The Pathogenic Role of CD4 Tissue-Resident Memory T Cells Bearing T Follicular Helper-Like Phenotype in Pemphigus Lesions.

In skin lesions caused by pemphigus, a group of life-threatening autoimmune bullous diseases, an over-representation of CD4 tissue-resident memory T (T) cells was found. We sought to investigate the contributions of CD4 T cells to the severity and refractoriness of pemphigus and their role in local immunological pathogenesis. Our data showed that CD4 T cells accumulated significantly in pemphigus skin lesions. These CD4 T cells expressed a specific set of T follicular helper cell‒related costimulatory molecules. We also found that CD4 T cells remaining in the lesions produced IL-17A and IL-21. In vitro, CD4 T cells exhibited strong support and assistance to autoantibody production. Through transcriptomic sequencing and bioinformatics analysis, we identified that the transcription factor IRF4 was responsible for IL-21 overexpression and autoantibody production. Our results showed that T follicular helper-like CD4 T cells in pemphigus lesions promoted local autoantibody production, resulting in the formation and recurrence of lesions, which supports targeting this cell subset in pemphigus treatment. IRF4 might serve as a potential therapeutic target.