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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2026.1766301</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>ScRNA-seq reveals dynamic macrophage heterogeneity in chronic liver disease progression and prognostic biomarkers <italic>KLF2/SPP1</italic> in HCC</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name><surname>Pan</surname><given-names>Qi</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="author-notes" rid="fn003"><sup>&#x2020;</sup></xref>
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<contrib contrib-type="author" equal-contrib="yes">
<name><surname>Wang</surname><given-names>Xinru</given-names></name>
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<name><surname>Li</surname><given-names>Borui</given-names></name>
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<name><surname>Cai</surname><given-names>Zhenzhen</given-names></name>
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<name><surname>Chen</surname><given-names>Shuwen</given-names></name>
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<contrib contrib-type="author">
<name><surname>Hu</surname><given-names>Jiahong</given-names></name>
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<contrib contrib-type="author">
<name><surname>Yuan</surname><given-names>Xuenan</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
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<contrib contrib-type="author">
<name><surname>Yang</surname><given-names>Jie</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
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<name><surname>Guo</surname><given-names>An-Yuan</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>*</sup></xref>
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<name><surname>Zhang</surname><given-names>Zhihong</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
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<aff id="aff1"><label>1</label><institution>School of Life and Health Sciences, Institute of Biomedical Research, Hainan Province Key Laboratory of One Health, Collaborative Innovation Center of Life and Health, Hainan University</institution>, <city>Haikou</city>, <state>Hainan</state>,&#xa0;<country country="cn">China</country></aff>
<aff id="aff2"><label>2</label><institution>State Key Laboratory of Digital Medical Engineering, Britton Chance Center for Biomedical Photonics, School of Biomedical Engineering, Hainan University</institution>, <city>Sanya</city>, <state>Hainan</state>,&#xa0;<country country="cn">China</country></aff>
<aff id="aff3"><label>3</label><institution>MOE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology</institution>, <city>Wuhan</city>, <state>Hubei</state>,&#xa0;<country country="cn">China</country></aff>
<aff id="aff4"><label>4</label><institution>Department of Thoracic Surgery, West China Biomedical Big Data Center, West China Hospital, Sichuan University</institution>, <city>Chengdu</city>,&#xa0;<country country="cn">China</country></aff>
<author-notes>
<corresp id="c001"><label>*</label>Correspondence: Zhihong Zhang, <email xlink:href="mailto:zhzhang@hainanu.edu.cn">zhzhang@hainanu.edu.cn</email>; An-Yuan Guo, <email xlink:href="mailto:guoanyuan@wchscu.cn">guoanyuan@wchscu.cn</email></corresp>
<fn fn-type="equal" id="fn003">
<label>&#x2020;</label>
<p>These authors have contributed equally to this work</p></fn>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-02-18">
<day>18</day>
<month>02</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2026</year>
</pub-date>
<volume>17</volume>
<elocation-id>1766301</elocation-id>
<history>
<date date-type="received">
<day>12</day>
<month>12</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>29</day>
<month>01</month>
<year>2026</year>
</date>
<date date-type="rev-recd">
<day>21</day>
<month>01</month>
<year>2026</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2026 Pan, Wang, Li, Cai, Chen, Hu, Yuan, Yang, Guo and Zhang.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Pan, Wang, Li, Cai, Chen, Hu, Yuan, Yang, Guo and Zhang</copyright-holder>
<license>
<ali:license_ref start_date="2026-02-18">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Metabolic dysfunction-associated steatohepatitis (MASH)-induced chronic liver diseases (CLDs) were worldwide prevalence and incidence. The stage-resolved cellular and molecular programs remained incompletely defined. This study aimed to resolve stage-specific immune and transcriptional features across CLDs processes and to identify prognostic biomarkers.</p>
</sec>
<sec>
<title>Methods</title>
<p>We integrated single-cell RNA sequencing datasets from healthy liver, MASH, cirrhosis and HCC to construct a stage-resolved cellular atlas. We performed cell-state scoring, diffusion pseudotime, gene regulatory network inference, and cell&#x2013;cell interaction to decipher various macrophages and T cells transcriptional profiles. We established a method of gene sets enrichment score to detect prognostic markers and employed RNA fluorescence <italic>in situ</italic> hybridization (FISH) to validate macrophage subtype abundances and spatial interactions.</p>
</sec>
<sec>
<title>Results</title>
<p>The integrated atlas revealed the heterogeneity cell-subtype composition and transcriptional features across CLD stages. In MASH, CXCL3<sup>+</sup> macrophage and CXCL10<sup>+</sup> macrophage were enriched and characterized by <italic>ETS2</italic>- and <italic>IRF1</italic>-driven inflammatory programs that might potentially contribute to the transition from MASH to HCC. SPP1<sup>+</sup> macrophage was exclusive to HCC and might contribute to cytotoxic T-cell (Tc) dysfunction but do not directly demonstrate functional suppression or exhaustion.</p>
<p>Subsequently, we sought to validate the robustness of these signature genes. We integrated clinical datasets from the TCGA-LIHC to validate signature genes in HCC derived from the scRNA-seq results and identify prognostic biomarker. Survival-linked analyses uncovered SPP1 and KLF2 as prognostic biomarkers. FISH confirmed stage-specific shifts in macrophage abundances and close spatial interactions between SPP1<sup>+</sup> macrophages and Tc in HCC specimens.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>We provided a stage-resolved framework to delineated macrophage heterogeneity during CLDs progression and identified SPP1 and KLF2 as candidate prognostic biomarkers and potential therapeutic targets in HCC.</p>
</sec>
</abstract>
<kwd-group>
<kwd>cell heterogeneity</kwd>
<kwd>chronic liver diseases processes</kwd>
<kwd>macrophage-T cell interactions</kwd>
<kwd>prognostic biomarkers</kwd>
<kwd>scRNA-seq</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Science and Technology Talent Innovation Project in Hainan Province (KJRC2023B09), the State Key Program of the National Natural Science Foundation of China (32330048), and the Collaborative Innovation Center of Life and Health, Hainan University (XTCX2022JKB11).</funding-statement>
</funding-group>
<counts>
<fig-count count="6"/>
<table-count count="0"/>
<equation-count count="2"/>
<ref-count count="64"/>
<page-count count="15"/>
<word-count count="6791"/>
</counts>
<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Cancer Immunity and Immunotherapy</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>Chronic liver diseases (CLDs) presented a significant global health burden, with a mortality rate of two million deaths per year (<xref ref-type="bibr" rid="B1">1</xref>). CLD was also a continuous and progressive deterioration of liver functions (<xref ref-type="bibr" rid="B2">2</xref>). The distribution of CLDs was changing, metabolic dysfunction&#x2013;associated steatohepatitis (MASH) has become the most prevalent cause of CLD, and its global incidence and prevalence were steadily rising within the next decade significantly (<xref ref-type="bibr" rid="B3">3</xref>). Cirrhosis was a leading cause of death among patients of CLD worldwide, frequently progressed to hepatocellular carcinoma (HCC) (<xref ref-type="bibr" rid="B4">4</xref>). Although the rapidly evolving single-cell RNA sequencing (scRNA-seq) technologies have provided valuable insight into the pathogenesis of liver diseases (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B6">6</xref>), comprehensive analysis of diverse cellular populations and phenotypic states during the transition from MASH to advanced liver disease and HCC remained limited. Hence, a deep understanding of the stage-specific immune landscapes and transcriptional programs of CLDs was urgently needed to improve the rational design of immunotherapies.</p>
<p>The immune system played a critical role in CLDs (<xref ref-type="bibr" rid="B7">7</xref>). It has been reported that both innate and adaptive immune cells shaped the hepatic microenvironment during the progression from MASH to fibrosis, cirrhosis, and HCC (<xref ref-type="bibr" rid="B8">8</xref>). Macrophages (Macs) represent a first-line defense in the liver, they showed impaired turnover in MASH and could be driven toward pro-inflammatory activation by the excess lipids and tissue damage in the fatty liver (<xref ref-type="bibr" rid="B9">9</xref>). The scar-associated macrophages (SAMacs), displaying a pro-fibrogenic phenotype, have been identified expand in liver cirrhosis (<xref ref-type="bibr" rid="B5">5</xref>). Tumor-associated macrophages (TAMs) exhibited distinct transcriptional states and were associated with poor prognosis in HCC (<xref ref-type="bibr" rid="B10">10</xref>). However, the cellular and molecular mechanisms involved in CLDs pathogenesis remain largely unknown.</p>
<p>Here, we integrated 29 samples of scRNA-seq data from healthy liver, MASH, cirrhosis and HCC to identify stage-specific macrophage and T cell subpopulations across chronic liver disease processes. We clarified the molecular dynamics of C1QA<sup>+</sup> Mac, CXCL3<sup>+</sup> Mac, CXCL10<sup>+</sup> Mac, SAMac and SPP1<sup>+</sup> Mac along CLDs processes, and discovered the transcription factor <italic>ETS2</italic> (ETS proto-oncogene 2) and <italic>IRF1</italic> (interferon regulatory factor 1) as key regulators in macrophages, potentially driving the transitions of MASH to HCC. Moreover, we revealed SPP1<sup>+</sup> macrophages established anergic interactions with cytotoxic T cell (Tc), with <italic>SPP1</italic> serving as a poor prognostic biomarker, whereas <italic>KLF2</italic> (KLF transcription factor 2) exhibited an anti-tumor phenotype in HCC.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<label>2</label>
<title>Materials and methods</title>
<sec id="s2_1">
<label>2.1</label>
<title>Data collection</title>
<p>ScRNA-seq data were collected from Gene Expression Omnibus (GEO; <ext-link ext-link-type="uri" xlink:href="https://www.ncbi.nlm.nih.gov/geo/">https://www.ncbi.nlm.nih.gov/geo/</ext-link>) database and Mendeley Data (<ext-link ext-link-type="uri" xlink:href="https://data.mendeley.com/">https://data.mendeley.com/</ext-link>). The inclusion criteria for scRNA-seq datasets were as follows: (1) liver tissue samples with clearly annotated disease status relevant to MASH, liver cirrhosis, or HCC; (2) the availability of raw or processed gene expression matrices and corresponding cell-type annotations; (3) the scRNA-seq analysis results have been confirmed by FISH, flow cytometry, immunostaining, or experimental studies in original article. We selected 5 cases of healthy controls and 5 cases of liver cirrhotic patients from GSE136103, (5) 3 cases of MASH patients from GSE159977. (6) Because the annual incidence of hepatocellular carcinoma arising from NASH-related cirrhosis was relatively low, we were unable to collect the dataset. Viral hepatitis-induced and NASH-induced HCC have been reported to share overlapping inflammatory and immune signaling pathways that drive malignant transformation (<xref ref-type="bibr" rid="B11">11</xref>). Therefore, we collected 6 cases of HBV-related cirrhosis with HCC from skrx2fz79n (<xref ref-type="bibr" rid="B12">12</xref>) as a surrogate. The data accession numbers and information were provided in <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;1</bold></xref>. Additionally, the RNA expression data and clinical information of HCC used in this study were obtained from The Cancer Genome Atlas public access web portal (TCGA-LIHC; <ext-link ext-link-type="uri" xlink:href="https://portal.gdc.cancer.gov/">https://portal.gdc.cancer.gov/</ext-link>).</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Single-cell RNA-seq data analysis</title>
<p>Cases from GSE136103 and GSE159977 were obtained raw fastq files. They were processed with the Cell Ranger pipeline (version 6.0.2, 10X Genomics) and mapped to GRCh38 reference genome to generate count matrices. The count matrix of skrx2fz79n dataset was obtained from rds files (<ext-link ext-link-type="uri" xlink:href="https://data.mendeley.com/datasets/skrx2fz79n/1">https://data.mendeley.com/datasets/skrx2fz79n/1</ext-link>). We used the &#x201c;emptyDrops&#x201d; function of the R package DropletUtils (version 1.14.2) (<xref ref-type="bibr" rid="B13">13</xref>) to remove barcode-swapped pseudo-cells. We applied &#x201c;doubletFinder_v3&#x201d; function of R package DoubletFinder (version 2.0.3) (<xref ref-type="bibr" rid="B14">14</xref>) to identify doublets. For quality control, cells with mitochondrial gene percentages less than 10%, genes expressed in over 3 cells, and detected genes between 200 to 4000 were kept. The R package Seurat (version 4.2.1) (<xref ref-type="bibr" rid="B15">15</xref>) was utilized to perform data normalization and dimensionality reduction. Gene expression counts were normalized and scaled by &#x201c;SCTransform&#x201d; function with glmGamPoi model, and we calculated a PCA matrix by &#x201c;RunPCA&#x201d; function. After PCA, we used the &#x201c;RunHarmony&#x201d; function with SCT assay for batch effect correction and datasets integration in the R package harmony (version 0.1.0) (<xref ref-type="bibr" rid="B16">16</xref>).</p>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>Unsupervised clustering and cell-type annotation</title>
<p>The top 40 harmony dimensions were used to carry out the uniform manifold approximation and projection (UMAP) dimensional reduction. We then constructed the nearest-neighbour graph by the &#x201c;FindNeighbors&#x201d; function with the reduction as &#x2018;harmony&#x2019;. The &#x201c;FindClusters&#x201d; function was then used to identify clusters with the resolution parameter of 0.09 of the whole object, which resulted in 15 clusters; the resolution of 0.3 for T cells and 0.4 for mononuclear phagocytes. To identify cluster-specific marker genes, we used &#x201c;FindAllMarkers&#x201d; function to select those detect in a minimum of 25% of cells within the cluster, displaying a <italic>p value</italic>&#x2009;&lt;&#x2009;0.05 in the Wilcoxon rank-sum test, and demonstrating a differential expression threshold of 0.25 log fold change (log2FC). The main cell types were annotated with known cell-type marker genes based on CellTypist (<ext-link ext-link-type="uri" xlink:href="https://www.celltypist.org/">https://www.celltypist.org/</ext-link>) (<xref ref-type="bibr" rid="B17">17</xref>) and CellMarker 2.0 (<ext-link ext-link-type="uri" xlink:href="http://117.50.127.228/CellMarker/">http://117.50.127.228/CellMarker/</ext-link>) (<xref ref-type="bibr" rid="B18">18</xref>). We applied type-specific markers to annotate mononuclear phagocyte and T cell subtypes.</p>
</sec>
<sec id="s2_4">
<label>2.4</label>
<title>Trajectory inference and cell-cell communication</title>
<p>Trajectory and diffusion-pseudotime (DPT) analysis were generated using the R package destiny (version 3.22.0) (<xref ref-type="bibr" rid="B19">19</xref>). The number of nearest neighbors, k, was set to 10. The principal components were set to 30. The R package CellChat (version 1.6.1) (<xref ref-type="bibr" rid="B20">20</xref>) was utilized to explore the communication of macrophages and T cells into functionally relevant signaling pathways. We used the processed expression matrices from the &#x201c;SCT&#x201d; data slot of the Seurat object with corresponding annotations to create a CellChat object. CellChatDB.human was set as the ligand-receptor interaction database. We applied the minimum cell count criterion of 10.</p>
</sec>
<sec id="s2_5">
<label>2.5</label>
<title>Macrophage and T cell states</title>
<p>We used the R package AUCell (<xref ref-type="bibr" rid="B21">21</xref>) to calculate the signature score of curated gene sets relate to macrophage and T cell functional states (<xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>) (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Tables&#xa0;2, 3</bold></xref>). AUCell could provide a relative measure of gene importance in each cell to evaluate the degree of gene set enrichment. The ranked gene expression matrix was built by the AUCell_buildRankings function, and then we calculated the AUC value using the AUCell_calcAUC function.</p>
</sec>
<sec id="s2_6">
<label>2.6</label>
<title>Functional enrichment analysis and SCENIC analysis</title>
<p>We performed GO enrichment analysis with the R package clusterProfiler (version 4.2.2) (<xref ref-type="bibr" rid="B24">24</xref>). The top 8 GO annotations were chosen for C1QA<sup>+</sup> Mac and SPP1<sup>+</sup> Mac for visualization. Enrichment scores for the eight selected GO annotations were calculated by a hypergeometric statistical test with a significance threshold of 0.01.</p>
<p>SCENIC (<xref ref-type="bibr" rid="B21">21</xref>) was a tool that utilizes scRNA-seq data to reconstruct gene regulatory networks. We used the pySCENIC (version 0.12.1) package in Python (version 3.10) to assess transcription factor enrichment and regulator activity of monocyte and nine macrophage subtypes. The grn function was used to infer gene co-expression relationships between transcription factors and their potential target. Then, ctx function was used to refine the regulons and separate direct and indirect target. Finally, the regulon activity was calculated by aucell function. The R package ComplexHeatmap (<xref ref-type="bibr" rid="B25">25</xref>) was used to visualize the regulon activity.</p>
</sec>
<sec id="s2_7">
<label>2.7</label>
<title>Signature genes</title>
<p>Based on cluster-specific marker genes, we identified the signature genes from FindAllMarkers function of Seurat (<xref ref-type="bibr" rid="B15">15</xref>). For macrophages, genes with adjusted <italic>p value</italic> &lt; 0.01 by Wilcoxon rank-sum test, in a minimum of 50% of cells within the cluster and in a maximum of 50% of cells within the others cluster (pct.1 &gt; 0.5 and pct.2 &lt; 0.5), and demonstrating a differential expression threshold of 1 log fold change (avg_log2FC &gt; 1) were defined as macrophage subtypes specific signature genes. For T cells, genes with adjusted <italic>p value</italic>&#x2009;&lt;&#x2009;0.01 by Wilcoxon rank-sum test, and demonstrating a differential expression threshold of 0.5 log fold change (avg_log2FC &gt; 0.5) were defined as T cell subtypes specific signature genes. Then, we manually checked the cell subtypes specific signature genes. We removed ALB and ATP5F1E to confirm the signature genes were specific to cell subtypes. Furthermore, we performed SelectGene function of R package (<xref ref-type="bibr" rid="B26">26</xref>) (version 1.0) to calculate total entropy difference. The genes with greater total entropy difference tend to be more specific and would be retained as cell subtypes specific signature genes.</p>
</sec>
<sec id="s2_8">
<label>2.8</label>
<title>Survival analysis and prognostic gene selection</title>
<p>We collected 424 samples from the TCGA-LIHC cohort, including 50 normal liver samples and 374 HCC samples. Clinical information and gene expression matrix were retrieved using the R package TCGAbiolinks. The clinical information was retrieved using the GDCquery_clinic function. Bulk RNA-seq data were obtained using the GDCquery function with project set to &#x201c;TCGA-LIHC&#x201d;, data_category set to &#x201c;Transcriptome Profiling&#x201d;, data_type set to &#x201c;Gene Expression Quantification&#x201d;, and workflow_type set to &#x201c;STAR&#x2013;Counts. The TCGA-LIHC data was used to evaluate the prognostic performance of signature gene sets derived from macrophage and T cell subtypes clusters. We performed survival analysis using the Cox proportional hazards model implemented in the R package survival (version 3.3-1). And the ggsurvplot function was employed to correct patient age and plot Kaplan&#x2013;Meier survival curves. Least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied to construct the prognostic model of the signature genes of SPP1<sup>+</sup> Mac and Tc. Univariate Cox proportional hazards regression analysis was performed on the signature genes of SPP1<sup>+</sup> Mac and Tc to screen genes significantly associated with OS in HCC (<xref ref-type="bibr" rid="B27">27</xref>).</p>
</sec>
<sec id="s2_9">
<label>2.9</label>
<title>Gene set enrichment score calculation</title>
<p>We employed ImmuCellAI (<xref ref-type="bibr" rid="B28">28</xref>) to calculate immune cell enrichment score (IS) of each sample to correct the bias of immune cell abundance. Hepatocytes can impair the function of T cell (<xref ref-type="bibr" rid="B29">29</xref>), so we calculated the enrichment score of Tc (CA) to assign the deviation. Next, we used the expression of signature gene set as input of ssGSEA to obtain the enrichment score (ES) of SPP1<sup>+</sup> Mac and Tc. Finally, the gene set enrichment score are as follows:</p>
<p>Gene set enrichment score of SPP1<sup>+</sup> Mac (Mscore):</p>
<disp-formula>
<mml:math display="block" id="M1"><mml:mrow><mml:mtext>Mscore</mml:mtext><mml:mo>=</mml:mo><mml:mfrac><mml:mrow><mml:mtext>ES</mml:mtext></mml:mrow><mml:mrow><mml:mtext>IS</mml:mtext></mml:mrow></mml:mfrac></mml:mrow></mml:math>
</disp-formula>
<p>Gene set enrichment score of Tc (Tscore):</p>
<disp-formula>
<mml:math display="block" id="M2"><mml:mrow><mml:mtext>Tscore</mml:mtext><mml:mo>=</mml:mo><mml:mfrac><mml:mrow><mml:mtext>ES</mml:mtext><mml:mo>*</mml:mo><mml:mtext>CA</mml:mtext></mml:mrow><mml:mrow><mml:mtext>IS</mml:mtext></mml:mrow></mml:mfrac></mml:mrow></mml:math>
</disp-formula>
</sec>
<sec id="s2_10">
<label>2.10</label>
<title>Mice</title>
<p>Experiments were conducted on 7&#x2013;8 weeks old C57BL/6J male mice. Mice were purchased from the Hunan SJA Laboratory Animal Co., Ltd (Changsha, Hunan, China) and were bred in a specific pathogen&#x2010;free barrier facility at the Animal Center of Wuhan National Laboratory for Optoelectronics. 5 healthy mice as control. For Diet-induced MASH mice models, 5 mice were fed with MCD diet for up to 3 weeks. Liver fibrosis models were induced in 5 mice through an intraperitoneal injection of 25% CCL<sub>4</sub> in corn oil (Sinopharm Chemical Reagent Co., Ltd., China) twice a week for 6 weeks. 5 HCC mice models generated by hydrodynamic tail vein injection of plasmids carrying the <italic>Akt</italic> and <italic>N-ras</italic> genes were established over six weeks and purchased from Shouzheng Pharma (Wuhan) Biotechnology Co., Ltd. Finally, all mice were anesthetized and transcardially perfused with RNase-free PBS. Liver samples of mice were immediately collected and subjected to further experiments.</p>
</sec>
<sec id="s2_11">
<label>2.11</label>
<title>Histology and FISH</title>
<p>H&amp;E staining and Masson&#x2019;s trichrome staining were used to evaluate and examine the histopathologic changes in liver structure. The sections were imaged with PanoBrain (Tinyphoton, Hubei, China). For each specimen, 5 fields per tissue section were randomly chosen and quantified by ImageJ software (National Institutes of Health, USA).</p>
<p>For FISH, the livers were maintained and fixed with 4% paraformaldehyde (PFA) for 6 hours, then incubated with 30% sucrose with 4% PFA. The liver lobes were immersed in optimal cutting temperature (OCT) tissue blocks, and stored at -80 &#xb0;C. Cryosections 30 &#x3bc;m thick were used for <italic>in situ</italic> amplification and hybridization. Padlock probes and primers were designed as target sequence of genes (<italic>C1qa, Cd3, Clec4f, Cxcl3, Cxcl10, Klf2, Trem2, Spp1, Akt and Nras</italic>). In brief, the sections were incubated with buffer (2&#xd7;SSC, 35% formamide, 1% TritonX-100 in RNase-free PBS) contain probes overnight at 37 &#xb0;C. Then, 5.7 U/&#x3bc;l T4 DNA ligase (TaKaRa, Japan) was added to ligate padlock probes at room temperature for 4 hours. After ligation, the sections were incubated with rolling circle amplification mixture (250 &#x3bc;M dNTP, 4 &#x3bc;M Dithiothreitol, 0.4 U/&#x3bc;l Recombinant RNase Inhibitor in ddH<sub>2</sub>O) by Phi29 DNA polymerase (New England Biolabs, America) at 30&#xb0;C for 2 hours. The sections were then incubated with monomer buffer (4% acrylamide, 0.2% bis-acrylamide, 0.1% ammonium persulfate, 0.2% tetramethylethylenediamine) at room temperature for 2 hours. Next, the sections were digested with Proteinase K (Biofrox, Germany) overnight in 37 &#xb0;C. Finally, the sections were incubated with fluorescent oligo (Alexa Fluor 488, TAMRA, Alexa Fluor 647) complementary to DNA amplicon at 37 &#xb0;C for 30 minutes. The sections were imaged on Olympus FLUOVIEW FV3000 confocal laser scanning microscopes for gene expression validations or cell subtypes analysis. The detailed probe information was listed on <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;4</bold></xref>.</p>
</sec>
<sec id="s2_12">
<label>2.12</label>
<title>Distance quantification of FISH data</title>
<p>The quantification of spatial distance was computed using cv2 python module. We used DAPI to stain the cell nucleus as the center point of the cell. We defined macrophages based on the fluorescent points of cell marker within the diameter of 20 &#x3bc;m, T cells were 10 &#x3bc;m. The FISH images were converted to the HSV color space, and which binary masks of valid regions were generated by applying specific thresholds. Next, the connected component analysis was performed on the masks to filter out small connected components and eliminate noise. The effective contours of fluorescent cells were extracted, and the distribution of their center points was calculated and visualized. For SPP1<sup>+</sup> Mac and Tc, the shortest distance to a tumor cell was extracted from the pairwise cell-cell distance matrix of all cell distances, which defined as the distance to the closest tumor cell.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<label>3</label>
<title>Results</title>
<sec id="s3_1">
<label>3.1</label>
<title>A comprehensive cellular landscape of CLDs explored by integrated scRNA-seq data</title>
<p>To uncovered the single-cell landscape during different processes of CLDs, we applied scRNA-seq data to characterize the dynamics from health liver, MASH, liver cirrhosis and HCC. In total, 99, 593 high-quality cells from 29 samples of 19 patients were analyzed after quality control in our study (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;1</bold></xref>). After performing quality control, sctransform normalization, dimensionality reduction, batch effect removal, and clustering, the 13 distinct main cell types were annotated by CellTypist (<xref ref-type="bibr" rid="B17">17</xref>) and cell marker genes from CellMarker (<xref ref-type="bibr" rid="B30">30</xref>) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1a</bold></xref>). We computed the spearman correlation of the main cell, and we observed a distinct correlation between adaptive immune cells (NKT and T cell) and innate immune cells (MP) and wanted to explore this further (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1b</bold></xref>). Each dataset with no obvious batch effects after batch correction (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1a</bold></xref>). All cells with the number of genes per cell between 200 and 4000, and the proportion of mitochondrial gene counts less than 10% were selected (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1b</bold></xref>). Of note, MP, T cell and NKT proportion were obviously dominant and distinct across different processes of CLDs, suggesting they might play a role in the immune microenvironment (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1c</bold></xref>). T cell expressed the T-cell receptor (TCR) signaling mediators CD3D (<xref ref-type="bibr" rid="B31">31</xref>), Mononuclear phagocyte (MP) was identified by the expression of C1QA, Natural killer T cell (NKT) was marked by XCL1 (<xref ref-type="bibr" rid="B32">32</xref>), Natural killer cell (NK) was identified by natural killer cell granule protein 7 (NKG7) (<xref ref-type="bibr" rid="B33">33</xref>), Endothelial cell was marked by known liver endothelial cell marker VWF (<xref ref-type="bibr" rid="B34">34</xref>), Cholangiocyte marker gene was KRT19 (<xref ref-type="bibr" rid="B35">35</xref>), B cell was identified by the canonical marker gene CD79A, Epithelial cell was defined by TNFAIP3 (<xref ref-type="bibr" rid="B36">36</xref>), Mesenchymal cell was marked by ACTA2 (<xref ref-type="bibr" rid="B37">37</xref>), Plasma cell was identified by the expression of JCHAIN (<xref ref-type="bibr" rid="B17">17</xref>), Plasmacytoid dendritic cell (pDC) was marked by IRF7 (<xref ref-type="bibr" rid="B38">38</xref>), Hepatocyte was defined by their classical marker ALB, Mast cell was positive for expression TPSB2 (<xref ref-type="bibr" rid="B39">39</xref>) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1d</bold></xref>, <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1c</bold></xref>). To characterize the heterogeneous cellular compositions among the four processes of CLDs, we calculated the proportion of cell types by a bias-corrected and accelerated (BCa) bootstrap algorithm (<xref ref-type="bibr" rid="B40">40</xref>). Interestingly, we observed MPs and T cells (including T cells and NKT cells) proportion were distinct across different processes, which suggesting the progression heterogeneity of CLDs (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1e</bold></xref>). This indicated the complexity immune-specific microenvironment of CLDs (<xref ref-type="bibr" rid="B41">41</xref>). Hence, we proceeded to further annotated MPs and T cell subtypes with manual marker-based annotation method for in-depth analysis.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Single-cell RNA-seq landscape of major cell types at different processes of CLDs. <bold>(a)</bold> UMAP plot showing cell clusters in the progression of the chronic liver disease. MP, Mononuclear phagocyte; NK, natural killer T cell; NK, natural killer cell; pDC, plasmacytoid dendritic cell. <bold>(b)</bold> Spearman correlation of transcriptomic profiles of different cell populations. <bold>(c)</bold> UMAP plot colored by different progression of chronic liver diseases. <bold>(d)</bold> Violin plots showing the expressed marker genes of main cell types. <bold>(e)</bold> Histogram showing the proportion of main cell types in different progression of chronic liver diseases.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g001.tif">
<alt-text content-type="machine-generated">Panel a shows a UMAP plot clustering thirteen cell types, each labeled and color-coded, including T cells, macrophages, epithelial cells, and hepatocytes. Panel b presents a heatmap illustrating the correlation between cell types, with hierarchical clustering and a color gradient indicating correlation strength. Panel c displays UMAP plots under four conditions&#x2014;Health, MASH, Cirrhotic, and HCC&#x2014;highlighting shifts in cell population distributions. Panel d features violin plots depicting gene expression levels of selected marker genes across thirteen cell types. Panel e provides a stacked bar chart comparing relative proportions of each cell type under the four disease states, color-coded for clarity.</alt-text>
</graphic></fig>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Intrahepatic macrophages and T cells subtypes exhibited distinct features during the progression of CLDs</title>
<p>To pinpoint the transcriptional diversity in four processes of CLDs, we performed unsupervised clustering analyses of MPs. In addition to conventional dendritic cells (cDC1 and cDC2) and neutrophils, we annotated 10 other myeloid cell subtypes, including monocytes and 9 macrophage subtypes (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2a</bold></xref>). We found C1QA<sup>+</sup> Mac highly enriched in healthy liver. SAMac and SPP1<sup>+</sup> Mac was predominant in liver cirrhosis and HCC (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2b</bold></xref>). CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac highly expressed the genes of CXCL subfamily. CXCL3<sup>+</sup> Mac exhibited the highest expression of CXCL8, CXCL3, CXCL2 and CCL20, which implied CXCL3<sup>+</sup> Mac might be associated with liver disease progression and survival time (<xref ref-type="bibr" rid="B42">42</xref>, <xref ref-type="bibr" rid="B43">43</xref>). CXCL10<sup>+</sup> Mac was characterized by the inflammatory response chemokines of CXCL10 and CXCL9. It has been reported CXCL10 and CXCL9 were often localized with CXCL13-expressing T cells, which suggested they could participate in inflammation and antitumor reactivity (<xref ref-type="bibr" rid="B44">44</xref>). C1QA<sup>+</sup> Mac highly expressed C1QA and C1QB, indicating that C1QA<sup>+</sup> Mac might be involved in inhibiting tumor progression (<xref ref-type="bibr" rid="B45">45</xref>). SAMac specifically expressed TREM2, which was known to regulate scar-producing myofibroblasts (<xref ref-type="bibr" rid="B5">5</xref>). SPP1<sup>+</sup> Mac was strikingly enriched in HCC and highest expressed immunosuppressive gene of <italic>SPP1</italic> (<xref ref-type="bibr" rid="B46">46</xref>) (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2c</bold></xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Characterization of macrophage subtypes and states during CLDs. <bold>(a)</bold> UMAP plot showing the MPs clusters, colors represent different cell populations, dots represent individual cells. cDC1, conventional dendritic cell 1; cDC2, conventional dendritic cell 2. <bold>(b)</bold> Histogram showing the proportion of MPs in different progression of CLDs. <bold>(c)</bold> Differential gene expression analysis showing up- (red) and down- (blue) regulated genes of monocytes and 9 macrophage subtypes. Adjusted p value &lt; 0.05. <bold>(d)</bold> Density plot showing M1, M2, angiogenesis and phagocytosis properties of monocytes and 9 macrophage subtypes.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g002.tif">
<alt-text content-type="machine-generated">Figure composed of four panels showing single-cell RNA-seq data analysis from human liver mononuclear phagocytes. Panel a shows a UMAP plot with cells colored and labeled by cluster number and cell type. Panel b presents a stacked bar graph illustrating proportions of mononuclear phagocytes types in healthy, NASH, cirrhotic, and HCC conditions. Panel c features a dot plot of differential gene expression by cell type, indicating upregulated and downregulated genes. Panel d contains four UMAP density plots demonstrating distribution of M1, M2, angiogenesis, and phagocytosis gene signatures across cell populations.</alt-text>
</graphic></fig>
<p>We next evaluated the macrophage polarization states of M1, M2, angiogenesis and phagocytosis properties to infer their functional states (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;3a</bold></xref>; <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;2</bold></xref>). CXCL10<sup>+</sup> Mac showed the highest M1 score, whereas CXCL3<sup>+</sup> Mac showed the higher M2 and angiogenesis score, suggesting CXCL10<sup>+</sup> Mac take part in chronic inflammation, CXCL3<sup>+</sup> Mac was an immunosuppressive phenotype (<xref ref-type="bibr" rid="B22">22</xref>). C1QA<sup>+</sup> Mac display the highest M2 and phagocytosis score, revealing that C1QA<sup>+</sup> Mac might promote tolerance and diminished pro-inflammation (<xref ref-type="bibr" rid="B47">47</xref>). Notably, C1QA<sup>+</sup> Mac also expressed the highest level of CD5L and MARCO, reported to be associated with anti-inflammation (<xref ref-type="bibr" rid="B48">48</xref>, <xref ref-type="bibr" rid="B49">49</xref>), which implicating that C1QA<sup>+</sup> Mac could be a beneficial cell population of CLDs (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2c, d</bold></xref>). SPP1<sup>+</sup> Mac showed the lowest M1 score, supporting SPP1<sup>+</sup> Mac contributors to pro-tumor (<xref ref-type="bibr" rid="B50">50</xref>). Our observations elucidated the inflammatory response of CXCL3<sup>+</sup> Mac, CXCL10<sup>+</sup> Mac and C1QA<sup>+</sup> Mac, and revealing SPP1<sup>+</sup> Mac predominant present in HCC, implicating their important roles during CLDs processes.</p>
<p>We identified 14 T cell subtypes by unsupervised clustering analysis of T cells and NK cells (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;2a</bold></xref>), including naive T cell (Tn), NKT, exhausted T cell (Tex), effector T cell (Teff), proliferating T cell (Tproli), T helper cell (Th), T regulatory cell (Treg), stress response T cell (Tstr), effector memory T cell (Tem), cytotoxic T cell (Tc), Cycling NK &amp; T, gamma delta T cell (&#x3b3;&#x3b4;T), mucosal-associated invariant T cell (MAIT) and tissue-resident memory T cell (Trm). But we didn&#x2019;t observe changing patterns in T cell compositions during CLDs processes (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;2b</bold></xref>). Tn expressed high levels of naive markers. Tex demonstrated the highest expression of CXCL13. Tstr characterized by high expression of heat shock genes. Tc markedly expressed cytolytic activity-related genes. Tem showed high expression of immunoglobulin-related genes (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;2c</bold></xref>). To understand the state of T cells, we calculated the scores of naive, activation, cytotoxicity, and exhaustion onto the UMAP, which was following their expected functions (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;2d</bold></xref>; <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;3</bold></xref>).</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>The trajectories and regulators of macrophages and T cells subtypes in different CLDs processes</title>
<p>The CLDs processes were dynamic (<xref ref-type="bibr" rid="B51">51</xref>). To reveal novel cellular and molecular mechanisms driving MASH to HCC, we further explored the differentiation trajectories and transcriptional regulation of macrophages and T cells subtypes. We applied Destiny (<xref ref-type="bibr" rid="B19">19</xref>) to infer the differentiation trajectory of macrophages and T cells subtypes. Macrophages subtypes displayed a trajectory that started with monocytes. FCN1<sup>+</sup> Mac, S100A8<sup>+</sup> Mac, and VSIR<sup>+</sup> Mac were primary site in initial state same as monocyte. CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac mainly in intermediate state, which might drive the unique transcriptomic identities of MASH microenvironment (<xref ref-type="bibr" rid="B52">52</xref>). C1QA<sup>+</sup> Mac, SAMac and SPP1<sup>+</sup> Mac were dominating located in terminal state (<xref ref-type="fig" rid="f3"><bold>Figures&#xa0;3a, b</bold></xref>), SAMac has been proved accumulation within the fibrotic niche (<xref ref-type="bibr" rid="B5">5</xref>). These findings supported that the HCC was correlated with C1QA<sup>+</sup> Mac and SPP1<sup>+</sup> Mac. T cells displayed two paths started with Tn. The path 1 ending in a terminally differentiation of Tex, Tc, &#x3b3;&#x3b4;T and Trm. The path 2 contained Tn, Treg and MAIT (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figures&#xa0;4b, c</bold></xref>). These suggested the path 1 of T cells might be associated with HCC (<xref ref-type="bibr" rid="B23">23</xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Developmental trajectory and of transcription factor activity analysis of macrophage subtypes during the progression of CLDs. <bold>(a)</bold> Confirmation of trajectories using a diffusion-map approach. <bold>(b)</bold> Pseudo-time trajectory projected of macrophage subtypes. Pseudo-time values were color coded. DPT, diffusion pseudo time. <bold>(c)</bold> Heatmap showing the regulon activities of transcription factors (left) and expression profiles (right) in different macrophage subtypes; the color key from blue to red indicated regulon specificity score and relative expression levels from low to high. <bold>(d, e)</bold>. Dot plots showing the enrichment of the biological process-related GO terms in CXCL3<sup>+</sup> Mac <bold>(d)</bold> and CXCL10<sup>+</sup> Mac <bold>(e)</bold>.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g003.tif">
<alt-text content-type="machine-generated">Multicolor scatterplots in panels a and b show single-cell data projected by diffusion components, colored by cell type (legend) and diffusion pseudotime (DPT), respectively. Panel c displays a clustered heatmap of regulon specificity scores for transcription factors versus cell types, associated motifs, gene targets, and transcription factor expression heatmap. Panels d and e present dot plots showing GO biological process enrichment for CXCL3+ macrophages and CXCL10+ macrophages, with pathways and gene ratios on axes; dot size indicates gene count and color represents adjusted p-values.</alt-text>
</graphic></fig>
<p>To investigate the transcriptional regulation dynamics of different macrophage subtypes during CLDs progression, we applied SCENIC (<xref ref-type="bibr" rid="B21">21</xref>) to calculate the activity of cell-type-specific regulators across CLDs processes. Interestingly, we found various transcription factors were highly expressed within the corresponding macrophage subtypes. The expression of <italic>ETS2</italic> and <italic>IRF1</italic> were consisted with transcription factors activities, which suggested that <italic>ETS2/IRF1</italic> was specific targeting to CXCL3<sup>+</sup> Mac/CXCL10<sup>+</sup> Mac (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3c</bold></xref>; <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;4a</bold></xref>). In addition, we explored gene ontology (GO) analyses to reveal CXCL3<sup>+</sup> Mac was enriched in chemokine&#x2212;mediated signaling pathway and inflammatory response (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3d</bold></xref>), CXCL10<sup>+</sup> Mac was significantly enriched in response to biotic stimulus and immune response (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3e</bold></xref>). These implied that CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac might play important roles in MASH.</p>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>Validation of the macrophage subtypes compositions using mouse models</title>
<p>To validate the compositions of macrophage subtypes across CLDs progresses from scRNA-seq analysis, we constructed the mouse models of MASH, liver fibrosis and HCC (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4a</bold></xref>). Firstly, we evaluated the inflammation and fibrosis at the histological level by H&amp;E and Masson&#x2019;s trichrome staining to confirm the results in the scRNA-seq analysis (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4b</bold></xref>). Next, we utilized FISH to visualize those macrophage subtypes and directly calculated their cellular abundances. We used <italic>Clec4f</italic> as canonical liver macrophage marker. The well-conserved genes of <italic>C1qa, Cxcl3, Cxcl10, Trem2</italic> and <italic>Spp1</italic> were used to mark the signature genes (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4c</bold></xref>; <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;4</bold></xref>). If the signal of macrophage subtype signature genes were within 20 microns in diameter of Clec4f signal at 400 &#xb5;m &#xd7; 400 &#xb5;m region, we recognized they were the corresponding macrophage subtype. As a result, C1QA<sup>+</sup> Mac was enriched in healthy liver, CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac were commonly present in MASH, SAMac was enriched in liver fibrosis, and SPP1<sup>+</sup> Mac was predominantly present in HCC (<xref ref-type="fig" rid="f4"><bold>Figures&#xa0;4d, e</bold></xref>). Collectively, we affirmed the 5 macrophage subtypes presented at different processes of CLDs progresses.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Validation of the macrophage subtypes abundance with healthy liver, MASH, liver fibrosis, and HCC mice models. <bold>(a)</bold> Schematic representation of the mouse models. <bold>(b)</bold> Histological observation of Healthy liver, MASH, liver fibrosis and HCC by H&amp;E and Masson&#x2019;s trichrome staining. Images were representative of three biologically independent mice. Scale bar: 200&#x2009;&#xb5;m. <bold>(c)</bold> FISH staining to validate the macrophage subtypes compositions. Scale bars: 200&#x2009;&#xb5;m. <bold>(d)</bold> The macrophage subtypes compositions across chronic liver disease progressions calculated from <xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4c</bold></xref> (n = 5). Two-sided Student&#x2019;s t test. Statistical significance was indicated as follows: p &lt; 0.05 (*), p &lt; 0.01 (**), p &lt; 0.001 (***), and p &lt; 0.0001 (****), ns, not significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g004.tif">
<alt-text content-type="machine-generated">Figure displaying stages of liver disease progression in a mouse model: panel a shows a diagram of disease progression from healthy liver to MASH, fibrosis, and hepatocellular carcinoma (HCC); panel b contains histological images (HE and Masson stains) for normal, MASH, fibrosis, and HCC liver tissue; panel c shows FISH staining with DAPI, the canonical liver macrophage marker(Clec4f ) and various signature gene markers (C1qa, Cxcl3, Cxcl10, Trem2, Spp1) in healthy, NASH, cirrhotic, and HCC conditions; panel d presents boxplots comparing the expression or proportion of these markers across the disease stages, with statistical significance indicated.</alt-text>
</graphic></fig>
</sec>
<sec id="s3_5">
<label>3.5</label>
<title>Macrophages-T cells interactions revealed hetero-cellular crosstalk in CLDs progresses</title>
<p>We next aimed to understand the complex cellular interactions among diseases-associated macrophages and T cells. CellChat (<xref ref-type="bibr" rid="B20">20</xref>) was used to compare macrophages-T cells interactions in the previous versus subsequent processes of CLDs. The comparisons of macrophages-T cells interactions were distinct differences during the progression of CLDs. We observed CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac showed stronger crosstalks with Tex, Trm and &#x3b3;&#x3b4;T between health and MASH processes. The interaction strength of SAMac and SPP1<sup>+</sup> Mac were increased in both MASH versus cirrhosis and cirrhosis versus HCC. C1QA<sup>+</sup> Mac showed strong interaction strength in healthy liver and from MASH to cirrhosis (<xref ref-type="fig" rid="f5"><bold>Figures&#xa0;5a, b</bold></xref>). MHC class II (MHC-II) were constitutively expressed on the surface of macrophages. MHC-II complexes depended on the distinct macrophage subtypes (<xref ref-type="bibr" rid="B53">53</xref>). We inferred cell-cell communication at the signaling pathway level. The interactions between CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac were mediated mainly by MHC-II signaling pathway. The interactions of MHC-II signaling pathway increased significantly from C1QA<sup>+</sup> Mac, SAMac and SPP1<sup>+</sup> Mac in healthy liver and HCC (<xref ref-type="fig" rid="f5"><bold>Figures&#xa0;5c-f</bold></xref>). To further elucidated the molecular characteristics of diseases-associated macrophages and &#x2009;T cells, we utilized entropy test to detect the signature gene sets from the differentially expressed genes of each cell subtype (<xref ref-type="fig" rid="f5"><bold>Figures&#xa0;5g, h</bold></xref>). Notably, we found <italic>SPP1, IFI27, FOLR2</italic> and <italic>SELENOP</italic> were the signature gene sets of SPP1<sup>+</sup> Mac. These genes were reported to participate in immunosuppression and influence liver metabolic activites (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B54">54</xref>, <xref ref-type="bibr" rid="B55">55</xref>). The signature gene sets of Tc contained cytotoxicity-related molecules (<italic>FGFBP2, GNLY, GZMB, PRF1</italic> and <italic>GZMH</italic>) and the transcription factor of suppress exhaustion (<italic>KLF2</italic>) (<xref ref-type="bibr" rid="B56">56</xref>, <xref ref-type="bibr" rid="B57">57</xref>). These results indicated that SPP1<sup>+</sup> Mac and Tc could be potential targets for HCC immunotherapy. We want to further identify the potential therapeutic targets from the signature gene sets. In brief, our results suggested a differentiated macrophages-T cells interactions and molecular phenotypes during the progression of CLDs.</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>The intercellular communication and signature genes of disease associated T cell and macrophage in different disease processes. <bold>(a)</bold> Circos plot showed differential interaction strength relative in healthy liver, MASH, liver cirrhosis and HCC, red indicated increased interaction strength and blue indicated decreased strength. <bold>(b)</bold> Heatmap showed interaction strength among 9 cell subtypes in chronic liver disease progressions, red represented increased interactive strength, blue represented decreased interactive strength. c-f. The MHC-II signaling pathway network in healthy liver <bold>(c)</bold>, MASH <bold>(d)</bold>, liver cirrhosis <bold>(e)</bold> and HCC <bold>(f)</bold>. <bold>(g)</bold> Radar charts showed the entropy difference of gene in C1QA<sup>+</sup> Mac, CXCL3<sup>+</sup> Mac, CXCL10<sup>+</sup> Mac, SAMac and SPP1<sup>+</sup> Mac. <bold>(h)</bold> Radar charts showed the entropy difference of gene in Tc, Tex, Trm and &#x3b3;&#x3b4;T.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g005.tif">
<alt-text content-type="machine-generated">Panel a shows three interconnected network diagrams comparing immune cell populations and their interactions for Health vs MASH, MASH vs Cirrhotic, and Cirrhotic vs HCC groups, with edges and node sizes representing interaction strength and cell type abundance. Panel b presents a heatmap of diseases-associated macrophages and T cells interaction strength across Health, MASH, Cirrhosis, and HCC, with color intensity indicating interaction strength. Panels c-f display MHC-II signaling pathway networks for diseases-associated macrophages and T cells populations and conditions, with nodes and lines denoting types and interactions. Panels g and h show radial plots with colored lines for the gene entropy differences and gene lists for various macrophage and T cell types, organized by subtype and color coded accordingly. Panels g and h show radial plots with colored lines for gene expression signatures and gene lists for various macrophage and T cell types, organized by subtype and color coded accordingly.</alt-text>
</graphic></fig>
</sec>
<sec id="s3_6">
<label>3.6</label>
<title>Integration of bulk RNA-seq data to revealed predictive prognostic biomarkers in HCC</title>
<p>ScRNA-seq provided an insight on the cellular heterogeneity in the TME. However, the scRNA-seq studies lacked survival data. We employed TCGA-LIHC data to verify the expression patterns of signature gene sets in HCC and reveal the key genes contributing to HCC. We developed a method of gene sets enrichment score to validate the signature gene sets from scRNA-seq (<xref ref-type="fig" rid="f5"><bold>Figures&#xa0;5g, h</bold></xref>) based on TCGA-LIHC dataset. We calculated gene sets enrichment score of macrophage subtypes and defined as Mscore. The Tscore was defined for gene sets enrichment score of T cell subtypes. The Mscore and Tscore were extensions of the ImmuCellAI (<xref ref-type="bibr" rid="B28">28</xref>), designed to provide a simple and intuitive summary of predefined immune gene sets derived from scRNA-seq data, enabling the comparison of estimated cell populations in HCC. The details of the method calculating gene sets enrichment score were described in Methods. We found Mscore of SPP1<sup>+</sup> Mac and Tscore of Tc were significant difference in the HCC group than the normal group (<xref ref-type="fig" rid="f6"><bold>Figures&#xa0;6a, b</bold></xref>), which further validating SPP1<sup>+</sup> Mac and Tc were associated with HCC. Next, basing on the clinical data from the TCGA-LIHC project, we confirmed that the higher Tscore of Tc was associated with a survival advantage in HCC, while an opposite effect was observed in SPP1<sup>+</sup> Mac (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6c</bold></xref>), consistent with our hypothesis. Furthermore, we employed LASSO regression model and Cox regression analysis to reveal <italic>KLF2</italic> was contributed to favorable prognosis and <italic>SPP1</italic> were associated with poor outcomes in HCC (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6d</bold></xref>; <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figures&#xa0;6a, b</bold></xref>). As reported, <italic>KLF2</italic> was favored effector differentiation and suppressed exhaustion (<xref ref-type="bibr" rid="B58">58</xref>). <italic>SPP1</italic> overexpression was identified in tumor-associated macrophages across several cancer types and associated with poor prognosis (<xref ref-type="bibr" rid="B59">59</xref>).</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>KLF2 contributed to the good and SPP1 induced bad clinical outcome in HCC. <bold>(a)</bold> Boxplot showing the Mscores of macrophage subtypes in healthy liver (n = 50) and HCC (n = 374). Wilcoxon test. <bold>(b)</bold> Boxplot showing the Tscores of T cell subtypes in healthy liver (n = 50) and HCC (n = 374). Wilcoxon test. <bold>(c)</bold> Kaplan-Meier plots showing clinical outcome in HCC with Mscore of SPP1<sup>+</sup> Mac and Tscore of Tc. <bold>(d)</bold> Kaplan-Meier plots showing clinical outcome in HCC with the expression of <italic>SPP1</italic> and <italic>KLF2</italic> in HCC. <bold>(e, f)</bold>. Left: Representative FISH micrographs (n &#x2265; 3) showed the distribution of Tc <bold>(e)</bold> and SPP1<sup>+</sup> Mac <bold>(f)</bold> in HCC. Close-up images on the (left bottom) correspond to boxed regions on the (top left). Top right: Scatterplots showed the distribution of SPP1<sup>+</sup> Mac and Tc corresponding to FISH micrographs on the Zoom 3. Bottom right: Violin plots showed the distance quantification of SPP1<sup>+</sup> Mac and Tc to the closest tumor cell corresponding cells identified on FISH micrographs on Zoom 3. <italic>Spp1</italic> (green), <italic>Klf2</italic> (yellow), <italic>Cd3</italic> and <italic>Clec4f</italic> (red), HCC (cyan) and DAPI (blue). Statistical significance was indicated as follows: p &lt; 0.05 (*), p &lt; 0.01 (**), p &lt; 0.001 (***), and p &lt; 0.0001 (****), ns, not significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-17-1766301-g006.tif">
<alt-text content-type="machine-generated">Panel a contains box plots comparing Mscores among macrophage subsets in normal and tumor tissues, showing significant differences. Panel b displays box plots of Tscores across T cell subsets, indicating variable expression between normal and tumor. Panel c includes Kaplan-Meier plots illustrating survival probability by gene expression for SPP1+ macrophages and Tc cells, with lower survival for high gene expression groups. Panel d shows additional Kaplan-Meier plots for KLF2 and SPP1 gene expression affecting survival. Panel e presents FISH micrographs and quantification of Klf2-expressing Cd3+ T cells near tumor regions, with close-up zoom panels. Panel f depicts similar imaging and quantification for Spp1+ macrophages, including zoom panels and spatial analysis.</alt-text>
</graphic></fig>
<p>In addition, we revealed the spatial distribution and cellular interaction of SPP1<sup>+</sup> Mac and Tc. We quantified distance from SPP1<sup>+</sup> Mac and Tc to its closest HCC cell by FISH micrographs. <xref ref-type="fig" rid="f6"><bold>Figures&#xa0;6e, f</bold></xref> showed the FISH micrographs of the markers (top left, <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table&#xa0;4</bold></xref>), the corresponding dot plots of Zoom 3 representing the spatial distribution of SPP1<sup>+</sup> Mac and Tc (bottom left), and the corresponding distance quantification from SPP1<sup>+</sup> Mac and Tc to the closest HCC cell in Zoom 3 (bottom right). We found that Tc localized further away from the HCC cell (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6e</bold></xref> and <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;6c</bold></xref>, with a median distance of 12.6 &#x3bc;m) compared to SPP1<sup>+</sup> Mac that infiltrated and tightly surrounded the HCC cell (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6f</bold></xref> and <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;6c</bold></xref>, with a median distance of 6.1 &#x3bc;m). The FISH micrographs also demonstrated that the number of SPP1<sup>+</sup> Mac and Tc were significantly higher in HCC, and the double-positive cell pairs of <italic>Spp1</italic> with <italic>Clec4f</italic> and <italic>Klf2</italic> with <italic>Cd3</italic> were close proximity to that in healthy liver (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figures&#xa0;6d-g</bold></xref>, with a median distance of 0 &#x3bc;m). It suggested the potential crosstalk between SPP1<sup>+</sup> Mac and Tc. Taken together, these findings suggested SPP1<sup>+</sup> Mac contributed to the immunosuppressive microenvironment in HCC, Tc played anti-tumorigenic roles of HCC. We also determined that <italic>KLF2</italic> and <italic>SPP1</italic> involved in the progression of HCC and could be further clinical investigation.</p>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<label>4</label>
<title>Discussion</title>
<p>MASH now became the fastest growing cause of liver cancer; however, the increased risk of HCC in patients with MASH was often misdiagnosed (<xref ref-type="bibr" rid="B51">51</xref>). Our study deciphered the molecular signatures and functional properties of the immune cells at different stages of CLD processes, rather than a linear evolutionary trajectory of NASH-induced chronic liver disease. By integrating scRNA-seq, bulk RNA-seq and FISH, we elucidated diverse cellular populations, phenotypic states and transcriptional profiles, which providing molecular characteristics for clinical diagnosis and immunotherapy of CLDs. Because mRNA and protein expression levels could differ substantially and were not necessarily linearly correlated, we employed FISH to validate the molecular markers at the transcriptional level. Future validation at the protein level using immunofluorescence or flow cytometry could strengthen these findings.</p>
<p>It has been recognized that both innate and adaptive immune mechanisms played important roles in promoting hepatic inflammation of MASH-HCC (<xref ref-type="bibr" rid="B8">8</xref>). Focused on macrophages and T cells, we identified five macrophage subtypes (CXCL3<sup>+</sup> Mac, CXCL10<sup>+</sup> Mac, C1QA<sup>+</sup> Mac, SPP1<sup>+</sup> Mac and SAMac) and four T cell subtypes (Tex, Tc, &#x3b3;&#x3b4;T and Trm) associated with CLDs processes. We overcame the limitations of single-disease data and identified stage-specific cell types by integrating data from multiple stages of CLDs. The stage-specific macrophage subtypes exhibited diverse patterns. The lipid-associated macrophage has been reported to arise prominently under obesity conditions in adipose tissue, highlighting the specific expression of <italic>Trem2</italic> (<xref ref-type="bibr" rid="B60">60</xref>). However, it resembled the SAMac in liver cirrhosis (<xref ref-type="bibr" rid="B5">5</xref>). We found CXCL3<sup>+</sup> Mac and CXCL10<sup>+</sup> Mac were enriched in MASH and resided in intermediate stages of CLDs progression, with <italic>ETS2</italic> and <italic>IRF1</italic> potentially involved in regulating their transcriptional programs, which might potentially contribute to the transition from MASH to HCC. <italic>ETS2</italic> has been reported as a central regulator of macrophage inflammation (<xref ref-type="bibr" rid="B61">61</xref>). <italic>IRF1</italic> could regulate the transcription of inflammation and cell death related genes, which induced further elicited inflammatory injury (<xref ref-type="bibr" rid="B62">62</xref>). C1QA<sup>+</sup> Mac, SPP1<sup>+</sup> Mac and SAMac displayed terminal-stage characteristics. Together, these findings suggested the distinct cellular heterogeneity gave rise to phenotypic and functional diversity, which in turn shaped microenvironmental variation in CLDs progression. A limitation of these results was supported at the transcriptomic level based on FISH; further validation at the protein level using immunofluorescence or flow cytometry could strengthen these findings.</p>
<p>Previous studies have reported SPP1<sup>+</sup> Mac could induce exhaustion and dysfunction of tumor-reactive CD8&#x2009;<sup>+</sup> T cell in extrahepatic tumors (<xref ref-type="bibr" rid="B63">63</xref>), while their effects on T cell subtype responses in HCC remained unclear. Notably, we uncovered SPP1<sup>+</sup> Mac was predominant in HCC and correlated with poor prognosis, potentially driving immune evasion by establishing anergic crosstalk with Tc. In addition, we constructed gene sets enrichment score to detect <italic>KLF2</italic> in Tc and <italic>SPP1</italic> in SPP1<sup>+</sup> Mac as HCC prognosis-related genes. <italic>KLF2</italic> has been reported to improve the clinical benefit in HCC (<xref ref-type="bibr" rid="B64">64</xref>), whereas <italic>SPP1</italic> was associated with worse overall survival in macrophage (<xref ref-type="bibr" rid="B46">46</xref>). We first found the closely interaction between SPP1<sup>+</sup> Mac and Tc in HCC, suggesting that SPP1<sup>+</sup> Mac could directly suppress the activation of Tc in HCC microenvironment, with <italic>KLF2</italic> and <italic>SPP1</italic> as key molecular biomarkers.</p>
<p>In conclusion, our work constructed the transcriptional atlas of CLD progression at single cell level, which might contribute to understanding molecular characteristics for clinical diagnosis and immunotherapy of CLDs. We revealed stage-specific macrophage subtypes and identified <italic>ETS2/IRF1</italic> regulated macrophage programs driving MASH to HCC transition. Additionally, we combined the signature gene sets from scRNA-seq with the TCGA-LIHC to resolve <italic>SPP1</italic> and <italic>KLF2</italic> were the HCC associated genes, which might provide relevant therapeutic targets.</p>
</sec>
</body>
<back>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Material</bold></xref>. Further inquiries can be directed to the corresponding authors.</p></sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The animal study was approved by the Animal Experimentation Ethics Committee of Huazhong University of Science and Technology (Hubei, China). The study was conducted in accordance with the local legislation and institutional requirements.</p></sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>QP: Project administration, Writing &#x2013; review &amp; editing, Conceptualization, Data curation, Formal Analysis, Methodology, Visualization, Writing &#x2013; original draft. XW: Validation, Visualization, Writing &#x2013; original draft. BL: Methodology, Visualization, Writing &#x2013; review &amp; editing. ZC: Visualization, Writing &#x2013; review &amp; editing. SC: Writing &#x2013; review &amp; editing. JH: Validation, Writing &#x2013; review &amp; editing. XW: Validation, Writing &#x2013; review &amp; editing. JY: Validation, Writing &#x2013; review &amp; editing. AG: Project administration, Supervision, Writing &#x2013; review &amp; editing. ZZ: Conceptualization, Data curation, Formal Analysis, Methodology, Project administration, Visualization, Writing &#x2013; review &amp; editing.</p></sec>
<ack>
<title>Acknowledgments</title>
<p>We thank the Optical Bioimaging Core Facility of WNLO-HUST for their support in data acquisition.</p>
</ack>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p></sec>
<sec id="s10" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p></sec>
<sec id="s11" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p></sec>
<sec id="s12" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fimmu.2026.1766301/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fimmu.2026.1766301/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="DataSheet1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/></sec>
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<fn id="n1" fn-type="custom" custom-type="edited-by">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1289254">Sonam Mittal</ext-link>, Washington University, United States</p></fn>
<fn id="n2" fn-type="custom" custom-type="reviewed-by">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/344188">Dong Xue</ext-link>, Anhui University of Chinese Medicine, China</p>
<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1862988">Feng Liu</ext-link>, Peking University People&#x2019;s Hospital, China</p></fn>
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<fn-group>
<fn fn-type="abbr" id="abbrev1">
<label>Abbreviations:</label>
<p>Bca, Bias-corrected and accelerated; cDC, Conventional dendritic cells; CLDs, Chronic liver diseases; ETS2, ETS proto-oncogene 2; GO, Gene ontology; HCC, Hepatocellular carcinoma; IRF1, Interferon regulatory factor 1; KLF2, KLF transcription factor 2; Mac, Macrophage; MAIT, Mucosal-associated invariant T cell; MHC-II, MHC class II; MP, Mononuclear phagocyte; MASH, Metabolic dysfunction&#x2013;associated steatohepatitis; NK, Natural killer cell; NKG7, Natural killer cell granule protein 7; NKT, Natural killer T cell; pDC, Plasmacytoid dendritic cell; SAMac, Scar-associated macrophage; scRNA-seq, Single-cell RNA sequencing; TAMs, Tumor-associated macrophages; Tc, Cytotoxic T cell; TCR, T-cell receptor; Teff, Effector T cell; Tem, Effector memory T cell; Tex, Exhausted T cell; Th, T helper cell; Tn, Naive T cell; Tproli, Proliferating T cell; Treg, T regulatory cell; Trm, Tissue-resident memory T cell; Tstr, Stress response T cell; &#x3b3;&#x3b4;T, Gamma delta T cell.</p>
</fn>
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