Summary

FOXP3 deficiency in mice and in patients with immune dysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome results in fatal autoimmunity by altering regulatory T (Treg) cells. CD4+ T cells in patients with IPEX syndrome and Foxp3-deficient mice were analyzed by single-cell cytometry and RNA-sequencing, revealing heterogeneous Treg-like cells, some very similar to normal Treg cells, others more distant. Conventional T cells showed no widespread activation or helper T cell bias, but a monomorphic disease signature affected all CD4+ T cells. This signature proved to be cell extrinsic since it was extinguished in mixed bone marrow chimeric mice and heterozygous mothers of patients with IPEX syndrome. Normal Treg cells exerted dominant suppression, quenching the disease signature and revealing in mutant Treg-like cells a small cluster of genes regulated cell-intrinsically by FOXP3, including key homeostatic regulators. We propose a two-step pathogenesis model: cell-intrinsic downregulation of core FOXP3-dependent genes destabilizes Treg cells, de-repressing systemic mediators that imprint the disease signature on all T cells, furthering Treg cell dysfunction. Accordingly, interleukin-2 treatment improved the Treg-like compartment and survival.

Overall design

Human CD4+T cells from IPEX, HD and mothers were isolated from frozen peripheral blood mononuclear cells by flow cytometry as DAPI–CD3+CD4+ cells. In cohort 1, cells from separate donor were encapsulated in separate channel following 10x Genomics Single Cell 3′ Reagent Kit (V2 chemistry). In cohort 2, samples were tagged using a different Hashtags, pooled and encapsulared following 10x Genomics Single Cell 3′ Reagent Kit (V3 chemistry).

Contributors

David Zemmour 1 2, Louis-Marie Charbonnier 3, Juliette Leon 1 4, Emmanuelle Six 4, Sevgi Keles 5, Marianne Delville 4 6, Mehdi Benamar 3, Safa Baris 7 8, Julien Zuber 4 6, Karin Chen 9 10, Benedicte Neven 4 6, Maria I Garcia-Lloret 11, Frank M Ruemmele 4 6, Carlo Brugnara 3, Nadine Cerf-Bensussan 4 6, Frederic Rieux-Laucat 4, Marina Cavazzana 12 13 14, Isabelle André 4 14, Talal A Chatila 3, Diane Mathis 15, Christophe Benoist 15

Contact

cbdm@hms.harvard.edu.(Christophe Benoist)