Disrupted microglial iron homeostasis in progressive multiple sclerosis

Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS). Despite therapies that reduce relapses, many patients eventually develop secondary progressive MS (SPMS), characterized by ongoing and irreversible neurodegeneration and worsening clinical symptoms. Microglia are the resident innate immune cells of the CNS. While the cellular and molecular determinants of disability progression in MS remain incompletely understood, they are thought to include non-resolving microglial activation and chronic oxidative injury. In this study, our aim was to better characterize microglia in SPMS tissues to identify disease-related changes at the single cell level. We performed single nucleus RNA-seq (snRNA-seq) on cryopreserved post-mortem brain cortex and identified disease associated changes in multiple cell types and in particular distinct SPMS-enriched microglia subsets. When compared to the cluster most enriched in healthy controls (i.e. homeostatic microglia), we found a number of SPMS-enriched clusters with transcriptional profiles reflecting increased oxidative stress and perturbed iron homeostasis. Using histology and RNA-scope, we confirmed the presence of iron accumulating, ferritin-light chain ( FTL )-expressing microglia in situ . Among disease-enriched clusters, we found evidence for divergent responses to iron accumulation and identified the antioxidant enzyme GPX4 as a key fate determinant. These data help elucidate processes that occur in progressive MS brains, and highlight novel nodes for therapeutic intervention. ### Competing Interest Statement JDP, MZ, SR, XY, YH, YCC, MRD, J. Saleh, J. Sancho, TH are Employees of Sanofi. AC and EC: Nothing to disclose. BDT: Consulting fees, speaker honoraria, and/or research funding (Biogen Idec, Disarm Therapeutics, EMD Serono, Novartis, Renovo Neural, and Sanofi Genzyme); principal investigator and/or speaking fees (Alkermes, Biogen, Celgene, EMD Serono, Genentech/Roche, Novartis, Sanofi, and TG Therapeutics).