Integrated multiomics reveals inflammation-driven excessive erythrocytosis in subjects with Monge's disease

Abstract

Monges disease, or Chronic Mountain Sickness (CMS), is a chronic high-altitude disorder characterized by hypoxia-induced excessive erythrocytosis (EE), elevating the risk of stroke and myocardial infarction. Using RNA-seq and ATAC-seq, we profiled iPSC-derived erythroid cells from CMS and non-CMS subjects under normoxia and hypoxia to identify statistically significant, disease-associated transcriptional and chromatin accessibility changes. RNA-seq revealed induction of inflammatory, stress, and erythropoiesis programs in CMS even under normoxia, including robust activation of JAK/STAT signaling, upregulation of heme metabolism and VEGF, and accelerated erythrocyte lineage commitment alongside repression of Notch and WNT/{beta}-catenin. Hypoxia amplified this dysregulated state, and critically, activated NF{kappa}B-driven inflammatory signaling together with canonical HIF targets. ATAC-seq revealed pronounced hypoxia-induced changes, with increased accessibility within inflammatory and erythrocyte lineage genes occurring concomitantly with decreased accessibility within pluripotency and ectodermal lineage genes. Pharmacological NF{kappa}B inhibition in CMS cells significantly reduced EE (p-value <0.0001), whereas NF{kappa}B activation in non-CMS cells was sufficient to drive EE (p-value <0.01), confirming the causal role inferred by our multiomics analyses. Collectively, our multiomics and functional experiments substantiate a coordinated chromatin-transcription paradigm favoring an inflammatory axis that, through hypoxia-driven NF{kappa}B activation, accelerates stress-induced erythroid commitment and underlies EE in CMS.