Single cell landscape of multicentric castleman disease in identical twins

Idiopathic Multicentric Castleman Disease (iMCD) is a rare IL-6-driven hematological disorder characterized by systemic lymphadenopathy, elevated immunoglobulin levels, and prominent plasmacytosis in the bone marrow and lymph nodes. An unusual occurrence of iMCD in identical twins provided a unique opportunity to answer genetic and molecular features of this disease, including the cell-of-origin of IL-6 signals, and the immune milieu within affected lymphoid organs and in circulation. Germline whole genome sequencing of the affected twins identified pathogenic homozygous mutations of NCOA4 c.G1322A and monoallelic mutations of TRAF3 c.G1504A – both genes recently implicated in IL-6 signaling and B-cell regulation. Their unaffected sister was heterozygous mutant for NCOA4 and homozygous wildtype for TRAF3 loci. Via single cell sequencing of 63,519 cells from bone marrow, lymph node, and peripheral blood mononuclear cells, we identified nodal endothelial cells and fibroblastic reticular cells (FRC) as the source of IL-6 signals. The latter are composed of mainly T-cell zone FRCs (CCL19+/CCL21+/IL7+/PDPN+/MADCAM1-) and a minor population of follicular dendritic cells (FDCs) (CD21+/CD35+/CXCL13+). An “inflammatory” peripheral monocytosis enriched for the expression of S100A family genes was evident in both twins, as well as a group of monocytes expressing cytotoxic gene signatures in the affected twin with milder clinical manifestations. Their unaffected sister mainly carried monocytes enriched for expression of major histocompatibility complex (MHC) class II genes. In conclusion, we provided evidence of a genetic cause of iMCD, identified the putative cell-of-origin of IL-6 signals in this rare disease, and described a distinct monocytic immune response phenotype. Encore Abstract—previously submitted to AACR 2023 The research was funded by: This work was supported by the Tanoto Foundation Professorship in Medical Oncology, New Century Foundation Limited, Ling Foundation, Singapore Ministry of Health’s National Medical Research Council Research Transition Award (TA21jun-0005), Large Collaborative Grant (OFLCG18May-0028), and TETRAD II Collaborative Centre Grant (CG21APR2002). Keywords: genomics, epigenomics, and other -omics, Lymphoid Cancers - Other, tumor biology and heterogeneity No conflicts of interests pertinent to the abstract.