Regulatory B Cells Expressing Granzyme B from Tolerant Renal Transplant Patients: Highly Differentiated B Cells with a Unique Pathway with a Specific Regulatory Profile and Strong Interactions with Immune System Cells.

The aim of our study was to determine whether granzyme B-expressing regulatory B cells (GZMB B cells) are enriched in the blood of transplant patients with renal graft tolerance. To achieve this goal, we analysed two single-cell RNA sequencing (scRNAseq) datasets: (1) peripheral blood mononuclear cells (PBMCs), including GZMB B cells from renal transplant patients, i.e., patients with stable graft function on conventional immunosuppressive treatment (STA, = 3), drug-free tolerant patients (TOL, = 3), and patients with antibody-mediated rejection (ABMR, = 3), and (2) ex-vivo-induced GZMB B cells from these groups. In the patient PBMCs, we first showed that natural GZMB B cells were enriched in genes specific to Natural Killer (NK) cells (such as and and regulatory B cells (such as , , and ). We performed a pseudotemporal trajectory analysis of natural GZMB B cells and showed that they were highly differentiated B cells with a trajectory that is very different from that of conventional memory B cells and linked to the transcription factor KLF13. By specifically analysing GZMB natural B cells in TOLs, we found that these cells had a very specific transcriptomic profile associated with a reduction in the expression of HLA molecules, apoptosis, and the inflammatory response (in general) in the blood and that this signature was conserved after ex vivo induction, with the induction of genes associated with migration processes, such as , , or . An analysis of receptor/ligand interactions between these GZMB natural B cells and all of the immune cells present in PBMCs also demonstrated that GZMB B cells were the B cells that carried the most ligands and had the most interactions with other immune cells, particularly in tolerant patients. Finally, we showed that these GZMB B cells were able to infiltrate the graft under inflammatory conditions, thus suggesting that they can act in locations where immune events occur.