Pub Date : 2026-03-04DOI: 10.1182/blood.2025032550
James B Bussel,Jory Max Hirshman,Rick Kapur
Maternal alloantibodies directed to HPA-1a on fetal platelets can induce fetal-neonatal alloimmune thrombocytopenia (FNAIT) which causes intracranial hemorrhage in 10-20% of fetuses/newborns. Presentation is usually unexpected and identified by neonatal bleeding, with implications for future pregnancies. This review synthesizes advances in diagnosis, pathophysiology, and management that reshape understanding of anti-HPA-1a-mediated FNAIT. Genomic and serologic testing, together with cell-free fetal DNA for fetal HPA typing, allow accurate identification of at-risk pregnancies. Among HPA-1bb women, those who carry DRB3*01:01 are at greatest risk of forming clinically-significant anti-HPA-1a. Not only anti-HPA-1a levels but also structural features, particularly decreased Fc-fucosylation enhancing FcγR-mediated effector functions, more accurately determine disease severity. Furthermore, increased Fc-galactosylation may contribute by enhancing complement activation. Fab-mediated effects impact platelets, megakaryocytes, trophoblasts, and endothelial cells. Taken together, this explains why anti-HPA-1a levels and neonatal platelet counts alone do not reliably predict bleeding including intracranial hemorrhage. Anti-HPA-1a also induces placental inflammation increasing risks of fetal growth restriction and long-term neurodevelopmental impairment, e.g. autism. Neonatal management involves random donor and matched platelet transfusions, and also IVIG if needed. Antenatal IVIG, with/without prednisone administered in an affected pregnancy typically increases fetal platelet counts with management strategies varying internationally. Blocking FcRn has emerged as an alternative approach to both reduce maternal anti-HPAa-1a levels and inhibit its transplacental transfer. Whether antenatal treatment reduces placental inflammation requires further study. These developments support the importance of identifying predictive biomarkers of fetal risk to guide antenatal management and of preventing affected pregnancies ideally by screening all pregnancies followed by prophylaxis.
{"title":"Anti-HPA-1a Fetal-Neonatal AlloImmune Thrombocytopenia: Reframing Diagnostics, Pathophysiology, and Management.","authors":"James B Bussel,Jory Max Hirshman,Rick Kapur","doi":"10.1182/blood.2025032550","DOIUrl":"https://doi.org/10.1182/blood.2025032550","url":null,"abstract":"Maternal alloantibodies directed to HPA-1a on fetal platelets can induce fetal-neonatal alloimmune thrombocytopenia (FNAIT) which causes intracranial hemorrhage in 10-20% of fetuses/newborns. Presentation is usually unexpected and identified by neonatal bleeding, with implications for future pregnancies. This review synthesizes advances in diagnosis, pathophysiology, and management that reshape understanding of anti-HPA-1a-mediated FNAIT. Genomic and serologic testing, together with cell-free fetal DNA for fetal HPA typing, allow accurate identification of at-risk pregnancies. Among HPA-1bb women, those who carry DRB3*01:01 are at greatest risk of forming clinically-significant anti-HPA-1a. Not only anti-HPA-1a levels but also structural features, particularly decreased Fc-fucosylation enhancing FcγR-mediated effector functions, more accurately determine disease severity. Furthermore, increased Fc-galactosylation may contribute by enhancing complement activation. Fab-mediated effects impact platelets, megakaryocytes, trophoblasts, and endothelial cells. Taken together, this explains why anti-HPA-1a levels and neonatal platelet counts alone do not reliably predict bleeding including intracranial hemorrhage. Anti-HPA-1a also induces placental inflammation increasing risks of fetal growth restriction and long-term neurodevelopmental impairment, e.g. autism. Neonatal management involves random donor and matched platelet transfusions, and also IVIG if needed. Antenatal IVIG, with/without prednisone administered in an affected pregnancy typically increases fetal platelet counts with management strategies varying internationally. Blocking FcRn has emerged as an alternative approach to both reduce maternal anti-HPAa-1a levels and inhibit its transplacental transfer. Whether antenatal treatment reduces placental inflammation requires further study. These developments support the importance of identifying predictive biomarkers of fetal risk to guide antenatal management and of preventing affected pregnancies ideally by screening all pregnancies followed by prophylaxis.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"12 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The contribution of immune cells to thrombus architecture and mechanical properties in acute ischemic stroke (AIS) remains poorly understood. Using 3D imaging and multiplex staining, we mapped immune cells in human stroke thrombi and identified neutrophils as the dominant population. Analysis of 19 thrombi confirmed their positive correlation with collagen, increased stiffness, and poorer clinical outcomes. To preserve the spatial context, we developed a laser capture-based proteomic workflow and analyzed thrombus neutrophils from 34 patients with AIS stratified by 90-day outcomes, followed by validation in an independent cohort of 22 patients. Proteomic analysis revealed SERPINB3 as a neutrophil-enriched protein strongly correlated with poor prognosis. In murine models of FeCl₃-induced carotid artery thrombosis and middle cerebral artery occlusion, experiments using wild-type, neutrophil-depleted, and Serpinb3a knockout mice demonstrated that neutrophil-derived SERPINB3 promotes early thrombus formation, enhances collagen deposition, and contributes to progressive thrombus stiffening. Mechanistically, SERPINB3 secreted by neutrophils amplifies thrombus stiffness through upregulation of TGFβ1, neutrophil extracellular traps, and COL1A1. Targeted SERPINB3 knockdown delayed vascular occlusion, improved thrombolysis efficiency, and resulted in better neurological recovery. Collectively, these findings identify a neutrophil-driven mechanism underlying thrombus stiffening and establish SERPINB3 as both a prognostic biomarker and a promising therapeutic target in AIS. This project has been registered with the Chinese Clinical Trial Registration Platform (https://www.chictr.org.cn/index.html) and has successfully passed the review process (Registration Number: ChiCTR2300077911).
{"title":"Pathogenic Role of SERPINB3-positive Neutrophils in Reinforcing Thrombus Stiffening during Ischemic Stroke.","authors":"Jiankun Zang,Aijun Lu,Bing Yang,Na Tan,Qihuan Liu,Liping Wei,Ying Liang,Sijie Zhou,Zefeng Tan,Xiufeng Xin,Shenwen He,Panwen Wu,Yufeng Li,Zhifeng Xu,Xuanlin Su,Hongcheng Mai,Anding Xu,Dan Lu","doi":"10.1182/blood.2025029516","DOIUrl":"https://doi.org/10.1182/blood.2025029516","url":null,"abstract":"The contribution of immune cells to thrombus architecture and mechanical properties in acute ischemic stroke (AIS) remains poorly understood. Using 3D imaging and multiplex staining, we mapped immune cells in human stroke thrombi and identified neutrophils as the dominant population. Analysis of 19 thrombi confirmed their positive correlation with collagen, increased stiffness, and poorer clinical outcomes. To preserve the spatial context, we developed a laser capture-based proteomic workflow and analyzed thrombus neutrophils from 34 patients with AIS stratified by 90-day outcomes, followed by validation in an independent cohort of 22 patients. Proteomic analysis revealed SERPINB3 as a neutrophil-enriched protein strongly correlated with poor prognosis. In murine models of FeCl₃-induced carotid artery thrombosis and middle cerebral artery occlusion, experiments using wild-type, neutrophil-depleted, and Serpinb3a knockout mice demonstrated that neutrophil-derived SERPINB3 promotes early thrombus formation, enhances collagen deposition, and contributes to progressive thrombus stiffening. Mechanistically, SERPINB3 secreted by neutrophils amplifies thrombus stiffness through upregulation of TGFβ1, neutrophil extracellular traps, and COL1A1. Targeted SERPINB3 knockdown delayed vascular occlusion, improved thrombolysis efficiency, and resulted in better neurological recovery. Collectively, these findings identify a neutrophil-driven mechanism underlying thrombus stiffening and establish SERPINB3 as both a prognostic biomarker and a promising therapeutic target in AIS. This project has been registered with the Chinese Clinical Trial Registration Platform (https://www.chictr.org.cn/index.html) and has successfully passed the review process (Registration Number: ChiCTR2300077911).","PeriodicalId":9102,"journal":{"name":"Blood","volume":"68 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-03DOI: 10.1182/blood.2025031733
Jennifer L Crombie,Sairah Ahmed,Matthew J Frigault,Bradley D Hunter,M Lia Palomba,Abu-Sayeef Mirza,Matthew A Lunning,Ogechukwu Egini,Maria Silvina Odstrcil Bobillo,Avyakta Kallam,Swetha Kambhampati Thiruvengadam,Dasom Lee,Saurabh Dahiya,Mehdi Hamadani,Alex F Herrera,Catherine J Lee,Krish Patel,Sagar S Patel,Patrick M Reagan,Mazyar Shadman,David Bernasconi,Soyoung Kim,Fei Fei Liu,Debasmita Roy,Marcelo C Pasquini,Iris Isufi
This study assessed real-world effectiveness and safety of lisocabtagene maraleucel (liso-cel) in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL), including those with high-risk disease, secondary central nervous system (sCNS) involvement, comorbidities, and poor fitness, using data in the Center for International Blood and Marrow Transplant Research Registry from 5 Feb 2021 to 4 Feb 2025. Eligible patients (N=1116) received liso-cel and had ≥1 effectiveness and safety assessment after infusion, including 195 in the second-line setting, 71 with sCNS, and 257 with transformed LBCL. Median age was 71.1 years (range, 21.5‒91.2), with 72.3% ≥65 years. Within the overall population, 6.6% had Eastern Cooperative Oncology Group performance status of ≥2, 53.4% had ≥1 comorbidity, and median number of prior lines of therapy was 3 (range, 1‒16). Median study follow-up was 12.6 months (95% confidence interval [CI], 12.5‒12.8). Among effectiveness-evaluable patients (n=1109), objective response rate was 81.2% and complete response rate was 71.3%. Duration of response, progression-free survival, and overall survival rates (95% CI) at 12 months were 60.2% (56.4‒63.9), 51.2% (48.0‒54.4), and 67.6% (64.5‒70.6), respectively. Cytokine release syndrome was reported in 51.0% of patients, with grade ≥3 events in 2.5%. Immune effector cell-associated neurotoxicity syndrome was reported in 26.6% of patients, with grade ≥3 events in 9.2%. The 12-month nonrelapse mortality rate was 6.1% (95% CI, 4.6‒7.8). These real-world data reinforce the effectiveness and safety of liso-cel in this broad population of patients with R/R LBCL, including younger patients and those with high-risk disease features.
{"title":"Real-world outcomes for lisocabtagene maraleucel in patients with relapsed or refractory large B-cell lymphoma.","authors":"Jennifer L Crombie,Sairah Ahmed,Matthew J Frigault,Bradley D Hunter,M Lia Palomba,Abu-Sayeef Mirza,Matthew A Lunning,Ogechukwu Egini,Maria Silvina Odstrcil Bobillo,Avyakta Kallam,Swetha Kambhampati Thiruvengadam,Dasom Lee,Saurabh Dahiya,Mehdi Hamadani,Alex F Herrera,Catherine J Lee,Krish Patel,Sagar S Patel,Patrick M Reagan,Mazyar Shadman,David Bernasconi,Soyoung Kim,Fei Fei Liu,Debasmita Roy,Marcelo C Pasquini,Iris Isufi","doi":"10.1182/blood.2025031733","DOIUrl":"https://doi.org/10.1182/blood.2025031733","url":null,"abstract":"This study assessed real-world effectiveness and safety of lisocabtagene maraleucel (liso-cel) in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL), including those with high-risk disease, secondary central nervous system (sCNS) involvement, comorbidities, and poor fitness, using data in the Center for International Blood and Marrow Transplant Research Registry from 5 Feb 2021 to 4 Feb 2025. Eligible patients (N=1116) received liso-cel and had ≥1 effectiveness and safety assessment after infusion, including 195 in the second-line setting, 71 with sCNS, and 257 with transformed LBCL. Median age was 71.1 years (range, 21.5‒91.2), with 72.3% ≥65 years. Within the overall population, 6.6% had Eastern Cooperative Oncology Group performance status of ≥2, 53.4% had ≥1 comorbidity, and median number of prior lines of therapy was 3 (range, 1‒16). Median study follow-up was 12.6 months (95% confidence interval [CI], 12.5‒12.8). Among effectiveness-evaluable patients (n=1109), objective response rate was 81.2% and complete response rate was 71.3%. Duration of response, progression-free survival, and overall survival rates (95% CI) at 12 months were 60.2% (56.4‒63.9), 51.2% (48.0‒54.4), and 67.6% (64.5‒70.6), respectively. Cytokine release syndrome was reported in 51.0% of patients, with grade ≥3 events in 2.5%. Immune effector cell-associated neurotoxicity syndrome was reported in 26.6% of patients, with grade ≥3 events in 9.2%. The 12-month nonrelapse mortality rate was 6.1% (95% CI, 4.6‒7.8). These real-world data reinforce the effectiveness and safety of liso-cel in this broad population of patients with R/R LBCL, including younger patients and those with high-risk disease features.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"32 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-03DOI: 10.1182/blood.2025032299
Marco Becilli,Pietro Merli,Mattia Algeri,Francesca Del Bufalo,Daria Pagliara,Valentina Bertaina,Chiara Agrati,Chiara Rosignoli,Maria Giuseppina Cefalo,Emilia Boccieri,Stefano Di Cecca,Laura Iaffaldano,Yunqin Lee,Biagio De Angelis,Soheil Meshinchi,Concetta Quintarelli,Dario Campana,Franco Locatelli
Autologous second-generation CD7-directed CAR T-cells, expressing an anti-CD7 protein expression blocker to prevent self-killing fratricide, were infused in three pediatric/young adult patients with relapsed/refractory CD7+ acute myeloid leukemia resulting in measurable residual disease negativity. The safety profile was favorable.
{"title":"Anti-CD7 fratricide-resistant chimeric antigen receptor T cells for relapsed/refractory acute myeloid leukemia.","authors":"Marco Becilli,Pietro Merli,Mattia Algeri,Francesca Del Bufalo,Daria Pagliara,Valentina Bertaina,Chiara Agrati,Chiara Rosignoli,Maria Giuseppina Cefalo,Emilia Boccieri,Stefano Di Cecca,Laura Iaffaldano,Yunqin Lee,Biagio De Angelis,Soheil Meshinchi,Concetta Quintarelli,Dario Campana,Franco Locatelli","doi":"10.1182/blood.2025032299","DOIUrl":"https://doi.org/10.1182/blood.2025032299","url":null,"abstract":"Autologous second-generation CD7-directed CAR T-cells, expressing an anti-CD7 protein expression blocker to prevent self-killing fratricide, were infused in three pediatric/young adult patients with relapsed/refractory CD7+ acute myeloid leukemia resulting in measurable residual disease negativity. The safety profile was favorable.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"1 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The TCF3::HLF fusion protein defines a highly aggressive and incurable subtype of B cell acute lymphoblastic leukemia (B-ALL). Using a newly established mouse model that faithfully recapitulates human TCF3::HLF B-ALL, including osteolytic bone lesions, we identified self-reinforcing IL-1β signaling networks as a central driver of disease progression. TCF3::HLF B-ALL cells displayed marked upregulation of inflammatory cytokines such as IL1B, IL6, and IFNG. Genetic deletion of IL1B or its receptor IL1R1 suppressed leukemic growth, reduced RANKL expression, and ameliorated bone destruction in vivo. Epigenetic profiling revealed a previously unrecognized intronic regulatory element within the IL1B locus bound directly by TCF3::HLF. Importantly, single-cell RNA-seq of patient samples demonstrated strong IL1B induction at relapse compared with diagnosis, underscoring its clinical relevance. Collectively, these findings establish the TCF3::HLF-IL-1β axis as a critical determinant of leukemic propagation and bone pathology, and highlight IL-1β blockade as a potential therapeutic strategy for this otherwise incurable leukemia.
{"title":"Self-reinforcing IL-1b signaling accelerates the development and recurrence of TCF3::HLF-positive B-ALL.","authors":"Aisa Suzuki,Tsukasa Shigehiro,Mayumi Hirakawa,Risa Hirano,Minori Tamai,Koshi Akahane,Kazuo Okamoto,Hiroshi Takayanagi,Yuya Terashima,Satoshi Ueha,Toshimori Kitami,Masatoshi Takagi,Dai Keino,Hiroshi Kawaguchi,Keisuke Kato,Moeko Hino,Takeshi Inukai,Akihiko Yoshimura,Tomokatsu Ikawa","doi":"10.1182/blood.2025031521","DOIUrl":"https://doi.org/10.1182/blood.2025031521","url":null,"abstract":"The TCF3::HLF fusion protein defines a highly aggressive and incurable subtype of B cell acute lymphoblastic leukemia (B-ALL). Using a newly established mouse model that faithfully recapitulates human TCF3::HLF B-ALL, including osteolytic bone lesions, we identified self-reinforcing IL-1β signaling networks as a central driver of disease progression. TCF3::HLF B-ALL cells displayed marked upregulation of inflammatory cytokines such as IL1B, IL6, and IFNG. Genetic deletion of IL1B or its receptor IL1R1 suppressed leukemic growth, reduced RANKL expression, and ameliorated bone destruction in vivo. Epigenetic profiling revealed a previously unrecognized intronic regulatory element within the IL1B locus bound directly by TCF3::HLF. Importantly, single-cell RNA-seq of patient samples demonstrated strong IL1B induction at relapse compared with diagnosis, underscoring its clinical relevance. Collectively, these findings establish the TCF3::HLF-IL-1β axis as a critical determinant of leukemic propagation and bone pathology, and highlight IL-1β blockade as a potential therapeutic strategy for this otherwise incurable leukemia.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"42 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CD4+CD25+Foxp3+ regulatory T cells (Tregs) are pivotal negative regulators of the adaptive immune system. Abnormalities in the number and/or function of Tregs contribute to the pathogenesis of primary immune thrombocytopenia (ITP). Strategies aimed at modulating Tregs offer potential therapeutic opportunities for ITP management. In this study, we demonstrated that inhibition of cyclin-dependent kinase 8 (CDK8) and CDK19 activity by the small-molecule inhibitor AS2863619 (AS) robustly promoted the conversion of CD4+CD25- effector T cells (Teffs) into CD4+CD25+Foxp3+ Tregs, endowing the converted Tregs with lineage stability and potent suppressive capacity. Mechanistically, AS rapidly augmented STAT5 phosphorylation and subsequent Foxp3 induction. STAT5 blockade completely abrogated this effect, confirming that the Treg-promoting activity of AS was critically dependent on STAT5 signaling. In parallel, AS suppressed STAT3 phosphorylation under IL-6-driven conditions, thereby attenuating Th17 polarization. These mechanistic findings were supported by global transcriptomic analysis, which revealed a profound transcriptional shift by broadly suppressing gene programs of Teff differentiation and function while simultaneously upregulating a robust signature characteristic of stable Tregs. Crucially, unbiased upstream analysis of these changes pinpointed STAT5, STAT3, and FOXP3 as the core transcription factors mediating the drug's effect. Functional metabolic analysis further revealed that AS mediated metabolic reprogramming in T cells by suppressing glycolysis, thereby providing the necessary metabolic adaptations for Treg conversion. In a murine model of active ITP, CDK8/CDK19 inhibition elevated Treg frequencies and ameliorated thrombocytopenia in a STAT5-dependent manner. Collectively, our study highlighted the therapeutic potential of CDK8/CDK19 inhibition in restoring immune homeostasis and managing ITP.
{"title":"CDK8/CDK19 inhibition restores T-cell homeostasis in primary immune thrombocytopenia.","authors":"Yan-Ming Wang,Hu Zhou,Shaoqiu Leng,Jun-Jie Ma,Huiyuan Yuan Li,Guosheng Li,Tao Sun,Yitong Xu,Shouqing Han,Yufeng Gu,Lin Dong,Zhenyu Yan,Lei Zhang,Jun Peng,Xin-Guang Liu","doi":"10.1182/blood.2025031332","DOIUrl":"https://doi.org/10.1182/blood.2025031332","url":null,"abstract":"CD4+CD25+Foxp3+ regulatory T cells (Tregs) are pivotal negative regulators of the adaptive immune system. Abnormalities in the number and/or function of Tregs contribute to the pathogenesis of primary immune thrombocytopenia (ITP). Strategies aimed at modulating Tregs offer potential therapeutic opportunities for ITP management. In this study, we demonstrated that inhibition of cyclin-dependent kinase 8 (CDK8) and CDK19 activity by the small-molecule inhibitor AS2863619 (AS) robustly promoted the conversion of CD4+CD25- effector T cells (Teffs) into CD4+CD25+Foxp3+ Tregs, endowing the converted Tregs with lineage stability and potent suppressive capacity. Mechanistically, AS rapidly augmented STAT5 phosphorylation and subsequent Foxp3 induction. STAT5 blockade completely abrogated this effect, confirming that the Treg-promoting activity of AS was critically dependent on STAT5 signaling. In parallel, AS suppressed STAT3 phosphorylation under IL-6-driven conditions, thereby attenuating Th17 polarization. These mechanistic findings were supported by global transcriptomic analysis, which revealed a profound transcriptional shift by broadly suppressing gene programs of Teff differentiation and function while simultaneously upregulating a robust signature characteristic of stable Tregs. Crucially, unbiased upstream analysis of these changes pinpointed STAT5, STAT3, and FOXP3 as the core transcription factors mediating the drug's effect. Functional metabolic analysis further revealed that AS mediated metabolic reprogramming in T cells by suppressing glycolysis, thereby providing the necessary metabolic adaptations for Treg conversion. In a murine model of active ITP, CDK8/CDK19 inhibition elevated Treg frequencies and ameliorated thrombocytopenia in a STAT5-dependent manner. Collectively, our study highlighted the therapeutic potential of CDK8/CDK19 inhibition in restoring immune homeostasis and managing ITP.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"32 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-02DOI: 10.1182/blood.2025031897
Karolos Douvlataniotis,Aleksei Titov,Julia Zeun,Merve Bilici,Heyilimu Palashati,Waywen Loh,Even Holth Rustad,Weiwen Yang,Trung T Tran,Fridtjof Lund-Johansen,Ravi Chand Bollineni,Jessica D Kepple,Luis P Huth,Ludvig A Munthe,Thorstein Boxaspen,Fredrik Schjesvold,Anders Waage,Dimitrios L Wagner,Katherine R Bull,Joanna Hester,Fadi Issa,Eirini Giannakopoulou,Johanna Olweus
T cell-based therapies have shown remarkable efficacy in multiple myeloma (MM), yet the disease remains largely incurable. Here, we investigated the constant domains of the immunoglobulin heavy chain (IgH) as novel targets for therapeutic T cell receptors (TCRs), after confirming high and homogeneous IGH expression in >95% of MM patients. MM cells secrete excessive monoclonal immunoglobulins (M-proteins) that drive complications but are inaccessible to CAR T-cell or antibody targeting. Peptides from IgA and IgG constant regions were eluted from HLA-A*02:01, and reactive TCRs were isolated from healthy donors using allo-HLA-A*02:01 presentation to circumvent self-tolerance. T cells engineered with two TCRs specific for IgA or IgG passed a stringent multi-tier safety screen and selectively eliminated MM cells from 20 HLA-A*02:01+ patients secreting the relevant IgH in vitro. In vivo, IgA-TCR T cells eradicated IgA+HLA-A*02:01+ MM cells in xenograft models and reduced circulating IgA in humanized mice. These findings establish immunoglobulin constant domains as viable TCR targets in MM, potentially making ~40% of patients of European descent eligible for TCR T cell therapy, and extension to additional HLA alleles could further broaden eligibility. The approach may also be applicable to lymphoma and antibody-mediated autoimmune diseases.
{"title":"TCR T cells targeting IgA- and IgG-expressing multiple myeloma.","authors":"Karolos Douvlataniotis,Aleksei Titov,Julia Zeun,Merve Bilici,Heyilimu Palashati,Waywen Loh,Even Holth Rustad,Weiwen Yang,Trung T Tran,Fridtjof Lund-Johansen,Ravi Chand Bollineni,Jessica D Kepple,Luis P Huth,Ludvig A Munthe,Thorstein Boxaspen,Fredrik Schjesvold,Anders Waage,Dimitrios L Wagner,Katherine R Bull,Joanna Hester,Fadi Issa,Eirini Giannakopoulou,Johanna Olweus","doi":"10.1182/blood.2025031897","DOIUrl":"https://doi.org/10.1182/blood.2025031897","url":null,"abstract":"T cell-based therapies have shown remarkable efficacy in multiple myeloma (MM), yet the disease remains largely incurable. Here, we investigated the constant domains of the immunoglobulin heavy chain (IgH) as novel targets for therapeutic T cell receptors (TCRs), after confirming high and homogeneous IGH expression in >95% of MM patients. MM cells secrete excessive monoclonal immunoglobulins (M-proteins) that drive complications but are inaccessible to CAR T-cell or antibody targeting. Peptides from IgA and IgG constant regions were eluted from HLA-A*02:01, and reactive TCRs were isolated from healthy donors using allo-HLA-A*02:01 presentation to circumvent self-tolerance. T cells engineered with two TCRs specific for IgA or IgG passed a stringent multi-tier safety screen and selectively eliminated MM cells from 20 HLA-A*02:01+ patients secreting the relevant IgH in vitro. In vivo, IgA-TCR T cells eradicated IgA+HLA-A*02:01+ MM cells in xenograft models and reduced circulating IgA in humanized mice. These findings establish immunoglobulin constant domains as viable TCR targets in MM, potentially making ~40% of patients of European descent eligible for TCR T cell therapy, and extension to additional HLA alleles could further broaden eligibility. The approach may also be applicable to lymphoma and antibody-mediated autoimmune diseases.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"14 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-02DOI: 10.1182/blood.2025031593
Paul Breillat,Samuel J Magaziner,Stéphane M Camus,Léa Dionet,Benjamin De Valence De Minardiere,Pierre Sohier,Amine Majdi,Quentin Delcros,Federica Pallotti,Nadia Rivet,Kevin Chevalier,Margot Poux,Athena Lam,Pierre-Louis Tharaux,Olivia Lenoir,Abdelrahim Zoued,Olivier Kosmider,David B Beck,Benjamin Terrier
VEXAS syndrome is a severe adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene, disrupting cytoplasmic ubiquitin-activating enzyme E1 function in hematopoietic progenitors. Its pathogenesis remains poorly understood, particularly the mechanisms by which UBA1 mutations disrupt myeloid cell function in the context of inflammatory stimuli. Here, we combine a genetically engineered THP-1 monocytic model with ex vivo analyses of blood and tissue samples from VEXAS patients to investigate the consequences of the canonical UBA1M41V mutation. We show that UBA1-mutated monocytes exhibit TNF-α-induced cell death, characterized by RIPK1 phosphorylation, and MLKL- and caspase-8-mediated cell death. Importantly, we extend these findings to patient-derived CD14⁺ sorted cells, confirming that these cells undergo aberrant apoptotic and necroptotic cell death. Mechanistically, activation of these cell death pathways appears to be promoted by defective NF-κB-dependent transcriptional responses and reduced cFLIP(L) expression following TNF-α stimulation. UBA1-mutated monocytes also display blunted cytokine responses to Toll-like receptor (TLR) agonists despite preserved TLR expression, linked to an impaired NF-κB response. UBA1M41V-derived macrophages exhibit a pro-inflammatory transcriptional profile with increased chemokine secretion that promotes monocyte recruitment. In addition, these UBA1-mutated macrophages display impaired efferocytosis due to lysosomal dysfunction. Together, these findings reveal a pathogenic axis in VEXAS syndrome linking UBA1 loss of function and defective ubiquitination to RIPK1-mediated inflammatory cell death, impaired antimicrobial signaling, and defective resolution mechanisms. Our study provides novel mechanistic insights into the myeloid dysfunction underlying inflammation and cytopenia in VEXAS and supports the therapeutic targeting of inflammatory cell death pathways.
{"title":"Inflammatory cell death and monocyte dysfunction in VEXAS syndrome.","authors":"Paul Breillat,Samuel J Magaziner,Stéphane M Camus,Léa Dionet,Benjamin De Valence De Minardiere,Pierre Sohier,Amine Majdi,Quentin Delcros,Federica Pallotti,Nadia Rivet,Kevin Chevalier,Margot Poux,Athena Lam,Pierre-Louis Tharaux,Olivia Lenoir,Abdelrahim Zoued,Olivier Kosmider,David B Beck,Benjamin Terrier","doi":"10.1182/blood.2025031593","DOIUrl":"https://doi.org/10.1182/blood.2025031593","url":null,"abstract":"VEXAS syndrome is a severe adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene, disrupting cytoplasmic ubiquitin-activating enzyme E1 function in hematopoietic progenitors. Its pathogenesis remains poorly understood, particularly the mechanisms by which UBA1 mutations disrupt myeloid cell function in the context of inflammatory stimuli. Here, we combine a genetically engineered THP-1 monocytic model with ex vivo analyses of blood and tissue samples from VEXAS patients to investigate the consequences of the canonical UBA1M41V mutation. We show that UBA1-mutated monocytes exhibit TNF-α-induced cell death, characterized by RIPK1 phosphorylation, and MLKL- and caspase-8-mediated cell death. Importantly, we extend these findings to patient-derived CD14⁺ sorted cells, confirming that these cells undergo aberrant apoptotic and necroptotic cell death. Mechanistically, activation of these cell death pathways appears to be promoted by defective NF-κB-dependent transcriptional responses and reduced cFLIP(L) expression following TNF-α stimulation. UBA1-mutated monocytes also display blunted cytokine responses to Toll-like receptor (TLR) agonists despite preserved TLR expression, linked to an impaired NF-κB response. UBA1M41V-derived macrophages exhibit a pro-inflammatory transcriptional profile with increased chemokine secretion that promotes monocyte recruitment. In addition, these UBA1-mutated macrophages display impaired efferocytosis due to lysosomal dysfunction. Together, these findings reveal a pathogenic axis in VEXAS syndrome linking UBA1 loss of function and defective ubiquitination to RIPK1-mediated inflammatory cell death, impaired antimicrobial signaling, and defective resolution mechanisms. Our study provides novel mechanistic insights into the myeloid dysfunction underlying inflammation and cytopenia in VEXAS and supports the therapeutic targeting of inflammatory cell death pathways.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"99 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-02DOI: 10.1182/blood.2025031983
Rathan Kumar,Lotus Neidemire-Colley,Elizabeth Ar Garfinkle,Camryn Steere,Simran Surana,Annie Murray,Giogia Giordano,Olivia Martin,Emerson D Woodbury,Adithe Rivaldi,Satishkumar Singh,Kara Corps,Katlyn Lederer,Malith Karunasiri,Mathew W Gorr,Loren E Wold,Lalit Sehgal,Kenneth Oestreich,Nicole Renee Grieselhuber,Marcos J de Lima,Bruce R Blazar,Ivan Maillard,Katherine E Miller,Hannah K Choe,Parvathi Ranganathan
Chronic graft-versus-host disease (cGVHD) significantly contributes to late mortality after allogeneic stem cell transplantation, with bronchiolitis obliterans syndrome (BOS) being a particularly lethal and treatment-resistant complication despite available therapies. Bromodomain and Extra terminal (BET) proteins are epigenetic readers driving inflammatory transcriptional programs across multiple cell types. We hypothesized that BET inhibition would suppress inflammatory T and B cells while also decreasing macrophage polarization to a profibrotic phenotype, alleviating disease. In an established BOS cGVHD model, BET inhibition reduced germinal center formation and response through a reduction of the CXCL13:CXCR5 axis, inflammatory Tfh/GC B cells in the spleen along with a reduction in plasma cell infiltration within the lung. Mice with cGVHD had elevated pathogenic IgG1 and IgM, both in circulation and deposited on lung tissue, which was attenuated under BET inhibition. Single-cell RNA sequencing analysis revealed distinct cell states in the BOS lung vs. control. In cGVHD mice, GSEA analysis revealed upregulation of profibrotic Arginase1 and Tgfb1 expression in alveolar macrophages (AM) and interstitial macrophages (IM), which was significantly reduced with BET inhibition. Furthermore, BET inhibition targeted lung-infiltrating M2 macrophages, through selective depletion of CD206+FcgR+ IMs and AMs, ultimately resulting in reduced collagen deposition and improved lung function. Our findings reveal a previously unrecognized mechanistic axis of BET regulation during cGVHD fibrosis and highlight BET inhibition as a promising therapeutic strategy.
{"title":"BET inhibition blunts antibody production and macrophage-mediated fibrosis to restore lung function in murine cGVHD.","authors":"Rathan Kumar,Lotus Neidemire-Colley,Elizabeth Ar Garfinkle,Camryn Steere,Simran Surana,Annie Murray,Giogia Giordano,Olivia Martin,Emerson D Woodbury,Adithe Rivaldi,Satishkumar Singh,Kara Corps,Katlyn Lederer,Malith Karunasiri,Mathew W Gorr,Loren E Wold,Lalit Sehgal,Kenneth Oestreich,Nicole Renee Grieselhuber,Marcos J de Lima,Bruce R Blazar,Ivan Maillard,Katherine E Miller,Hannah K Choe,Parvathi Ranganathan","doi":"10.1182/blood.2025031983","DOIUrl":"https://doi.org/10.1182/blood.2025031983","url":null,"abstract":"Chronic graft-versus-host disease (cGVHD) significantly contributes to late mortality after allogeneic stem cell transplantation, with bronchiolitis obliterans syndrome (BOS) being a particularly lethal and treatment-resistant complication despite available therapies. Bromodomain and Extra terminal (BET) proteins are epigenetic readers driving inflammatory transcriptional programs across multiple cell types. We hypothesized that BET inhibition would suppress inflammatory T and B cells while also decreasing macrophage polarization to a profibrotic phenotype, alleviating disease. In an established BOS cGVHD model, BET inhibition reduced germinal center formation and response through a reduction of the CXCL13:CXCR5 axis, inflammatory Tfh/GC B cells in the spleen along with a reduction in plasma cell infiltration within the lung. Mice with cGVHD had elevated pathogenic IgG1 and IgM, both in circulation and deposited on lung tissue, which was attenuated under BET inhibition. Single-cell RNA sequencing analysis revealed distinct cell states in the BOS lung vs. control. In cGVHD mice, GSEA analysis revealed upregulation of profibrotic Arginase1 and Tgfb1 expression in alveolar macrophages (AM) and interstitial macrophages (IM), which was significantly reduced with BET inhibition. Furthermore, BET inhibition targeted lung-infiltrating M2 macrophages, through selective depletion of CD206+FcgR+ IMs and AMs, ultimately resulting in reduced collagen deposition and improved lung function. Our findings reveal a previously unrecognized mechanistic axis of BET regulation during cGVHD fibrosis and highlight BET inhibition as a promising therapeutic strategy.","PeriodicalId":9102,"journal":{"name":"Blood","volume":"320 1","pages":""},"PeriodicalIF":20.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-02DOI: 10.1182/blood.2025030207
Simone Minnie, Kenneth Ho, Julie R Boiko, Rachael C Adams, Kathleen S Ensbey, Nicole S Nemychenkov, Samuel Rw Legg, Christine R Schmidt, Melissa L Comstock, Justina Lyons, Tomoko Sekiguchi, Motoko Koyama, Andrew Spencer, Damian J Green, Geoffrey R Hill
Autologous stem cell transplantation (ASCT) with maintenance lenalidomide remains the mainstay of consolidation therapy for eligible multiple myeloma (MM) patients but preventing disease relapse remains a critical unmet need. Here we investigated whether immunosuppressive myeloid populations in bone marrow (BM) correlated with ASCT outcomes. We identified a subset of CD64+CD169+CD163+ macrophages that expressed CSF-1R, PD-L1, and CD155, and were expanded in patients who relapsed post-ASCT. Using a preclinical ASCT model with suboptimal endogenous anti-myeloma activity, we demonstrated that while neither CSF-1R inhibition nor lenalidomide monotherapy significantly improved outcomes, their combination synergistically attenuated disease progression and prolonged survival. Single-cell RNA sequencing revealed that lenalidomide expanded NK-like CD8+ T-cells but paradoxically also increased the frequency of Csf1r+ macrophages. Cell-cell communication analyses identified Csf1r+ macrophages as suppressors of these NK-like and effector-like exhausted (Tphex) CD8 T-cell populations through CD94/NKG2A and PD-L1/PD-1, respectively. CSF-1R blockade depleted these immunosuppressive macrophages, which correlated with decreased expression of inhibitory receptors and enhanced expression of activation markers in Tphex. Given the FDA approval of axatilimab for chronic GVHD, combining CSF-1R blockade with lenalidomide maintenance represents a readily testable strategy to improve progression-free survival after ASCT.
{"title":"CSF-1R inhibition and lenalidomide synergize to promote myeloma control after autologous stem cell transplantation.","authors":"Simone Minnie, Kenneth Ho, Julie R Boiko, Rachael C Adams, Kathleen S Ensbey, Nicole S Nemychenkov, Samuel Rw Legg, Christine R Schmidt, Melissa L Comstock, Justina Lyons, Tomoko Sekiguchi, Motoko Koyama, Andrew Spencer, Damian J Green, Geoffrey R Hill","doi":"10.1182/blood.2025030207","DOIUrl":"https://doi.org/10.1182/blood.2025030207","url":null,"abstract":"<p><p>Autologous stem cell transplantation (ASCT) with maintenance lenalidomide remains the mainstay of consolidation therapy for eligible multiple myeloma (MM) patients but preventing disease relapse remains a critical unmet need. Here we investigated whether immunosuppressive myeloid populations in bone marrow (BM) correlated with ASCT outcomes. We identified a subset of CD64+CD169+CD163+ macrophages that expressed CSF-1R, PD-L1, and CD155, and were expanded in patients who relapsed post-ASCT. Using a preclinical ASCT model with suboptimal endogenous anti-myeloma activity, we demonstrated that while neither CSF-1R inhibition nor lenalidomide monotherapy significantly improved outcomes, their combination synergistically attenuated disease progression and prolonged survival. Single-cell RNA sequencing revealed that lenalidomide expanded NK-like CD8+ T-cells but paradoxically also increased the frequency of Csf1r+ macrophages. Cell-cell communication analyses identified Csf1r+ macrophages as suppressors of these NK-like and effector-like exhausted (Tphex) CD8 T-cell populations through CD94/NKG2A and PD-L1/PD-1, respectively. CSF-1R blockade depleted these immunosuppressive macrophages, which correlated with decreased expression of inhibitory receptors and enhanced expression of activation markers in Tphex. Given the FDA approval of axatilimab for chronic GVHD, combining CSF-1R blockade with lenalidomide maintenance represents a readily testable strategy to improve progression-free survival after ASCT.</p>","PeriodicalId":9102,"journal":{"name":"Blood","volume":" ","pages":""},"PeriodicalIF":23.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：