Application of single-cell sequencing in autoimmune uveitis: a comprehensive review
关键词
摘要
Autoimmune uveitis is one of the most common inflammatory eye diseases leading to blindness globally. Its etiology is primarily associated with autoimmune responses. Patients with this condition often exhibit complex and chronic disease courses, with a high propensity for recurrence. Current treatments mainly involve corticosteroids and immunosuppressive agents, which, despite their effectiveness, entail significant side effects that severely impact patients' vision and quality of life. There are still unresolved questions regarding the etiology and immunopathogenesis of autoimmune uveitis, and traditional high-throughput sequencing techniques fall short of adequately elucidating its pathogenic mechanisms at the cellular level. With the continuous advancement of single-cell sequencing technology, an increasing number of studies are leveraging this approach to deeply investigate the pathogenesis of autoimmune uveitis, thereby offering new insights for identifying novel diagnostic and therapeutic targets. This paper reviews the latest applications of single-cell sequencing technology in exploring the pathogenesis of autoimmune uveitis. Through the utilization of this technology, researchers can gain a more comprehensive understanding of cellular-level changes in patients, providing robust support for the search for new therapeutic avenues. These studies offer new directions for the diagnosis and treatment of autoimmune uveitis and provide valuable information for the development of future therapeutic strategies and approaches.
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HIGHLIGHTS
INTRODUCTION
SINGLE-CELL SEQUENCING TECHNOLOGIES : FROM TRANSCRIPTOMICS DISCOVERY TO MULTI-OMICS INSIGHTS IN DISEASE PATHOGENESIS
Beyond scRNA-seq, Single-cell sequencing assay for transposase-accessible chromatin (scATAC-seq) provides a detailed view of chromatin accessibility, helping to elucidate the regulatory elements that drive gene expression changes in diseases.[20-21] This technique has been instrumental in identifying key transcription factors and regulatory networks involved in immune cell activation and inflammation.
Integrative approaches combining scRNA-seq with other omics technologies, such as epigenomics and proteomics, offer a comprehensive understanding of cellular states and regulatory mechanisms.[22-24] These multi-omics approaches are particularly valuable for studying the complex interactions between different molecular layers in autoimmune uveitis.
IDENTIFYING PATHOGENIC IMMUNE CELL SUBSETS
CD4+ T Cell
T cells are believed to play a central role in the pathogenesis of human uveitis.[4] Retinal antigen-specific T cells that escape elimination in the thymus encounter activating stimuli and costimulatory "danger" signals, evade Treg control, and differentiate into pathogenic effector T cells.[4,25] These cells undergo clonal expansion, migrate to the eye, break down the blood-retinal barrier, and recruit inflammatory leukocytes from the circulation.[4,25] The inflammation damages the tissue and releases ocular antigens. However, the specific T-cell subtypes involved remain unclear.SCS has been pivotal in delineating the diverse cell populations involved in AU. In 2019, Heng et al.[26]published a pioneering study utilizing scRNA-seq to characterize the cellular and immune landscapes within the retinas of mice with experimental autoimmune uveitis (EAU). Using a spontaneous EAU model, they identified Th1 cells as the primary drivers of immune inflammation. Additionally, they observed various retinal cells exhibiting responses to interferon-gamma (IFN-γ). Moreover, single-cell TCR sequencing of CD4+ T cells specific for a predominant interphotoreceptor retinoid-binding protein (IRBP) epitope in spontaneous EAU model revealed a remarkable diversity of autoantigen-specific TCRs, with greater clonal expansions in diseased mice.[27] This highlights the complexity of the immune response in autoimmune uveitis and underscores the utility of single-cell technologies in identifying pathogenic immune cell subsets and potential therapeutic targets.
In another study, the mechanism of gingival mesenchymal stem cells (GMSCs) in treating EAU was explored using scRNA-seq. The treatment reduced the generation of CCR6- CCR2+ phenotype Th17 cells and increased the generation of CCR6+ CCR2+ phenotype Th17 cells, which secrete IL-10 for immunoregulation in the lymph nodes of treated EAU mice.[28] A single-cell study reported that aging Th17 cells weaken pathogenicity and ameliorate experimental autoimmune uveitis in mice.[29] These studies found that Th17 cells play both positive and negative roles in regulating antitumor immune responses.
Monocytes
Accumulating evidence has also highlighted the role of monocytes in AU progression. In Vogt-Koyanagi-Harada (VKH) patients, elevated levels of ISG15+ proinflammatory monocyte subpopulations have been observed.[30] This subgroup displayed a distinctive gene expression profile indicative of inflammation, antiviral activity, and pathological activation, suggesting their involvement in active inflammation during VKH disease. Further supporting this, Zheng et al.[31] used scRNA-seq to analyze peripheral blood mononuclear cells (PBMCs) from Behçet’s disease (BD) patients, revealing significant expansion and transcriptional changes in monocytes. Detailed analysis identified a notable accumulation of C1q-high monocytes in BD patients, driven by activated IFN-γ signaling. Notably, treatment with tofacitinib, a Janus kinase inhibitor, effectively reduced C1q-high monocytes, suggesting a promising therapeutic approach.Neutrophil
Recent studies employing scRNA-seq have also uncovered sex-specific heterogeneity in neutrophil subsets and their role in the male-biased susceptibility to BD.[32] These findings suggest that targeting unconventional neutrophil subsets could offer novel, sex-specific therapeutic strategies to mitigate the progression of inflammatory diseases.CD8+ T cell
Further utilizing scRNA-seq and single-cell TCR sequencing (scTCR-seq), researchers have identified clonal transitions between skin-resident and circulating CD8+ T cells in skin samples from BD patients, potentially linked to inflammation recurrence.[33]Additionally, current research has focused on the pathogenic role of intraocular CD8+ T cells in human AU.[34]Microglia
Microglia, the resident immune cells of the central nervous system, including the retina, are crucial for maintaining the homeostasis of the retinal microenvironment.[35] Microglia in AU can help leukocytes cross the blood-retinal barrier.[36] However, their exact role in the pathogenesis of AU remains uncertain.SCS study targeted CD74 and CCL5 in retinal microglia, which could offer new strategies for treating AU by providing insights into the cellular dynamics and mechanisms of immune responses, highlighting potential therapeutic targets to mitigate disease progression and retinal damage.[37]Dendritic Cell
Kasper et al.[38] first reported a single-cell intraocular immunological atlas of patients with HLA-B27-associated acute anterior uveitis, highlighting the infiltration of dendritic cells (DC). Building on this, Hiddingh et al. [39] further characterized the immunological features of CX3CR1+CD1C+ DCs in autoimmune uveitis patients in 2023, noting their secretion of high levels of inflammatory cytokines. Other study also reported that DCs might be related to proinflammatory states in VKH patients.[40]Macrophages
Finally, research highlights the significant role of ocular macrophages in uveitis through the production of CCL2 and CXCL10, which are crucial for recruiting inflammatory cells to the eye.[41] Understanding these chemokine-mediated mechanisms of immune cell recruitment offers potential targets for novel therapeutic strategies to manage uveitis more effectively.In summary, CD4+ T cells, particularly Th1 and Th17 subsets, are key drivers of inflammation in AU, with Th1 cells predominating in experimental models and Th17 cells modulating immune responses. Monocytes, especially pro-inflammatory subpopulations, are involved in diseases like VKH and BD, while neutrophils exhibit sex-specific roles affecting disease susceptibility. CD8+ T cells contribute to inflammation recurrence, and microglia and dendritic cells offer potential therapeutic targets due to their roles in immune response and cytokine production. Macrophages also play a significant role by producing chemokines that recruit inflammatory cells to the eye. These findings highlight the complex interplay of immune cells in AU and identify key areas for potential therapeutic intervention.
UNCOVERING MOLECULAR PATHWAYS AND TARGETS
SCS has revealed novel molecular pathways and potential therapeutic targets in AU. Utilizing scRNA-seq and scATAC-seq, researchers have identified specific cytokines and signaling pathways that could be leveraged for targeted interventions.Id2/Pim1 axis
For instance, Li et al. [42] using the EAU mice model and scRNA-seq, discovered that PIM1 might inhibit the pathogenicity of Th17 cells by regulating the protein kinase B-FOXO1 pathway, suggesting PIM1 as a potential therapeutic target. Additionally, Li et al.[29] found immunological differences between aged and young EAU mice, indicating that aging might reduce the pathogenicity of Th17 cells, thus enhancing the understanding of Th17 cell immunological roles across different ages in EAU mice. Progesterone has also shown potential in modulating pathological processes related to inflammatory cell migration, activation, and differentiation in the EAU model.[43] It was found to regulate the Th17/Treg imbalance by enhancing the regulatory mediators of Tregs and reducing the overactivation of pathological Th17 cells. Additionally, progesterone treatment reversed the Id2/Pim1 axis, IL-23/Th17/GM-CSF signaling, and the enhanced pathogenicity of Th17 cells, leading to reduced EAU inflammation and providing a potential treatment for AU.Glycolysis
Zhu et al.[44] identified that HIF1α plays a significant pro-inflammatory role in the EAU model, which has important implications for clinical diagnosis and treatment. Additionally, the glycolysis-associated gene LDHA was found to be related to AU, suggesting that modulating LDHA could present a novel therapeutic approach, highlighting the role of anaerobic metabolism in AU.[45]GM-CSF/IL-23R/IL-23 Pathway
Li et al.[46] utilized scRNA-seq of lymph nodes in EAU mice to elucidate that IL-38 confers protective effects via the GM-CSF/IL-23R/IL-23 pathway, demonstrating IL-38's protective role in EAU. Moreover, Liu et al.[47] established a sleep deprivation mouse model and an EAU model, creating a scRNA-seq atlas of cervical lymph nodes. They found that sleep deprivation enhances Th17 cell pathogenicity and the development of AU via the GM-CSF/IL-23 pathway, suggesting that targeting this pathway with anti-GM-CSF could mitigate the pathological immune response in sleep-deprived EAU mice.UNVEILING EPIGENETIC REGULATION
ScATAC-seq provide valuable insights into chromatin accessibility and the epigenetic regulation of gene expression in autoimmune uveitis. By mapping open chromatin regions in individual cells, researchers can identify regulatory elements and transcription factors that drive the inflammatory response. This epigenetic information is crucial for understanding how gene expression is controlled in uveitis and for identifying potential epigenetic targets for therapy. Combining scATAC-seq with scRNA-seq often offers a more comprehensive understanding of epigenetic changes in disease states.Nuclear Factor-kappa B Transcriptionfactor
In 2021, Shi et al.[40] created the first single-cell chromatin accessibility map of PBMCs from VKH patients. They reported that the nuclear transcription factor NF-κB was highly enriched in conventional dendritic cells, potentially associated with poor disease prognosis. In a 2023 study, researchers conducted scATAC-seq on PBMCs from BD patients and, through integrated analysis with scRNA-seq, predicted that the AP-1, NF-κB, and ETS transcription factor families might act as pro-inflammatory transcription factors in BD.[48] They also identified cytotoxic CD8+ T cells as critical components of the inflammatory pathogenic mechanisms in BD, consistent with findings from other scRNA-seq studies on BD patients.Signal Transducer and Activator of Transcription
Additionally, another scATAC-seq study on VKH patients found significant enrichment of the JAK/STAT signaling pathway in CD4+ T cells, highlighting the potential of JAK inhibitors as a treatment strategy for uveitis[49]. However, research on single-cell epigenetics in autoimmune uveitis is still in its early stages, necessitating further extensive studies.These studies underscore the importance of understanding epigenetic regulation in autoimmune uveitis, revealing potential therapeutic targets and advancing the field toward more effective treatments.
IMPLICATIONS FOR DIAGNOSTIC AND THERAPEUTIC PRACTICE
The detailed cellular and molecular insights gained from SCS studies have profound implications for the development of therapies and diagnosis for autoimmune uveitis. By identifying specific cell populations and molecular pathways involved in disease pathogenesis, SCS facilitates the design of precision medicine approaches. For instance, targeting specific cytokines or signaling pathways identified through scRNA-seq can lead to more effective and tailored treatments. Additionally, understanding clonal expansions and genetic variations can guide the use of personalized immunotherapies.Dimethyl Fumarate
One example is the use of dimethyl fumarate (DMF), which has been shown to effectively ameliorate EAU by reversing immune cell alterations and gene expressions associated with the disease.[50] Inhibition of PIM1 and CXCR4 plays a critical role in reducing ocular effector T cell infiltration and restoring immune cell balance, highlighting DMF's potential as a therapeutic strategy for autoimmune uveitis.Cyclosporin A
Researchers also treated EAU mice with Cyclosporin A (CsA) and provided a comprehensive single-cell immunological atlas of peripheral lymph nodes under CsA treatment for EAU.[51] This study offers new insights into the mechanism of CsA in treating autoimmune diseases. Additionally, the mechanism of action of mycophenolate mofetil in the EAU model was explored, revealing that it reduces the antigen-presenting and antibody-producing capabilities of B cells in EAU mice.Liquid Biopsies
Integrating proteomics of liquid biopsies with single-cell transcriptomics allows tracing the cellular origins of proteins in the eye, revealing disease mechanisms and accelerating molecular aging in specific cell types.[52] This integration transforms diagnostics and prognostics for ocular and other organ diseases.Kurarinone
A study utilized single-cell sequencing to create a high-resolution atlas of the immunoregulatory effects of Kurarinone (KU) treatment on EAU.[53] The findings revealed that KU significantly modulates immune responses and reduces inflammation in EAU. By elucidating the potential therapeutic mechanisms of KU, the research suggests that KU holds substantial promise for treating autoimmune disorders. KU's ability to target specific immune pathways and cells involved in uveitis highlights its potential as an effective therapeutic strategy.Mesenchymal stem cells
Mesenchymal stem cells (MSCs) also show great promise in treating AU.[28,54] Recent study also provides valuable insights into the molecular characteristics of EAU model, highlighting the role of Müller glia as antigen-presenting cells and the Th1-driven immune response.[54] The findings suggest that overexpressing CCR5 in MSCs could be a promising therapeutic strategy, improving their efficacy in preventing EAU by modulating the immune response and reducing inflammation. GMSCs show significant promise as a therapeutic strategy for autoimmune uveitis and potentially other autoimmune diseases. Further research is warranted to fully understand their mechanisms and optimize their clinical use.Mycophenolate mofetil
CONCLUSION
Correction notice
NoneAcknowledgement
The author would like to express our gratitude to everyone who contributed to this project.Author Contributions
(Ⅰ) Conception and design: Yingfeng Zheng(Ⅱ) Administrative support: Yingfeng Zheng
(Ⅲ) Provision of study materials or patients: None
(Ⅳ) Collection and assembly of data: Wen Shi
(Ⅴ) Data analysis and interpretation: Wen Shi
(Ⅵ) Manuscript writing: All authors
(Ⅶ) Final approval of manuscript: All authors