Abstract

Objectives: Systemic sclerosis (SSc; scleroderma) disproportionately affects biological females, and results of multiple studies implicate lymphocyte derangements in disease pathogenesis supporting use of mycophenolate mofetil (MMF) treatment. Here, we surveyed chromatin accessibility of circulating CD4+ T lymphocytes from SSc patients commencing MMF to gain molecular insights into systemic immune activation. Methods: Peripheral blood samples were collected longitudinally. We used the Assay for Transposase-Accessible Chromatin by sequencing (ATAC-seq) to interrogate genome-wide chromatin accessibility profiles of peripheral CD4+ T cells compared with publicly available healthy control (HC) data. Results: ATAC-seq libraries were generated for 18 SSc patients [78% with diffuse cutaneous (dc), 78% female, and 17% + anticentromere autoantibodies (ACA)]. Disease status (SSc vs. HC), biological sex, and serum autoantibody type were significantly associated with CD4+ T cell epigenomic profile variability, while MMF treatment had no significant effect. Present serum ACAs associated with elevated T helper 2 (Th2) cell proportions. +ACA patients consistently displayed distinct epigenetic profiles of increased open chromatin at gene loci encoding fibrosis-driving Th2 cytokines IL-4, IL-13, and the IL-4 receptor. Conclusions: Our results demonstrate the utility of interrogating chromatin accessibility profiles of patient CD4+ cells to stratify and understand better clinical SSc heterogeneity. They highlight a potential mechanism underlying the female sex preponderance for SSc as females had more open chromatin. Our findings nominate Th2 cell activation as a novel mechanistic hallmark and therapeutic opportunity to address SSc, especially in those with +ACA. KEYWORDS: Scleroderma, systemic sclerosis, anticentromere, ATAC-Seq, Il-4/13, mycophenolate mofetil, sex predilection