Table_11_The genomic landscape of ANCA-associated vasculitis: Distinct transcriptional signatures, molecular endotypes and comparison with systemic lupus erythematosus.xlsx

IntroductionAnti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) present with a complex phenotype and are associated with high mortality and multi-organ involvement. We sought to define the transcriptional landscape and molecular endotypes of AAVs and compare it to systemic lupus erythematosus (SLE).MethodsWe performed whole blood mRNA sequencing from 30 patients with AAV (granulomatosis with polyangiitis/GPA and microscopic polyangiitis/MPA) combined with functional enrichment and network analysis for aberrant pathways. Key genes and pathways were validated in an independent cohort of 18 AAV patients. Co-expression network and hierarchical clustering analysis, identified molecular endotypes. Multi-level transcriptional overlap analysis to SLE was based on our published data from 142 patients.ResultsWe report here that “Pan-vasculitis” signature contained 1,982 differentially expressed genes, enriched in leukocyte differentiation, cytokine signaling, type I and type II IFN signaling and aberrant B-T cell immunity. Active disease was characterized by signatures linked to cell cycle checkpoints and metabolism pathways, whereas ANCA-positive patients exhibited a humoral immunity transcriptional fingerprint. Differential expression analysis of GPA and MPA yielded an IFN-g pathway (in addition to a type I IFN) in the former and aberrant expression of genes related to autophagy and mRNA splicing in the latter. Unsupervised molecular taxonomy analysis revealed four endotypes with neutrophil degranulation, aberrant metabolism and B-cell responses as potential mechanistic drivers. Transcriptional perturbations and molecular heterogeneity were more pronounced in SLE. Molecular analysis and data-driven clustering of AAV uncovered distinct transcriptional pathways that could be exploited for targeted therapy.DiscussionWe conclude that transcriptomic analysis of AAV reveals distinct endotypes and molecular pathways that could be targeted for therapy. The AAV transcriptome is more homogenous and less fragmented compared to the SLE which may account for its superior rates of response to therapy.

抗中性粒细胞胞质抗体(ANCA)相关血管炎(AAV)呈现复杂表型，并与高死亡率及多器官受累相关。本研究旨在明确AAV的转录组景观和分子表型，并将其与系统性红斑狼疮(SLE)进行比较。研究方法：我们对30例AAV患者（包括肉芽肿性多血管炎/GPA和微小多血管炎/MPA）的全血mRNA进行了测序，并结合功能富集和网络分析以识别异常通路。在独立队列的18例AAV患者中验证了关键基因和通路。通过共表达网络和层次聚类分析确定了分子表型。基于我们已发表的142例SLE患者的数据，进行了多层次的转录组重叠分析。结果：我们发现“全血管炎”特征包含1,982个差异表达基因，富集于白细胞分化、细胞因子信号通路、I型和II型IFN信号通路以及异常B-T细胞免疫。活动性疾病以与细胞周期检查点和代谢通路相关的特征为特征，而ANCA阳性患者则表现出体液免疫转录组特征。GPA和MPA的差异表达分析揭示了GPA中存在IFN-g通路（除I型IFN外）以及MPA中与自噬和mRNA剪接相关的基因异常表达。无监督的分子分类学分析揭示了四种表型，其中中性粒细胞脱颗粒、异常代谢和B细胞反应作为潜在的机制驱动因素。与SLE相比，AAV的转录组更为同质化和碎片化程度较低，这可能解释了其治疗反应率更高的原因。讨论：我们得出结论，AAV的转录组分析揭示了独特的表型和分子通路，这些通路可以作为治疗靶点。与SLE相比，AAV的转录组更为同质化和碎片化程度较低，这可能解释了其治疗反应率更高的原因。