Single-Cell Profiling Reveals Innate Lymphoid Cells and OX40 Activation in Breast Cancer-Related Lymphedema

ABSTRACT Breast cancer-related lymphedema (BCRL) is a severe complication affecting up to 40% of breast cancer survivors. Stage II or chronic disease stages are characterized by upper-limb edema, fibrotic adipose tissue accumulation, pain, and recurrent infections. Despite its clinical burden, BCRL lacks effective pharmacological therapies and the molecular mechanisms driving disease progression remain poorly understood. To better define the regulatory mechanisms underlying chronic BCRL, we performed transcriptomic and quantitative analyses of stromal vascular fraction cells (SVF or non-adipose cell fraction) in BCRL-derived subcutaneous adipose tissue. CD45+ immune cells from stage II BCRL were compared with those from healthy lean and obese adipose tissue controls. Although our analyses identified multiple leukocyte populations, we focused primarily on innate lymphoid cells (ILCs), particularly ILC2 and ILC3 subsets, which were more abundant and active in BCRL tissues. Bioinformatics analysis of cell-cell communication positioned ILCs as central immune-regulatory hubs in BCRL through inflammatory and tissue-remodeling pathways, including connections to IL2, OX40, KIT, and LT signaling. Strong bidirectional communication between ILCs and regulatory T cells via OX40 signaling was uniquely detected in BCRL. Consistent with these findings, protein-based analyses confirmed increased inflammatory mediators and enrichment of the OX40 and OX40L co-stimulatory pair in BCRL tissues. Taken together, our findings identify OX40-dependent ILC-signaling as a novel regulatory program supporting chronic inflammation and pathological tissue remodeling in BCRL.