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1 2 weeks high holesterol diet 2 weeks high holesterol diet 2 weeks high holesterol diet 2 μm Mrophges Crystls Hoehst μm Mrophges Crystls Hoehst Hoehst Crystls Mrophges 2 μm 2 μm Supplementry Fig. 1: Erly orti sinus therosleroti lesions ontin rystl-loded mrophges. -, Comined onfol fluoresene nd refletion mirosopy of erly orti sinus therosleroti lesions of Apo-E-KO mie fed high holesterol diet for 2 weeks. Lser refletion of holesterol rystls (red), immunofluoresene of mrophges (green) identified y MoM-2 nd nulei (lue) ounterstined with Hoehst dye. Note: In erly lesions individul suendothelil rystl-positive mrophges n e seen () nd grnulom-like lesions of few tens of mrophges enirling holesterol rystl depositions re visile (). Additionlly, holesterol-rystl positive mrophges n e found in leflets of the hert vlves (). Representtive imges from seril setions of groups of 3 mie re shown. 1

2 3 μm Crystls Crystls Hoehst Dendriti ells Crystls 2 μm Crystls Hoehst Dendriti ells Crystls 2 Crystls Hoehst Dendriti ells Mrophges Crystls Crystls Hoehst Neutrophils Mrophges Supplementry Fig. 2: Erly therosleroti lesions ontin rystl-loded mrophges t different sites of orte. -, Comined onfol fluoresene nd refletion mirosopy of erly orti sinus therosleroti lesions of Apo-E-KO mie fed high holesterol diet for 4 weeks. Smples were stined for () dendriti ells (CD11, red), () mrophges (MoM-2, red) nd dendriti ells (CD11, green) or () mrophges (MoM-2, red) nd neutrophils (nti-neutrophil, green). Nulei were ounterstined with Hoehst dye. Representtive imges from seril setions of groups of 3 mie re shown. 2

3 Tuni dventiti Tuni medi Atherosleroti plque Tuni intim Arteril lumen 1 μm Mrophges (CD68) Smooth musle ells (phlloidin) Nulei (Hoehst) Crystl (refletion) 3 μm 2 μm Supplementry Fig. 3: Humn oronry rtery therosleroti lesions ontin rystls suendothelilly nd in neroti ores. Comined onfol fluoresene nd refletion mirosopy of humn oronry rtery therosleroti lesion. Overview imge ws otined without refletion mirosopy, while mgnifitions of oxed res were otined using omined immunofluoresene nd refletion detetion. Tissue ws stined for mrophges (CD68, red), smooth musle ells (phlloidin, light lue) nd nulei (Hoehst dye, drk lue). A representtive setion of one ptient is shown. 3

4 3 μm Mrophges Crystls Hoehst Mrophges Crystls Hoehst Trihrome stin 2 μm μm 2 μm 2 μm Supplementry Fig. 4: Humn oronry rtery lesion ontining lrge holesterol rystls -, Comined onfol fluoresene nd refletion mirosopy of humn oronry rtery therosleroti lesion. Lesion ws stined with Msson s trihrome stin (). Note: Lrge holesterol rystl lefts re visile, ut smll holesterol rystls re not pprent. (, ) Lesions were stined for mrophges (CD68, red). Note: Lrge holesterol rystls re found extrellulrly () nd smll rystls re found intrellulrly (). Smple imged t 37 C using wrmstge. Representtive setions of two ptients (, ) (different from ptient shown in Supplementry Fig. 3) re shown. 4

5 6 3 Syntheti holesterol + MCD MCD Drkfield mirosopy IL18 (pg/ml) Cholesterol rystls (μg/ml) MDP-priming 2 1 Cholesterol rystls (µg/ml) Nigeriin 2 1 iedap-priming 16 Cholesterol (μg/ml) d Cholesterol rystls LDL priming (µg/ml) ATP 1 2 Cholesterol rystls ATP LPS priming Supplementry Fig. 5: Cholesterol rystl-medited IL-1β relese in primry murine onemrrow ells is dependent of the NLRP3 inflmmsome., IL-18 ELISA of superntnts from LPS-primed wild-type mrophges stimulted with holesterol rystls or nigeriin., IL-1β ELISA of superntnts from LPS-primed one mrrow derived DCs stimulted with syntheti holesterol rystls with or without methylylodextrin (MCD). Equivlent doses of MCD were diluted into medi of LPS-primed mrophges. Note: Upon dilution in queous ulture medi, smll holesterol rystls fll out of solution y dilution of the holesterol-soluilizing gent MCD (, right)., d, IL-1β ELISA of superntnts from () MDP- or iedap- nd (d) etylted LDL- or LPS-primed mouse mrophges, stimulted with holesterol rystls, ATP or left untreted. Mens with s.e.m. from one out of two (,, d) three () representtive experiments re shown. 5

6 2 16 No Inhiitor Ltrunulin A Overly fluoresene DiD DiI holesterol rystlsholesterol rystls IL-1β in pg/ml Ex: 488 nm; Em: mn e Cell numer Cell numer 2 1 dadt Cholesterol rystls (μg/ml) Monoytes.63 DiI holesterol rystls 2% mdcs.63 DiI holesterol rystls Overly + trnsmitted light pdcs.63 DiI holesterol rystls μg/ml 2 μg/ml μg/ml 1 μg/ml 4% 6% 9% Aridine ornge fr red fluoresene (lysosome) 18% Overly + refletion f Lymphoytes DiI holesterol rystls d 1 Bfilomyin (nm) none Cholesterol rystls (μg/ml) Supplementry Fig. 6: Fluoresent holesterol rystls re phgoytosed y monoytes, mrophges nd dendriti ells., IL-1β ELISA of superntnts from LPS-primed mouse mrophges stimulted with holesterol rystls or dadt in the presene or sene of Ltrunulin A., A mixture of unleled, DiI-leled (green) or DiD-leled (red) holesterol rystls ws inuted for 24 h nd susequently imged y omintion of refletion (unleled, white) or fluoresene onfol imging. Note: Dyes ound to the rystls do not exhnge nd non-leled rystls do not quire dye., PBMCs were inuted with DiI-leled holesterol rystls in the sene or presene of inresing mount of ytohlsin D. Cells were stined with surfe mrkers to distinguish ell popultions nd nlyzed y flow ytometry. The men fluoresene intensity of DiI-holesterol rystl uptke is shown for the different ell popultions. d, LPS-primed humn PBMCs were left untreted or treted with ytohlsin D nd susequently inuted with 2 μg/ml holesterol rystls. IL-1β ws determined in superntnts y ELISA. e, Murine mrophges stimulted with holesterol rystls for 6h, stined with ridine ornge nd nlyzed y FACS. f, IL-1β ELISA of superntnts from LPSprimed, murine mrophges stimulted with holesterol rystls in the presene or sene of filomyin A1. Dt re representtive of one experiment repeted twie (-d) or three times (e, f). 6

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