Single-cell profiling reveals a shared proinflammatory macrophage signature across multiple organs in myopia

Myopia is a leading cause of visual impairment, with its prevalence rising rapidly worldwide. Our prior investigations suggest that cross-organ communication, involving the eye, brain, and gut, may play a role in myopia. However, the extent of this cross-organ communication in myopia remains unclear. To elucidate the underlying mechanisms, this study generates a comprehensive pan-tissue transcriptome profile of myopic mice covering eye, brain, blood, bone marrow, spleen, thymus, intestines, liver, kidney, lung, and adrenal gland using single-cell RNA sequencing (scRNA-seq). Widespread immunologic alterations in myopia are identified, characterized by a significant increase in macrophage abundance and macrophage-mediated cell communications across multiple tissues. Notably, these macrophages exhibit a cross-tissue proinflammatory phenotype, which is marked by significant activation of the hypoxia pathway, with upregulation of key markers, including Car1, HIF-1α, and reactive oxygen species, a pattern also observed in the blood of myopic patients. Further analysis suggested that hypoxia stress likely regulates the energy metabolism of proinflammatory macrophages. Inhibition of the hypoxia pathway suppressed the proinflammatory phenotype of macrophages and their hypoxia-related gene expression in myopic mice, reducing the degree of myopia. More importantly, analysis of a large cohort of 114,661 patients reveals 16 extraocular diseases with a myopia-biased prevalence. Our findings underscore the link between myopia and extraocular diseases and suggest that proinflammatory macrophages may potentially serve as the shared mechanism across organs.