1009 In-depth Analysis of Myeloid Cell Subsets in Lupus Nephritis Kidneys Provides Insights into Disease Mechanisms: Lessons from the Accelerating Medicines Partnership (AMP) in RA/SLE Consortium

We present a detailed analysis of myeloid cell populations found in the kidneys of lupus nephritis (LN) patients, based on the single-cell RNA-sequencing (scRNA-seq) data collected as part of the Accelerating Medicines Partnership (AMP) in RA/SLE consortium. Overall, 23,819 cells isolated from 156 LN patients and 30 healthy donors passed QC. Clustering of these cells (figure 1A) identified populations of CD14 and CD16 monocytes, two subsets of tissue-resident macrophages and several types of dendritic cells (DCs). In addition, we found several transcriptionally-distinct subsets of differentiated macrophages, that were missing from healthy donors (figure 1B- C). The ratio between the frequency of these macrophage subsets and that of infiltrating monocytes positively correlated with the Activity Index (AI) (figure 1D). To infer the origins of the observed disease-specific macrophages, we compared them to several published scRNA-seq datasets of blood and kidney samples, and performed in addition trajectory analysis. Our results suggested that these subsets likely originate from both infiltrating monocytes and tissue-resident macrophages (figure 2A). Furthermore, our analysis indicated that the differentiation into disease-specific macrophages mostly takes place within the kidney. To identify putative extracellular signals driving the differentiation of infiltrating CD16 monocytes into disease-related activation states, we performed in vitro experiments in which CD16 monocytes were stimulated with a wide array of cytokines and molecules suggested to play role in SLE pathology, such as immune complexes (ICs) and various types of cellular debris. We measured transcriptional changes associated with each in vitro condition, and utilized the generated data to identify enriched signatures in the AMP scRNA-seq data, using gene set enrichment analysis (GSEA). This analysis suggested that apoptotic cells likely promote differentiation of CD16 monocytes into a phagocytic state (cluster 11; figure 2B). In contrast, ICs containing TLR7 ligands, as well as IFNγ, were found to be plausible drivers of differentiation into an activation state that was characterized by high production of several proinflammatory cytokines and chemokines ('high producers' – clusters 12 and 13; figure 2C-D). Of note, our analysis suggested that through chemokine production, these 'high producers' may play a central role in recruiting and retaining the phagocytic macrophage subsets. The frequency of a single population of disease-specific macrophages positively correlated with both the AI and the Chronicity Index (CI; figure 3A-B). This population (cluster 17) was characterized by the upregulation of a set of genes associated with lipid metabolism. While previous studies have reported the presence of a similar macrophage subset in other tissues, this has not yet been demonstrated in kidneys. Furthermore, our analysis identified subclusters within this population, associated with different specific pathways, that were separately correlated with the AI and CI. In particular, we found a proinflammatory signature in these cells that was negatively correlated with the AI and positively correlated with the CI (figure 3C-D). A systemic differential expression analysis showed that several myeloid subsets modulated their gene expression in a manner correlated with the AI, compared to healthy donors; a particular clear response was observed in CD16 monocytes (cluster 2), in both proliferative/mixed and pure membranous LN (figure 4A-B). GSEA suggested that these changes were driven, at least in part, by type I and type II IFN, IL-6 and TNFβ. A conjoint analysis of changes in subset frequencies and of the differentially expressed (DE) genes in these populations and in glomerular endothelial cells pointed to the concurrent upregulation of molecules that may promote fibrosis, and in particular fibronectin in CD16 monocytes and integrins capable of binding it in glomerular endothelial cells (figure 4D-F); furthermore, several of the phagocytic macrophages derived from CD16 monocytes upregulated a set of genes regulating the extracellular matrix (figure 4G). Of note, these observations were found in LN patients that had a 0 glomerular CI (defined as the sum of glomerular subscores of the CI), suggesting that these molecular events precede fibrosis and may promote it. An increase in glomerular CI was associated with significant changes in gene expression, in particular in cDC2 and pDCs (clusters 4 & 15), as well as 2 specific populations of phagocytic macrophages (clusters 14 and 15; figure 4C); these changes included a decrease in the interferon response. We verified the reproducibility of these signatures in an independent set of LN patients. Taken together, our results shed light on the mechanisms of kidney inflammation in LN, and provide a detailed view of the different subsets and activation states of myeloid cells found in LN kidneys and the putative relations between them, as well as the extracellular signals giving rise to these states.