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Human and beastly abstraction protocols were accustomed by the Analysis Ethics Board (REB) of the Hospital for Sick Children, Toronto, Canada. Donors active the accord anatomy above-mentioned to the participation. In addition, all beastly protocols were accustomed by the Toronto Centre for Phenogenomics (TCP) (Toronto, Canada), and all the procedures were performed according to the protocols and ethical guidelines.



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Peripheral claret from advantageous macho donors was calm in K2 EDTA claret tubes. We exclude claret accumulating from any advantageous donor accepting flu or any accepted anarchic symptoms. Isolation of neutrophils was agitated out as declared previously6,46,63. Briefly, PolymorphPrep (Axis-Shield) was acclimated for isolating polymorphonuclear neutrophils from blood. Red claret beef were afresh lysed and cellular bits were abandoned application afterwards washes as declared ahead (see references for details). Antiseptic neutrophils were resuspended in RPMI boilerplate (Invitrogen) absolute 10 mM HEPES (pH 7.2). Beef were counted and action was arrested by Trypan dejected application a hemocytometer. Purity of neutrophils was bent by Cytospin alertness and imaging. Neutrophil affairs with >95–98% authentic applicable beef were acclimated in this study.

Human neutrophils (100,000) in 1 mL of RPMI media were angry with 5 μg/mL LPS (O182:B12) from Escherichia coli (Sigma) to abet NETosis. Samples were incubated for 4 h at 37 °C in 5% CO2 with alternate affable bond by inverting the tubes (once anniversary 30 min), in adjustment to abstain corpuscle sedimentation. Afterwards incubation, samples were centrifuged at 400×g for 10 min. Supernatants were calm and snap-frozen in dry ice. DNA absorption in the antiseptic NETs was bent with Quant-iTPicoGreen dsDNA Kit (Invitrogen) afterward manufacturer´s instructions.

Human SP-D was acquired from ameliorative bronchoalveolar lavage (BAL) of individuals with pulmonary alveolar proteinosis. The antiseptic hSP-D from these BALs has been acclimated in abounding anatomic studies as appear earlier64,65. Briefly, BAL was incubated with maltose-agarose chaplet in the attendance of 10 mM CaCl2. The chaplet were caked into an abandoned cavalcade and done with 1 M NaCl to abolish non-specifically apprenticed apparatus on an AKTA FPLC arrangement (G.E. Healthcare). SP-D was eluted with Tris-MnCl2 absorber (20 mM Tris (pH 7.4), 100 mM MnCl2). Then, fractions absolute SP-D were affiliated and concentrated, and added antiseptic with a Superose 6 (10 × 300 mm) gel filtration cavalcade in 20 mM Tris (pH 7.4), 150 mM NaCl, 5 mM EDTA buffer, as ahead described64,65. The oligomeric structural absoluteness of the antiseptic SP-D from the BAL of proteinosis patients has been adjourned by electrophoresis and diminutive force microscopy (AFM)27. The AFM images appearance that hSP-D antiseptic from proteinosis preserves its archetypal oligomeric structure, accumulated as ample oligomers (Supplementary Fig. 1). Routine anatomic abstracts affirm that this protein alertness retains the adeptness to bind and agglutinate bacilli (i.e., E. coli).



SytoxGreen (Life Technologies), a cell-impermeable nucleic acerbic bounden dye, was acclimated for ecology NETosis over time. Microplates of 96-wells were seeded with 100 μL of a abeyance absolute 50,000 neutrophils and 5 μM SytoxGreen dye in anniversary well. Agonists (known NETs inducers; absolute control), or agonists with SP-D (at 10, 20, 40 μg/mL), or RPMI with SP-D absorber (negative control) were able in 10 μL of media and incubated for 30 min at 37 °C in 5% (v/v) CO2 incubator. Calcium absorption of SP-D absorber was adapted above-mentioned to use at 5 mM CaCl2. Afterwards evolution time, a aggregate of 10 μL, abeyance absolute absorber abandoned (negative control), or agonist (with and afterwards SP-D) was added to the beef and the fluorescence acuteness of the dye was tracked at 30-min time intervals up to 240 min afterwards neutrophil activation, application a POLARstar OMEGA fluorescence bowl reader. Between readings, the plates were kept at 37 °C in 5% (v/v) CO2 incubator. Final calcium absorption in the agreement was 0.5 mM. The final concentrations of the altered agonists in these abstracts were 25 nM PMA, 2.5 μM ionomycin (calcium ionophore produced by the bacillus Streptomyces conglobatus) and 5 μg/mL LPS. For LPS dose-response, altered LPS concentrations were titrated. The accomplishments fluorescence at 0-min time point was subtracted from the fluorescence at anniversary time point and was afresh disconnected by the fluorescence ethics of the neutrophils lysed with 0.5% (v/v) Triton X-100 (the best fluorescence in the neutrophils advised with Triton X-100, advised as 100% DNA release).

Neutrophils (50,000 in 100 μL of RPMI media/well) were seeded in 12-well alcove slides (Ibidi). The agonists and controls with or afterwards SP-D above-mentioned abacus to neutrophils were able as declared above. In this case, two final calcium concentrations (0.5 mM and 2 mM) were tested. Afterwards stimulation, neutrophils were placed at 37 °C, 5% CO2 incubator for 2 h. Beef were afresh anchored with 4% (w/v) PFA for brief at 4 °C. Afterwards fixation, samples were done three times with PBS and permeabilized with 0.05% (w/v) Triton X-100 for 10 min. Beef were done three times with PBS again. For non-specific antigen blocking, 4% (w/v) BSA were acclimated for 1 h. Afterwards blocking, primary antibodies were added to the samples and incubated brief (ON) at 4 °C. The antibodies acclimated were anti-myeloperoxidase abrasion antibiotic (ab25989, Abcam) at 1:500 for staining myeloperoxidase (MPO) (with anti-mouse accessory antibiotic conjugated with a blooming fluorescence Alexa fluor 488 dye; 1:5000 dilution; ThermoFisher), while aerial anti-citH3 antibiotic (ab5103; Abcam) at 1:500 concoction was acclimated for audition the attendance of citrullinated histone H3 (CitH3, with anti-rabbit accessory antibiotic conjugated with a far-red fluorescence dye Alexa fluor 647; 1:5000 dilution; ThermoFisher). DNA was decrepit with DAPI (4’,6-diamidino-2-phenylindole) (1:100 concoction of the banal 1 mM). Afterwards evolution with the accessory antibody, slides were done and army in bottle awning block (ThermoFisher) with anti-fade beaming ascent boilerplate (Dako). The images were taken application an Olympus IX81 astern fluorescence microscope with a Hamamatsu C9100-13 back-thinned EM-CCD camera and Yokogawa CSU × 1 spinning deejay confocal browse arch with Spectral Aurora Borealis upgrade, four abstracted diode-pumped solid-state laser curve (Spectral Activated Research, 405, 491, 561, and 642 nm). Samples were beheld at ×40/0.95 deepening and images were candy by Volocity software (version 6.3, Corpuscle Imaging Perkin-Elmer).

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LPS (O182:B12) dilutions at 2.5, 5, 10, 20, 60, and 80 μg/mL were dotted (2 μL) assimilate a nitrocellulose blur (Amersham Biosciences). SP-D (370 ng) and SP-D absorber were additionally activated as absolute and abrogating controls, respectively. Afterwards dehydration at allowance temperature (RT), membranes were blocked with 5% (w/v) BSA in TBST-Ca absorber (50 mM Tris (pH 7.4), 150 mM NaCl, 0.02% (v/v) Tween and 5 mM CaCl2) brief at 4 °C. Three washes with TBST-Ca absorber were done and the altered membranes were incubated with 5 μg/mL or 15 μg/mL of SP-D in TBST-Ca or 5 μg/mL of SP-D in TBST-EDTA (20 mM) for 5 h at RT. A ascendancy set with TBST-Ca afterwards SP-D was additionally performed. Afterwards incubation, membranes were done four times with TBST-Ca and incubated with SP-D antibiotic adjoin beastly recombinant SP-D (custom polyclonal anti-SP-D generated in rabbits by Cocalico Biologicals, PA, USA)66 at 1 μg/mL ON at 4 °C, followed by four washes with TBST-Ca. Membranes were afresh incubated for 1 h with the accessory antibody, donkey anti-rabbit IgG-HRP (ThermoFisher; 1:10000) and done as declared above. SP-D complexes were detected by ECL (Millipore).

Balb/c agrarian blazon (WT) SP-D / and Knock out (KO) SP-D−/− mice (generated by Dr. S. Hawgood, UCSF) were bred in the Toronto Centre for Phenogenomics (TCP), Canada. For airway instillation, mice were anesthetized with 2–4% (v/v) isofluorane with O2 at 1 L/h. Then, 5 μg of LPS (O182:B12) in 25 μL of antiseptic PBS or 25 μL of antiseptic PBS (negative control) were absolute intranasally. Mice were sacrificed with an intraperitoneal bang of 0.1 mL of Euthanyl (Bimeda-MTC) 24 h afterwards instillation, and three times with 1 mL of absorber (Tris 5 mM (pH 7.4), NaCl 150 mM) were acclimated to alike the lungs. All procedures were performed in accordance with TCP accustomed protocols and ethical guidelines.

BAL samples were arctic with dry ice and stored until use at −80 °C. Above-mentioned to use anniversary sample was aqueous at 37 °C and centrifuged for 10 min at 400×g, auctioning the pellet. An aliquot of 400 μL of BAL afloat was adored and arctic for added abstracts (determination of CitH3 and absolute protein, DNA and NE-DNA ELISA in BAL). Two mililiter of BAL afloat aliquots were ultra-centrifuged at 100,000×g (4 °C, 1 h) to pellet lung surfactant components. Surfactant pellets were resuspended in 10–15 μL of absorber (Tris 5 mM (pH 7.4), NaCl 150 mM). Phosphatidylcholine (PC), as a advertence for phospholipids (PL) concentration, and cholesterol in lung surfactant samples were bent application kits (Spinreact) based on enzymatic methods67,68. Samples were activated in the bound balloon surfactometer (CBS) at a absorption of 10 mg/mL of PC.

Total protein and DNA concentrations were bent in BAL supernatants. Pierce BCA Protein Assay Kit (ThermoFisher) was active to actuate absolute protein absorption in the samples. Quant-iTPicoGreen dsDNA Kit (Invitrogen) was acclimated for accepting DNA absorption in BAL supernatants, and in this case, samples were adulterated 1:3, and 50 μL of the adulterated samples were assayed. Manufacturer’s instructions for 96-wells bowl protocols were followed for both bartering kits.

All the BAL samples, from WT and SP-D KO mice absolute with LPS or agent ascendancy (PBS), were analyzed for neutrophil elastase-DNA (NE-DNA) circuitous application a sandwich ELISA protocol. A aggregate of 100 μL of undiluted samples were added in alike to a 96-well plates, which were pre-coated with anti-neutrophil elastase antibodies (MyBioSource). The plates were closed and incubated for 90 min at 37 °C. Afterwards the incubation, wells were done three times by application 350 μL 1× abrasion buffer. Afterwards abrasion afterwards dehydrating the wells, a aggregate of 100 μL of anti-DNA antibiotic was added to anniversary able-bodied (diluted 1:100 in evolution buffer; Roche, archive #11774425001). The plates were afresh closed and incubated for 2 h on a rocker at allowance temperature. Afterwards the evolution wells were afresh washed, and 100 μL of ABTS substrate (MyBioSource, archive #MBS269576) was added to anniversary well. Afterwards substrate evolution for 30 min at allowance temperature in the dark, the reactions were chock-full by abacus the abortion band-aid and the absorbance ethics were apprehend at 405 nm application a bowl reader. NETs able from beastly neutrophils with PMA activation were quantified (DNA content) and ran as a ascendancy to body a standard-curve.

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SP-D KO and WT mice were absolute with either PBS ascendancy or LPS. Afterwards 24 h, lungs were perfused with 1 mL of optimal acid temperature (OCT) admixture (Tissue-Tek; Sakura Finetechnical Co., Ltd., Tokyo, Japan) through trachea. Afterwards attached off the trachea to advance the aqueous in the lung, the accomplished lung was added emerged into the OCT and preserved at −80 °C. Arctic lungs were cut as 10 μm sections in a cryostat microtome and army on bottle slides. Lung tissue sections from altered groups (WT and KO mice, absolute with either PBS or LPS) were aqueous at allowance temperature and anchored in 4% (v/v) paraformaldehyde for 15 min. Afterwards washing, sections were advised with 5% (w/v) BSA for 1 h at allowance temperature to block the all-embracing binding. Rest of the immunostaining accomplish and confocal imaging were followed as declared aloft (see area “Immunostaining and confocal imaging”).

Organic abstract (OE) from built-in surfactant antiseptic from beefy lungs was acquired as ahead declared by Schürch and colleagues37. A aggregate of 335 μL of OE at 8.97 μg/μL were evaporated beneath nitrogen breeze and afresh beneath exhaustion in an UNIVAP at 37 °C, for 2 h to abolish traces of amoebic solvents. Samples were reconstituted to 60 mg/mL final PL absorption in a two-step process: (i) first, 25 μL of absorber 5 mM Tris (pH 7.4), 150 mM NaCl were added and incubated at 45 °C for 30 min; (ii) then, 25 μL of antiseptic NETs in RPMI media with a DNA absorption of 0.65 μg/mL were additionally added and incubated afresh at 37 °C for addition 30 min. All incubations in the reconstitution action were performed with alternate afraid (10 min shaking/10 min repose; 1400 rpm in a Thermomixer). For convalescent experiments, the 25 μL of absorber in reconstitution footfall 1 were commissioned by 25 μL of SP-D at 808 μg/mL (final SP-D absorption in the sample account to lipids was 0.67% (w/w)). Samples were adulterated to 20 mg/mL PL absorption with antiseptic NETs in RPMI media and incubated 30 min at 37 °C above-mentioned to use. RPMI media abandoned was acclimated as a ascendancy to assay any aftereffect produced by the RPMI media vehicle.

The CBS is a accessory that allows evaluating the biophysical action of lung surfactant in vitro69. This accessory creates an ambiance that mimics the bearings of a distinct alveolus in the lung56,69,70. A baby air-bubble was created central a alcove abounding with absorber (150 mM NaCl, 5 mM Tris (pH 7.4), and 10% (w/v) sucrose). The sample to be activated (150 nL) was activated with a capillary central the alcove abreast the apparent of the bubble. Adsorption of the actual to the air-water interface was appropriately evaluated during the antecedent adsorption (IA) period. The appearance of the balloon was monitored and recorded for 5 min to beam changes in the apparent astriction (γ). Afterwards adsorption, the alcove was sealed. Compression-expansion cycles of the balloon at 20 cycles/min were afresh agitated out to appraise the activating behavior of the surfactant. These cycles actor the bearings in the alveoli during breathing, while lungs are aggrandized and abandoned during air afflatus and expiration, respectively.

To assay the samples from mice, 30 activating cycles were agitated out at 30 cycles/min, which is the best acceleration accustomed by the CBS device, alike admitting mice breath abundance is higher. Three replicates were performed of anniversary abandoned LS, and the boilerplate apparent action of the replicates was represented in the graphs.

To beam and assay the crabbed anatomy of interfacial surfactant films, surfactant suspensions were advance assimilate a buffered (150 mM NaCl, 5 mM Tris pH 7.4) sub-phase in a Langmuir apparent antithesis able with a connected Teflon award barrier and a 200 cm2 canal (Nima Technology, Coventry). Amoebic abstract from built-in surfactant was antiseptic from beefy lungs as ahead described, and benumbed with a trace of Alexa488 (Invitrogen) fluorescently-labeled surfactant protein SP-B (F-SP-B, 1% (w/w) with account to lipids). The sample was broiled beneath nitrogen breeze and afresh beneath exhaustion in an UNIVAP at 37 °C, for 2 h to abolish traces of amoebic solvents. The admixture was reconstituted to 10 mg/mL final PL absorption with absorber 150 mM NaCl, 5 mM Tris pH 7.4. Then, it was labeled with rhodamine-DOPE (Avanti Polar Lipids, Inc.) (0.1% mol of probe/mol of phospholipid each, added in a trace of dimethyl sulfoxide) in the attendance or absence of 20 μL of antiseptic NETs in RPMI media with a DNA absorption of 0.65 μg/mL, at 37 °C for 1 h with alternate afraid (10 min shaking/10 min repose; 1400 rpm in a Thermomixer), demography the surfactant abeyance to a final PL absorption of 5 mg/mL. Drops of the surfactant abeyance were assuredly deposited assimilate the apparent of the aqueous sub-phase in the apparent antithesis until a apparent burden of 2 mN/m was achieved. Afterwards 10 min to acquiesce the actual to stabilize, the interfacial blur was aeroembolism at 65 cm2/min to a final ambition burden of 30 mN/m. Afterwards 10 min of added equilibration, Langmuir–Blodgett films were able by appointment the interfacial films assimilate bottle awning slides application the COVASP adjustment as declared elsewhere69 at a alteration amount of 25 cm2/min, appropriately acceptance the actual transference afterwards altering the anatomy of the surfactant layers. Epifluorescence microscopy images were acquired in a Leica DM 4000B microscope, able with a camera Hamamatsu Orca-R2.

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Samples for WBs of lung surfactant proteins were able by applying 10 μg of surfactant PC per sample. Samples to assay SP-A and SP-C were loaded beneath abbreviation altitude application Laemmli absorber as loading buffer71 absolute 4% (v/v) β-mercaptoethanol; assay of SP-B was performed beneath non-reducing conditions. Samples were above at 99 °C, 10 min. They were loaded in 16% (w/v) or 4-20% (w/v) acrylamide gels and after transferred assimilate a PVDF blur for 1 h at 300 mA. Membranes were blocked with 5% (w/v) BSA in PBS with 0.05% (v/v) Tween (PBS-T) for 2 h, followed by evolution with primary antibodies overnight. SP-B (1:5000 dilution) or SP-C (1:5000 dilution) antibodies were from Seven Hills Bioreagents72,73. SP-A (1:10,000 dilution) antibodies were attentive supplied by Dr. J. Floros from Penn State University, USA74. Accessory antibiotic was anti-rabbit-HRP (Dako) at 1:10,000 concoction for SP-A and 1:5000 concoction for SP-B and SP-C.

To assay the citH3, 25 μL of anniversary mice BAL-supernatant were alloyed with Laemmli absorber with 4%(v/v) β-mercaptoethanol and acrimonious at 99 °C for 10 min. Samples were loaded into 12% (w/v) acrylamide gels and transferred assimilate nitrocellulose membranes. Membranes were blocked as ahead declared and incubated with primary anti-citH3 antibiotic (Abcam ref. #5103) at 1:500 concoction and accessory anti-rabbit antibiotic (Dako) 1:5000 dilution. In both cases, bands were developed with ECL (Millipore) and densitometry assay was agitated out with ImageJ software.

All statistical analyses were performed on GraphPad Prism 7. For assorted comparisons Two-way ANOVA with Bonferroni post-test and One-way ANOVA with Tukey’s post-test or t-test were acclimated as appropriate. All abstracts are presented as mean ± SD. The biological replicates and activated statistical tests are acclaimed in the corresponding amount legends. Significant differences were advised with a p-value of <0.05(*), <0.01(**), <0.001(***), and <0.0001(****).

Further advice on analysis architecture is accessible in the Nature Analysis Reporting Summary affiliated to this article.

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