IL-6 receptor blockade impedes proinflammatory atypical Treg subset associated with immune checkpoint inhibitor–induced inflammatory arthritis
Yifei Ma, Nianqi Liu, Yan Li, Denghan Zhang, Shaohui He, Jun Lv, Yongluo Jiang, Guangmin Jian, Jingyao Zhang, Pengfei Zhu, Yue Ma, Jiacai Lin, Jin Li, Tong Wu, Yiwei Xu, Xiajie Lyu, Youlong Wang, Yiming Li, Yu Si Niu, Zhenyun Guo, Churong Lin, Ningnan Fang, Wei Jiang, Lihong Wang, Mengqin Yuan, Shenyue Wang, Shulin Huang, Qi Huang, Jinjian Li, Jun Lu, Bocen Chen, Guanqing Zhong, Haizhou Liu, Fadian Ding, Shangeng Weng, Rui Li, Ao Zhang
Yifei Ma, Nianqi Liu, Yan Li, Denghan Zhang, Shaohui He, Jun Lv, Yongluo Jiang, Guangmin Jian, Jingyao Zhang, Pengfei Zhu, Yue Ma, Jiacai Lin, Jin Li, Tong Wu, Yiwei Xu, Xiajie Lyu, Youlong Wang, Yiming Li, Yu Si Niu, Zhenyun Guo, Churong Lin, Ningnan Fang, Wei Jiang, Lihong Wang, Mengqin Yuan, Shenyue Wang, Shulin Huang, Qi Huang, Jinjian Li, Jun Lu, Bocen Chen, Guanqing Zhong, Haizhou Liu, Fadian Ding, Shangeng Weng, Rui Li, Ao Zhang
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Clinical Research and Public Health Immunology Oncology

IL-6 receptor blockade impedes proinflammatory atypical Treg subset associated with immune checkpoint inhibitor–induced inflammatory arthritis

Abstract

BACKGROUND Immune checkpoint inhibitor–induced inflammatory arthritis (ICI-IA) significantly impairs cancer therapy and patient quality of life, yet its pathogenic mechanisms remain unclear.METHODS Through integrated single-cell multi-omics analysis of paired peripheral blood, synovial fluid, and tumor samples from longitudinal ICI-IA cohorts and matched controls, we identified a unique regulatory T-cell (Treg) population coexpressing CD137 and IL-6R (AtpTreg).RESULTS These cells exhibited reduced immunosuppressive capacity while aberrantly producing high levels of IL-17 and promoting proinflammatory responses of synoviocytes. AtpTreg exhibits shared clonotypes and phenotypes across tissue compartments. Notably, AtpTreg frequency correlates with increased arthritis severity yet paradoxically associates with improved overall survival. Anti-IL6R therapy reduced AtpTreg levels, corresponding with improved arthritis outcomes and quality of life, without compromising anti-tumor immunity.CONCLUSION Our findings define a pathogenic Treg subset in ICI-IA and validate IL-6R blockade as a mechanism-based therapeutic strategy, bridging mechanistic discovery to clinical translation.TRIAL REGISTRATION NCT07357636.FUNDING The National Natural Science Foundation of China General Fund Project; National Natural Science Foundation of China Youth Science Fund Project; Regional joint key support project of National Natural Science Foundation of China; Natural Science Foundation of Fujian Province; Joint Funds for the Innovation of Science and Technology, Fujian Province.

Authors

Yifei Ma, Nianqi Liu, Yan Li, Denghan Zhang, Shaohui He, Jun Lv, Yongluo Jiang, Guangmin Jian, Jingyao Zhang, Pengfei Zhu, Yue Ma, Jiacai Lin, Jin Li, Tong Wu, Yiwei Xu, Xiajie Lyu, Youlong Wang, Yiming Li, Yu Si Niu, Zhenyun Guo, Churong Lin, Ningnan Fang, Wei Jiang, Lihong Wang, Mengqin Yuan, Shenyue Wang, Shulin Huang, Qi Huang, Jinjian Li, Jun Lu, Bocen Chen, Guanqing Zhong, Haizhou Liu, Fadian Ding, Shangeng Weng, Rui Li, Ao Zhang

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Figure 3

Stable AtpTreg cell phenotype and clonotype across blood, synovial fluid, and tumor samples.

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Stable AtpTreg cell phenotype and clonotype across blood, synovial fluid...
(A) Research flowchart showing grouping of bead-enriched Treg cells from paired samples. (B) UMAP clustering annotated by single-cell surface proteomics. (C) AtpTreg cell percentage in each group and compartment sample, showing that ICI-IA group has high AtpTreg population in blood, SF, and tumor samples. (D) Signature proteins of AtpTreg clusters in blood, SF, and tumor samples of patients with ICI-IA, depicted as the bubble plot. (E) IL17A-secreting cell percentage in AtpTreg versus other cells of each paired compartment ICI-IA sample in single-cell secreting proteomics. (F) Dominant cell clone (defined as cells with > 1% expanded clonotype per sample) percentage in AtpTreg versus other Treg cells of each paired compartment ICI-IA sample in single-cell VDJseq. (G) Shared cell clone percentage in AtpTreg cell in single-cell VDJseq of patients with ICI-IA. (H) Research flowchart showing grouping of single-cell surface proteomics, single-cell VDJ sequencing, and flow cytometry analysis (FCA), of paired ICI-IA samples of blood as well as synovial fluid (SF) at 4 clinical stages: ICI-naive, preclinical, onset, and 5–7 months follow-up stage after ICI-IA onset. (I and J) Example gating (I) and flow cytometry analysis of AtpTreg cells in 4 patients at 4 clinical stages, gated on Treg cells of peripheral blood. (K) Single-cell surface proteomic analysis of AtpTreg cells in 4 patients at 3 clinical stages of paired samples of peripheral blood and SF. (L) Clonotype expansion rate of multiple clonotypes found to be persistent between onset and follow up (but were not present at preclinical stage), in paired samples of peripheral blood via single-cell VDJseq in one patient (Patient # 13). *P < 0.05, **P < 0.01, ***P < 0.001, calculated with paired Wilcoxon signed-rank test.