Spatial Transcriptomics of Meningeal Inflammation Reveals Variable Penetrance of Inflammatory Gene Signatures into Adjacent Brain Parenchyma

Reviewer #1 (Public Review):

Multiple sclerosis (MS) is a debilitating autoimmune disease that causes loss of myelin in neurons of the central nervous system. MS is characterized by the presence of inflammatory immune cells in several brain regions as well as the brain barriers (meninges). This study aims to understand the local immune hallmarks in regions of the brain parenchyma that are adjacent to the leptomeninges in a mouse model of MS. The leptomeninges are known to be a foci of inflammation in MS and perhaps "bleed" inflammatory cells and molecules to adjacent brain parenchyma regions. To do so, they use novel technology called spatial transcriptomics so that the spatial relationships between the two regions remain intact. The study identifies canonical inflammatory genes and gene sets such as complement and B cells enriched in the parenchyma in close proximity to the leptomeninges in the mouse model of MS but not control. The manuscript is very well written and easy to follow. The results will become a useful resource to others working in the field and can be followed by time series experiments where the same technology can be applied to the different stages of the disease.

Reviewer #2 (Public Review):

Accumulating data suggests that the presence of immune cell infiltrates in the meninges of the multiple sclerosis brain contributes to the tissue damage in the underlying cortical grey matter by the release of inflammatory and cytotoxic factors that diffuse into the brain parenchyma. However, little is known about the identity and direct and indirect effects of these mediators at a molecular level. This study addresses the vital link between an adaptive immune response in the CSF space and the molecular mechanisms of tissue damage that drive clinical progression. In this short report the authors use a spatial transcriptomics approach using Visium Gene Expression technology from 10x Genomics, to identify gene expression signatures in the meninges and the underlying brain parenchyma, and their interrelationship, in the PLP-induced EAE model of MS in the SJL mouse. MRI imaging using a high field strength (11.7T) scanner was used to identify areas of meningeal infiltration for further study. They report, as might be expected, the upregulation of genes associated with the complement cascade, immune cell infiltration, antigen presentation, and astrocyte activation. Pathway analysis revealed the presence of TNF, JAK-STAT and NFkB signaling, amongst others, close to sites of meningeal inflammation in the EAE animals, although the spatial resolution is insufficient to indicate whether this is in the meninges, grey matter, or both.

UMAP clustering illuminated a major distinct cluster of upregulated genes in the meninges and smaller clusters associated with the grey matter parenchyma underlying the infiltrates. The meningeal cluster contained genes associated with immune cell functions and interactions, cytokine production, and action. The parenchymal clusters included genes and pathways related to glial activation, but also adaptive/B-cell mediated immunity and antigen presentation. This again suggests a technical inability to resolve fully between the compartments as immune cells do not penetrate the pial surface in this model or in MS. Finally, a trajectory analysis based on distance from the meningeal gene cluster successfully demonstrated descending and ascending gradients of gene expression, in particular a decline in pathway enrichment for immune processes with distance from the meninges.

Although these results confirm what we already know about processes involved in the meninges in MS and its models and gradients of pathology in sub-pial regions, this is the first to use spatial transcriptomics to demonstrate such gradients at a molecular level in an animal model that demonstrates lymphoid like tissue development in the meninges and associated grey matter pathology. The mouse EAE model being used here does reproduce many, although not all, of the pathological features of MS and the ability to look at longer time points has been exploited well. However, this particular spatial transcriptomics technique cannot resolve at a cellular level and therefore there is a lot of overlap between gene expression signatures in the meninges and the underlying grey matter parenchyma.

The short nature of this report means that the results are presented and discussed in a vague way, without enough molecular detail to reveal much information about molecular pathogenetic mechanisms.

The trajectory analysis is a good way to explore gradients within the tissues and the authors are to be applauded for using this approach. However, the trajectory analysis does not tell us much if you only choose 2 genes that you think might be involved in the pathogenetic processes going on in the grey matter. It might be more useful to choose some genes involved in pathogenetic processes that we already know are involved in the tissue damage in the underlying grey matter in MS, for which there is already a lot of literature, or genes that respond to molecules we know are increased in MS CSF, although the animal models may be very different. Why were C3 and B2m chosen here?

Strengths:
- The mouse model does exhibit many of the features of the compartmentalized immune response seen in MS, including the presence of meningeal immune cell infiltrates in the central sulcus and over the surface of the cortex, with the presence of FDC's HEVs PNAd+ vessels and CXCL13 expression, indicating the formation of lymphoid like cell aggregates. In addition, disruption of the glia limitans is seen, as in MS. Increased microglial reactivity is also present at the pial surface.
- Spatial transcriptomics is the best approach to studying gradients in gene expression in both white matter and grey matter and their relationship between compartments.
- It would be useful to have more discussion of how the upregulated pathways in the two compartments fit with what we know about the cellular changes occurring in both, for which presumably there is prior information from the group's previous publications.

Limitations:
- EAE in the mouse is not MS and may be far removed when one considers molecular mechanisms, especially as MS is not a simple anti-myelin protein autoimmune condition. Therefore, this study could be following gene trajectories that do not exist in MS. This needs a significant amount of discussion in the manuscript if the authors suggest that it is mimicking MS.
- The model does not have the cortical subpial demyelination typical of MS and it is unknown whether neuronal loss occurs in this model, which is the main feature of cytokine-mediated neurodegeneration in MS. If it does not then a whole set of genes will be missing that are involved in the neuronal response to inflammatory stimuli that may be cytotoxic.
- Visium technology does not get down to single cell level and does not appear to allow resolution of the border between the meninges and the underlying grey matter.
- Neuronal loss in the MS cortex is independent of demyelination and therefore not related to remyelination failure. There does not appear to be any cortical grey matter demyelination in these animals, so it is difficult to relate any of the gene changes seen here to demyelination.
- No mention of how the ascending and descending patterns of gene expression may be due to the gradient of microglial activation that underlies meningeal inflammation, which is a big omission.

Reviewer #3 (Public Review):

In this study, Gadani et al. induced EAE in SJL/J mice and performed a comprehensive spatial transcriptomic analysis in areas of meningeal inflammation during the relapse phase of the disease. The authors found specific enrichment in spatial gene signatures (cluster 11) in the regions of increased contrast-enhancement by MRI (where meningeal extravasation of activated immune cells is observed) that overlap with signatures in the adjacent brain parenchyma, namely the thalamus. Several pathways were similarly upregulated in the meningeal-associated cluster 11 and adjacent parenchymal clusters (like adaptive mediated immunity, and antigen processing and presentation), suggestive of a "leakage" of inflammatory mediators from the meninges into the brain during the re-activation of disease. The tested hypothesis, as well as the data presented in this study, is quite interesting and novel.

Author Response:

We thank Reviewer #1 for their positive assessment of our work.

Reviewer #2 (Public Review):

[…] Although these results confirm what we already know about processes involved in the meninges in MS and its models and gradients of pathology in sub-pial regions, this is the first to use spatial transcriptomics to demonstrate such gradients at a molecular level in an animal model that demonstrates lymphoid like tissue development in the meninges and associated grey matter pathology. The mouse EAE model being used here does reproduce many, although not all, of the pathological features of MS and the ability to look at longer time points has been exploited well. However, this particular spatial transcriptomics technique cannot resolve at a cellular level and therefore there is a lot of overlap between gene expression signatures in the meninges and the underlying grey matter parenchyma.

We appreciate the reviewer’s concise summary and comments on our manuscript. We agree that the Visium spatial sequencing technology we applied is limited in its resolution and cannot precisely distinguish individual cells or anatomic regions. For that reason, there is undoubtedly some overlap between gene expression signatures in the meninges and underlying parenchyma, particularly in spots on the borders of the meningeal inflammation clusters. However, we believe that the majority of meningeal inflammation (“cluster 11”) spots are indeed in the meninges and represent the spatial transcriptome of that niche. To support this, in the revised manuscript we will provide H&E images with the UMAP clusters overlayed to demonstrate the anatomic borders that correlate with the clusters.

The short nature of this report means that the results are presented and discussed in a vague way, without enough molecular detail to reveal much information about molecular pathogenetic mechanisms.

We thank the reviewer for this comment. The goal of this work is to transcriptomically characterize the spatial relationship between areas of meningeal inflammation and the underlying parenchyma. While we agree that mechanistic studies are needed to further evaluate the role of presented signaling pathways, those experiments are beyond the scope of this brief report.

The trajectory analysis is a good way to explore gradients within the tissues and the authors are to be applauded for using this approach. However, the trajectory analysis does not tell us much if you only choose 2 genes that you think might be involved in the pathogenetic processes going on in the grey matter. It might be more useful to choose some genes involved in pathogenetic processes that we already know are involved in the tissue damage in the underlying grey matter in MS, for which there is already a lot of literature, or genes that respond to molecules we know are increased in MS CSF, although the animal models may be very different. Why were C3 and B2m chosen here?

We appreciate the reviewer’s points here. C3 and B2m were chosen as examples of genes that have differential fit to the gradient descending pattern to assist the reader in interpreting subsequent gene set trajectory analysis. However, we agree that there are many other genes of interest and will expand the number of genes displayed in our revised manuscript.

Strengths:
- The mouse model does exhibit many of the features of the compartmentalized immune response seen in MS, including the presence of meningeal immune cell infiltrates in the central sulcus and over the surface of the cortex, with the presence of FDC's HEVs PNAd+ vessels and CXCL13 expression, indicating the formation of lymphoid like cell aggregates. In addition, disruption of the glia limitans is seen, as in MS. Increased microglial reactivity is also present at the pial surface.
- Spatial transcriptomics is the best approach to studying gradients in gene expression in both white matter and grey matter and their relationship between compartments.
- It would be useful to have more discussion of how the upregulated pathways in the two .compartments fit with what we know about the cellular changes occurring in both, for which presumably there is prior information from the group's previous publications.

Limitations:
- EAE in the mouse is not MS and may be far removed when one considers molecular mechanisms, especially as MS is not a simple anti-myelin protein autoimmune condition. Therefore, this study could be following gene trajectories that do not exist in MS. This needs a significant amount of discussion in the manuscript if the authors suggest that it is mimicking MS.
- The model does not have the cortical subpial demyelination typical of MS and it is unknown whether neuronal loss occurs in this model, which is the main feature of cytokine-mediated neurodegeneration in MS. If it does not then a whole set of genes will be missing that are involved in the neuronal response to inflammatory stimuli that may be cytotoxic.
- Visium technology does not get down to single cell level and does not appear to allow resolution of the border between the meninges and the underlying grey matter.
- Neuronal loss in the MS cortex is independent of demyelination and therefore not related to remyelination failure. There does not appear to be any cortical grey matter demyelination in these animals, so it is difficult to relate any of the gene changes seen here to demyelination.
- No mention of how the ascending and descending patterns of gene expression may be due to the gradient of microglial activation that underlies meningeal inflammation, which is a big omission.

We thank the reviewer for their insightful comments on the strengths and limitations of our study. Regarding the SJL EAE model we use in this paper, it certainly is not a perfect model of meningeal inflammation in MS, indeed we believe that no such animal model exists, but it does recapitulate several key features of human disease as described by the reviewer. Spatial transcriptomics of cortical grey matter lesions and overlying meninges of samples derived from patients with MS would be ideal, though access to this tissue is highly limited. In the revised manuscript we will include more detailed discussion of the limitations in applying these findings to MS. However, in addition to potential implications for MS research, our data contribute more generally to understanding of meningeal inflammation and penetrance of inflammation into brain tissue.

We acknowledge that sub-pial neuronal loss has not been assessed in SJL EAE, and if present it would increase the relevance of this model to neurodegeneration. We are currently working to assess this.

We agree with the reviewer that Visium technology is limited in its ability to discriminate individual cells, as discussed above (2.2).

We agree that gene expression by activated microglia is likely a major driver of the transcriptomic changes observed in the parenchyma, and thank the reviewer for highlighting this. We will add discussion of this to our revised manuscript, and intend to generate additional data regarding the contribution of subpial microglial activation to the measured transcriptomic changes.

Finally, we thank Reviewer #3 for their assessment of our work.