Resolving ScRNA-Seq Signatures of Antigen-Specific CD4 + T Cells in Tolerance across Semi-Allogeneic Transplantation and Pregnancy

SUMMARY Transplantation of allogeneic organs requires lifelong immunosuppression to prevent rejection. Prior sensitization and resultant memory T cells are barriers to achieving successful transplant tolerance. In reproductive immunology by contrast, pregnancy represents a spontaneous model of tolerance where the semi-allogeneic fetus evades rejection even in multiparous or rejection-sensitized mothers. CD8+ T cell phenotypes of tolerance and rejection have been previously reported in transplant and pregnancy, but the transcriptional states of donor and fetus-specific CD4+ T cells remain poorly defined. Here, we performed Single-cell RNA-sequencing on endogenous, antigen-specific CD4+ T cells across models of allogeneic heart transplants and naïve or paternal skin-sensitized pregnancy. We identified expanded T follicular helper (Tfh) and non-follicular effectors in transplant rejection absent in tolerance. Naïve pregnancy resulted in a modest expansion of effector clusters with transcriptional quiescence that mirrored virgin mice. Successful sensitized pregnancy resulted in expanded Tfh clusters consistent with increased fetal-specific antibodies and limited non-Tfh effector responses. Most striking were the extensive changes imposed on donor-specific Foxp3pos regulatory T cells (Tregs) resulting in the co-clustering together with Foxp3neg T conventional cells (Tconvs) in transplant tolerance and the emergence of a Foxp3neg Type I Regulatory cluster observed in pregnancy of sensitized dams. Finally, we showed that these transcriptomes were relevant and enriched in human datasets of health and disease respectively. Thus, the context-dependent signatures of antigen-specific CD4+ T cells provide new insights into their divergent responses to allogeneic conflict at the intersection of transplant and reproductive immunology. Competing Interest Statement The authors have declared no competing interest. Footnotes Updated Text and Added Metabolism Analyses.