Antigen-reactive CD4+ T cells after SARS-CoV-2 vaccination show divergent phenotypic states with or without restimulation bias

Understanding antigen reactivity is crucial for characterizing CD4+ T helper (Th) cell fate, yet conventional peptide restimulation assays introduce phenotypic bias by activating cells ex vivo. However, by performing single-cell RNA and T cell receptor (TCR) sequencing on both antigen-stimulated and unstimulated samples, clonotypes can be tracked across conditions to identify antigen-reactive CD4+ T cells and simultaneously be assessed for their phenotypes in the unperturbed state. Using this reverse phenotyping strategy, complemented by DNA-barcoded peptide-HLA (pHLA) class II multimers, we here tracked SARS-CoV-2 spike-reactive CD4+ T cells longitudinally after repeated mRNA vaccination. Without stimulation, reactive clones showed more Th-neutral features and less of an activated Th1-like state than would be assessed after antigen restimulation. Furthermore, transgenic TCR re-expression guided separation of antigen-specific from bystander-activated clones. These results uncover unbiased phenotypes of antigen-reactive CD4+ T cells and highlight that cell state classification can differ fundamentally when judged by phenotype versus function.