Search Results (6,155)

Diabetic retinopathy (DR) reflects retinal microvascular injury and systemic immune-metabolic stress, and most public DR transcriptomic datasets lack paired microbiome/metabolomic profiles. We used gutMGene v2.0 as a curated microbe/metabolite–host gene prior and integrated it with peripheral blood transcriptomics from GSE221521. Candidate genes were refined by weighted gene co-expression network analysis (WGCNA), repeated resampling, cross-dataset assessment, mechanism scoring, peripheral blood mononuclear cell (PBMC) single-cell localization and filamin A (FLNA)-centered single-cell gene regulatory network (GRN) virtual knockout. The gutMGene prior contained 238 host genes; 15 DR-associated genes overlapped this prior, and WGCNA retained ten candidate gut microbe and microbial metabolite-related genes (GMMRGs): FLNA, AKT1, IRAK1, BCL10, CDK6, CTSD, JUP, CXCL1, CXCR2 and IL4R. Resampling prioritized FLNA as the most consistent candidate. Cross-dataset assessment localized the strongest signal to type 2 diabetes (T2D) PBMCs, retinal endothelial cells and advanced proliferative diabetic retinopathy with diabetic macular edema (PDR + DME) retinal tissue, with weaker separation in whole blood, broad retinal tissue and six-donor type 1 diabetes (T1D) PBMCs. FLNA virtual knockout predicted cell-context-dependent perturbation of immune-related transcriptional programs, including IL4R in DR B cells and CTSD in DR monocytes/NK cells. This prior-guided study identifies FLNA within a ten-gene GMMRG set as a circulating host-response signal that links curated microbe/metabolite–host records to immune-vascular and cytoskeletal remodeling in DR. Full article

Background: Cigarette smoking promotes persistent systemic alterations in COPD, yet the interplay among genetic susceptibility, oxidative stress, immune dysregulation, impaired control of persistent viral replication, and long-term outcomes remains incompletely understood. Methods: We conducted an observational study in 102 patients aged ≥70 years with severe-to-very-severe COPD undergoing pulmonary rehabilitation. Current smokers (n = 38) were compared with never/former smokers (n = 64). Analyses included Chr15q25 genotyping (rs16969968), oxidative stress biomarkers (tail intensity, 8-OHdG, MDA, and bilirubin), hematological and immunological parameters, α7nAChR expression, TTV load as a surrogate marker of immune competence, latent virus prevalence, and five-year survival assessed by multivariable Cox regression. Results: Current smokers exhibited significantly higher DNA damage (tail intensity, p = 0.001; 8-OHdG, p = 0.002), lower bilirubin levels (p = 0.031), increased neutrophil and CD4⁺ T-cell counts (p = 0.031 and p = 0.028, respectively), altered α7nAChR expression on CD4⁺ T cells (p = 0.030), and higher TTV load (p = 0.002) than never/former smokers. The rs16969968 AA genotype was more frequent among current smokers. In survival analyses, an elevated WBC count was independently associated with increased mortality risk (HR 1.12, 95% CI 1.01–1.23; p = 0.035), whereas higher bilirubin levels showed a protective association. TTV load, smoking status, and FEV1 were not independently associated with mortality. Conclusions: In severe-to-very-severe COPD, smoking is associated with a distinct biological profile characterized by enhanced oxidative DNA damage, systemic inflammation, immune remodeling, reduced antioxidant defenses, and impaired control of persistent viral replication. WBC and bilirubin emerged as the biomarkers most consistently associated with long-term outcomes. These findings support integrated biological profiling as a tool for risk stratification and precision-guided rehabilitation in advanced COPD. Full article

Idiopathic pulmonary fibrosis (IPF) is one of the most severe forms of idiopathic interstitial pneumonia. Increasing evidence indicates that the gradual accumulation of senescent fibroblasts and alveolar epithelial cells contributes significantly to IPF pathogenesis, suggesting senescence as a potentially targetable process. Recurrent injury to the alveolar epithelium promotes senescence in epithelial cells, impairing their regenerative capacity and thereby predisposing the tissue to fibrotic degeneration. Although epithelial senescence is strongly implicated in the initiation and progression of lung fibrosis, the mechanisms through which it drives IPF remain challenging, partially due to the lack of physiologically relevant in vitro models capable of recapitulating lung architecture under both normal and pathological conditions. The objective of the present study was to develop a reproducible alveolosphere model in healthy and senescent conditions as a preliminary approach to investigate epithelial features that may be relevant to aspects of the IPF microenvironment. An alveolosphere system was generated by culturing alveolar epithelial cells with or without basement membrane components in combination with alveolar/epithelial optimized medium. Cultures were maintained for 3, 6, and 8 days, and cell viability together with morphological assessment confirmed the absence of cytotoxicity. The expression of keratin 8/18 and AQP5 was consistent with the maintenance of epithelial and alveolar-associated features. Cellular senescence was induced by exposing alveolospheres to doxorubicin for 24 h. Subsequent analyses of viability, along with the expression of senescent and pro-fibrotic markers, inflammatory mediators, and tissue remodeling factors, such as MMPs, were carried out in senescent 3D structures. The results demonstrated robust cell viability at all time points, supported by morphological observations. Marker expression suggested preservation of key epithelial characteristics, while senescence-inducing conditions were associated with an increase in senescence-associated, pro-fibrotic, inflammatory, and matrix-modulating markers. Collectively, these findings describe the preliminary establishment of a cost-effective and reproducible alveolosphere platform that may represent a useful starting point for studying epithelial senescence and its potential association with pro-fibrotic signaling relevant to aspects of IPF pathogenesis. Furthermore, this model may provide a basis for the preliminary evaluation of senotherapeutic compounds aimed at delaying or preventing the onset of cellular senescence. Full article

Background: Chronic rhinosinusitis with nasal polyps, CRSwNP, represents one of the most clinically relevant models of type 2 inflammation in the upper airways. Its pathogenesis is not sustained by a single mechanism but by the continuous interaction between epithelial barrier damage, immune activation and tissue remodeling. Although several systemic biomarkers are currently used in clinical practice, they do not always reflect the inflammatory processes occurring directly within the sinonasal mucosa. Objective: This review discusses nasal cytology as a local and clinically accessible read-out of type 2 inflammation and epithelial barrier dysfunction in CRSwNP. Particular attention is given to the relationship between cytological patterns, underlying immune mechanisms and the use of biologic therapies. Methods: A narrative review of the literature was conducted, focusing on epithelial barrier abnormalities, type 2 inflammatory pathways, cytological phenotypes and available monoclonal antibodies. The clinical relevance of these elements was considered, with particular regard to patient stratification and therapeutic decision-making. Results: Epithelial barrier disruption promotes the release of alarmins such as TSLP, IL-25 and IL-33. These mediators activate both innate and adaptive type 2 immune responses and contribute to the persistence of mucosal inflammation. Nasal cytology allows direct assessment of the local inflammatory infiltrate and makes it possible to identify eosinophilic, mast cell-predominant and mixed eosinophil–mast cell patterns. These profiles appear to mirror different inflammatory settings. In particular, the coexistence of eosinophils and mast cells may identify patients with more severe, persistent or recurrent disease. When integrated into clinical tools such as clinical–cytological grading (CCG), nasal cytology may improve disease stratification, support follow-up and help orient biologic therapy according to the level of the inflammatory cascade predominantly involved. These cytological profiles may also support biologic treatment selection, therapeutic monitoring, and future tapering strategies by reflecting the predominant inflammatory pathway active at the mucosal level. Conclusions: Nasal cytology is a direct, reproducible and clinically useful approach for evaluating local inflammation in CRSwNP. By providing information from the mucosal site of disease, it complements systemic biomarkers and may support personalized therapeutic strategies and biologic treatment selection in CRSwNP. Full article

Nanosecond electric pulses (nsEPs) are an emerging pulsed-power technology with unique bioelectric characteristics distinct from conventional long-pulse electroporation. As a tunable physical modality, nsEPs can modulate intracellular structures, membrane dynamics, and signaling pathways. Increasing evidence supports nsEPs as a promising non-thermal tumor ablation approach due to their high spatial precision, preservation of critical tissue structures, and minimal adverse effects. One of the most significant discoveries associated with nsEP tumor ablation is the induction of potent systemic antitumor immunity, particularly in situ vaccination (ISV) effects and, in some cases, abscopal effects against distant untreated tumors. Substantial evidence demonstrates that nsEPs can function as authentic immunogenic cell death (ICD) inducers by promoting the release of damage-associated molecular patterns (DAMPs), including calreticulin (CRT), ATP, and HMGB1. These events facilitate dendritic cell activation, antigen presentation, and the generation of long-term antitumor T-cell immunity. In addition to enhancing tumor immunogenicity, nsEPs profoundly remodel the tumor microenvironment (TME), including disruption of tumor vasculature, reduction in immunosuppressive cell populations, and alteration of stromal components. Emerging studies further suggest that nsEPs act as electric metabolic modulators capable of influencing mitochondrial function, calcium signaling, and metabolism-associated signaling pathways. Current evidence indicates that the immunological outcomes induced by nsEPs are highly dependent on pulse parameters, waveform characteristics, and tumor type. Despite its considerable therapeutic promise, the development of nsEP-induced ISV immunotherapy faces several important challenges, including standardization and optimization of pulse protocols, identification of critical molecular and cellular targets, and clarification of tumor- and cell-type-specific responses. Addressing these challenges through multidisciplinary collaboration and advanced technologies, including multi-omics, spatial analysis, and computational modeling, may accelerate the development of next-generation bioelectric immunotherapies for cancer treatment. Full article

Background: This study aimed to evaluate longitudinal changes in retinal layers, retinal vessel diameters, and choroidal thickness using optical coherence tomography (OCT) in patients with central retinal artery occlusion (CRAO). Methods: This retrospective study included 35 patients (70 eyes) diagnosed with unilateral CRAO between 1 January 2020 and 5 January 2024. Unaffected fellow eyes served as internal controls. OCT-based macular segmentation, retinal arterial and venous diameter measurements, and subfoveal and peripapillary choroidal thickness were assessed in the acute phase (<24 h) and at 1-month and 6-month follow-up visits. Subgroup analyses compared patients who received hyperbaric oxygen therapy (HBOT) with those who did not. Statistical analyses included t-tests, Mann–Whitney U, Wilcoxon signed-rank, and chi-square tests. Results: Retinal arterial and venous diameters showed significant narrowing during follow-up (arteries: 77.91  ±  11.77 µm to 70.74  ±  15.12 µm; veins: 130.94  ±  22.54 µm to 118.57  ±  20.61 µm; both p  <  0.05). Macular segmentation demonstrated marked thinning of the inner retinal layers, most prominently in the retinal nerve fiber layer and ganglion cell layer (40.09 ± 26.86 to 12.51 ± 4.99 µm and 61.20 ± 25.83 to 24.26 ± 12.11 µm, respectively; both p = 0.001). Subfoveal choroidal thickness progressively decreased over time (from 206.40 ± 34.91 µm to 178.86 ± 28.28 µm, p = 0.009). Peripapillary choroidal thickness increased across all quadrants at 6 months, most consistently in the inferior quadrant (p = 0.001). No significant differences in retinal or choroidal parameters were observed between HBOT-treated and non-treated patients. All cases exhibited persistent vascular occlusion without reperfusion. Conclusions: CRAO is characterized by progressive inner retinal atrophy, retinal vessel narrowing, and distinct temporal changes in choroidal morphology. The relative preservation and subsequent increase in peripapillary choroidal thickness during follow-up suggest dynamic choroidal involvement despite persistent occlusion. OCT-based macular segmentation and retinal vessel analysis provide objective biomarkers for longitudinal structural assessment in CRAO. By jointly quantifying retinal layer, retinal vascular, and choroidal remodeling, these findings may also provide reference data for future studies of structural evolution in non-reperfused CRAO. Full article

Cardiometabolic residual risk in type 2 diabetes mellitus (T2D) persists despite major advances in glucose-lowering therapy, lipid management, blood pressure control, weight reduction, and organ-protective strategies. This residual burden should not be interpreted solely as the consequence of incomplete achievement of conventional therapeutic targets, but rather as the clinical expression of persistent molecular activity involving multiple interconnected organs and pathways. Insulin resistance, metaflammation, oxidative stress, mitochondrial dysfunction, lipotoxicity, endothelial impairment, hepatic metabolic dysregulation, renal inflammation, fibrotic remodeling, and metabolic memory interact within a dynamic network linking adipose tissue, liver, kidney, immune cells, and vasculature. In this review, we discuss the biochemical and molecular drivers of cardiometabolic residual risk in T2D, with particular emphasis on impaired insulin receptor substrate/PI3K/Akt signaling, stress-kinase activation, NLRP3 inflammasome priming and assembly, MASLD-related lipotoxicity and fibrogenesis, podocyte and tubular injury, endothelial nitric oxide synthase uncoupling, AGE-RAGE signaling, and thrombo-inflammatory vascular injury. These pathways explain why biological vulnerability may persist even when conventional clinical parameters appear adequately controlled. We also examine the role of translational biomarkers and simple clinical indices, including TyG-derived indices, adiposity markers, hepatic steatosis and fibrosis scores, albuminuria, eGFR, and lipid-related markers, as accessible windows into active biological pathways. Finally, we review how contemporary therapeutic strategies may modulate selected components of this residual-risk network. A pathway-centered interpretation of T2D may support more precise residual-risk phenotyping and help move cardiometabolic care beyond isolated target control toward mechanism-based prevention. This review further links these mechanisms to the contemporary cardiovascular–kidney–metabolic (CKM) framework, as defined by the 2026 AHA/ACC/ADA/ASN CKM Guideline, and disaggregates the underlying molecular network into organ-specific pathway cascades that make the causal relationships between metabolic, inflammatory, hepatic, renal, and vascular injury more explicit. Full article

Circadian rhythms synchronize physiological processes with the light–dark cycle and regulate biological functions relevant to cancer, including cell-cycle control, metabolism, DNA repair, immunity, and tissue homeostasis. Growing evidence indicates that disruption of these temporal mechanisms contributes to tumor initiation, progression, metastasis, and treatment response. In colorectal cancer (CRC), circadian clock dysregulation has emerged as an important component of tumor biology. A systematic search identified 1338 records, of which 43 studies met the eligibility criteria (20 human, 19 experimental, and 4 chronotherapy studies). Across the included studies, statistically significant associations were consistently reported between dysregulation of clock genes such as PER1, PER3, CLOCK, BMAL1, CRY1, TIMELESS, and ARNTL2 and alterations in proliferation, metabolism, epithelial plasticity, immune regulation, metastatic potential, and treatment responsiveness. Experimental evidence also supported interactions with Wnt signaling, ferroptosis, oxidative-stress adaptation, epithelial–mesenchymal remodeling, and a proposed clock–microbiota–immune axis. Overall, the available evidence indicates that circadian dysregulation represents a systems-level disturbance that gives rise to a multidimensional biological condition, here referred to as the Tumor Temporal State, integrating the metabolic, immune, invasive, and therapeutic dimensions of colorectal cancer biology. Full article

Melittin, a cationic amphipathic 26-residue peptide from bee venom, displays broad-spectrum antibacterial, antitumor and anti-inflammatory activities, yet severe hemolysis, poor cell selectivity, rapid plasma degradation and high immunogenicity hinder its clinical translation. Structural modification is a vital strategy to overcome its druggability limitations. This review systematically summarizes three mainstream modification approaches of melittin: sequence remodeling, chemical derivatization and conjugate engineering. We illustrate how these strategies tune melittin’s conformation, charge and amphiphilicity to lower toxicity and immunogenicity, improve in vivo stability, and enable targeted stimulus-responsive delivery, while unraveling its core functional sites and mechanisms. Current research gaps and future directions including combined modification, multifunctional intelligent conjugates, preclinical safety assessment and scaled production optimization are discussed, providing theoretical support for developing safe, effective melittin-based therapeutics. Full article

Infectious wounds are plagued by persistent infection, uncontrolled inflammation, and delayed repair, while traditional therapies suffer from the poor solubility of natural drugs, low bioavailability, and bacterial drug resistance. To address these issues, this study developed a photo-responsive chitosan composite hydrogel (BBR-AS@Ce6@Matrix) cross-linked by chitosan (CS) and oxidized sodium alginate (OSA), co-loaded with Berberine–Asiaticoside cocrystal (BBR-AS) and chlorin e6-loaded chitosan nanoparticles (Ce6@CS NPs). The BBR-AS co-crystal was prepared by solvent method and verified to significantly improve the solubility and dissolution of asiaticoside. The Ce6@CS NPs were fabricated via non-solvent-assisted counterion complexation, showing high encapsulation efficiency, uniform particle size, and efficient singlet oxygen generation under irradiation. The hydrogel exhibited a three-dimensional porous network, favorable rheology, high water content, pH-dependent swelling and erosion behaviors, and significantly promoted BBR/AS release in vitro. In vitro experiments demonstrated strong antibacterial activity against Escherichia coli and Staphylococcus aureus, good cytocompatibility, and enhanced migration of L929 and Hacat cells. In a rat infectious wound model, the hydrogel combined with light irradiation markedly accelerated wound closure, promoted collagen deposition and angiogenesis, upregulated VEGF/CD31, and downregulated TNF-α/IL-6. In conclusion, BBR-AS@Ce6@Matrix integrates co-crystal solubilization, nanoparticle-facilitated release, and photodynamic synergy to achieve antibacterial, anti-inflammatory, pro-angiogenic and tissue remodeling effects, providing a promising multifunctional platform for infectious wound repair. Full article

Background: Benzo[a]pyrene (BaP), a common food contaminant, is a recognized gastric carcinogen. This study aimed to identify therapeutic targets and repurposed drugs for gastric cancer (GC) using BaP as a network toxicology query. Methods: An integrated strategy combining network toxicology, multi-omics, machine learning (Random Forest, LASSO, SVM-RFE), and experimental validation was applied. Results: By intersecting GC-associated genes with BaP-related targets and machine learning, we identified three hub genes. The logistic regression model further revealed KCNE2 as a protective factor (OR = 0.515, 95% CI: 0.383–0.692), while SULF1 (OR = 2.940, 95% CI: 1.399–6.179) and TIMP1 (OR = 5.351, 95% CI: 2.020–16.743) were identified as potential risk factors. Survival analysis confirmed their prognostic significance. Single-cell transcriptomics descriptively showed TIMP1 and SULF1 enrichment in malignant/stromal cells and fibroblasts, respectively, whereas KCNE2 was restricted to normal epithelial cells and silenced in tumors. GSVA implicated epigenetic regulation, ECM remodeling, and TGF-β signaling. Molecular docking and dynamics simulations suggested that BaP can form stable complexes with DNMT1 and DNMT3A. Accordingly, drug enrichment analysis identified DNMT inhibitor 5-azacytidine as a top candidate. Cellular experiments confirmed that 5-azacytidine selectively inhibited GC cells and was associated with modulation of the DNMT3A–KCNE2 axis. Conclusions: Our findings provide a novel molecular target and a repurposed drug for GC from the perspective of a food contaminant. Full article

Background/Objectives: Allergic rhinitis (AR) is a highly prevalent chronic inflammatory disease of the upper airway characterized by immune dysregulation. This study aimed to systematically characterize the immunomodulatory landscape of AR and identify exploratory molecular and cellular features associated with disease-related immune remodeling. Methods: Public bulk transcriptomic datasets and single-cell RNA sequencing data were integrated to identify immunomodulatory-related differentially expressed genes (IMRDEGs), construct an immunomodulatory score (IM.Score), evaluate immune cell infiltration, and characterize cell-type composition and intercellular communication. Machine learning was used to derive an exploratory molecular signature, and L1000CDS2-based drug repositioning analysis was performed to identify in silico candidate compounds predicted to oppose AR-associated transcriptional signatures. Results: A total of 12 IMRDEGs were identified and used to construct the IM.Score, which was lower in AR samples relative to control samples. Immune infiltration analysis demonstrated that IM.Score stratification was associated with distinct immune microenvironmental profiles. Single-cell analysis revealed potential reductions in CD4⁺ central memory T cells, which represent an immune cellular alteration requiring further experimental verification, alongside attenuated intercellular communication involving this cell population. A six-gene exploratory molecular signature comprising NFKBIA, PDCD1, MYC, IFNG, FOXP3, and CD274 showed favorable performance in the training cohort (AUC = 0.992, 95% CI: 0.974–1.000) but failed to generalize in the external validation cohort (AUC = 0.500, 95% CI: 0.245–0.755), precluding clinical diagnostic interpretation at this stage. Drug repositioning analysis identified candidate compounds, including narciclasine and BRD-K91370081, with the potential to reverse AR-associated transcriptional alterations. Conclusions: This integrative multi-omics analysis identifies coordinated molecular, cellular, and communication-level immune alterations in AR. The IM.Score, altered CD4⁺ central memory T-cell abundance, and six-gene exploratory molecular signature may be regarded as hypothesis-generating candidate clues pending further experimental and clinical validation. Full article

Diabetic kidney disease (DKD) progression results from complex interactions between metabolic stress, inflammatory activation, maladaptive intracellular signalling, and fibrotic remodelling. While previous studies demonstrated renoprotective effects of cell-specific Adam17 deletion, the impact of global Adam17 deficiency on the integrated renal response to diabetes remains incompletely understood. Here, we investigated the effects of tamoxifen-induced global Adam17 deletion in a streptozotocin-induced murine model of type 1 diabetes. Renal function, structural injury, inflammatory responses, stress-related signalling pathways, and fibrotic remodelling were comprehensively assessed in diabetic Adam17 knockout and control mice. Despite persistent hyperglycemia and ongoing albuminuria, diabetic Adam17 knockout mice exhibited preservation of glomerular filtration rate together with marked attenuation of diabetes-associated kidney injury. Global Adam17 deletion reduced mesangial expansion and structural damage, limited macrophage infiltration and chemokine expression, and significantly attenuated fibrotic remodelling. At the molecular level, Adam17 deficiency was associated with selective modulation of stress-related signalling pathways, including reduced activation of the PI3K/Akt axis and partial preservation of mitochondrial stress regulators, without evidence of generalized suppression of cellular stress responses. Notably, preservation of renal function occurred despite persistent albuminuria, supporting a partial dissociation between glomerular permeability alterations and progressive renal dysfunction. These findings demonstrate that global Adam17 deletion confers robust protection against diabetes-associated kidney injury through coordinated attenuation of inflammatory, stress-related, and profibrotic pathways. Our results extend previous cell-specific observations and highlight the context-dependent role of Adam17 in DKD progression, supporting the concept that integrated Adam17-related signalling may represent a relevant therapeutic target in diabetic kidney disease. Full article

Cancer remains one of the most frightening global health challenges, contributing substantially to morbidity and mortality across diverse populations. In recent years, naturally derived compounds have attracted considerable attention due to their potential therapeutic efficacy and fewer adverse effects. Among these, the flavokawain subclass of chalcones, comprising Flavokawains A, B, and C, obtained from various plant sources, has emerged as a promising group of bioactive phytochemicals exhibiting a broad spectrum of pharmacological activities, with notable anticancer potential. This review critically compiles and evaluates the existing preclinical evidence regarding the anticancer mechanisms of flavokawains across various cancer models. It was found that these compounds have significant potential to inhibit cancer cell proliferation, induce apoptosis, disrupt cell-cycle progression, and modulate multiple molecular pathways implicated in tumorigenesis, including phosphoinositide 3 kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), extracellular-signal regulated kinase/c-Jun N-terminal kinase/mitogen-activated protein kinase (ERK/JNK/MAPK) and so on. Importantly, flavokawains exert significant modulatory effects within the tumor microenvironment by suppressing angiogenesis through downregulation of vascular endothelial growth factor (VEGF) and Angiopoietin-1 (Ang-1), attenuating epithelial-mesenchymal transition via restoration of E-cadherin and suppression of vimentin and Snail1, inhibiting matrix metalloproteinase (MMP)-mediated extracellular matrix remodeling, and disrupting cancer stem cell (CSC)-supportive niches. Preclinical toxicity profiles suggest a favorable safety margin, though further investigation is required to fully elucidate their therapeutic index. Due to their multifaceted mechanisms of action and selective cytotoxicity toward cancer cells, flavokawains are considered promising preclinical candidates for development as adjuncts or alternatives to conventional chemotherapeutic agents. Full article

Percutaneous coronary intervention (PCI) treats focal coronary obstruction by compressing plaque, injuring the vessel wall, and placing a metallic or bioresorbable scaffold. Most treated segments heal, but a small minority enter a prolonged, excessive, or unstable repair state that contributes to in-stent restenosis (ISR), in-stent neoatherosclerosis, and stent thrombosis (ST). Human evidence is strongest for delayed healing, uncovered struts, macrophage-rich neoatherosclerosis, and hypersensitivity-associated late thrombosis, whereas routine immune biomarker-guided care remains unsupported. The practical question addressed here is therefore not whether inflammation participates, which is established, but which immune signals, read together with intravascular imaging, could realistically change post-PCI management. The narrowed lumen is only the visible endpoint; beneath it sits vascular repair shaped by device-material exposure, local haemodynamics, and host immunity. Endothelial denudation and platelet activation initiate fibrin deposition, complement signalling, and release of damage-associated molecular patterns (DAMPs). Neutrophils, monocytes, and macrophages dominate early, followed by lymphocytes and vascular smooth muscle cells that remodel the repair compartment. Drug-eluting stents (DES) have markedly reduced early neointimal hyperplasia, yet selected late failures still involve delayed endothelial recovery, chronic peristrut inflammation, hypersensitivity, and neoatherosclerotic transformation. Immune biology is useful at the bedside only when interpreted with procedural context, device design, and patient phenotype. Imaging-defined endpoints and paired immune phenotyping are therefore needed to guide treatment by mechanism instead of angiography or isolated biomarkers. Full article