Polymeric nanoparticles-based targeted delivery of drugs and bioactive compounds for arthritis management

This review explores the potential of polymeric nanoparticles (PNPs) as targeted drug delivery systems for arthritic treatment, overcoming the limitations of the present therapy. A thorough literature search was conducted on the databases PubMed, Scopus, and Web of Science to find published articles on the use of polymeric nanoparticles in the treatment of arthritis. This includes synthesis methods, mechanisms in drug delivery, and applications of PNPs. Polymeric nanoparticles showed excellent promise in the management of arthritis through enhanced stability of drugs, controlled and sustained drug release, and reduced systemic side effects. Some of the highlighted biocompatible and targeting capabilities of natural and synthetic polymers include chitosan, hyaluronic acid, and PLGA. Bioactive compounds such as curcumin and resveratrol delivered by PNPs enhanced therapeutic efficacy in preclinical arthritis models. Despite their promise, challenges such as rapid clearance and manufacturing scalability remain critical barriers. Polymeric nanoparticles offer a transformative approach to arthritis management by enabling targeted, sustained, and safe drug delivery. Translation into clinical applications would thus require developments in nanoparticle design, personalized medicine, and scalable production techniques.

Immune checkpoint inhibitor-associated pneumonitis: focus on diagnosis and underlying mechanisms

PURPOSE OF REVIEW

This review aims to provide an updated overview of the diagnosis, risk factors, and treatment strategies for immune checkpoint inhibitor (ICI) pneumonitis, with a particular emphasis on its underlying pathophysiology.

RECENT FINDINGS

Recent advances, such as single-cell RNA sequencing of bronchoalveolar lavage fluid and the identification of biomarkers, including autoantibodies, are enhancing our understanding of ICI-related pneumonitis. These findings suggest that both cell-mediated and humoral mechanisms contribute to the pathophysiology of the condition.

SUMMARY

Pneumonitis can significantly limit the efficacy of life-saving cancer treatments, such as ICIs. Although corticosteroids are the first-line treatment according to guidelines, steroid-refractory pneumonitis remains common and is associated with high mortality. Emerging data is providing a more detailed understanding of the dysregulated immune response responsible for pneumonitis, which may guide the development of targeted therapies and direct future research efforts.

Effects of Probiotics, Prebiotics, and Synbiotics on Sarcopenia Parameters in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

CONTEXT

There is scarce evidence about which probiotic, prebiotic, or synbiotic supplementation is the most appropriate to improve sarcopenia parameters, and this presents a challenge.

OBJECTIVE

The effects of consumption of probiotics, prebiotics, and synbiotics on sarcopenia, muscle strength, muscle mass, and physical performance and function were assessed in this study. In addition, another aim of the study was to determine the best probiotic, prebiotic, and/or synbiotic for the management of sarcopenia in older adults.

DATA SOURCES

A systematic search was conducted in the MEDLINE/PubMed, Cochrane Library, SCOPUS databases, and other sources (eg, references obtained from articles identified in databases).

DATA EXTRACTION

The search was limited from 2000 to 2023 and was based on sarcopenia parameters, and probiotics, prebiotics, or synbiotics supplementation. The quality of each included study also was assessed.

DATA ANALYSIS

A meta-analysis was performed with the Review Manager program and publication bias and sensitivity analysis were performed.

RESULTS

Eight randomized controlled trials (RCTs) were included in the systematic review and 4 in the meta-analysis. Results showed that probiotics supplementation improved muscle strength and physical performance and function and suggested a beneficial effect on muscle mass. Prebiotics are suggested to be effective on muscle strength. The meta-analysis also determined that probiotic interventions were effective in increasing muscle strength by handgrip strength (mean difference [MD], 2.50 kg [95% CI, 1.33-3.66]; P < .0001) and physical performance and function by gait speed (MD, 0.10 m/s [95% CI, 1.33-3.66]; P < .0001) and physical performance and function by gait speed (MD, 0.10 m/s [95%CI, 0.03-0.16]; P = .003), but when sensitivity analysis was applied, the effectiveness was only maintained for gait speed.

CONCLUSION

Nutritional strategies based on probiotic supplementation seem to improve muscle strength and physical function. More robust research is needed with high-quality RCTs to confirm probiotics' effects. There is still limited evidence about prebiotic and synbiotic strategies, and more evidence is needed to elucidate their effects on sarcopenia parameters.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022360514.

Platelets in cancer and immunotherapy: functional dynamics and therapeutic opportunities

Platelets play a critical role in tumor immunity, particularly in promoting cancer progression. Numerous studies suggest that platelets could serve as a novel target for cancer immunotherapy, however, no comprehensive reviews have yet summarized and discussed this potential. Our review provides an in-depth discussion of the roles and mechanisms of platelets within both the immunosuppressive tumor microenvironment and the anti-tumor immune microenvironment. Additionally, we summarize the key therapeutic targets and approaches for clinical translation. This work offers essential insights for reprogramming platelets to shift their function from tumor promotion to tumor suppression, providing a foundation for the development of novel immunotherapeutic strategies and related research.

Effects of Probiotics on Liver Diseases: Current In Vitro and In Vivo Studies

Various types of liver or hepatic diseases cause the death of about 2 million people worldwide every year, of which 1 million die from the complications of cirrhosis and another million from hepatocellular carcinoma and viral hepatitis. Currently, the second most common solid organ transplant is the liver, and the current rate represents less than 10% of global transplant requests. Hence, finding new approaches to treat and prevent liver diseases is essential. In liver diseases, the interaction between the liver, gut, and immune system is crucial, and probiotics positively affect the human microbiota. Probiotics are a non-toxic and biosafe alternative to synthetic chemical compounds. Health promotion by lowering cholesterol levels, stimulating host immunity, the natural gut microbiota, and other functions are some of the activities of probiotics, and their metabolites, including bacteriocins, can exert antimicrobial effects against a broad range of pathogenic bacteria. The present review discusses the available data on the results of preclinical and clinical studies on the effects of probiotic administration on different types of liver diseases.

Association between phase angle and hospital-associated disability in hospitalized patients in the internal medicine ward: A prospective observational study

OBJECTIVE

This study aimed to evaluate the association between the phase angle (PhA) and hospital-associated disability (HAD) in older patients admitted to an internal medicine ward.

METHODS

This was a prospective observational study in a single acute care hospital. HAD was defined as a decrease of at least five points in the Barthel index at discharge compared to pre-admission. Multiple logistic regression analysis was used to determine the association between PhA and HAD. The cut-off point for PhA was evaluated using a receiver operating characteristic curve.

RESULTS

This study included 215 patients (113 males; mean age: 80.8 years). The HAD incidence rate was 27.9 %. Multiple logistic regression analysis showed that PhA was associated with HAD (odds ratio: 3.47, 95 % confidence interval: 1.95-6.18, p < 0.001). The PhA cut-off points for predicting HAD were 3.7° for men and 3.6° for women.

CONCLUSION

PhA was associated with HAD in older patients admitted to the internal medicine ward and may be a useful indicator for predicting HAD.

The 'Stop TPO-RA in ITP Patients' study: Clinical and immune modulatory effects of romiplostim tapering

Sustained remissions off-treatment (SROTs) after tapering of thrombopoietin receptor agonists (TPO-RAs) have been reported in 15%-50% of patients with immune thrombocytopenia (ITP). The STIP (Stop TPO-Receptor Agonist in ITP Patients) study is a prospective trial aimed to investigate the clinical effects of romiplostim tapering. Adult patients (22/40) with ITP ≥3 months received romiplostim for 1 year, were tapered and followed for 1 year. Anti-platelet antibodies (APAs), TPO levels and indium-111 platelet scintigraphy were assessed before, during and after romiplostim. Censored survival analysis showed that the probability of SROT at 1 year after tapering was 23.6% (95% confidence interval: 11.0%-50.5%). Patients with SROT had higher platelet levels on romiplostim (median: 332.5 vs. 84.5 × 109/L) and lower romiplostim doses at the start of tapering (median: 1.0 vs. 4.5 μg/kg) compared to those with a non-sustained response (NSR). APAs were detected in 8/25 patients at baseline, of which 5 showed a substantial decrease during romiplostim. The indium-111 scan revealed an improved platelet survival at the start of tapering for 50% of patients with SROT (2/4, missing n = 1) versus none with an NSR (0/14, missing n = 3). Overall, the STIP study demonstrated a probability of SROT of 23.6% in a diverse and largely chronic group of adult patients with ITP.

Long-term safety and efficacy of bimekizumab in axial spondyloarthritis: 2-year results from two phase 3 studies

OBJECTIVES

Bimekizumab, a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A, previously demonstrated efficacy and was well tolerated to 1 year in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA). Here, we report bimekizumab safety and efficacy to 2 years.

METHODS

Patients completing week 52 in the phase 3 studies BE MOBILE 1 (nr-axSpA; NCT03928704) and 2 (r-axSpA; NCT03928743) were eligible for an ongoing open-label extension (OLE; NCT04436640). All OLE patients received subcutaneous bimekizumab 160 mg every 4 weeks. Safety outcomes for patients who received ≥1 bimekizumab dose, and efficacy outcomes for all randomized patients, are reported to week 104.

RESULTS

In the OLE (weeks 52 - 104), 70.8% (367/518) of patients reported ≥1 treatment-emergent adverse event (TEAE). Most frequent TEAEs [exposure-adjusted incidence rate per 100 patient-years (EAIR/100PY)] were SARS-CoV-2 (COVID-19) infection (25.2), nasopharyngitis (11.0) and oral candidiasis (5.4). Fungal infection EAIR/100PY was 11.8 (majority Candida infections: 6.8; most mild/moderate, none serious/systemic). Inflammatory bowel disease and uveitis rates were low; no major adverse cardiovascular events or deaths occurred. TEAE incidence rate was generally similar across weeks 0 - 52 and 52 - 104.At week 104, >50% of randomized patients (N = 586) achieved Assessment of SpondyloArthritis international Society 40% response (ASAS40); ∼60% achieved Axial Spondyloarthritis Disease Activity Score (ASDAS) low disease activity (<2.1) and >30% achieved ASDAS inactive disease (<1.3). Bimekizumab demonstrated sustained suppression of MRI inflammation at week 104, with >57% of patients achieving MRI remission.

CONCLUSIONS

The safety profile of bimekizumab remained consistent with prior reports, with no new safety signals identified. 1-year efficacy was sustained to 2 years across patients with nr-axSpA and r-axSpA.

Diagnostic and prognostic value of miR-146b-5p in acute pancreatitis

OBJECTIVE

MicroRNAs hold great potential as biomarkers for assessing the progression of acute pancreatitis (AP). This study aimed to explore the value of miR-146b-5p in the diagnosis and prognosis of AP patients.

METHODS

110 AP patients were included and divided into 40 severe AP (SAP) patients and 70 non-SAP patients based on disease severity. Serum miR-146b-5p levels were measured using RT-qPCR. The diagnostic value of miR-146b-5p was evaluated utilizing ROC curves. Pearson correlation coefficient was employed to analyze the correlations between APACHEII, BISAP, and MCTSI scores and miR-146b-5p levels. The AP cell model was constructed by treating AR42J cells with deoxycholic acid (DCA), the proliferative capacity of cells was measured with CCK-8, apoptosis was measured by flow cytometry, and IL-6 and IL-8 protein levels were analyzed by ELISA.

RESULTS

Serum miR-146b-5p levels were decreased in SAP and unfavorable patients. Serum miR-146b-5p was able to effectively differentiate between SAP and non-SAP patients, and also effectively differentiate between unfavorable and favorable patients. MiR-146b-5p levels were significantly negatively correlated with APACHEII score (r=-0.6676), BISAP score (r=-0.5696), and MCTSI score (r=-0.5857). Furthermore, in the AP cell model, miR-146b-5p expression was down-regulated, proliferative capacity was diminished, apoptosis was increased, and IL-6 and IL-8 levels were elevated, but overexpression of miR-146b-5p partially reversed these changes.

CONCLUSION

miR-146b-5p expression is down-regulated in the serum of SAP patients and cells, and it has a good diagnostic effect. It may be a potential biomarker and therapeutic target for AP.

Importance of comprehensive nutritional assessment in predicting survival in cirrhosis

Carteri et al reaffirmed the value of the Child-Turcotte-Pugh score in predicting survival in patients with cirrhosis. However, the lack of association with nutritional markers warrants careful interpretation. In cirrhosis, complex conditions often lead to malnutrition and individual markers may not be fully captured. Comprehensive assessments such as Subjective Global Assessment, handgrip strength, muscle mass measurements, and bioelectrical impedance analysis can improve risk stratification and inform personalized nutritional management. This letter emphasizes the need for standardized nutritional assessments for patients with cirrhosis and further research to clarify their impact on long-term outcomes, potentially improving patient care.

Bronchiectasis: A Clinical Review of Inflammation

Bronchiectasis is a chronic inflammatory airway disease characterized by a self-perpetuating vortex of impaired mucociliary clearance, persistent infection, and progressive structural lung damage. While inflammation is central to disease activity and progression, targeted anti-inflammatory treatments have been limited. Understanding the different types of inflammation involved and their significant overlap is essential for effective management. This review explores key inflammation patterns, biomarkers, and available treatments across the spectrum of inflammation in bronchiectasis, with a particular focus on non-cystic fibrosis bronchiectasis in adults. Neutrophilic inflammation remains the hallmark of bronchiectasis, with promising reversible dipeptidyl peptidase-1 inhibitors reducing the activation of neutrophil serine proteases during neutrophil maturation. Eosinophilic inflammation has also gained attention, with evidence indicating that patients with this endotype may benefit from glucocorticoids and biologic therapies targeting type 2 inflammation. Additional inflammatory mechanisms discussed here include impaired epithelial function and mucociliary abnormalities, immune dysregulation, and airway inflammation triggered by infections, environmental irritants, and autoimmune conditions. Written for general clinicians, this review simplifies complex concepts, underscores key aspects of diagnostic evaluation, and discusses both conventional and emerging treatments for bronchiectasis, providing practical insights for improved personalized patient care.

Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis

Inflammatory bowel disease (IBD) is an incurable disease of the digestive system; however, the therapeutic methods for IBD remain limited. The pathogenesis of IBD was systematically discussed and compared in this paper, primarily comprising Crohn’s disease and ulcerative colitis. This paper focused on six common aspects: (1) Dysregulated immune responses; (2) Gene function changes; (3) Intestinal microbes disorder and imbalance; (4) Microbial infections; (5) Associations between IBD and other inflammatory diseases; and (6) Other factors. In addition, the pathogenesis differences between these two forms of IBD were unraveled and clearly distinguished. These unique aspects of pathogenesis provide crucial insights for the precise treatment of both Crohn’s disease and ulcerative colitis. This paper illustrates the root causes and beneficial factors of resistance to IBD, which provides novel insights on early prevention, development of new therapeutic agents, and treatment options of this disease.

Tie2-expressing monocytes/macrophages promote angiogenesis in chronically ischaemic brain tissue

BACKGROUND

Over half of patients with chronically ischaemic cerebrovascular disease (CICD) exhibit poor revascularization potential. Tie2-expressing monocytes/macrophages (TEMs) have been reported to promote angiogenesis in tumour tissue; however, whether TEMs promote angiogenesis in chronically ischaemic brain tissue (CIBT) and the regulatory mechanism through which TEMs are recruited to CIBT remain unclear.

METHODS

We first analysed the proportion of TEMs in blood from the internal jugular veins (IJVs) of CICD patients and then isolated TEMs for coculture with human umbilical vein endothelial cells (HUVECs) and for intraventricular injection into nude mice to explore the proangiogenic effects of TEMs in CIBT. Then, molecular biology experiments were performed to verify the upstream regulatory mechanism of the ANGPT2-Tie2 axis, and cell transfection experiments were conducted to confirm the regulatory effects of the detected pathway on Tie2 receptors on the endothelial cell surface. Additionally, a 2-vessel occlusion plus encephalomyosynangiosis rat model was established to confirm the recruitment mechanism of TEMs in CIBT and their ability to improve cerebral blood perfusion (CBP) and cognitive function.

RESULTS

The proportion of TEMs from the IJV blood of CICD patients significantly increased, especially in patients who exhibited Matsushima Grade-A revascularization. The viability of HUVECs cocultured with TEMs was significantly increased, and CBP and the expression of CD31 in the CIBT of nude mice treated with TEMs were significantly increased. The above increases were positively correlated with the concentration of TEMs used for coculture and intraventricular injection. Moreover, molecular biology experiments indicated that miR-126-5p can directly bind to the 3'UTR of TRPS1 mRNA and that TRPS1 can directly bind to the promoter of Angpt2. HUVECs transfected with miR-126-5p mimics presented significantly decreased TRPS1 expression, a reduced pTie2/Tie2 ratio, increased ANGPT2 expression, and increased cell viability. Finally, significantly increased TEMs infiltration, downregulated TRPS1 expression, and upregulated ANGPT2, CD31, VEGFA, and IGF1 expression were detected in the CIBT of the rats transfected with the miR-126-5p agomir, accompanied by significant improvements in CBP and cognitive function.

CONCLUSIONS

TEMs promote angiogenesis in CIBT through a paracrine mechanism, and the recruitment of TEMs to CIBT is regulated by the miR-126-5p/TRPS1/ANGPT2 pathway.

Lipid accumulation product: A novel marker for gout and hyperuricemia

BACKGROUND AND AIM

Using cross-sectional data from the 2009-2018 National Health and Nutrition Examination Survey, the purpose of this study was to investigate the potential link between lipid accumulation product and gout/hyperuricemia.

METHODS

The data from 10,871 individuals who participated in the National Health and Nutrition Examination Survey spanning the years 2009-2018 were utilized for additional scrutiny. Participants self-reported gout and hyperuricemia as measured by laboratory test data, and other relevant variables and information for LAP were included. Multivariate logistic regression, restricted cubic spline and p-trend test were employed to determine the association between LAP and gout/hyperuricemia.

RESULTS

The study included 10,871 adults. The prevalence of hyperuricemia and gout was 20.9% and 5.57%, respectively. Compared with the first quartile, the fourth quartile of lipid accumulation product was associated with a 271% higher risk of hyperuricemia (OR = 3.711, 95% CI 2.732-5.042, p < 0.001) in a fully adjusted model. A similar association was found between continuous increase in lipid accumulation product and hyperuricemia (OR = 2.441, 95%CI = 1.348-4.42, p = 0.005), with p trends showing both < 0.001. The RCS model suggests a significant non-linear relationship between lipid accumulation product and the risk of gout/hyperuricemia. There was an inverted U-shaped relationship between lipid accumulation product and gout/hyperuricemia.

CONCLUSIONS

This study confirmed that lipid accumulation product has a high potential to predict the risk of gout/hyperuricemia. These findings suggested that the adjustment of the degree of fat accumulation may be a potential way to prevent and control the onset of gout/hyperuricemia.

Immunological Mechanisms and Effects of Bacterial Infections in Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) is a severe clinical syndrome characterized by high morbidity and mortality rates. Bacterial infection is a frequent precipitating factor and complication in ACLF patients, significantly worsening patient outcomes. Elucidating the mechanisms underlying bacterial infections and their impact on ACLF pathophysiology is crucial for developing effective therapies to reduce infection rates and mortality. Current research highlights that immune suppression in ACLF increases susceptibility to bacterial infections, which in turn exacerbate immune dysfunction. However, a comprehensive review summarizing the emerging mechanisms underlying this immunosuppression is currently lacking. This review aims to provide an overview of the latest research, focusing on alterations in the immune responses of innate immune cells-including monocytes, macrophages, and neutrophils-as well as adaptive immune cells such as T and B lymphocytes during the onset and progression of bacterial infections in ACLF. In addition, recent advances in immunomodulatory therapies, including stem cell-based interventions, will also be discussed.

Immunosuppressive agents in diabetes treatment: Hope or despair?

Exploration of immunosuppressive agents for the treatment of diabetes is a burgeoning field that has captured the attention of the medical community. The innovative approach of using these agents to combat diabetes is driven by their diverse capabilities to regulate the immune system, which is pivotal for disease pathogenesis. The primary objective is to enhance the management of blood glucose levels, which is a critical factor in the daily life of diabetic patients. This comprehensive review delves into the therapeutic horizons opened by immunosuppressive agents, particularly their potential impact on type 1 and type 2 diabetes mellitus, and their utility in the transplantation process. The complex etiology of diabetes, which involves a delicate interplay of genetic, environmental, and immunological factors, presents a multifaceted target landscape for these therapies. The agents discussed in the review, including CD3 inhibitors, cytotoxic T-lymphocyte-associated protein 4-immunoglobulin G, Janus kinase inhibitors, anti-thymocyte globulin, tumor necrosis factor-α inhibitors, CD20 inhibitors, alefacept, and alemtuzumab, each bring a unique mechanism to the table, offering a tailored approach to immune modulation. As research progresses, emphasis is being placed on evaluating the long-term efficacy and safety of these agents to pave the way for more personalized and effective diabetes management strategies.

Pt-Induced Sublattice Distortion Facilitates Enzyme Cascade Reactions for Eradicating Intracellularly Methicillin-Resistant Staphylococcus aureus and Enhancing Diabetic Wound Healing

Metal oxide nanozymes hold significant potential in combating bacterial infections; however, their ordered crystal structures limit the enhancement of catalytic activity, posing challenges in addressing clinical needs for eliminating intracellularly colonized bacteria. Here, we report the development of an integrated diagnostic-therapeutic microneedle patch incorporates the Res@PtZ-Z nanozyme hybrid. Res@PtZ-Z consists of a ZIF shell loaded with the natural compound resveratrol (Res), encapsulating a Pt-doped zinc oxide (ZnO) nanozyme core (PtZ). The Res component modulates charge distribution on the ZIF shell and attenuates bacterial virulence, thereby promoting the uptake of Res@PtZ-Z by host cells. The PtZ core, doped with Pt4+ to induce sublattice distortion in ZnO, exhibits oxidase-like, peroxidase-like, and catalase-like activities. Under intracellular hypoxic conditions, the cascade of these enzyme-like activities ensures a sustained generation of reactive oxygen species (ROS), enabling robust antibacterial effects. Additionally, Res@PtZ-Z enables real-time infection monitoring by oxidizing the 3,3',5,5'-tetramethylbenzidine (TMB) substrate to produce a distinct colorimetric response. This approach addresses both methicillin-resistant Staphylococcus aureus (MRSA) invasion and intracellular persistence, contributing to improved infection management and promoting wound healing.

IL17RA genetic variants are associated with susceptibility and severity of psoriasis

BACKGROUND

Genetic variants that can play an important role in psoriasis (PsO) ethiology and pathophysiology.

OBJECTIVE

To evaluate the association between the IL17RA genetic variants with the susceptibility and severity of PsO.

METHODS

This study included 154 patients with PsO and 154 healthy controls. The severity of PsO was determined using Psoriatic Activity and Severity Index (PASI). The IL17RA single nucleotide variants T > C rs2241043, A > G rs2241049, and G > A rs6518661 were genotyped.

RESULTS

The IL17RA A > G (rs2241049) GG genotype was associated with protection against PsO [odds ratio (OR): 0.391, 95 % confidence interval (CI):0.199-0.768, p = 0.006)] while the IL17RA T > C (rs2241043) CC genotype and the IL17RA G > A (rs6518661) AA genotype were associated with the PsO severity (OR = 0.30, 95 % CI 0.10-0.093, p = 0.020 and OR = 0.22, 95 % CI 0.05-0.99, p = 0.020, respectively).

CONCLUSION

The results demonstrated that the IL17RA A > G (rs2241049) GG genotype may be a protective factor against the development of PsO and the CC genotype of the IL17RA T > C (rs2241043) and the AA genotype of the IL17RA G > A (rs6518661) variants were associated with protection against the severity of PsO. Considering that these variants are located in intronic regions of the IL17RA, other genetic and epigenetic mechanisms involved in these associations should be investigated.

Emerging Therapies for Palmoplantar Pustulosis with a Focus on IL-23 Inhibitors

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by recurrent pustules, erythema, and scaling on the palms and soles, leading to a significantly reduced quality of life. Although PPP shares some immunopathological features with psoriasis vulgaris, it is distinguished by unique genetic predispositions, including a higher prevalence in East Asian populations, and a complex immune profile, particularly dysregulation of the IL-23/Th17 axis and IL-36 cytokines. Recent advances in psoriasis treatment have highlighted IL-23 inhibitors, which target the p19 subunit to suppress Th17 activation and inflammatory cytokines. Clinical trials show that IL-23 inhibitors significantly improve disease severity and patient-reported outcomes in PPP while maintaining favorable safety profiles. Notably, guselkumab and risankizumab have recently been approved for PPP treatment in Japan and Korea. In contrast, IL-17 inhibitors and IL-36 blockers have yielded mixed results. A recent phase 3 trial in Japan demonstrated the significant efficacy of apremilast in treating PPP, with a favorable safety profile, suggesting that apremilast may be a promising treatment option for PPP. Due to PPP's lower prevalence compared with psoriasis vulgaris, clinical trials remain limited. Further large-scale, controlled studies are needed to clarify the efficacy and long-term safety of these therapies in diverse populations. This review summarizes emerging evidence on IL-23 inhibitors and other treatments for PPP, detailing their mechanisms of action, clinical efficacy, safety profiles, current challenges, and future perspectives in optimizing therapy.

Mortality and exacerbations in bronchiectasis patients with carbapenem-resistant Pseudomonas aeruginosa isolation: a long-term retrospective cohort study

BACKGROUND

Few studies have investigated the impact of carbapenem-resistant Pseudomonas aeruginosa (CRPA) on long-term outcomes in bronchiectasis. This study aimed to analyze acute exacerbations and mortality in bronchiectasis patients with CRPA isolation.

METHODS

This retrospective study included bronchiectasis patients with PA-positive cultures from January 1, 2014, to July 31, 2023, at West China Hospital of Sichuan University. PA was isolated from sputum or bronchoalveolar lavage fluid (BALF) and classified into CRPA and non-CRPA groups based on antimicrobial susceptibility testing. Multivariate logistic regression was used to assess risk factors for acute exacerbations, while multivariate Cox regression identified independent risk factors for all-cause and cause-specific mortality.

RESULTS

Among 564 patients with PA-positive isolates, 143 (25.36%) harbored CRPA strains. CRPA isolation was associated with an increased risk of acute exacerbations (adjusted odds ratio [aOR] 2.072, p = 0.001), while antibiotic treatment reduced the risk of exacerbations (aOR 0.439, p = 0.011). CRPA isolation was an independent risk factor for all-cause (adjusted hazard ratio [aHR] 1.488, p = 0.031) and cause-specific mortality (aHR 1.882, p = 0.010). The 1-, 3-, 5-, and 7-year cause-specific survival rates in the CRPA group were 88.6%, 79.8%, 73.2%, and 68.0%, respectively, versus 95.4%, 91.0%, 85.6%, and 81.8% in the non-CRPA group (p = 0.001).

CONCLUSION

CRPA isolation was significantly associated with an increasing risk of acute exacerbations, overall and cause-specific mortality. These findings underscored the urgent need to strengthen antibiotic stewardship to reduce the emergence of CRPA and to implement early detection and targeted management strategies to improve outcomes for patients with CRPA.

Real-World Evidence for Baricitinib in the Treatment of Rheumatoid Arthritis in Spain: A Systematic Literature Review

INTRODUCTION

Baricitinib is a Janus kinase inhibitor approved for the treatment of moderate-to-severe rheumatoid arthritis (RA) in adults who have responded inadequately, or are intolerant, to disease-modifying antirheumatic drugs (DMARDs). This systematic literature review was conducted to understand the use of baricitinib in RA in the real-world setting in Spain.

METHODS

Embase and MEDLINE databases were systematically searched for publications (in English or Spanish) published between March 2017 and June 2023; Spanish data presented at national rheumatology congresses were also obtained, with a date limitation of 2021-2023.

RESULTS

Nineteen eligible publications were identified (5 full papers, 14 conference abstracts), including more than 1000 patients who received baricitinib for RA in Spain. Most patients were older and female with long disease duration, and moderate-to-severe active disease. Studies included both biologic DMARD-experienced and DMARD-naïve patients, and most patients received baricitinib 4 mg/day. Baricitinib persistence ranged from 6 to 48 months, with ineffectiveness (primary or secondary) being the most frequently reported reason for discontinuation. Baricitinib was consistently shown to decrease disease activity, across all outcome measures (Disease Activity Score-28 for RA, the Simplified and Clinical Disease Activity Indexes, swollen and tender joint counts and patient-reported outcomes). Thirteen studies reported safety outcomes, with discontinuation rates due to adverse events ranging from 9.5 to 20%. Across these studies, adverse events of interest included eleven cases of herpes zoster, six serious infections, two major adverse cardiovascular events, and three malignant neoplasms.

CONCLUSION

These results suggest baricitinib is effective in the real-world setting in Spain, with a consistent safety profile, similar to findings reported in clinical studies and in real-world studies conducted in other countries.

Molecular mechanism of tumor-infiltrating immune cells regulating endometrial carcinoma

Endometrial carcinoma (EC) is a prevalent gynecological cancer, and its interaction with the immune system is pivotal in cancer progression. This comprehensive review explores the molecular mechanisms involved in the regulation of EC by tumor-infiltrating immune cells. This review discusses the composition and functions of various immune cell types within the tumor microenvironment, including T cells, B cells, macrophages, and natural killer cells, and elucidates their specific roles in cancer control. It also delves into the immune evasion strategies employed by EC cells, with a specific focus on immune checkpoint pathways and their influence on tumor development. Signaling pathways, cytokines, and chemokines mediating immune responses within the tumor microenvironment are also detailed. Furthermore, clinical implications and therapeutic strategies, such as immunotherapies, are also reviewed, and relevant clinical trials are discussed. Additionally, this review discusses the existing gaps in our knowledge, suggests potential avenues for future research, and emphasizes the significance of understanding these mechanisms for enhanced EC treatment. This review provides an exhaustive overview of the current knowledge, supporting the ongoing quest for more effective therapeutic interventions on EC.

Effects of the DPP-1 inhibitor HSK31858 in adults with bronchiectasis in China (SAVE-BE): a phase 2, multicentre, double-blind, randomised, placebo-controlled trial

BACKGROUND

Airway neutrophil inflammation with excessive neutrophil serine proteases is implicated in frequent exacerbations of bronchiectasis. HSK31858 is a novel reversible inhibitor of DPP-1. We aimed to assess the efficacy and safety of HSK31858 in decreasing the frequency of bronchiectasis exacerbations among adults with bronchiectasis.

METHODS

SAVE-BE was a phase 2, double-blind, randomised, placebo-controlled trial in 25 tertiary centres in China. Participants were aged 18 years or older with a physician diagnosis of bronchiectasis, according to chest high-resolution CT showing bronchial dilatation and compatible respiratory symptoms, and at least two exacerbations within 12 months before screening. Participants were randomly assigned (1:1:1) via a central interactive web-response system to receive 20 mg HSK31858, 40 mg HSK31858, or placebo, orally, once daily for 24 weeks. Randomisation was stratified by exacerbation frequency in the previous year (less than three vs three or more annually) and study investigators and participants were masked to group assignment for analysis of study outcomes. The primary endpoint was the annualised exacerbation frequency over 24 weeks, assessed in the full analysis set. Safety was monitored throughout the study. This trial is registered with ClinicalTrials.gov, NCT05601778.

FINDINGS

Between Dec 6, 2022, and March 31, 2024, 292 patients were screened, 226 of whom were enrolled and randomly assigned (75 to the 20 mg HSK31858 group, 76 to the 40 mg HSK31858 group, and 75 to the placebo group. 74 patients received 20 mg HSK31858, 75 received 40 mg HSK31858, and 75 received placebo and were included in the full analysis set. In the full analysis set, 136 (61%) participants were female and 88 (39%) were male. The mean annualised frequency of exacerbations was 1·00 per person-year (SD 1·44) in the 20 mg HSK31858 group, 0·75 per person-year (1·37) in the 40 mg HSK31858 group, and 1·88 per person-year (1·97) in the placebo group. The least-squares mean frequency of exacerbations was 1·05 per person-year (95% CI 0·73-1·51) in the 20 mg HSK31858 group, 0·83 per person-year (0·55-1·25) in the 40 mg HSK31858 group, and 2·01 per person-year (1·53-2·63) in the placebo group. The incidence rate ratio compared with placebo was 0·52 (95% CI 0·34-0·80; p=0·0031) for the 20 mg HSK31858 group and 0·41 (0·26-0·66; p=0·0002) for the 40 mg HSK31858 group. The incidence of adverse events was similar across the three groups. Neither HSK31858 dose was associated with an increased incidence of adverse events of special interest (eg, hyperkeratosis, gingivitis, or life-threatening infections).

INTERPRETATION

Both HSK31858 doses improved clinical outcomes in adults with bronchiectasis, significantly reducing the exacerbation frequency compared with placebo. The development of new drugs targeted at amelioration of neutrophilic inflammation (eg, via suppression of DPP-1 activity) might lead to new options for hindering the progression of bronchiectasis.

FUNDING

Haisco.

Dry powder Inhalation of lytic mycobacteriophages for adjunct therapy in a mouse model of infection with Mycobacteriumtuberculosis

Inhaled therapy of tuberculosis (TB) by a Dry Powder Inhalation (DPI) comprising mycobacteriophage D29 and TM4 was non-inferior to oral anti-tuberculosis therapy (ATT) with isoniazid and rifampicin in a mouse model of infection with Mycobacterium tuberculosis (Mtb). No pharmaceutical phage product of mycobacteriophages is approved for large-scale production. We scaled up preparation and downstream processing of phages, developed DPI formulations, and established methods for determining identity, purity, assay, stability, and critical quality attributes (CQA). We carried out cell-based assays of intracellular bactericidal activity and pharmacokinetics and comparative efficacy in Mtb-infected mice. Daily doses of the DPI containing ∼1010 Plaque Forming Units/dose DPI reduced Mtb colony forming units (CFU) in the lungs from 6.4 ± 0.3-log to 4.8 ± 0.7-log in four weeks, while oral human equivalent doses (HED) of isoniazid and rifampicin reduced CFU to 3.8 ± 0.8-log. Combining inhaled phages with oral drugs sterilized the lungs of one of four mice and reduced group mean CFU to 2.3-log. Inhalations significantly upregulated tumor necrosis factor (TNF) in lung tissue to ∼1500 pg/ml of homogenate, improved organ morphology, and reduced histopathology. The HD DPI may be a useful adjunct to oral drugs. Dose-finding animal efficacy studies are required before assessing preclinical safety.

Importance of sputum and computed tomography assessments of airway neutrophil inflammation and mucus plugging in bronchiectasis management

Sputum myeloperoxidase quantification and computed tomography scoring of mucus plugs in central airways deepen understanding of relationships between airway neutrophilic inflammation, mucus plugging and disease severity in patients with bronchiectasis https://bit.ly/3YHP4dF.

Escherichia coli aggravates inflammatory response in mice oral mucositis through regulating Th17/Treg imbalance

Introduction

Microbial dysbiosis links to mucosal immune dysregulation, but the specific bacterial contributions to oral mucosal inflammation remain unclear. Escherichia coli (E. coli), a pathogen well-characterized in mucosal immunity and immune regulation studies, has been observed to be enriched in chronic oral inflammatory lesions and was reported to modulate T helper 17 cells (Th17)/T regulatory cells (Treg) homeostasis. Here, we developed an oral mucositis mouse model via tongue scratch and E. coli topical application to investigate its role in Th17/Treg imbalance.

Methods

The inflammatory infiltration was evaluated by macroscopic photography and HE staining. The expression of inflammatory factors in tongue tissue and peripheral blood of mice were detected by immunohistochemical staining and enzyme-linked immunosorbent assay. The number of Th17 and Treg in mice spleen lymphocytes were evaluated with flow cytometry. Differential gene expression analysis, functional enrichment analysis and immune infiltration analysis were performed using RNA-seq data from oral lichen planus (OLP).

Results

E. coli stimulation aggravated inflammatory responses induced by scratching in lingual mucosa of mice, including increased local and systemic expression of interleukin 6 (IL6), interleukin 17 (IL17), chemokine receptor 6 (CCR6) and chemokine C-C motif ligand 20 (CCL20), increased proportions of Th17 cells and increased Th17/Treg ratio in spleen lymphocytes. Analysis of RNA-seq data from OLP revealed alterations in antimicrobial responses and inflammatory factors associated with upregulation of Th17/Treg balance.

Conclusion

This study supports the role of E. coli in promoting oral mucosal inflammation and provides an experimental basis for in vivo study of OLP from the perspective of microorganisms.

Individuals Infected with SARS-CoV-2 Prior to COVID-19 Vaccination Maintain Vaccine-Induced RBD-Specific Antibody Levels and Viral Neutralization Activity for One Year

The effectiveness of multiple COVID-19 vaccinations in individuals with a history of SARS-CoV-2 infection remains unclear; specifically, elucidation of the durability of anti-viral antibody responses could provide important insights for epidemiological applications. We utilized the BU ELISA protocol to measure the circulating SARS-CoV-2 receptor-binding domain (RBD) and nucleocapsid (N) specific IgG and IgA antibody levels in a cohort of individuals infected with SARS-CoV-2 in the spring of 2020, with the sample collection spanning six months to two years post-symptom onset. Further, we interrogated the neutralization activity of these samples against the ancestral SARS-CoV-2 (WA-1) and Delta and Omicron (BA.1) variants. Consistent with previous studies, we found a more rapid waning of anti-N compared to anti-RBD antibodies in months prior to the first vaccinations. Vaccine-induced antibody responses in individuals previously infected with SARS-CoV-2 were elevated and sustained for more than one year post-vaccination. Similarly, neutralization activity against WA-1, Delta, and Omicron increased and remained higher than pre-vaccination levels for one year after the first COVID-19 vaccine dose. Collectively, these results indicate that infection followed by vaccination yields robust antibody responses against SARS-CoV-2 that endure for one year. These results suggest that an annual booster would stably boost anti-SARS-CoV-2 antibody responses, preventing infection and disease.

The pathogenesis of neurological immune-related adverse events following immune checkpoint inhibitor therapy

Cancer is a leading cause of morbidity and mortality worldwide. The development of immune checkpoint inhibitors (ICI) has revolutionised cancer therapy, and patients who were previously incurable can now have excellent responses. These therapies work by blocking inhibitory immune pathways, like cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death-1 (PD-1), its ligand PD-L1, and lymphocyte activation gene 3 (LAG-3); which leads to increased anti-tumour immune responses. However, their use can lead to the development of immune-related adverse events (irAEs), which may result in severe disability, interruption of cancer therapy, and even death. Neurological autoimmune sequelae occur in 1-10 % of patients treated with ICIs and can be fatal. They encompass a broad spectrum of diseases, may affect the central and the peripheral nervous system, and include syndromes like encephalitis, cerebellitis, neuropathy, and myositis. In some cases, neurological irAEs can be associated with autoantibodies recognising neuronal or glial targets. In this review, we first describe the key targets in ICI therapy, followed by a formulation of irAEs and their clinical presentations, where we focus on neurological syndromes. We comprehensively formulate the current literature evaluating cell surface and intracellular autoantibodies, cytokines, chemokines, leukocyte patterns, other blood derived biomarkers, and immunogenetic profiles; and highlight their impact on our understanding of the pathogenesis of neurological irAEs. Finally, we describe therapeutic pathways and patient outcomes, and provide an overview on future aspects of ICI cancer therapy.

Association between platelet-to-high-density lipoprotein cholesterol ratio and gallstone prevalence in the American adult population: a cross-sectional study analysis

OBJECTIVE

The platelet-to-high-density lipoprotein cholesterol ratio(PHR), a novel marker of inflammatory response and metabolic dysregulation, has been linked to various chronic conditions.This study aimed to evaluate the association between PHR and the prevalence of gallstones.

METHODS

This cross-sectional study analyzed data collected from the United States National Health and Nutrition Examination Survey(NHANES)between 2017 and 2023. Multivariate logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship between PHR and gallstone prevalence.

RESULTS

A total of 13,163 participants were included, of whom 1,441(10.95%) self-reported a history of gallstones. After adjusting for potential confounders, a positive association was observed between the natural log-transformed PHR(LN[PHR])and gallstone prevalence(OR = 1.27, 95%CI: 1.09-1.49). This positive correlation became more pronounced with increasing PHR levels(P-trend = 0.01). Smooth curve fitting analysis indicated a linear relationship between PHR and gallstone prevalence. Subgroup analyses revealed that the association was strongest in participants aged 20-39 years, women, and individuals of other racial/ethnic groups.

CONCLUSION

Elevated PHR levels are significantly associated with a higher risk of gallstones. While our observational data suggest plausibility for PHR-gallstone, these findings should be interpreted as hypothesis-generating rather than definitive clinical evidence. Future mechanistic studies should elucidate whether this association reflects causal pathways or epiphenomenal relationships.

Mapping of rehabilitation interventions and assessment methods for patients with liver cirrhosis: a scoping review

BACKGROUND

This scoping review aimed to delineate the detailed components of exercise therapy and the evaluation methods used for patients with liver cirrhosis.

METHODS

The methodology involved searching the original PubMed, Web of Science, and Scopus for studies published between January 1975 and March 2025. The search was completed on 13 March 2025. Studies describing exercise therapy for liver cirrhosis patients were selected. Relevant information matching the study objectives, such as intervention duration, content, intensity setting, evaluation criteria, and outcomes, was extracted and documented.

RESULTS

Of the 2314 articles identified, 18 fit the inclusion and exclusion criteria, with a total of 950 participants. The most prevalent form of exercise therapy was a combined aerobic exercise and strength training program (55.6%). Commonly used assessment criteria included the 6-minute walking distance for endurance evaluation (44.4%) and the Chronic Liver Disease Questionnaire for quality of life assessment (33.3%). Intervention durations ranged from 30 to 60 min per day, 2 to 7 days per week, and 8 to 12 weeks. Concerning intensity setting, subjective fatigue levels and heart rate were frequently used (38.9%), though detailed descriptions were limited.

CONCLUSIONS

For the establishment of effective exercise therapy for patients with liver cirrhosis, future research should concentrate on tailoring intensity settings according to individual patient needs. Additionally, standardized reporting of intervention details and assessment methods is crucial for improving the quality and comparability of studies in this field.

Pretreatment plasma sCD14 as a prognostic indicator in advanced non-small cell lung cancer patients undergoing immunotherapy

BACKGROUND

This study aims to evaluate cytokines as a prognostic biomarker in patients with advanced non-small cell lung cancer (aNSCLC) undergoing immunotherapy.

METHODS

A comprehensive analysis was conducted to assess the prognostic significance of sCD14 and other cytokines in aNSCLC patients receiving immune checkpoint inhibitors (ICIs) using flow fluorescence. A discovery cohort (n = 42) was used to evaluate the differential expression of 41 cytokines between durable clinical benefit (DCB) and no durable benefit (NDB) groups in Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS). The prognostic value was further validated in multiple independent cohorts, including plasma protein measurements (n = 109), multiplex immunofluorescence (mIF) (n = 22), and messenger RNA datasets (n = 403) of NSCLC in CHCAMS.

RESULTS

In the discovery cohort, 7 cytokines (CD14, CCL27, IL-17 A, EGF, TNFR1, GFAP, CHI3L1) exhibited differential expression between the DCB and NDB groups. Among these, CD14, CCL27, IL-17 A, and TNFR1 were significantly elevated in the DCB group, while EGF, CHI3L1, and CCL5 were higher in the NDB group. CD14 showed a high area under the curve (AUC = 0.84) for predicting clinical benefit. Functional enrichment analysis indicated that these cytokines are involved in key immune pathways, including the inflammatory response and MAPK signaling. Univariate COX for progression-free survival (PFS) analysis demonstrated prognostic value for CD14 (p < 0.001, HR = 0.054 [0.014-0.219]), CCL27 (p < 0.001, HR = 0.054 [0.015-0.196]), IL-17 A (p < 0.001, HR = 0.110 [0.041-0.298]), and CCL5 (p < 0.05, HR = 2.387 [1.023-5.570]). Validation in the CHCAMS cohort confirmed that CD14 expression, measured via mIF, was a predictor of PFS (p < 0.05). Furthermore, high CD14 expression was consistently associated with superior PFS across multiple external datasets (GSE126044, GSE135222, GSE136961, and GSE218989). CD14 expression was found to be elevated in various normal tissue types, particularly in lung adenocarcinoma and lung squamous cell carcinoma, compared to tumors, indicating its potential role in immune surveillance.

CONCLUSION

sCD14 is a promising prognostic biomarker for aNSCLC patients undergoing immunotherapy. Elevated plasma sCD14 levels are associated with improved PFS and a favorable immune response.

Platelet-Derived Soluble CD40L and Its Impact on Immune Modulation and Anti-IL6R Antibody Treatment Outcome in Rheumatoid Arthritis

BACKGROUND

Platelets (PLTs) from healthy donors (HD) modulate T lymphocyte responses but PLTs from rheumatoid arthritis (RA) patients contribute to persistent systemic inflammation. This suggests that PLTs from RA patients and HD have different immunomodulatory effects.

METHODS

Using cell culture, flow cytometry, proteomics, and ELISA, we compared PLTs from HD and RA patients and their effects on T lymphocyte activation and cytokine production.

RESULTS

HD PLTs suppressed T lymphocyte proliferation and IFNγ and TNF production, while RA PLTs exhibited reduced suppressive capacity. In the presence of RA PLTs, IFNγ levels correlated with T lymphocyte proliferation, greater disease activity, and anti-citrullinated protein antibodies (ACPA). Proteomic analysis revealed that RA PLTs show upregulation of proteins linked to acute-phase response and complement activation. RA PLTs secreted higher levels of soluble CD40L (sCD40L) and PDGF-BB that correlated with enhanced IFNγ production. Seropositive RA patients had higher levels of sCD40L, and these levels were predictive of disease remission in RA patients treated with anti-IL6R. sCD40L was found to enhance T lymphocyte activation and to contribute to increased pro-inflammatory cytokine production.

CONCLUSIONS

This study highlights the diminished ability of RA PLTs to suppress T lymphocyte activation and that sCD40L can be a potential biomarker and therapeutic target in RA.

Exploring the pathogenesis and clinical implications of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO): a narrative review

The complexity and diversity of the immune response in patients with asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap present significant challenges for disease management. Relying on a limited number of biomarkers and clinical data is insufficient to fully reveal the immunopathogenesis of these diseases. However, in vitro technologies such as cell analysis, cytokine investigation, and nucleic acid sequencing have provided new insights into the underlying mechanisms of these diseases, leading to the discovery of several biomarkers-including cell degranulation, cell function, secreted cytokines, and single nucleotide polymorphisms-that have potential clinical implications. This paper reviews the immunopathogenesis in asthma, chronic obstructive pulmonary disease, and asthma-COPD overlap and examines the applications of recent in vitro models to detect candidate biomarkers that could enhance diagnostic precision, predict severity, monitor treatments, and develop new treatment strategies. A deeper understanding of the immune response in these diseases, along with the integration of in vitro models into clinical practice, could greatly improve the management of these respiratory diseases, making approaches more personalized and efficient.

HSP-CAR30 with a high proportion of less-differentiated T cells promotes durable responses in refractory CD30+ lymphoma

ABSTRACT

CD30-directed chimeric antigen receptor T-cell therapy (CART30) has limited efficacy in relapsed or refractory patients with CD30+ lymphoma, with a low proportion of durable responses. We have developed an academic CART30 cell product (HSP-CAR30) by combining strategies to improve performance. HSP-CAR30 targets a proximal epitope within the nonsoluble part of CD30, and the manufacturing process includes a modulation of ex vivo T-cell activation, as well as the addition of interleukin-21 (IL-21) to IL-7 and IL-15 to promote stemness of T cells. We translated HSP-CAR30 to a phase 1 clinical trial of 10 patients with relapsed/refractory classic Hodgkin lymphoma (HL) or CD30+ T-cell non-Hodgkin lymphoma. HSP-CAR30 was mainly composed of memory stem-like (TSCM-like) and central memory (TCM) CAR30+ T cells (87.5% ± 5%). No dose-limiting toxicities were detected. Six patients had grade 1 cytokine release syndrome, and no patient developed neurotoxicity. The overall response rate was 100%, and 5 of 8 patients with HL achieved complete remission (CR). An additional patient with HL achieved CR after a second HSP-CAR30 infusion. Remarkably, 60% of patients have ongoing CR after a mean follow-up of 34 months. CAR30+ T cells at expansion peak had a predominance of TSCM and TCM cells, and CAR30+ T cells remained detectable in 3 of 5 evaluable patients at least 12 months after infusion. Our study shows that selection of the epitope targeting CD30 and ex vivo preservation of less-differentiated memory T cells may enhance the efficacy of CART30 in patients with refractory HL. This trial is registered at www.clinicaltrials.gov (NCT04653649).

Neuronal Mechanisms of Psoriatic Itch: Role of IL-17R/ERK/TRPV4 Signaling Pathway

Itch represents a major disease burden of psoriasis. Despite recent clinical studies showing the effectiveness of IL-17- and IL-17R-blocking antibodies in alleviating psoriatic itch, significant questions remain unanswered. Specifically, the crucial cellular site of action and the impacted signaling pathway of IL-17/IL-17R in psoriatic itch are elusive. Itch sensation relies on dorsal root ganglion (DRG) sensory neurons that transmit pruriceptive signals from the periphery to the CNS. IL-17RA and IL-17RC, 2 cognate receptors for IL-17, are expressed in DRG neurons. In this study, we demonstrated that IL-17RA and IL-17RC are upregulated in DRG neurons in a mouse model of psoriasis induced by imiquimod. Notably, conditional knockout of Il17ra or Il17rc in sensory neurons potently attenuated psoriasis-like itch. Furthermore, our in vitro assay with cultured neurons and in vivo experiment with animal model of psoriasis demonstrated that IL-17RA and IL-17RC upregulate the pruritic ion channel TRPV4 in DRG neurons through the extracellular signal-regulated kinase (ERK) signaling pathway. Specific deletion of Trpv4 or suppression of phosphorylation of ERK in DRG neurons mitigated psoriasis-like itch. These findings suggest that the IL-17R/ERK/TRPV4 signaling pathway in sensory neurons plays a significant role in psoriatic itch.

Study of Lysozyme Activity in Bird Egg Whites by Fluorescence Polarization Assay Using Chitooligosaccharide Tracer

The storage duration and hatchability of eggs largely depend on the lysozyme content in egg whites; therefore, determining the lysozyme status is important for characterizing their quality. For the first time, a fast and accurate method for determining the active lysozyme in egg whites has been proposed to establish the lysozyme status of eggs using the fluorescence polarization assay and synthetic chitooligosaccharide conjugates with a fluorescent label without sample preparation. The egg whites of hens, black hens, chukars, quails, ducks, geese, turkeys, peacocks, and ostriches were studied. Samples of egg whites from hens, black hens, chukars, and quails demonstrate the possibility of measuring the lysozyme activity. Samples of hen and black hen eggs from a farm showed approximately the same enzymatic activity of lysozyme. A relatively higher enzymatic activity was demonstrated by the samples from quail egg whites; however, a wide range of data was observed among the eggs. Chitooligosaccharide conjugates demonstrate that they bind only to C-type lysozyme, and no interaction with G-type lysozyme has been shown. Lysozyme activity in the egg whites of duck, goose, turkey, peacock, and ostrich eggs has not been detected by using the obtained chitooligosaccharide tracers, which may be related to the structural features of lysozyme in different bird species. Thus, the method of fluorescence polarization (FP), using fluorescently labeled chitopentaoside to determine the lysozyme status, can be used to characterize hen, black hen, chukar, and quail eggs, which will allow for the selection of a batch of eggs with a high content of active lysozyme, for example, for long-term storage.

Blood Coagulation Favors Anti-Inflammatory Immune Responses in Whole Blood

BACKGROUND

We studied the effects of human blood coagulation on antioxidant activity and the cellular secretion of immunoregulatory molecules in vitro.

METHODS

Reactive oxygen species (ROS) activity and cytokine content were determined in plasma and serum blood samples incubated with lipopolysaccharide (LPS) for 3 h or 18 h.

RESULTS

Coagulation process significantly decreased ROS activity induced by LPS in blood samples from healthy donors. Human serum was found to have significantly higher antioxidant activity than plasma. Blood coagulation markedly reduced LPS-induced secretion of TNF-α by cells, without significantly affecting the secretion of interleukin-1 (IL-1), IL-6, IL-8, or C-reactive protein (CRP). Blood clotting led to an increase in LPS-induced release of vascular endothelial growth factor (VEGF) by blood cells. A significant increase in procalcitonin levels was also observed in serum samples.

CONCLUSIONS

Blood clotting enhances the antioxidant and anti-inflammatory functions of immunoreactive blood cells.

Achievement of treatment targets and maintenance of response with upadacitinib in patients with moderate-to-severe rheumatoid arthritis in real-world practice: 1-year outcomes from the UPHOLD observational study

BACKGROUND

Upadacitinib (UPA), an oral Janus kinase inhibitor, has shown efficacy with an acceptable safety profile in rheumatoid arthritis (RA) clinical trials.

OBJECTIVE

To assess the real-world effectiveness and safety of UPA in adults with moderate-to-severe RA in the UPHOLD observational study.

METHODS

Co-primary endpoints were: (i) proportion of patients achieving disease activity score in 28 joints using C-reactive protein (DAS28[CRP]) remission (< 2.6) at 6 months; and (ii) proportion of those patients maintaining remission at 12 months. Additional analyses included proportions of patients achieving and maintaining DAS28(CRP) low disease activity (LDA; ≤ 3.2), other composite measures of disease activity, and subgroup analyses by therapy strategy and prior treatment. Treatment-emergent adverse events (TEAEs) in the full analysis set (FAS; patients receiving ≥ 1 UPA dose) were reported through August 10, 2023. Co-primary and selected secondary endpoints were analyzed by modified non-responder imputation (mNRI) in modified (m)FAS1 (FAS patients who completed 6 months of treatment and had DAS28[CRP] data available, and those who discontinued before 6 months) and mFAS2 (mFAS1 patients who achieved remission at 6 months, completed 12 months of treatment, and had DAS28[CRP] data available, and those who discontinued between 6 and 12 months); and as observed (AO) in patients with non-missing data.

RESULTS

Of 1719 participants, 1717 were enrolled; 1701 comprised the FAS. Overall, 400/1719 (23.3%) patients discontinued before 12 months. Of mFAS1 patients, 499 (mNRI: 499/1074 [46.5%]; AO: 499/902 [55.3%]) achieved DAS28(CRP) remission at 6 months; of mFAS2 patients, 269 (mNRI: 269/340 [79.1%]; AO: 269/317 [84.9%]) maintained remission at 12 months. DAS28(CRP) remission or LDA rates were consistent regardless of whether UPA was initiated and maintained as monotherapy or combination therapy. Similar responses were observed across prior treatment subgroups. Among selected TEAEs of special interest, herpes zoster and serious infection occurred at 3.12 and 2.62 events/100 patient-years, respectively. No new safety signals were identified.

CONCLUSIONS

UPA demonstrated real-world effectiveness in moderate-to-severe RA, with approximately half of patients achieving DAS28(CRP) remission at 6 months and most maintaining remission through 12 months. The real-world benefit-risk profile of UPA remains favorable and is consistent with phase 3 clinical trial data.

TRIAL REGISTRATION

NCT04497597.

CD73low B-cell phenotypes and distinct cytokine profiles in patients with active anti-Jo-1 antibody positive idiopathic inflammatory myopathies

OBJECTIVES

We performed multiparameter phenotyping of peripheral B cells in anti-Jo-1 antibody positive idiopathic inflammatory myopathies (IIM) to delineate disease-associated immunological profiles and the influence of B cells on disease activity.

METHODS

Purified B cells from peripheral blood mononuclear cells from 16 patients with anti-Jo-1 antibody positive IIM (7 with untreated active IIM, 4 with active and treated IIM and 5 with inactive IIM) were analysed by multiparameter spectral flow cytometry. Dimensionality reduction and clustering analysis were applied to pre-gated CD19+B cells. Serum levels of 21 cytokines and anti-Jo-1 IgG autoantibodies were determined. All patients with IIM in this study were positive for anti-Jo-1 antibody.

RESULTS

Anti-Jo-1 antibody levels correlated positively to disease activity. Flow cytometry demonstrated B-cell dysregulation with significantly lower CD73 expression on naïve, switched memory and double negative B cells in patients with active IIM. Clustering analysis further revealed expansions of CD73- IgM+naïve B cells and CD73- CD95+ switched memory B cells in active IIM. In unswitched memory B cells, CD73+CD21+ cells were decreased in active IIM. Patients with active IIM had significantly higher serum levels of B-cell activating factor, inducible protein-10, interleukin-6 and sCD40L which correlated with changes in B-cell populations.

CONCLUSIONS

Since CD73 has an immunoregulatory function by modulating the ATP/adenosine pathway, which is also targeted by methotrexate, the low CD73 B-cell expression in anti-Jo-1 antibody-positive IIM may lead to B-cell hyperactivation. These novel findings further highlight B cells as central in the pathogenesis of IIM and important therapeutic targets.

Nbeal2 knockout mice are not protected against hypoxia-induced pulmonary vascular remodeling and pulmonary hypertension

ABSTRACT

Inflammation drives the initiation and progression of pulmonary hypertension (PH). Platelets, increasingly recognized as immune cells, are activated and increased in the lungs of patients with PH. Platelet activation leads to the release of α-granule chemokines, many of which are implicated in PH. We hypothesized that hypoxia-induced secretion of platelet α-granule-stored proteins and PH would be prevented in Neurobeachin-like 2 knockout (Nbeal2-/-) α-granule-deficient mice. Wild-type (WT) and Nbeal2-/- mice were maintained in normoxia or exposed to 10% hypobaric hypoxia for 3, 14, 21, or 35 days. We observed macrothrombocytopenia, increased circulating neutrophils and monocytes, and increased lung interstitial macrophages (IMs) in Nbeal2-/- mice at baseline. Hypoxia-induced platelet activation was attenuated, and hypoxia-induced increase in lung platelet factor 4 (PF4) and platelets was delayed in Nbeal2-/- mice compared with in WT mice. Finally, although pulmonary vascular remodeling (PVR) and PH were attenuated at day 21, Nbeal2-/- mice were not protected against hypoxia-induced PVR and PH at day 35. Although this mutation also affected circulating monocytes, neutrophils, and lung IMs, all of which are critical in the development of experimental PH, we gained further support for the role of platelets and α-granule proteins, such as PF4, in PH progression and pathogenesis and made several observations that expand our understanding of α-granule-deficient mice in chronic hypoxia.

Unveiling the mechanism of amelioration of adjuvant-induced rheumatoid arthritis by Drynaria quercifolia rhizome extract using network pharmacology and gene expression-based studies

Rhizomes of Drynaria quercifolia have long been traditionally used to manage rheumatic pain. However, there is limited research supporting this traditional practice and insufficient evidence demonstrating the molecular mechanisms of action of plant-derived bioactives in rheumatoid arthritis (RA). The current study aims to identify the effective components in Drynaria quercifolia methanol rhizome extract (DME) and their probable pharmacological mechanisms in alleviating Rheumatoid Arthritis (RA) using network-pharmacology, molecular docking, molecular-dynamics simulations, and gene expression-based validation. Gas chromatography-mass spectrometry (GC-MS) based screening identified 41 volatile phytocomponents from DME having drug-like potentiality. Network pharmacology-based screening revealed 117 therapeutic targets for RA of which 11 have been identified as core targets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis indicated that key target genes were mostly enriched in the inflammatory response associated with multiple signalling pathways. Molecular docking and molecular dynamics studies revealed that key target proteins like serine/threonine-protein kinase (AKT1), peroxisome proliferator-activated receptor alpha (PPARA), and peroxisome proliferator-activated receptor gamma (PPARG), exhibited strong binding affinity and stable interactions with multiple phytocomponents present in DME. For experimental verification FCA (Freund's complete adjuvant)-induced chronic arthritis model employed for further molecular investigation. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) results validated that DME significantly (p ≤ 0.05) regulate the expression of key identified target genes AKT and PPARG in experimental RA model. Moreover, this study further confirmed that DME significantly (p ≤ 0.05) downregulated pro-inflammatory mediators like COX-2, IL-6 and TNF-α at gene and protein levels and also normalized (p ≤ 0.05) different oxidative stress parameters in both the low and high dose groups of DME-treated arthritic animals. In conclusion, the network-based in silico approach indicated that the phytocomponents present in DME probably act in a synergistic way to modulate key identified targets associated with RA, which was further validated by experimental studies. Therefore, DME could be a potential alternative in immunomodulatory therapies to combat RA and related chronic inflammatory conditions.

High interleukin-35 expression is associated with the severity of rheumatic mitral stenosis

Background

Rheumatic mitral stenosis (RMS) is the most common manifestation of rheumatic heart disease, with high morbidity and mortality. Interleukin-35 (IL-35) is a novel anti-inflammatory cytokine associated with many autoimmune diseases. However, the relation between IL-35 expression and RMS remains unknown. We aimed to study IL-35 expression in RMS and its association with disease progression.

Methods

IL-35 concentration was analyzed in blood samples from 40 patients, including 20 moderate, 20 severe RMS, and 20 healthy controls by ELISA. Mitral valve (MV) IL-35 expression was determined by western blot and immunohistochemistry in patients with RMS (22 and 29 cases, respectively) in comparison to control specimens with mitral valve prolapsed (5 cases, respectively).

Results

IL-35 levels were significantly elevated in the blood of the RMS patients compared to those from healthy subjects(p<0.05) and positively correlated with the severity of RMS (r=0.317, p<0.05). The expression of IL-35 and its subunits (p35 and EBI3) was also detected in MV tissues of patients with moderate or severe RMS. The expression of IL-35 and its subunits (p35 and EBI3) had a positive association with the severity of RMS in MV tissues (r=0.528, p<0.01; r=0.561, p<0.001; r=0.456, p<0.01). Co-localization of p35 and EBI3 was seen in MV tissues of RMS patients in a predominantly perivascular pattern.

Conclusion

We show for the first time an increase of IL-35 level in the blood and MV tissues of RMS patients, which is strongly correlated with the severity of RMS. These results suggest that IL-35 plays an important regulatory role in the progression of RMS.

Surgical Approach to Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by painful nodules, abscesses, and sinus tracts that may lead to irreversible scarring complications. Therapeutic options include antibiotics, biologic therapies, and surgical procedures. Current management of hidradenitis suppurativa favors early surgical intervention along with medical therapy to promote healing and minimize scars and complications in a disease characterized by a therapeutic window of opportunity. Surgical techniques range from incision and drainage to wide excision, with varying recurrence rates mainly based on the extent of procedures. Reconstruction techniques would vary primarily based on the extent of the defect and the area involved. In all cases, a good preoperative planning and delimitation with imaging modalities, preferably intra- or perioperative facilitates complete removal of involved tissue, preserving the integrity and function of healthy skin and minimizing recurrences.

Home-based LIver FrailTy Intervention (LIFT) in Transplant Candidates: A Feasibility Study

BACKGROUND

Frailty is prevalent in end-stage liver disease and predicts higher waitlist and posttransplant mortality. Despite association of frailty with poor clinical outcomes, evidence-based interventions to reverse frailty remain scarce.

METHODS

In this pilot study, we tested the feasibility of a novel home-based frailty intervention using home exercise equipment, a smartphone application, and remote frailty assessments to create a dynamic and personalized exercise program for patients with cirrhosis evaluated for liver transplantation.

RESULTS

Fifty-four patients (mean 57.2 [±9.9] y, 59% men) enrolled in the study, with a mean Model for End-Stage Liver Disease-Na 16.9 (±5.8; 70% decompensated). The mean baseline Liver Frailty Index (LFI) was 3.59 (±0.60). The mean follow-up time was 259 (±190) d and the mean change in LFI at the end of the intervention was -0.11 (3.59 versus 3.48, P  = 0.05), representing a clinically meaningful improvement in frailty previously associated with increased survival. In comparison, the retrospective control group, which had similar demographics and clinical characteristics as the intervention group, did not show a significant change in LFI (3.97 versus 3.91, P  = 0.57). Fifty-six percent of patients were adherent (fully or partially) to recommended levels of exercise, and adherence rates declined from 1 to 3 mo after enrollment, underscoring the need to maintain patient engagement in exercise.

CONCLUSIONS

This study shows that a home-based frailty intervention is feasible. The intervention led to significant improvement in frailty, which was not seen in the retrospective control group. Future studies, including randomized controlled trials, are necessary to further assess the efficacy of the intervention and also determine its impact on downstream clinical outcomes.

Neutrophilic inflammation in bronchiectasis

Noncystic fibrosis bronchiectasis, hereafter referred to as bronchiectasis, is a chronic, progressive lung disease that can affect people of all ages. Patients with clinically significant bronchiectasis have chronic cough and sputum production, as well as recurrent respiratory infections, fatigue and impaired health-related quality of life. The pathophysiology of bronchiectasis has been described as a vicious vortex of chronic inflammation, recurring airway infection, impaired mucociliary clearance and progressive lung damage that promotes the development and progression of the disease. This review describes the pivotal role of neutrophil-driven inflammation in the pathogenesis and progression of bronchiectasis. Delayed neutrophil apoptosis and increased necrosis enhance dysregulated inflammation in bronchiectasis and failure to resolve this contributes to chronic, sustained inflammation. The excessive release of neutrophil serine proteases, such as neutrophil elastase, cathepsin G and proteinase 3, promotes a protease-antiprotease imbalance that correlates with increased inflammation in bronchiectasis and contributes to disease progression. While there are currently no licensed therapies to treat bronchiectasis, this review will explore the evolving evidence for neutrophilic inflammation as a novel treatment target with meaningful clinical benefits.

Systemic inflammation in asymptomatic hyperuricaemia with sonographic crystal deposits, including a comparison with normouricaemia and gout

OBJECTIVE

To describe the inflammatory profile of asymptomatic hyperuricaemia (AH) with ultrasound evidence of monosodium urate (MSU) crystals (AH-MSUpos), vs AH without deposits (AH-MSUneg), intercritical gout and normouricaemia.

METHODS

Based on serum urate levels, musculoskeletal ultrasound and history of flares, we divided 122 participants into four groups: normouricaemia, AH-MSUneg, AH-MSUpos and intercritical gout. We tested four ultrasound definitions for MSU deposition in AH: grade 2-3 (G2-3) double contour and/or tophi, G1-3 double contour and/or tophi, G1-3 Stewart scheme (double contour sign in knee cartilage and/or first metatarsophalangeal joint and/or tophi in first metatarsophalangeal joint) and G2-3 Stewart scheme. Serum acute phase reactants, cytokines, pyroptosis derivates and neutrophil-related proteins were measured and compared between groups. A linear regression model was fitted to correlate crystal and inflammatory burden (measured by ultrasound) with inflammatory markers in hyperuricaemics.

RESULTS

Rates of MSU deposition in AH ranged from 26.0% to 68.8%, depending on the definition used. Levels of CRP, leukocytes, IL-1RA, IL-6, sIL-6R, IL-18, TNF-α, TGF-β and galectin-3 were higher in hyperuricaemics vs normouricaemics. Sex, obesity and comorbidity scores influenced some comparisons. We saw no differences comparing AH-MSUposvs AH-MSUneg groups, except for higher calprotectin using G1-3 sonographic definitions and higher CRP and TGF-β when restricted to women and obese participants.

CONCLUSIONS

Hyperuricaemia is associated with substantial inflammation and some degree of active pyroptosis. Four different ultrasound definitions for AH with MSU deposits yielded similar findings, although we noted some differences in calprotectin, CRP, and TGF-β. Sex, obesity, and comorbidities influenced some inflammatory responses.

Platelets and monocytes: A dynamic duo aiding in the prediction of the clinical response to thrombopoietin receptor agonists in immune thrombocytopenia?

Patients with immune thrombocytopenia (ITP) suffer from an autoimmune bleeding disorder with an isolated low number of platelets. Platelets and megakaryocytes are targeted by the immune system, due to a loss of immune tolerance, via the action of platelet-autoantibodies and/or cytotoxic T cells. ITP is a highly variable disorder regarding the underlying biological mechanisms, disease trajectories and treatment responses. Predictive indicators are therefore strongly warranted. To analyze the predictive response to the thrombopoietin receptor agonist eltrombopag, in this issue of the British Journal of Haematology, Osuna-Gomez and co-workers research platelet-leukocyte complexes in 38 ITP patients upon treatment with eltrombopag. Elevated platelet counts upon treatment with eltrombopag were associated with increased complexes of platelets bound to leucocytes. A higher percentage of monocytes bound to platelets, with an increased IL-10 production in monocytes, was found to be associated to a favorable clinical response to treatment with eltrombopag. Further validation is required but these findings reveal the potential of analyzing platelet-monocyte complexes as a predictive indicator for the clinical response to eltrombopag in patients with ITP. Commentary on: Osuna-Gómez et al. Interplay of leucocyte-platelet complexes and clinical response to eltrombopag in immune thrombocytopenia patients. Br J Haematol 2025; 206:1200-1212.

Segmental phase angle can predict incidence of severe exacerbation in male patients with COPD

OBJECTIVE

To investigate whether segmental phase angle (PhA) is a useful predictor of severe chronic obstructive pulmonary disease (COPD) exacerbation.

RESEARCH METHODS AND PROCEDURES

This prospective cohort study enrolled consecutive patients with COPD with a follow-up period of 3 years. The primary outcome was incidence of severe exacerbation. PhA was measured for the whole body and segmental body sites (trunk and upper and lower limbs). We used receiver operating characteristic (ROC) curves to determine the cut-off values and area under the curve (AUC) for predicting exacerbation based on PhA. We applied Cox proportional hazard regression analyses to estimate the independent prognostic effect of PhA on the incidence of severe exacerbation.

RESULTS

We analyzed 108 male participants (mean age 75.1±7.9 years) and the median follow-up period was 1082 [643-1103] days, with an annual severe exacerbation incidence rate of 0.23 per person-year. ROC analysis revealed that the AUC for Whole-body and segmental PhA were as follows: Whole-body: AUC = 0.69 (95% confidence interval [CI] = 0.59-0.79); right arm: AUC = 0.65 (95% CI = 0.53-0.77); left arm: AUC = 0.68 (95% CI = 0.56-0.79); right leg: AUC = 0.73 (95% CI = 0.64-0.82); left leg: AUC = 0.71 (95% CI = 0.62-0.81); trunk: AUC = 0.58 (95% CI = 0.46-0.69). Cox proportional hazard analysis demonstrated that PhA of the right leg (hazard ratio [HR]=3.50, 95% CI=1.33-9.20), left leg (HR=3.26, 95% CI=1.18-9.04), and left arm (HR=2.61, 95% CI=1.17-6.80) were independently and significantly associated with incidence of severe exacerbation. Whole and trunk PhA were not significantly associated with the incidence of severe exacerbation.

CONCLUSIONS

Segmental PhA may serve as a valuable predictive indicator of severe exacerbation in male patients with COPD. Notably, both leg PhA were strongly associated with the occurrence of severe exacerbations.

REGISTRY NUMBER

UMIN000044824.

Mendelian randomization and mediation analysis reveal the role of immune cell subsets in the causal pathways between blood cell perturbation responses and rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by complex immune interactions. Elucidating the causal relationships between blood cell perturbations, immune cell subsets, and RA can provide valuable insights into its pathogenesis.

METHODS

This study employed bidirectional two-sample Mendelian Randomization (MR) to explore the causal effects of blood cell perturbations on RA risk, with a focus on immune cell mediation. Genetic data from large-scale Genome-Wide Association Studies (GWAS) were utilized to select instrumental variables (IVs) for exposure, mediator, and outcome. Inverse Variance Weighted (IVW) analysis was applied, supplemented by sensitivity tests. Mediation analysis was conducted to assess the indirect effects mediated by immune cells.

RESULTS

Significant causal associations were identified between perturbations in reticulocytes, monocytes, and lymphocytes and specific immune cell subsets, including CD3 + CD39 + regulatory T cells (Tregs) and CD45RA + terminally differentiated CD8 + T cells (CD45RA + TD CD8 + cells). Erythropoiesis perturbation was associated with a reduced RA risk, while perturbations in monocytes and lymphocytes were found to facilitate RA progression through immune-mediated mechanisms.

CONCLUSION

This study underscores the pivotal role of immune cell subsets in mediating the effects of blood cell perturbations on RA development. These findings suggest that targeting immune cell-mediated pathways, particularly those involving Tregs and CD8 + T cells, can provide new therapeutic strategies for RA management. Key Points • Causal Relationships: Mendelian randomization (MR) analysis identified significant causal relationships between specific blood cell disturbances (e.g., reticulocytes, monocytes, and lymphocytes) and rheumatoid arthritis (RA). • Role of Immune Cells: CD3 + CD39 + regulatory T cells (Tregs) and CD45RA + Terminally Differentiated CD8 + T cells (CD45RA + TD CD8 + cells) mediate the association between blood cell disturbances and RA. • Protective Role of Reticulocytes: Reticulocyte disturbances under potassium chloride (KCl) conditions are negatively associated with RA, potentially protecting joints from inflammatory damage by reducing oxidative stress. • Protective Role of Non-Classical Monocytes: Baseline disturbances in monocyte median side scatter are negatively associated with RA, suggesting non-classical monocytes may reduce RA-related inflammation. • Positive Association of Lymphocyte Disturbances with RA: Lymphocyte side scatter standard deviation under colchicine disturbances shows a significant positive association with RA, indicating abnormal T cell activation may exacerbate RA progression.AQ.