Comparative immuno-biology at clinical recognition of early multiple organ dysfunction syndrome in pediatric and adult patients using single-cell transcriptomics

Globally, sepsis remains a major health issue, with Multiple Organ Dysfunction Syndrome (MODS) being a leading cause of mortality. MODS, a severe condition often seen in intensive care units, typically results from infections or trauma and involves complex pathophysiological processes requiring various clinical interventions. Although infections are the main triggers, the mechanisms driving MODS remain unclear. To investigate the transition of sepsis to MODS, we generated a single cell RNA sequencing dataset comprising 86,839 immune cells from pediatric sepsis patients at the clinical onset of MODS patients and age-matched controls, identifying 22 distinct cell types. A cluster of S100 genes, located in the same genomic region, was highly expressed in neutrophils in MODS patients, demonstrating strong diagnostic potential across cohorts (AUC=0.94– 0.99) and potential as therapeutic targets. We found that many B and T cells showed heightened inflammation and increased apoptotic activity during early MODS. Additionally, specific transcription regulators and surface proteins associated with inflammation and S100 regulations were uniquely expressed in MODS. Pseudotime analysis revealed distinct S100 gene expression patterns between controls and MODS. Cell-cell interaction analysis highlighted dendritic cells as key mediators, enhancing communication between plasma cells and Vδ T cells while activating inflammatory and immunosuppressive pathways. We also analyzed 116,803 immune cells from adult MODS patients, revealing stronger immune dysregulation compared to pediatric MODS, including altered S100 gene expression, and enhanced cell-cell interactions. These findings suggest that S100 genes may serve as a marker for MODS. Furthermore, insights gained from adult MODS could improve our understanding of rare pediatric MODS and contribute to the development of better therapeutics for all MODS patients.