Notch Signaling Exacerbates Pulmonary Fibrosis by Regulating the Differentiation of CD4(+) Tissue-Resident Memory T Cells.

The involvement of the immune system in pulmonary fibrosis is established, the precise contributions of tissue-resident memory T (T(RM)) cells are still poorly defined. This study sought to define the contribution of CD4(+) T(RM) cells to pulmonary fibrosis, their origin, and regulatory mechanisms. We combined bioinformatic analysis of human fibrotic lung single-cell RNA-sequencing data with experiments in a bleomycin-induced C57BL/6 mouse model. Flow cytometry, targeted in vivo depletion, lymphocyte trafficking blockade, cell co-culture, and pharmacological inhibition were employed. CD4(+) T(RM) cells were observed at higher frequencies within fibrotic lung tissue. Their presence correlated with disease severity, and they were found to exhibit a pro-inflammatory and pro-fibrotic phenotype. Their specific depletion alleviated fibrosis. These cells primarily originated from recruited circulating lymphocytes, as blocking this recruitment reduced T(RM) accumulation and attenuated disease. Furthermore, the Notch signaling pathway was activated in fibrotic lung CD4(+) T(RM) cells, and its inhibition suppressed their differentiation and impaired their pro-fibrotic function. We conclude that CD4(+) T(RM) cells are pathogenic drivers in pulmonary fibrosis, originating from circulating precursors and being regulated by Notch signaling, underscoring their relevance for therapeutic intervention.