Terminally differentiated cytotoxic CD4+ T cells were clonally expanded in the brain lesion of radiation‐induced brain injury

Abstract Background Accumulating evidence supports the involvement of adaptive immunity in the development of radiation‐induced brain injury (RIBI). Our previous work has emphasized the cytotoxic function of CD8 + T cells in RIBI. In this study, we aimed to investigate the presence and potential roles of cytotoxic CD4 + T cells (CD4 + CTLs) in RIBI to gain a more comprehensive understanding of adaptive immunity in this context. Main Text Utilizing single‐cell RNA sequencing (scRNA‐seq), we analyzed 3934 CD4 + T cells from the brain lesions of four RIBI patients and identified six subclusters within this population. A notable subset, the cytotoxic CD4 + T cells (CD4 + CTLs), was marked with high expression of cytotoxicity‐related genes ( NKG7 , GZMH , GNLY , FGFBP2 , and GZMB ) and several chemokine and chemokine receptors ( CCL5 , CX3CR1 , and CCL4L2 ). Through in‐depth pseudotime analysis, which simulates the development of CD4 + T cells, we observed that the CD4 + CTLs exhibited signatures of terminal differentiation. Their functions were enriched in protein serine/threonine kinase activity, GTPase regulator activity, phosphoprotein phosphatase activity, and cysteine‐type endopeptidase activity involved in the apoptotic signaling pathway. Correspondingly, mice subjected to gamma knife irradiation on the brain showed a time‐dependent infiltration of CD4 + T cells, an increase of MHCII + cells, and the existence of CD4 + CTLs in lesions, along with an elevation of apoptotic‐related proteins. Finally, and most crucially, single‐cell T‐cell receptor sequencing (scTCR‐seq) analysis at the patient level determined a large clonal expansion of CD4 + CTLs in lesion tissues of RIBI. Transcriptional factor‐encoding genes TBX21 , RORB , and EOMES showed positive correlations with the cytotoxic functions of CD4 + T cells, suggesting their potential to distinguish RIBI‐related CD4 + CTLs from other subsets. Conclusion The present study enriches the understanding of the transcriptional landscape of adaptive immune cells in RIBI patients. It provides the first description of a clonally expanded CD4 + CTL subset in RIBI lesions, which may illuminate new mechanisms in the development of RIBI and offer potential biomarkers or therapeutic targets for the disease.