Circulating senescent CD8 + CD57 + T cells have been implicated in reduced post-myocardial infarction survival and impaired glucose homeostasis in type 2 diabetes (T2D) patients. Despite these associations, their specific role in human atherosclerotic plaques, particularly in the context of aggravated plaque pathology in T2D remains unknown. In this study, we analyzed single-cell transcriptomic data from 75,049 immune cells obtained from plaques from 12 T2D and 10 no diabetes patients enrolled in the ATHERO-IN study. We identified 14 clusters of CD8 + T cells clusters, revealing distinct subsets such cytotoxic CD8 + T cells with a terminally differentiated effector memory phenotype, cytotoxic/exhausted, naïve/CM and regulatory CD8 + T cells. These clusters expressed varying degrees of senescent genes, with a notable heightened senescent transcriptional signature in T2D patients. Fibrocalcific plaques, which were prevalent in T2D patients, showed significantly enrichment in cytotoxic, inflammatory, naïve/CM, and interferon response CD8 T cell clusters. In contrast, fibroatheroma samples were predominantly enriched in MAIT-like CD8 T cells and cytotoxic/exhausted clusters. Aged CD8 T cells expanded in T2D patients exhibited elevated senescence and cytotoxic score, manifested a senescence-associated secretory phenotype expressing cytotoxic, pro-inflammatory and proatherogenic genes. Trajectory analysis and regulatory network analysis, highlighted ZEB2— a GWAS gene associated to coronary artery disease and myocardial infarction— as a potential transcription factor driving the senescence phenotype. CRISPR-based studies corroborated this, demonstrating that ZEB2 KO CD8 T cells reduced senescence, cytotoxicity, and activation markers, underscoring the pivotal role of ZEB2 in driving the terminal differentiation and aging phenotype. In conclusion, our findings shed light on the intricate interplay between senescent CD8+ T cells and atherosclerotic plaque pathology in the context of T2D. The identification of ZEB2 as a key regulator of T cell senescence offers a potential target for therapeutic interventions aimed at mitigating the senescence-associated effects on plaque pathology and cardiovascular outcomes in T2D patients.
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