A20 (TNFAIP3) deficiency in myeloid cells triggers erosive polyarthritis resembling rheumatoid arthritis

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1 A20 (TNFAIP3) deficiency in myeloid cells triggers erosive polyarthritis resembling rheumatoid arthritis Mourad Matmati 1,2 *, Peggy Jacques 3 *, Jonathan Maelfait 1,2, Eveline Verheugen 3, Mirjam Kool 1,4, Mozes Sze 1,2, Lies Geboes 5, Els Louagie 3, Conor Mc Guire 1,2, Lars Vereecke 1,2, Yuanyuan Chu 6, Louis Boon 7, Steven Staelens 8, Patrick Matthys 5, Bart N. Lambrecht 4, Marc Schmidt-Supprian 6, Manolis Pasparakis 9, Dirk Elewaut 3+, Rudi Beyaert 1,2+ and Geert van Loo 1,2+ 1 Department for Molecular Biomedical Research, Unit of Molecular Signal Transduction in Inflammation, VIB, B-9052 Ghent, Belgium. 2 Department of Biomedical Molecular Biology, Ghent University, B-9052 Ghent, Belgium. 3 Department of Rheumatology, Laboratory for Molecular Immunology and Inflammation, Ghent University Hospital, B-9000 Ghent, Belgium. 4 Department of Respiratory Diseases, Laboratory of Immunoregulation and Mucosal Immunology, Ghent University Hospital, B-9000 Ghent, Belgium. 5 Rega Institute, Leuven University, B-3000 Leuven, Belgium. 6 Max Planck Institute of Biochemistry, D Martinsried, Germany. 7 Bioceros BV, N-3584 Utrecht, The Netherlands. 8 Medical Image and Signal Processing, Ghent University IBBT, B-9000 Ghent, and Molecular Imaging Center Antwerp, Antwerp University, B-2610 Antwerp, Belgium. 9 Institute for Genetics, Centre for Molecular Medicine (CMMC), and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D Cologne, Germany. *These authors contributed equally + These authors share senior authorship Address correspondence to: geert.vanloo@dmbr.ugent.be or rudi.beyaert@dmbr.ugent.be or dirk.elewaut@ugent.be

2 Supplementary Table Supplementary Table 1 Primer sequences of mouse-specific cytokines for qpcr TNF forward ACCCTGGTATGAGCCCATATAC TNF reverse ACACCCATTCCCTTCACAGAG IL-1β forward CACCTCACAAGCAGAGCACAAG IL-1β reverse GCATTAGAAACAGTCCAGCCCATAC IL-6 forward GAGGATACCACTCCCAACAGACC IL-6 reverse AAGTGCATCATCGTTGTTCATACA IL-23 forward GCACCAGCGGGACATATGA IL-23 reverse CCTTGTGGGTCACAACCATCT

3 Supplementary Figures Supplementary Figure 1 Generation of myeloid-specific A20 knockout mice. (a) Targeting scheme. Diagram showing the wild-type Tnfaip3 genomic locus (WT), the neomycinresistance-containing (neo) allele, the LoxP-flanked (Floxed) allele, and the deleted A20 allele. Boxes indicate exons 1 to 9 (E1 E9). Restriction enzyme sites and the location of the probe used for Southern blot analysis are depicted. B, BamH1; V, EcoRV. LoxP and Frt sites are indicated by arrowheads. (b) Western blot analysis for A20 expression in BMDMs, derived from WT mice and A20 myel-ko mice.

4 Supplementary Figure 2 Immune cell infiltration in joints from A20 myel-ko mice. Immunohistological section of ankle joints stained with anti-f4/80 (macrophages), anti-cd3 (T cells), and anti-b220 (B cells) antibodies. Detail magnification (lower); scale bars = 20µm.

5 Supplementary Figure 3 Antibody production in A20 myel-ko mice. Serum levels of IgG autoantibodies specific for collagen type II in A20 myel-ko mice (n=9) and control littermates (WT, n=6). * p < 0.05.

6 Supplementary Figure 4 A20 myel-ko mice do not develop multi-organ inflammation. H&E staining of histological sections of intestine, liver and lung tissue from A20 myel-ko and littermate control (WT) mice.

7 Supplementary Figure 5 Systemic anti-il-6 treatment suppresses disease progression in A20 myel-ko mice, in contrast to anti-tnf treatment. (a) 20-week-old A20 myel-ko mice showing arthritis-like pathology were treated with neutralizing anti-tnf antibodies (n=5) or isotype control antibodies (n=5) and clinically scored for disease regression. (b) 20-week-old A20 myel- KO mice showing arthritis-like pathology were treated with neutralizing anti-il-6 antibodies (n=5) or isotype control antibodies (n=5) and clinically scored for disease regression. * p < 0.05 compared to start of therapeutic treatment.

8 Supplementary Figure 6 Antibiotic treatment does not protect A20 myel-ko mice from arthritis development. Histological section of ankle joint of 25 weeks old A20 myel-ko mouse either or not treated with broad-spectrum antibiotics; magnification 40x (upper); detail magnification 100x (lower). Each picture is representative of at least four mice.

9 Supplementary Figure 7 Induction of the adaptive immune system in A20 myelo-ko mice. (a) Percentages of CD4 + and CD8 + memory cells in the lymphocyte gate of A20 myel-ko (n=6) and WT littermates (n=5) as assessed by flow cytometry. (b) Percentages of Th17 positive CD4 + T cells in the inguinal lymph node and spleen from A20 myel-ko mice (n=6) and WT littermates (n=5) as assessed by flow cytometry. * p < 0.05.

10 Supplementary Figure 8 A20 myel-ko mice have splenomegaly and enlargement of inguinal and axillary lymph nodes. (a) Splenomegaly and enlargement of inguinal lymph nodes in A20 myel-ko mice. (b) Spleen weight of 12-week-old A20 myel-ko (n=10) and WT mice (n=10). (c) Spleen weight of 20-week-old A20 myel-ko /MyD88 +/+ (n=6), A20 myel-ko /MyD88 +/- (n=8), A20 myel-ko /MyD88 -/- (n=6) and WT mice (n=6). Bars represent averages ± SEM. * p < 0.05.