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Single-cell RNA-Seq resolves phenotypically heterogeneous subtypes in systemic juvenile idiopathic arthritis (SJIA)

ABSTRACT: Systemic juvenile idiopathic arthritis (SJIA) is a clinically heterogenous systemic inflammatory disorder sometimes complicated by macrophage activation syndrome (MAS) and lung disease (LD), which are thought to be driven by IFN signaling. To identify cellular sources and novel gene programs underlying SJIA pathogenesis, we performed the first in-depth single-cell RNA Sequencing (scRNA-Seq) analysis of 21 SJIA, SJIA-LD, and SJIA-MAS patient PBMCs. To define novel heterogenous patient-subtypes associated with shared transcriptional responses and associate these with clinical and diagnostic metadata, we developed the tools UDON and SATAY-UDON. These tools identify hidden patient-subtypes, including a novel Complement and IFN signaling gene program expressed by SJIA-LD monocyte populations, unravel cellular sources of IFN signaling in SJIA-MAS as CD4 T cells and monocytic cell types, and identify a previously unknown role for platelets and S100 proteins as drivers of systemic inflammation. These data provide insights into new potential therapeutic targets for SJIA complications.

ORGANISM(S): Homo sapiens

PROVIDER: GSE207633 | GEO | 2023/04/12

REPOSITORIES: GEO

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Project description:Objective. Follistatin-like protein 1 (FSTL-1) is a secreted glycoprotein that is over-expressed in certain inflammatory diseases. Our objective in this study was to correlate FSTL-1 levels with measures of clinical disease activity in systemic juvenile idiopathic arthritis (sJIA), including macrophage activation syndrome (MAS). Methods. FSTL-1 serum levels were measured by ELISA in 28 patients with sJIA, including 7 patients who developed MAS, as well as in 30 normal controls. Levels were correlated with erythrocyte sedimentation rate (ESR), ferritin and sIL-2Rα expression. Differential gene expression based on FSTL-1 levels was analyzed in peripheral blood mononuclear cells (PBMCs). Results. FSTL-1 serum levels were elevated at time of presentation (pre-treatment) of sJIA (mean 200.7 ng/ml) and decreased to normal (mean 133.7 ng/ml) over 24 months (p<0.01). FSTL-1 levels were markedly elevated during acute MAS (mean 279.8 ng/ml) and decreased to normal (mean 120.3 ng/ml) following treatment (p<0.001). FSTL-1 levels correlated with serum markers of inflammation, including sIL-2Rα and ferritin, in patients with MAS. PBMCs from patients with FSTL-1 levels >200 ng/ml showed an increase in expression of genes related to innate immunity and erythropoiesis, and decrease in NK cell function. Patients with the highest FSTL-1 levels at disease onset (>300 ng/ml) ultimately required cyclosporine treatment. Conclusion. In patients with sJIA, serum FSTL-1 is a biomarker for MAS and FSTL-1 levels at presentation may predict subsequent disease course. Patients with FSTL-1 levels >200 ng/ml had altered gene expression patterns suggestive of subclinical MAS and may represent a subgroup of sJIA with more severe disease. FSTL-1 serum levels were measured by ELISA in 28 patients with sJIA, including 7 patients who developed MAS, as well as in 30 normal controls. Levels were correlated with erythrocyte sedimentation rate (ESR), ferritin and sIL-2Rα expression. Differential gene expression based on FSTL-1 levels was analyzed in peripheral blood mononuclear cells (PBMCs). Only 11 patients were run on microarray.

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Single-cell RNA-Seq resolves phenotypically heterogeneous subtypes in systemic juvenile idiopathic arthritis (SJIA)

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