Pre-treatment of ECFCs with 1 ng/ml of TNFα enhances TNFR2 expression
We first investigated if treating ECFCs with TNFα could change the expression of ECFC principle markers. Therefore, CB-ECFCs were incubated with increasing doses of TNFα (0, 0.01, 0.1, 1, 10, 50, 100 ng/ml). After 24 hours, no difference was noticed in CD31 expression (data not shown). The same result was observed for the percentage of CD144 expression; however, we detected a slight increase in CD144 expression level (Mean Fluoresce Intensity (MFI)) starting from 0.1 ng/ml of TNFα which was significant only with 1 ng/ml treatment (Figure 1A). In case of VEGFR2, we observed no difference in the percentage of VEGFR2 expression until 1 ng/ml of TNFα but a dose dependent decrease in higher doses. The MFI of VEGFR2 was increased with 0.01 and 0.1 ng/ml of TNFα then reached to basal level in 1 ng/ml and significantly dropped in higher doses (Figure 1B).
We then evaluated the impact of TNFα stimulation on the expression of TNFRs. The percentage of expression and MFI of TNFR1 was dramatically increased when ECFCs were treated with low doses of TNFα (0.01 and 0.1 ng/ml) and then reached to basal level in intermediate doses of 1 and 10 ng/ml and elevated again following high doses of 50 and 100 ng/ml of TNFα treatment (Figure 1C). Interestingly, while 0.01 and 0.1 ng/ml of TNFα did not changes the TNFR2 expression, pre-treating ECFCs with 1 ng/ml significantly increased the percentage of expression and MFI of TNFR2. The higher TNFα doses significantly reduced the TNFR2 expression (Figure 1D).
This proved that pre-treatment of ECFCs with 1 ng/ml of TNFα can increase the TNFR2 expression without a dramatic change in the basal expression level of CD144, VEGFR2, and pro-inflammatory TNFR1 marker.
Pre-treatment of ECFCs with 1 ng/ml of TNFα provides sufficient inflammation
One of the main aims of this study was to achieve a controlled inflammatory environment in which ECFCs up-regulate TNFR2 expression without passing the borderline of toxic and pro-apoptotic state. CB-ECFCs were incubated with increasing doses of TNFα. After 24 hours, cells were analyzed for the expression of ICAM, VCAM and TIE-2 pro-inflammatory/injury markers.51 We observed that 0.01 and 0.1 ng/ml of TNFα provided low inflammation. In these setting, ICAM and TIE-2 (only with 0.1 ng/ml) markers were up-regulated while VCAM remained untouched (Figure 2A, B and C). Nevertheless, this was accompanied by a significant increase in the percentage of apoptotic CD31+CD144+ cells (20.26 % and 36.11% respectively) (Figure 2 D). Interestingly, our data showed that 1 ng/ml of TNFα was the threshold between the low inflammatory and extensive inflammatory/injury status. In this dose, we observed an intermediate expression of ICAM, VCAM and TIE-2 markers (Figure 2A, B and C) and remarkably lower apoptosis (14.63%) compared to lower doses of TNFα (Figure 2D). The higher doses of TNFα (10, 50 and 100 ng/ml) entered ECFCs into uncontrolled and toxic inflammation with considerably higher ICAM, VCAM and TIE-2 expression. This was accompanied by high levels of apoptosis notably with 50 and 100 ng/ml of TNFα (25.03%, 73.3% and 65.54% respectively). Therefore, 1 ng/ml of TNFα was validated as the ideal dose to treat ECFCs prior co-culturing with T cells.
TNFα priming increases ECFC immunosuppressive effect
We previously demonstrated that ECFCs can suppress T cells and this effect was dependent on the production of TNFα by activated T cells and the expression of TNFR2 by ECFCs (Figure 3A).27,28 Here, we aimed to explore if the pre-treatment of ECFCs with TNFα could boost TNFR2 expression and consequently their immunosuppressive effect (Figure 3B).
We treated two sources of ECFCs (CB and APB-ECFCs) with 1 ng/ml of TNFα for duration of 24 hours. As expected, this treatment effectively increased the percentage and MFI of TNFR2 on both types of ECFCs (Figure 4A). Then, untreated or primed ECFCs were co-cultured with CFSE labeled human CD3+CD25- responder T cells in 6 increasing ratios (1/1 to 1/32 for ECFCs/T cells). CD25+ T cells were depleted from starting T cell population to eliminate 1) pre-activated T cells and 2) unspecific immunosuppression by natural CD25high Tregs. After 3 days, T cells were collected and the proliferation capacity of CD4+ and CD8+ T cells was measured. To observe the effect of EGM2 medium and the probable TNFα remnant on T cells, two control group were considered in which T cells were cultured either in 50% EGM2+ 50% RPMI or 50% EGM2+ 50% RPMI + 1 ng/ml of TNFα. No difference was observed between those controls (Figure 4B, C, D and E). As expected, we observed a significant dose dependent decrease in proliferation capacity of both CD4+ and CD8+ T cells when co-cultured with APB-ECFCs (Figure 4B and C) and CB-ECFCs (Figure 4D and E). Among untreated APB-ECFCs, the immunosuppressive effect was only observed in 1/1 and 1/2 ratios (30.65% and 12% of suppression, respectively) for CD4+ T cells and equally for CD8+ T cells (43.87% and 17.36% of suppression, respectively) and then was lost for more elevated ratios (Figure 4B and C). Interestingly, pre-treating with 1 ng/ml TNFα increased APB-ECFC immunosuppressive capacity up to 1/8 ratio with 10.75% of CD4+ T cell suppression versus 3% in 1/8 untreated condition (Figure 4B) and a tendency to more CD8+ T cell immunosuppression in 1/8 ratio (1.37% in untreated versus 5.75% in primed condition) (Figure 4C). A stronger immunosuppression of T cells was observed after co-culturing with untreated CB-ECFCs, starting from 1/1 (59.12% of suppression) up to 1/16 ratio (11.78% of suppression) for CD4+ T cells and from 1/1 (52.45% of suppression) up to 1/16 ratio (18.44% of suppression) for CD8+ T cells (Figure 4D and E). Except 1/32 ratio in CD8 group, TNFα priming significantly increased CB-ECFC immunosuppressive capacity in all ratios of CD4+ (81.33% to 9.66% of suppression for 1/1 and 1/32 ratio, respectively) and CD8+ T cells (61.60% to 31.32% of suppression for 1/1 and 1/16 ratio, respectively) (Figure 4D and E). Hence, we report an increased immunosuppressive effect of TNFα primed ECFCs which is more accentuated in CB-ECFCs than APB-ECFCs.
Interaction of TNFα with TNFR2 and not TNFR1 increases ECFC immunosuppressive effect
We next sought to understand which TNFR is responsible for increased ECFC immunosuppressive effect. Thus, we have re-created ECFC/T cell co-culture experiment but to selectively stimulate TNFR1, we blocked TNFR2 on ECFCs using anti-TNFR2 neutralizing Ab for 24 hours. Then, we treated them with 1 ng/ml of TNFα for another 24 hours and assessed their immunosuppressive effect (Figure 5A). Untreated or primed CB-ECFCs were co-cultured with CFSE labeled CD3+CD25- responder T cells in 6 increasing ratios (1/1 to 1/32 for ECFCs/T cells). After 3 days, T cells were collected and the proliferation capacity of CD4+ and CD8+ T cells was measured. Our result revealed that, while untreated CB-ECFCs suppressed T cells in a dose dependent manner, TNFR1-stimulated ECFCs did not exert any immunosuppressive effect regardless of ECFC/ T cell ratios (Figure 5B, C and D). Surprisingly, TNFR1 stimulation directed ECFCs toward immunogenic phenotype as starting from 1/4 ratio, CD4+ T cells proliferated even more than activated T cells alone control group. This immunogenic effect was observed only in 1/32 ratio for CD8+ T cells (Figure 5B and C). Altogether, these data proved that interaction of TNFα merely by TNFR2 is responsible of increased ECFC immunosuppressive effect.
TNFα priming increases ECFC capacity to down-modulate T cell activation markers
To understand if TNFα priming increases ECFC capacity to modulate T cell activation profile, CB-ECFCs and APB-ECFCs were co-cultured with activated CD3+CD25- T cells at a fixed 1:6 ECFC to T cell ratio. After 3 days, T cells were collected and analyzed for the percentage of expression and the MFI of different activation markers among CD4+ and CD8+ T cells. We first measured the expression of CD25 marker which is constitutively expressed on T reg and activated T cell.52,53 We observed a dramatic reduction of CD25 expression among CD4+ T cells after co-culturing with CB-ECFCs or APB-ECFCs and among CD8+ T cells while co-cultured with CB-ECFCs (Figure 6A and Supplementary Figure 1). Priming CB-ECFCs and APB-ECFCs with 1 ng/ml of TNFα significantly increased their immunomodulatory effect against both T cell populations (Figure 6A and Supplementary Figure 1). Moreover, we evaluated the expression of two members of TNFα receptor superfamily, GITR (TNFRSF18) and TNFR2 (TNFRSF1B). Our results showed that while only CB-ECFCs were able to down-modulate the MFI of GITR on CD4+ T cells, TNFα priming of CB-ECFCs remarkably reduced the percentage of expression and MFI of GITR among CD4+ and CD8+ T cells (Figure 6B and Supplementary Figure 1). Interestingly, even though APB-ECFCs were unable to decrease the percentage of GITR expression in neither of T cell populations, TNFα priming of APB-ECFCs led to a significant reduction in the MFI of GITR on CD4+ T cells (Supplementary Figure 1). In case of TNFR2 marker, we noticed that while both CB-ECFCs and APB-ECFCs were able to significantly decrease the TNFR2 expression, APB-ECFCs demonstrated a stronger modulatory effect. Once more, priming ECFCs with 1 ng/ml of TNFα increased ECFC immunomodulatory effect regardless of the ECFC source or T cell population (Figure 6C). Furthermore, except an increased expression level on CD4+ T cells co-cultured with primed APB-ECFCs, our result did not reveal any alteration in the MFI of TNFR2 on neither of T cell populations (Supplementary Figure 1). Finally, we studied the expression of inducible co-stimulatory molecule (ICOS). This co-stimulatory receptor is essential for T cell activation and proliferation.54 We observed a significant reduction of ICOS expression among CD4+ and CD8+ T cells co-cultured with either of ECFCs (Figure 6D and Supplementary Figure 1). Once again, TNFα priming led to increased ECFC immunomodulatory effect (Figure 6D and Supplementary Figure 1). Altogether, these data suggest that priming ECFCs with TNFα can strongly increase their immunomodulatory effect.