- Bocharnikov, Alexandra V;
- Keegan, Joshua;
- Wacleche, Vanessa S;
- Cao, Ye;
- Fonseka, Chamith Y;
- Wang, Guoxing;
- Muise, Eric S;
- Zhang, Kelvin X;
- Arazi, Arnon;
- Keras, Gregory;
- Li, Zhihan J;
- Qu, Yujie;
- Gurish, Michael F;
- Petri, Michelle;
- Buyon, Jill P;
- Putterman, Chaim;
- Wofsy, David;
- James, Judith A;
- Guthridge, Joel M;
- Diamond, Betty;
- Anolik, Jennifer H;
- Mackey, Matthew F;
- Alves, Stephen E;
- Nigrovic, Peter A;
- Costenbader, Karen H;
- Brenner, Michael B;
- Lederer, James A;
- Rao, Deepak A
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by pathologic T cell-B cell interactions and autoantibody production. Defining the T cell populations that drive B cell responses in SLE may enable design of therapies that specifically target pathologic cell subsets. Here, we evaluated the phenotypes of CD4+ T cells in the circulation of 52 SLE patients drawn from multiple cohorts and identified a highly expanded PD-1hiCXCR5-CD4+ T cell population. Cytometric, transcriptomic, and functional assays demonstrated that PD-1hiCXCR5-CD4+ T cells from SLE patients are T peripheral helper (Tph) cells, a CXCR5- T cell population that stimulates B cell responses via IL-21. The frequency of Tph cells, but not T follicular helper (Tfh) cells, correlated with both clinical disease activity and the frequency of CD11c+ B cells in SLE patients. PD-1hiCD4+ T cells were found within lupus nephritis kidneys and correlated with B cell numbers in the kidney. Both IL-21 neutralization and CRISPR-mediated deletion of MAF abrogated the ability of Tph cells to induce memory B cell differentiation into plasmablasts in vitro. These findings identify Tph cells as a highly expanded T cell population in SLE and suggest a key role for Tph cells in stimulating pathologic B cell responses.