cultured in a density of cells ml -1 were transferred to fresh PBS-containing 1% BSA. Displayed are means ± SD of the concentrations of cytokines/chemokines released from aggnets into the culture supernatants after 20 minutes, 2 hours, and 18 hours. Values of mocktreated neutrophils served as baseline. One representative out of 3 independent experiments is shown.

11 Supplementary Figure 8: Cytokine degradation is mediated by normal but not ROS-deficient neutrophils. Neutrophils from NHD or patients with CGD were stimulated with MSUcrystals. Exogenously added cytokines/chemokines were then incubated with cell pellets or isolated DNA from these cells and concentrations were determined after 18 hours by multiplex bead technology. Bars show means ± SD of triplicates within one representative out of two independent experiments.

12 Supplementary Figure 9: Pro-IL-1β and IL-1β levels are decreased by serine proteases in aggregated NETs in a Ca 2+ - and transglutaminase-independent manner. (a) Total protein from THP-1 cells incubated with or without externally added aggregated NETs was extracted by water lysis of cells. The expression of human pro-il-1β and mature IL-1β was analyzed with a rabbit anti-pro-il-1β/anti-il-1β by immunoblotting using standard

13 protocols. Blots stained with Coomassie Blue served as loading controls and revealed a shift to lower molecular weight after addition of aggnets. Pictures show one representative out of 3 independent experiments. (b) Exogenous cytokines/chemokines were incubated with aggnets (black), aggnets plus EDTA (blue), or aggnets plus z-don (red), an inhibitor of tissue transglutaminase. The circles represent the time points 0, 30, 120, 360, and 720 minutes incubation time. Graph shows one representative out of 3 independent experiments. (c) Recombinant IL-1β in PBS/1% BSA was incubated with preformed aggnets in the presence or absence of the serine proteinase inhibitor PMSF. Samples were then run on Western blot. PMSF inhibited degradation of IL-1β by aggnets.

14 Supplementary Figure 10: Levels of pro-inflammatory mediators are higher in animals that cannot form aggnets. 5 mg MSU-crystals were injected into preformed air pouches on the back of WT and Ncf1** mice and 24 hours later selected pro-inflammatory cytokines were quantified in the lavages of the air-pouch. Scatter plots show individual measurements and means of cytokine concentrations in lavages of individual mice. * P < 0.05, ** P < 0.01 as determined by Mann-Whitney U test.

15 Supplementary Figure 11: Inhibition of NET-aggregation results in increased chemokine levels in vivo. MSU-crystals were injected into preformed air pouches on the back of BALB/c WT mice with or without DNase I and 3 hours later the sizes of aggnets were determined. (a) and the neutrophil chemokines IP-10 and KC were quantified in the lavage of the air-pouches (b). Scatter plots show individual measurements and medians of cytokine concentrations in lavages of individual mice. One dot represents one mouse. The open dot in (b) represents the pictures shown in (a). * P < 0.05 as determined by Mann Whitney U-test.

16

17 Supplementary Figure 12: Inflammatory mediators are upregulated in chronic murine MSU-induced arthritis. Scatter plot shows protein concentrations in protein lysates from paws obtained from WT and Ncf1** mice 30 days after injection of MSUcrystals, at a time when arthritis in WT mice had resolved but had proceeded into the chronic phase in Ncf1** animals. Depicted are concentrations in MSU-injected paws (+) and contralateral PBS-injected paws ( ), one dot represents one mouse. * P < 0.05 as determined by Mann-Whitney U test.

18 Supplementary Figure 13: Model for pro-inflammatory NETosis and inflammation-limiting aggnet-formation. In areas of low neutrophil densities (e.g., in blood or in affected tissues during early stages of gouty arthritis), individual NETting neutrophils trap MSU-crystals in an inflammatory manner, releasing their load of proinflammatory mediators (upper panel). In areas of high cell densities (e.g., in tissue infiltrates during late stages of gout), the NETting neutrophils clump together in a process influenced by lactoferrin and ATP, and form felted aggregates (aggnets). These structures initially trap and finally degrade the inflammatory mediators and thus initiate the resolution of inflammation (lower panel).

19 Video 1: Untreated isolated human neutrophils do not undergo NETosis Isolated human neutrophils ( cells ml -1 ) were stained with Hoechst 33342, incubated with PBS as control, and analyzed by time-lapse video microscopy. The original length of the video is 70 minutes. Video 2: Generation of NETs by neutrophils Isolated human neutrophils ( cells ml -1 ) were stained with Hoechst 33342, incubated with monosodium urate crystals, and analyzed by time-lapse video microscopy. Video show neutrophils rearranging their internal structures and finally forming NETs in a rapid disintegration process. The original length of the video is 70 minutes.

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