POS0156 CD4+HLADR+ T CELLS WITH AUTOIMMUNE REACTIVITY THAT RESIST REGULATORY CONTROL AND PERPETUATE DISEASE INFLAMMATION IN JUVENILE IDIOPATHIC ARTHRITIS
Authors: J. Y. Leong, P. Kumar, S. H. Tay, G. Mijnheer, J. G. Yeo, S. Hazirah, A. J. M. Lim, C. Chua, P. Chen, A. Consolaro, M. Gattorno, T. Arkachaisri, F. Van Wijk, A. Martini, S. Albani
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Circulatory CD4<sup>+</sup>HLADR<sup>+</sup> effector and regulatory T cells have been previously shown to possess strong overlap in immunological phenotypes and TCRs with synovium counterparts[1,2]. In particular, systemic CD4<sup>+</sup>HLADR<sup>+</sup> T effectors were significantly increased in arthritic patients that are non-responsive to TNFi treatment. Yet, despite of the presence of regulatory T cells within the synovium, why CD4<sup>+</sup>HLADR<sup>+</sup> T effectors continue to perpetuate inflammation and its relationship with CD4<sup>+</sup>HLADR<sup>+</sup> regulatory counterparts remains unknown. <h3>Objectives:</h3> This study aims to employ immunomics platforms (CyToF, deep RNA sequencing) coupled with regulatory and antigenic T cell assays, to provide critical insights in understanding the functional and pathogenic properties of CD4<sup>+</sup>HLADR<sup>+</sup> T cells in juvenile idiopathic arthritis (JIA). Importantly, we seek to dissect the disease mechanisms for which CD4<sup>+</sup>HLADR<sup>+</sup> T cells contribute to autoimmunity in JIA. <h3>Methods:</h3> CyToF analysis of JIA patients (PBMC=7, SFMC=7). FACS sorting and deep RNA sequencing of CD4<sup>+</sup>HLADR<sup>+</sup> or CD4<sup>+</sup>HLADR<sup>-</sup> effectors or regulatory T cells in (a) JIA patients (PBMC=8, paired PBMC/SFMC=8). CpG methylation profiling in JIA patients (paired PBMC/SFMC=3) and healthy controls (n=6). Micro-suppression assay in JIA patients (paired PBMC/SFMC=8) and healthy controls (n=7). CD4<sup>+</sup>HLADR<sup>+</sup> Treg destabilisation assay (n=6). MHC-II pathway flow cytometry analysis (JIA PBMC=5, Healthy controls=11). Antigenic memory recall response of JIA (SFMC=7). <h3>Results:</h3> We performed CyToF analysis of the CD4 memory landscape in JIA patients and detected a significant increase (p &lt; 0.001) of CD4<sup>+</sup>HLADR<sup>+</sup> T effectors in the synovium as compared with circulation. The synovium CD4<sup>+</sup>HLADR<sup>+</sup> T effectors were inflamed, expressing higher levels of TNFa, IFNg and IL-21 as compared with HLADR<sup>-</sup> counterparts. CD4<sup>+</sup>HLADR<sup>+</sup> T effectors strongly correlated (r= 0.74, p &lt; 0.01) with levels of CD4<sup>+</sup>HLADR<sup>+</sup> T regulatory cells across the circulatory and synovium compartments. Next, we sorted CD4<sup>+</sup>HLADR<sup>±</sup> subsets from JIA patients and performed deep RNA sequencing, seeking to understand their functional properties and relationships. Phylogenetic tree analysis reveal that circulatory CD4<sup>+</sup>HLADR<sup>+</sup> T effectors and regulatory cells were uncoupled from their respective compartments and displayed strong convergence. This transcriptomic convergence in circulatory CD4<sup>+</sup>HLADR<sup>+</sup> subsets was further supported by pathway/transcription factor network analysis, indicating similar T cell activation pathways and transcriptomic drivers. Importantly, synovium CD4<sup>+</sup>HLADR<sup>+</sup> T cells were enriched for 7 key pathways (MHC-II, IFNg signalling, viral defence, chemotaxis, apoptosis, T cell co-stimulation and LPS/Bacteria defence), and displayed stronger TCR clonatype sharing (p &lt;0.01) as compared with HLADR<sup>-</sup> counterparts. JIA CD4<sup>+</sup>HLADR<sup>+</sup> Tregs displayed stable CpG methylation profiles in the FoxP3 promoter sites, and were capable of suppressing disease T effectors. Yet, synovium CD4<sup>+</sup>HLADR<sup>+</sup> T effectors were able to resist regulatory control (p &lt; 0.05). As CD4<sup>+</sup>HLADR<sup>+</sup> T effectors expressed high levels of IFNg and exhibited pronounced IFNg signalling, we destabilised Tregs in the presence of IFNg and mitotic agents. CD4<sup>+</sup>HLADR<sup>+</sup> regulatory cells demonstrated higher instability and decreased FoxP3 levels (p &lt; 0.05) as compared with HLADR- counterparts. Additionally, CD4<sup>+</sup>HLADR<sup>+</sup> T effectors demonstrated memory recall response to disease relevant peptide (Hsp60) in the absence of APCs. <h3>Conclusion:</h3> We have shown that CD4<sup>+</sup>HLADR<sup>+</sup> T cells are expanded in systemic and synovium compartments of JIA patients, whilst displaying strong transcriptomic convergence with shared TCR clonatypes, indicating a strong ontogenic disease origin. Though CD4<sup>+</sup>HLADR<sup>+</sup> Tregs are poised to suppress, CD4<sup>+</sup>HLADR<sup>+</sup> T effectors could resist regulatory control and respond to disease relevant antigens independently, thereby amplifying disease activity. Specific targeting of CD4<sup>+</sup>HLADR<sup>+</sup> T effectors in JIA may present as a potential therapeutic avenue. <h3>REFERENCES:</h3> [1] Spreafico R, et al. Ann Rheum Dis. 2016 Feb;75(2):459-65. [2] Rossetti M, et al. Ann Rheum Dis. Feb 2017; 76(2): 435-441. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>