NK Cell Exhaustion in Wilson's Disease Revealed by Single-cell RNA Sequencing Predicts the Prognosis of Cholecystitis

Metabolic abnormalities associated with liver disease have a significant impact on the risk and prognosis of cholecystitis. However, the underlying mechanism is complicated and remains to be elucidated. In particular, the effect of metabolic abnormalities on the progression of cholecystitis through the regulation of immune cell function is poorly understood. In this study, we investigated this issue using Wilsons disease (WD) as a model. Wilsons disease is a genetic disorder characterized by impaired mitochondrial function and abnormal copper metabolism. Our retrospective clinical study of over 600 patients with WD found that they have a significantly higher incidence of cholecystitis and a poorer prognosis. The immune cell landscape in the hepatic mesenchymal stromal microenvironment of WD patients was shown using single-cell RNA. A major change is the constitution and function of the innate immune system, including enhanced antigen presentation process, activation of the immune response, and activation of lymphocytes. The proportion of mononuclear phagocytes and natural killer (NK) cells is increased, and the primary characteristic and function of macrophage, Kupffer cell, neutrophil, and NK cell are altered. Exhaustion of NK cell is the fundamental factor, supported by an increase in the expression of the inhibitory receptors KLRC1 and TIGIT and a decrease in the expression of cytotoxic molecules. Clinical tissue and blood samples verified increased KLRC1+ and TIGIT+ NK cells and decreased IFN{gamma}+ NK cells in WD. Further bioinformatic analysis has confirmed a positive correlation between NK cell exhaustion and poor prognosis in cholecystitis and other inflammatory diseases. The study demonstrated abnormal function of liver mesenchymal immune cells triggered by specific metabolic dysfunction in WD, with a focus on the correlation between NK cell exhaustion and poor healing of cholecystitis. Our findings highlight the immune cell dysfunction due to metabolic changes in hepatocytes and provide new insights into the improvement of inflammatory diseases by assessing immune cell function.