Nucleic acid-based therapeutics, which involve the manipulation of genetic materials to treat or prevent diseases, have gained considerable attention, leading to the approval of medicines such as COVID-19 vaccines, patisiran (Onpattro), and nusinersen (Spinraza). However, their clinical application is hindered by challenges such as nuclease degradation, poor biodistribution, limited cellular uptake, and inefficient endosomal escape. Extracellular vesicles (EVs), which are natural nanoscale drug delivery systems derived from various eukaryotic and prokaryotic cells, offer a safe, efficient, specifically targeted, and non-pathogenic method for nucleic acid delivery. In this review, we summarize the classical methods and the latest research advances in EV preparation and nucleic acid loading. Additionally, we review the primary administration routes for nucleic acid-loaded EVs, such as intravenous, local, oral, intranasal, and inhalation delivery. By addressing these aspects, this review aims to guide the optimal design and clinical application of nucleic acid-loaded EVs.

ARG1 catalyzes the conversion of L-arginine to L-ornithine, urea, polyamines, and L-proline, thereby balancing nitrogen detoxification with tissue-specific roles in proliferation and immunity. This review delineates the context-dependent functions of ARG1 across diverse cell types-including tumor cells, immune cells, endothelial cells, keratinocytes, and stem cells. In tumors, ARG1 drives immunosuppression and metabolic reprogramming but can paradoxically suppress tumorigenesis. Immune modulation via ARG1-polyamine crosstalk regulates T cell differentiation, macrophage polarization, and microbiota interactions, influencing infection and autoimmunity. Endothelial ARG1 exacerbates obesity-related vascular dysfunction, while keratinocyte ARG1 impacts wound healing and psoriasis. Emerging therapies-such as ARG1 inhibitors, engineered extracellular vesicles, and microbiome interventions-show preclinical promise in cancer, cardiovascular, and neurodegenerative diseases. By mapping ARG1's spatiotemporal metabolic networks, this work highlights its dual roles and positions ARG1 as a central player for precision medicine in complex pathologies.

Zone II flexor tendon injuries remain among the most challenging conditions in hand surgery due to the region's complex anatomy and high rates of postoperative complications, particularly adhesion formation and the resulting loss of range of motion. Although platelet-rich plasma (PRP), mesenchymal stromal cell (MSC) therapies, and hyaluronic acid (HA) have demonstrated therapeutic potential in other musculoskeletal conditions, their effectiveness in preventing postoperative adhesions following zone II flexor tendon repair, specifically, remains unclear. A comprehensive review of the literature was conducted using PubMed and Google Scholar to identify randomized controlled trials, prospective and retrospective cohort studies, and original research evaluating the use of PRP, MSCs, or HA in zone II flexor tendon repair. Only full-length English-language studies specifically addressing zone II injuries were included. Studies were excluded if they did not focus explicitly on zone II flexor tendon injuries, lacked clearly reported outcomes, or failed to assess postoperative adhesion formation and functional recovery. Search terms included but were not limited to "Zone II flexor tendon," "PRP Zone II flexor tendon repair," "stem cell Zone II flexor tendon repair," "hyaluronic acid Zone II flexor tendon repair." Data from both human and animal studies were collected to compare postoperative adhesion formation and functional outcomes. Studies across all compounds showed inconsistent results in animal and human trials. PRP for zone II flexor tendon repair showed limited and inconsistent benefits, with most preclinical and clinical trials reporting no significant improvement in adhesion prevention or range of motion. Higher leukocyte concentrations in PRP were associated with increased inflammatory activity, potentially promoting scar formation. In contrast, mesenchymal stromal cell therapies, particularly adipose- and synovium-derived MSCs, demonstrated promising preclinical effects by modulating inflammation, reducing scar-related gene expression, limiting apoptosis, and enhancing tendon gliding though statistical significance was not always achieved. HA showed the most promising results with a majority of animal and human studies consistently reducing adhesion formation and improving tendon excursion and functional outcomes in the long-term. Across all the examined studies, no agent- PRP, MSCs, or HA- consistently prevented postoperative adhesions or reliably improved range of motion following zone II flexor tendon repair, specifically. The complex anatomy of zone II, inconsistent functional outcomes, limited mechanistic understanding, and wide methodological variation among studies, continue to limit the ability to draw definitive conclusions. Cost and accessibility further complicate the clinical adoption of these adjuncts. Current evidence does not support the routine use of PRP, MSCs, or HA for preventing postoperative adhesions after zone II flexor tendon repair. Nevertheless, while research on this topic remains limited, a few existing studies have shown promising trends that warrant further investigation. Future research should incorporate age-specific analyses, standardized agent formulations, clearer mechanistic evaluation, and optimized delivery methods to better determine whether these adjuncts can consistently and reliably improve outcomes in this anatomically challenging region.

Both primary and metastatic brain tumors rely on signals from the surrounding environment for their survival and progression. In particular, the most common and lethal brain cancer, glioblastoma (GBM), derived from glial cells (astrocytes or microglia), has been shown to integrate into synaptic networks and to receive paracrine signals from neighbouring tumor microenvironment (TME) cells. There is increasing evidence that metastatic disease in the brain exhibits similar behavior. The TME both maintains malignant cells and is maintained by them, a process that relies on cancer stem cells (CSCs). These stem cells and their signaling mechanisms, including in the case of GBM, "GSCs," provide possible novel targets for immunotherapy. In this review, we will discuss the integration of primary and malignant brain tumors into normal synaptic networks, the role of tumor stem cells and the TME in this integration, and the potential for immunotherapeutic targeting of these processes.

This review synthesizes evidence from recent clinical and mechanistic studies published between 2015 and 2024 to provide updated insights into the prevention and management of adverse drug reactions (ADRs) associated with first-line anti-tuberculosis drugs (ATDs)-namely isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (EMB)-which are essential for tuberculosis (TB) treatment but frequently cause significant ADRs that threaten therapeutic success. We examine four major toxicities: hepatotoxicity (primarily from INH and RIF, mediated by oxidative stress, mitochondrial dysfunction, and cytochrome P450 induction); peripheral neuropathy (driven by INH-induced pyridoxine depletion and EMB-related copper chelation leading to optic and axonal damage); central nervous system (CNS) toxicity (notably INH-induced seizures due to GABAergic disruption); and myelosuppression (mainly RIF- or PZA-related, involving oxidative injury to hematopoietic stem cells and impaired DNA synthesis). Key risk factors include advanced age, malnutrition, pre-existing organ dysfunction, and pharmacogenetic variations (eg, NAT2 acetylator status). Management strategies emphasize protocol-driven monitoring-including baseline and serial liver function tests (LFTs), complete blood counts (CBC), neurologic exams, and monthly visual assessments for EMB-and graded interventions based on severity thresholds (eg, temporary discontinuation if ALT >3× upper limit of normal (ULN) with symptoms or >5× ULN asymptomatic), alongside targeted therapies such as pyridoxine for neuropathy and N-acetylcysteine for hepatotoxicity. Proactive measures, including pretreatment risk stratification, patient education, and multidisciplinary coordination, are critical to optimizing adherence and outcomes. Effective management of first-line anti-TB drug toxicity requires mechanism-informed monitoring, individualized interventions, and proactive patient education to maintain treatment adherence and improve global TB outcomes.

To systematically evaluate the efficacy and safety of mesenchymal stem cell (MSC) therapy for patients with Multiple System Atrophy (MSA) by synthesising available clinical trial evidence and clarifying signals of disease modification.

Protein S-palmitoylation is a highly conserved posttranslational lipid modification that occurs on cysteine residues and critically influences protein maturation, subcellular localization, trafficking, and stability. Owing to its unique reversibility and dynamic nature, S-palmitoylation plays a pivotal role in cancer. This review comprehensively summarized the expression profiles and distribution of key cancer-related S-palmitoylation enzymes in recent years. Importantly, we highlight the specific mechanisms by which the dual states of palmitoylation and depalmitoylation function as a dynamic regulatory axis during the transformation of cancer cells into cancer stem cells and during the transition from a normal tissue environment to a tumor microenvironment. Furthermore, we discussed emerging therapeutic strategies targeting S-palmitoylation, including the development of specific inhibitors and competitive blockade of substrate-binding sites, which offer additional insights into the translational potential of S-palmitoylation as a therapeutic target for cancer.

Male factors contribute to approximately half of all infertility cases globally, with heat stress recognized as a major environmental determinant of impaired male reproductive function. Extensive research indicates that heat stress disrupts spermatogenesis through multiple pathways, including testicular oxidative stress (OS), compromise of the blood-testis barrier, and dysregulation of the spermatogonial stem cell niche. As global temperatures rise, the prevalence of heat-induced reproductive impairment is increasing, underscoring the urgent need to identify safe and effective interventions that target the underlying oxidative damage. L-citrulline demonstrates significant potential in the field of male reproductive protection. However, existing reviews primarily focus on general discussions of antioxidants, lacking a systematic analysis of the specific mechanisms of L-citrulline. This review systematically synthesizes current knowledge on the molecular mechanisms of heat stress-induced oxidative injury in male gametes. Particular emphasis is placed on the multifaceted protective role of L-citrulline, which acts through synergistic mechanisms involving modulation of the arginine-nitric oxide (NO) pathway, preservation of mitochondrial homeostasis, restoration of autophagy flux, and suppression of apoptotic signaling. By integrating experimental and clinical evidence, this analysis aims to elucidate both the translational potential and the key scientific challenges of L-citrulline supplementation in male reproductive health. The review seeks to advance the translation of L-citrulline from basic research to clinical practice and to propose novel nutritional strategies for improving fertility outcomes in men exposed to heat stress.

Male infertility due to spermatogenic failure remains a global challenge. While in vitro spermatogenesis (IVS) offers potential for fertility preservation, recapitulating the complex, species-specific testicular niche remains a formidable task. This review evaluates IVS progress and bottlenecks across rodents, primates, domestic animals, and humans.

The purpose of the study was to discuss the role of molecular imaging in stem cells (SCs) therapy and SC tracking with the special focus on nuclear medicine (NM) applications.

Small extracellular vesicles (sEVs) have emerged as central mediators of intercellular communication in the central nervous system (CNS) and are increasingly recognized for their dual roles in the pathogenesis and treatment of neurodegenerative diseases (NDDs). In disease contexts, sEVs facilitate the intercellular dissemination of pathogenic proteins and nucleic acids, thereby contributing to the propagation of Alzheimer's disease (AD) and Parkinson's disease (PD) pathology. Conversely, their intrinsic biocompatibility, capacity to traverse brain barriers, and inherent organotropic properties position sEVs as highly promising nanocarriers for CNS drug delivery. While mesenchymal stem cell-derived sEVs have been widely investigated in preclinical NDD models, accumulating evidence suggests that sEVs derived from neural cells, including neural stem cells, neurons, astrocytes, microglia, oligodendrocytes, and brain endothelial cells may offer superior brain targeting, disease relevance, and functional efficacy. This review provides a comprehensive and critical analysis of current knowledge on neural cell-derived sEVs, encompassing their physiological roles in brain homeostasis, their involvement in AD and PD pathogenesis, and their emerging therapeutic applications. We discuss cell-type-specific sEV cargo profiles, mechanisms underlying blood-brain and blood-cerebrospinal fluid barrier traversal, and recent advances in endogenous and exogenous engineering strategies that enhance cargo loading, targeting precision, and therapeutic performance. Importantly, we address key translational challenges that currently limit clinical implementation. By integrating mechanistic insights with therapeutic and engineering perspectives, this review highlights neural cell-derived sEVs as a biologically informed and versatile platform, underscoring their potential to advance next-generation neuro-nanomedicine for NDDs.

Skin photoaging, clinically characterized by wrinkles and hyperpigmentation, accounts for 80% of extrinsic aging. Chronic UV exposure drives this process via oxidative damage. However, its synergistic axis with mitochondrial dysfunction remains mechanistically elusive. This study aims to elucidate the mechanistic link between mitochondrial oxidative stress and UV-induced photoaging, focusing on reactive oxygen species overproduction as a central driver of cellular decline.

Stem cell transplantation (SCT) holds significant promise for regenerative medicine, yet immune rejection remains a major obstacle. To address this, recent advances leverage CRISPR/Cas9 to engineer hypoimmunogenic induced pluripotent stem cells. These modified cells lack classical immune recognition markers (HLA class I/II) yet retain immune-tolerant molecules such as HLA-E, HLA-G, and CD47, enabling their universal use across different individuals. Additionally, mesenchymal stem cell-derived exosomes and immune checkpoint modulators (e.g., PD-L1) have shown clinical effectiveness by reducing graft-versus-host disease and autoimmune reactions. They achieve this through mechanisms such as suppressing inflammatory T-cell activation, promoting regulatory T-cell expansion, and modulating macrophage polarization. Despite these advances, several challenges remain. One key concern is the potential tumorigenic risk caused by genomic instability during genome editing and long-term cell expansion. Emerging precision editing platforms, including base editing and prime editing, provide strategies to reduce double-strand DNA break-induced chromosomal rearrangements and improve genomic safety. Future research priorities include integrating AI-based immune profiling, precision genome editing, and advanced 3D-bioprinting technologies. Together, these innovations represent a paradigm shift toward developing safer, more effective, universally compatible stem cell therapies for diseases previously deemed untreatable.

Hal E. Broxmeyer profoundly shaped modern hematopoietic stem cell biology through a rigorously functional approach that defined stem and progenitor cells by what they do rather than how they appear. Across five decades, his work established a unifying principle: biological mechanisms matter most when they preserve or enhance durable, multilineage hematopoietic reconstitution, particularly in transplantation. This function‑first philosophy guided seminal contributions spanning cytokine regulation of hematopoiesis, umbilical cord blood transplantation, stem cell mobilization, and the biology of hypoxia. Broxmeyer helped define hematopoietic regulation as emerging from a complex, context‑dependent "sea of cytokines," challenging reductionist models that assigned fixed roles to individual factors. This conceptual framework informed translational advances, including the identification of dipeptidyl peptidase‑4 (DPP4/CD26) as a key regulator of chemokine activity, stem cell homing, mobilization, and engraftment, ultimately influencing clinical mobilization strategies and cord blood transplantation outcomes. His pioneering demonstration that human umbilical cord blood contains functionally competent hematopoietic stem cells transformed discarded biological material into a globally used graft source. Equally transformative was his recognition of oxygen tension as a critical, often overlooked determinant of stem cell integrity. By defining extraphysiological oxygen shock/stress (EPHOSS), Broxmeyer revealed how routine handling conditions compromise stem cell function and identified mechanistic strategies to preserve engraftment capacity. Together, these contributions reshaped experimental standards, aligned basic discovery with clinical reality, and trained generations of scientists to prioritize functional validation. Broxmeyer's legacy endures not only in clinical practice worldwide, but in a way of thinking that anchors discovery to biological and therapeutic relevance. TEASER ABSTRACT: Hal E. Broxmeyer helped define modern hematopoietic stem cell biology through a singular guiding principle: stem and progenitor cells must ultimately be judged by function durable, multilineage hematopoietic reconstitution rather than phenotype alone. This tribute synthesizes five decades of his scientific impact across cytokine biology, umbilical cord blood transplantation, stem cell mobilization, DPP4/CD26-mediated regulation of homing and engraftment, and the recognition of hypoxia and extra-physiologic oxygen stress as critical determinants of stem cell integrity. From conceptualizing hematopoietic regulation as a context-dependent "sea of cytokines," to establishing umbilical cord blood as a clinically viable graft source, to translating mechanistic insights into mobilization and engraftment strategies, Broxmeyer consistently linked molecular discovery to transplantation-relevant outcomes. His work reshaped experimental standards, clinical practice, and translational thinking in hematology. In an era increasingly dominated by descriptive depth, his legacy remains a powerful reminder that the highest measure of discovery is enduring biological function.

The CXCR4/CXCL12 signaling axis plays a central role in regulating immune cell trafficking, hematopoietic homeostasis, and organogenesis. However, dysregulation of this axis contributes to the pathogenesis of numerous disorders, highlighting CXCR4 inhibition as a promising therapeutic strategy. Mavorixafor, the first orally available small-molecule CXCR4 antagonist, recently received FDA approval for WHIM syndrome (Warts, Hypogammaglobulinemia, Infections, and Myelokathexis) and is currently being developed for additional indications. Despite extensive research on CXCR4 biology, a comprehensive analysis of mavorixafor's pharmacologic profiles and its performance in preclinical and clinical settings is lacking. This systematic review synthesizes the pharmacology, efficacy, and safety of mavorixafor, summarizing evidence from various sources, including PubMed/MEDLINE, Web of Science, Google Scholar, conference proceedings, clinicaltrials.gov, and FDA resources. Mavorixafor demonstrates potent CXCR4 antagonism, rapid oral absorption, and a long half-life, enabling once-daily dosing. Clinically, it has been shown to increase neutrophil counts and reduce infection rates, contributing to its approval for WHIM syndrome. Early clinical studies in chronic neutropenia indicate sustained neutrophil elevation and decreased dependence on G-CSF. Additionally, emerging data suggest potential benefits in specific malignancies and its utility in mobilizing hematopoietic stem and progenitor cells, as well as in other immune-mediated disorders related to CXCR4 dysregulation. Furthermore, this review positions mavorixafor within the broader CXCR4-targeted therapeutic landscape, identifying current research gaps and suggesting directions for future studies. In conclusion, by integrating mechanistic insights with preclinical and clinical findings, this article highlights mavorixafor's promise as a targeted therapy with the potential to transform treatment paradigms for CXCR4-driven diseases.

Zinc is a component of the antioxidant defense system. Its functions protecting biological systems from oxidation are exerted at multiple levels including competing with redox active metals for binding sites, dynamically interacting with thiol groups and inducing metallothionein (MT) expression, regulating oxidant production, and increasing antioxidant defenses in part via NRF2 modulation. Zinc also directly and indirectly modulates redox regulated signaling cascades. Zinc deficits can affect not only the capacity of cells to defend against oxidative challenges but also alter redox signaling that modulate key cellular processes. Zinc is essential at different stages of development given its capacity to regulate key participating processes, e.g. cell proliferation, differentiation and survival. In the developing brain, the adverse consequences of a decrease in zinc availability depend on the severity and the timing of the deficiency. While gestational severe zinc deficiency causes teratogenesis in the brain and several other organs, mild zinc deficiency has significant deleterious consequences on the neural stem cell pool, neurogenesis, oligodendrogenesis, and astrogliogenesis in the offspring. Alterations in neuron, oligodendrocyte and astrocyte number, neuronal specification and myelination associated with zinc deficits in early development persist into adulthood, affecting behavior and motor performance. This review will focus on the role of zinc on brain development and on the interconnection between zinc and the redox tone in shaping different windows of neurodevelopment.

Bone marrow organoids (BMOs) are three-dimensional cell culture models that recapitulate key structural and functional features of the bone marrow (BM) niche. BMOs offer important advantages in hematopoietic research by modeling key aspects of human hematopoiesis compared to classical in vitro two- and three-dimensional cellular models including bioreactors, BM-on-a-chip platforms, 2D models or BM ossicles by better recreating the three-dimensional architecture, cellular heterogeneity, and spatial organization of the BM microenvironment. They offer a scalable and cost-effective alternative to animal models and reduce the need for animal experiments. Induced pluripotent stem cell (iPSC)-derived BMOs can be generated from a patient's own cells, enabling personalized disease modeling and drug testing and are highly amenable to gene editing technologies allowing precise modifications to study gene function or model diseases. Recent landmark studies from Christoph Klein and Abdullah Khan have established protocols for the generation of BMOs and demonstrated their applications in disease modeling. Here, we review the critical steps in BMO generation, their structural/ functional validation and discuss how BMOs can be applied to model inflammatory responses, rare genetic bone marrow failure syndromes, and multiple myeloma. These advances demonstrate BMOs' growing potential as powerful tools in hematopoietic research and will pave the way for further innovation and increasingly refined systems in future studies.

Regenerative medicine increasingly relies on therapeutic cells such as mesenchymal stem cells (MSCs), induced pluripotent stem cells (iPSCs), and engineered cellular constructs to repair and restore damaged tissues. However, clinical translation is constrained by challenges in maintaining viability, ensuring precise localization, achieving durable engraftment of transplanted cells, and producing enough clinically relevant cells at scale. Microfluidic technologies are emerging as transformative tools to address these barriers by enabling precise manipulation of fluids, biomaterials, and cells at the microscale. In the context of therapeutic cell delivery, these platforms can improve early retention and engraftment compared with conventional needle injection, tighten control over delivered cell dose, preserve viability under defined shear conditions, enable site-specific placement of cell-laden carriers, and support immunoisolating or immunomodulatory architectures that enhance immune safety. These platforms provide controlled microenvironments that mimic native tissue architecture, regulate biochemical and mechanical cues, and support scalable production of cell-laden carriers. Advances in microfabrication, from soft lithography and thermoplastics to 3D printing and hydrogel integration, have expanded device versatility, while embedded sensors allow real-time monitoring of cell state, metabolism, and differentiation. Beyond single-cell delivery, microfluidics facilitates encapsulation, co-culture, and organoid assembly, enabling multicellular systems with physiologically relevant interactions. Coupled with CRISPR genome editing and synthetic biology, these platforms allow the engineering of "smart" therapeutic cells with enhanced regenerative and immunomodulatory functions. Applications extend to microfluidic sorting for stem cell purification, controlled differentiation, and advanced manufacturing of immune cell therapies such as Chimeric Antigen Receptor (CAR)-T cells, alongside exosome-based strategies for precision delivery. Despite promising progress, obstacles remain in regulatory standardization, large-scale manufacturing, and integration with clinical workflows. This review highlights state-of-the-art microfluidic approaches for controlled delivery of stem cells and engineered cells, emphasizing how these systems impact key delivery metrics such as retention, dose control, shear resilience, spatial targeting, and immune interfaces to advance precision and personalized regenerative medicine.

Dormant cancer stem cells (CSCs) are the root cause of the drug resistance and metastatic processes of malignant tumors, but an in-depth analysis of their biological mechanisms is needed. Dormant CSCs are in the G0 phase of the cell cycle and are characterized by enhanced autophagic activity, a stable genomic structure and strong plasticity. Recently, several new specific markers of dormant CSCs, such as p27, CD13, QSOX1, Survivin, GPD1 and BEX2, have been identified, which offer hope for targeted therapy. In addition, epigenetic modifications such as DNA methylation and histone modifications have been reported to regulate the transition between the quiescent and proliferative states of dormant CSCs. From a clinical perspective, keeping cancer stem cells in a dormant state is helpful for preventing tumor recurrence and metastasis. To this end, clarifying the potential mechanisms and molecular regulation of cancer stem cell dormancy is vital. Here, in this review, we examine recent significant findings regarding tumor stem cell dormancy in both experimental and human disease models, emphasizing the underlying molecular mechanisms, regulatory processes, experimental models, and prospective research directions aimed at advancing this field and enhancing clinical translation.

Ameloblastoma is a benign odontogenic tumor with an aggressive growth phenotype orchestrated by a complex and heterogeneous tumor microenvironment. This review addresses how tumor cells, cancer-associated fibroblasts, mesenchymal stem cells, endothelial cells, and immune cells interact with non-cellular elements especially the extracellular matrix and hypoxic niches to drive invasive growth and recurrence. Several genetic changes associated with ameloblastoma activate mitogen-activated protein kinase (MAPK), Hedgehog (HH), Wnt/β-catenin, and less commonly PI3K/AKT signaling pathways. These pathways increase matrix-degrading enzymes such as matrix metalloproteinases and heparanase and reorganize collagen to create paths for local spread of ameloblastoma cells. Hypoxic niches in ameloblastoma stabilize hypoxia-inducible factor (HIF-1)α and activate vascular endothelial growth factor (VEGF) thereby linking low oxygen tension to new blood vessel growth within the microenvironment. Crosstalk between ameloblastoma epithelium and stroma through interleukin-6, transforming growth factor (TGF)-β, and connective tissue growth factor (CTGF) activates a positive feedback loops that stiffen the extracellular matrix and promote collective invasion. Within the encompassing jaw bone, a higher receptor activator of nuclear factor kappa-Β ligand/osteoprotegerin (RANKL/OPG) ratio and parathyroid hormone-related protein (PTHrP) level stimulate osteoclastogenesis, which accounts for the characteristic osteolysis displayed by ameloblastoma. Additionally, PD-L1 expression in ameloblastoma weakens T-cell activity in spite of the high population of M1 macrophages at the tumor leading edge. Collectively, coordinated interplay of these molecular processes define the invasive and aggressive growth phenotypes of ameloblastoma. Opportunities abound for development of targeted therapies for management of ameloblastoma. Potential candidates are inhibitors of BRAF/MEK and smoothened (SMO) gene/HH pathways, interruption of the TGF-β-Cancer-associated fibroblast axis, anti-angiogenic strategies, immune checkpoint blockade, and RANKL-directed therapy.