1.Advances in platelet-associated membrane delivery systems
Ting PAN ; Li CHEN ; Chunyan YAO
Chinese Journal of Blood Transfusion 2026;39(2):277-284
Progress in biomimetic membrane systems has enabled the extensive application of cell membranes in constructing nano-drug delivery systems. These biological membranes endowed the delivery systems with advantages, including superior biocompatibility, precision targeting capabilities, and long circulation. Platelet membranes, owing to their distinctive biological properties, have emerged as exceptional natural materials for nano-drug delivery systems and have continuously promoted the development of the delivery systems in the field of disease treatment. This review comprehensively summarizes the biological characteristics and molecular basis of platelet-associated membranes, various coated systems and methods, and systematically summarizes the research progress of platelet-related membrane delivery systems in the treatment of tumors, inflammatory diseases, cardiovascular and cerebrovascular diseases, and thrombotic diseases. It also analyzes the application challenges in the biomedical field and looks forward to the future development direction.
2.Skeleton Binding Protein 1 of Plasmodium berghei Influences Deformability and Cytoskeletal Ultrastructure of Infected Erythrocyte
Xin-Yue GUO ; Huan-Qi ZHAO ; Yan-Xuan ZHONG ; Ru-Meng JIANG ; Yao-Xian LI ; Lei-Ting PAN ; Qian WANG ; Xiao-Yu SHI
Progress in Biochemistry and Biophysics 2026;53(4):1015-1027
ObjectiveThe malaria parasites remodel the host erythrocyte structure by exporting parasite proteins that interact with the membrane skeleton proteins of red blood cells (RBCs), facilitating their intracellular survival and pathogenicity. Skeleton-binding protein 1 (SBP1) is a conserved exported protein across Plasmodium species. In Plasmodium falciparum, SBP1 has been reported to interact with erythrocyte membrane skeleton proteins 4.1R and spectrin, while its contribution to erythrocyte remodeling and parasite virulence in Plasmodium berghei (Pb) remains unclear. This study aims to determine whether PbSBP1 associates with the host cytoskeletal protein 4.1R and to investigate its role in the remodeling of host RBCs and the pathogenicity of Plasmodium berghei. MethodsIn Plasmodium berghei, the relationship between PbSBP1 and the erythrocyte cytoskeletal protein 4.1R was examined using co-immunoprecipitation. A Pbsbp1 gene knockout mutant of Plasmodium berghei (Pbsbp1∆) was generated based on the principle of double crossover homologous recombination. The deformability of erythrocytes infected with Pbsbp1∆ parasites was assessed using microfluidic methods. Microchannels with an array of cylindrical pillars were used to detect modifications in infected RBC deformability. The infected RBCs were squashed between the rows and recovered between the columns and the transit velocity (μm/s) of infected RBCs travelling through the microchannel was recorded. The component of the erythrocyte membrane skeleton junctional complex, tropomodulin (TMOD), was fluorescently labeled, and the cytoskeletal network of infected erythrocytes was imaged using super-resolution stochastic optical reconstruction microscopy (STORM) to analyze ultrastructural changes in the cytoskeleton of wild-type (WT) and Pbsbp1∆-infected erythrocytes. Actin-based junctional complexes were displayed as individual clusters by the labeled TMOD in the STORM images, and the cluster densities and distances between adjacent clusters of infected RBCs were calculated. Additionally, rodent malaria models (BALB/c mice) and experimental cerebral malaria models (C57BL/6 mice) were employed to monitor the growth of Pbsbp1∆ and WT parasites during the intraerythrocytic stage and their capacity to induce cerebral malaria in mice. ResultsPbSBP1 may participate in the remodeling of infected erythrocytes through direct or indirect interaction with the erythrocyte cytoskeletal protein 4.1R. Microfluidic assays revealed that the deformability of erythrocytes infected with Pbsbp1∆ parasites was significantly enhanced compared to those infected with WT parasites. STORM imaging further demonstrated that the ultrastructure of the erythrocyte cytoskeleton in Pbsbp1∆-infected cells was altered relative to that in WT-infected erythrocytes. The distances between nearest neighbors of clusters had a tendency to increase while the cluster densities were decreased in Pbsbp1∆-infected RBCs compared to WT-infected RBCs. Subsequent phenotypic analysis indicated that the growth rate of Pbsbp1∆ parasites during the intraerythrocytic stage was significantly slower than that of WT parasites, and their ability to induce cerebral malaria in mice was also attenuated. These findings suggest that PbSBP1 is involved in the remodeling of the erythrocyte membrane skeleton, likely through its direct or indirect interaction with protein 4.1R, thereby regulating the deformability of infected erythrocytes and influencing the pathogenicity of the blood-stage parasites. ConclusionThis study establishes a role for PbSBP1 in host erythrocyte remodeling and parasite virulence, providing new research strategies for the prevention and treatment of malaria.
3.TGF-β1-engineered Biomimetic Platelet Nanoparticles for Targeted Therapy of Ischemic Stroke
Li-Qi CHEN ; Tian-Fang KANG ; Guo-Jun HUANG ; Ting YIN ; Ai-Qing MA ; Lin-Tao CAI ; Hong PAN
Progress in Biochemistry and Biophysics 2026;53(3):697-710
ObjectivePost-ischemic acute inflammation and the subsequent persistent dysregulation of the immune microenvironment represent major pathological drivers that aggravate neuronal injury and severely restrict functional recovery following ischemic stroke. Although current reperfusion therapies partially restore blood flow, they fail to effectively modulate the secondary inflammatory cascade and oxidative stress, which remain critical barriers to neurological restoration. To address this challenge, this study aimed to engineer and systematically evaluate a biomimetic nanosystem composed of transforming growth factor-β1 (TGF-β1)-loaded platelet membrane-camouflaged lipid nanoparticles (PLP). This nanosystem was designed to achieve dual lesion-targeted delivery and immune microenvironment remodeling. By verifying its spatiotemporal accumulation, anti-inflammatory activity, and neuroprotective efficacy, we sought to establish an integrated therapeutic strategy that simultaneously enables lesion targeting, immune regulation, and functional recovery after ischemic injury. MethodsThe physicochemical properties of PLP, including hydrodynamic particle size, zeta potential, structural stability, and morphology, were characterized using dynamic light scattering, zeta potential analysis, and transmission electron microscopy. The preservation of platelet membrane-derived adhesion and immunoregulatory proteins was confirmed by SDS-PAGE through comparative analysis of protein band profiles between PLP and native platelet membranes. The in vitro biological activities of PLP were evaluated using two complementary cellular models. LPS-induced M1-polarized RAW264.7 macrophages were employed to assess inflammatory modulation, while oxygen glucose deprivation/reperfusion (OGD/R)-induced BV2 microglial cells and SH-SY5Y neuronal cells were utilized to investigate neuroinflammatory regulation and neuronal protection. For in vivo validation, a transient middle cerebral artery occlusion (tMCAO) mouse model was established to mimic ischemia-reperfusion injury. The spatiotemporal biodistribution and lesion-targeting capability of the PLP were monitored through live fluorescence imaging. Therapeutic efficacy was comprehensively evaluated by triphenyltetrazolium chloride (TTC) staining, glial fibrillary acidic protein (GFAP) immunofluorescence analysis, body weight monitoring, and neurological severity score (NSS) assessment. ResultsPLP nanoparticles displayed a uniform spherical morphology, nanoscale particle size distribution, and stable negative surface charge, indicating favorable colloidal stability and circulation potential. SDS-PAGE results confirmed the effective retention of key platelet membrane proteins associated with endothelial adhesion, immune evasion, and inflammatory regulation, demonstrating the successful biomimetic construction. Optimal therapeutic concentrations were determined in OGD/R-induced BV2 cells, where PLP exhibited excellent cytocompatibility and anti-inflammatory activity.In vitro experiments demonstrated that PLP significantly inhibited the polarization of RAW264.7 macrophages toward the pro-inflammatory M1 phenotype and markedly reduced neuronal apoptosis under ischemia-reperfusion conditions. In vivo fluorescence imaging revealed that PLP rapidly accumulated in the ischemic brain hemisphere and maintained prolonged retention for up to 7 d, suggesting enhanced lesion-specific targeting and sustained drug release. Compared with control group, PLP treatment significantly reduced cerebral infarct volume, attenuated reactive astrogliosis, improved weight recovery, and accelerated neurological functional restoration, as reflected by significantly improved NSS scores. ConclusionThis study establishes a multifunctional biomimetic nanoplatform that integrates platelet membrane-mediated active targeting with the anti-inflammatory, antioxidative, and neuroprotective properties of TGF-β1. The PLP system enables rapid lesion homing and long-term retention while synergistically regulating the post-stroke inflammatory microenvironment by suppressing pro-inflammatory immune activation, reducing neuronal apoptosis, and limiting excessive astrocyte reactivity. Importantly, this study proposes a conceptually therapeutic paradigm that combines targeted delivery with immune microenvironment remodeling to achieve comprehensive neurovascular protection. These findings provide strong experimental evidence supporting the translational potential of biomimetic nanotherapeutics as next-generation precision interventions for ischemic stroke.
4.Buzhong Yiqitang Regulates Mitochondrial Homeostasis of Skeletal Muscle via PINK1 Pathways to Resist Exercise-induced Fatigue
Huani WEI ; Ting JIANG ; Juan PENG ; Chunxiang JING ; Wei LIU ; Huashan PAN ; Daorui CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):31-39
ObjectiveTo explore the effect of Buzhong Yiqitang on exercise-induced fatigue and its potential mechanism. MethodsSixty male SPF-grade C57BL/6J mice were randomized into blank, model, low-, medium-, high-dose (4.1, 8.2, 16.4 g·kg-1, respectively) Buzhong Yiqitang, and vitamin C (0.04 g·kg-1) groups. The blank and model groups were administrated with normal saline. Each group was administrated with corresponding agents by gavage at a dose of 0.2 mL once a day. Except the blank group, other groups underwent a 6-weeks exhaustive swimming test under negative gravity. At the end of the experiment, blood was collected, and the thymus, spleen, liver, and kidney weights were measured. Serum levels of lactic acid (LD), blood urea nitrogen (BUN), creatine kinase (CK), and malondialdehyde (MDA) were assessed by kits to evaluate fatigue. Hematoxylin-eosin staining was performed to observe pathological changes in the skeletal muscle. Electron microscopy was used to examine the skeletal muscle cell ultrastructure, with a focus on mitochondrial morphological changes. The adenosine triphosphate (ATP) content and activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ in skeletal muscle were determined by kits. The expression levels of key genes and proteins in the PTEN-induced putative kinase 1 (PINK1)-mediated mitochondrial homeostasis pathways in the skeletal muscle were evaluated via Real-time PCR and Western blot, respectively. ResultsCompared with the blank group, the model group showed reductions in weight gain rate (P<0.01) and thymus index (P<0.01), rises in serum levels of LD, BUN, MDA, and CK (P<0.01), disarrangement of skeletal muscle, broken muscle fibers, inflammatory cell infiltration in muscle fiber gaps, abnormal morphological changes (increased vacuolated mitochondria and disappearance of cristae) of mitochondria in skeletal muscle cells, and decreased mitochondria. In addition, the skeletal muscle in the model group showed reduced content of ATP, weakened activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05), up-regulated mRNA levels of PINK1, E3 ubiquitin-protein ligase (Parkin), hairy/enhancer-of-split related with YRPW motif 1 (HEY1), dynamin-related protein 1 (Drp1), sequestosome 1 (p62), and hypoxia-inducible factor 1 alpha (HIF-1α) (P<0.05), and down-regulated protein level of microtubule-associated protein 1-light chain 3B (LC3B) (P<0.01). Compared with the model group, Buzhong Yiqitang prolonged the swimming exhaustion time (P<0.01), increased the weight gain rate (P<0.01) and thymus index (P<0.01), lowered the serum levels of LD, BUN, MDA, and CK (P<0.05, P<0.01). The skeletal muscle in the Buzhong Yiqitang groups showed neat arrangement, reduced inflammatory cells, intact mitochondria with dense cristae, and increased mitochondria. In addition, the skeletal muscle in the Buzhong Yiqitang groups showcased increased ATP content, enhanced activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05, P<0.01), up-regulated protein levels of PINK1, Parkin, HEY1, LC3B, and Drp1 and mRNA level of HIF-1α (P<0.05, P<0.01), and down-regulated expression level of p62 (P<0.05, P<0.01). ConclusionBuzhong Yiqitang can prevent and treat exercise-induced fatigue by regulating the mitochondrial homeostasis of skeletal muscle via the HIF-1α/PINK1/Parkin and HIF-1α/HEY1/PINK1 signaling pathways.
5.Scientific analysis and usage reassessment of suspected medicinal cinnabar unearthed from Mawangdui Tomb No.3 of the Han Dynasty.
Ning-Ning XU ; Ting-Yan REN ; Ming-Jie LI ; Pan XIAO ; Guo-Hui SHEN ; Ji-Qing BAI ; Qi LIU
China Journal of Chinese Materia Medica 2025;50(11):2915-2923
Cinnabar(HgS) was widely used in ancient times for medicinal purposes, religious rituals, and pigments. A group of bright red powdery clumps was excavated from Mawangdui Tomb No.3 of the Han Dynasty. Early studies considered the clumps as evidence of cinnabar's medicinal use during the Qin-Han period. This study employed a range of archaeometric techniques, including extended-depth-of-field stereo imaging, micro-CT, scanning electron microscopy-energy dispersive spectroscopy, Raman spectroscopy, and Fourier transform infrared spectrometry FTIR, to systematically analyze the material composition and structural characteristics of these remains. The results revealed that the cinnabar particles were granular, finely ground, and tightly bound to silk matrix, with no detectable excipients typically associated with medicinal formulations. Micro-CT imaging indicated a well-preserved textile structure, with clear signs of sedimentary accumulation and mechanical damage. Based on historical and archaeological studies, this study suggested that these remains were more likely degraded accumulations of cinnabar-colored silk textiles rather than medicinal cinnabar. By clarifying the diversity of ancient cinnabar applications and preservation states, this study provides new insights for the archaeological identification of mineral medicinal materials and contributes to the standardized study of Chinese medicinal materials and understanding of the historical use of cinnabar.
History, Ancient
;
China
;
Humans
;
Medicine, Chinese Traditional/history*
;
Archaeology
;
Drugs, Chinese Herbal/history*
;
Spectroscopy, Fourier Transform Infrared
;
Spectrum Analysis, Raman
;
Mercury Compounds
6.Pharmaceutical process omics and its applications and prospects in drug quality control.
Yu-Ting LU ; Jia-Yu YANG ; Ying-Ting SHI ; Xin-Yuan XIE ; Jian-Yang PAN ; Hai-Bin QU
China Journal of Chinese Materia Medica 2025;50(13):3628-3634
The quality of drugs is a crucial premise for ensuring the safety and effectiveness of clinical medication, while quality control during the pharmaceutical process directly affects the quality and consistency of the final product formulation. However, there is a lack of a comprehensive and scientific system for assessing and optimizing the quality control level during the manufacturing process in the field of drug quality control. Therefore, this study proposed the concept of "pharmaceutical process omics", clarified its advantages in guiding drug production, and explored in depth the research approaches, diverse analytical techniques, and broad range of applications in drug quality control. In addition, this study anticipated the broad application prospects of pharmaceutical process omics in the field of drug quality control, aiming to provide a scientific basis for the development of pharmaceutical process quality control standards.
Quality Control
;
Humans
;
Drugs, Chinese Herbal/chemistry*
7.Two cases of creatine deficiency syndrome caused by GAMT gene mutations and literature review.
Ting-Ting ZHAO ; Zou PAN ; Jian-Min ZHONG ; Hai-Yun TANG ; Fei YIN ; Jing PENG ; Chen CHEN
Chinese Journal of Contemporary Pediatrics 2025;27(3):340-346
OBJECTIVES:
To summarize the clinical manifestations and genetic characteristics of creatine deficiency syndrome (CDS) caused by GAMT gene mutations.
METHODS:
A retrospective analysis was conducted on the clinical and genetic data of two children diagnosed with GAMT deficiency-type CDS at the Children's Medical Center of Xiangya Hospital, Central South University, from December 2020 to December 2024.
RESULTS:
The two patients presented with symptoms in infancy, and both had compound heterozygous mutations in the GAMT gene. Case 1 exhibited seizures and intellectual disability, while Case 2 had intellectual disability and attention-deficit hyperactivity disorder. Magnetic resonance spectroscopy of cranial MRI in both patients indicated reduced creatine peaks. After creatine treatment, seizures in Case 1 were controlled, but both patients continued to experience intellectual disabilities and behavioral issues. As of December 2024, a total of 21 cases have been reported in China (including this study), and 115 cases have been reported abroad. All patients exhibited developmental delay or intellectual disabilities, with 66.9% (91/136) experiencing seizures, 33.8% (46/136) presenting with motor disorders, and 36.8% (50/136) having behavioral problems. Seventy-five percent (102/136) of patients received creatine treatment, leading to significant improvements in seizures and motor disorders, although cognitive improvement was not substantial.
CONCLUSIONS
GAMT deficiency-type CDS is rare and presents with nonspecific clinical features. Timely diagnosis facilitates targeted treatment, which can partially improve prognosis.
Child
;
Female
;
Humans
;
Male
;
Creatine/deficiency*
;
Guanidinoacetate N-Methyltransferase/deficiency*
;
Intellectual Disability/genetics*
;
Mutation
;
Retrospective Studies
;
Rhabdomyolysis/genetics*
;
Language Development Disorders
;
Movement Disorders/congenital*
8.Additional role of low-density lipoprotein cholesterol on the risk of osteoporosis in men with or without coronary heart disease: a real-world longitudinal study.
Jing ZENG ; Zi-Mo PAN ; Ting LI ; Ze-Yu CHEN ; Xiao-Yan CAI ; Mei-Liang GONG ; Xin-Li DENG ; Sheng-Shu WANG ; Nan LI ; Miao LIU ; Chun-Lin LI
Journal of Geriatric Cardiology 2025;22(2):219-228
BACKGROUND:
Early control of low-density lipoprotein cholesterol (LDL-C) is crucial for reducing the progress of cardiovascular disease. However, its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive. Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China.
METHODS:
The retrospective cohort study of 1546 men aged 69.74 ± 11.30 years conducted in Beijing, China from 2015 to 2022. And the incidence of primary osteoporosis was annually recorded. LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C. The association of baseline LDL-C for osteoporosis was estimated using hazard ratio (HR) with 95% CI in Cox proportional hazard model, while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio (OR) with 95% CI in logistic regression model.
RESULTS:
During the median 6.2-year follow-up period, 70 men developed primary osteoporosis. The higher level of baseline LDL-C (HR = 1.539, 95% CI: 1.012-2.342) and mean LDL-C (OR = 2.190, 95% CI: 1.443-3.324) were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates. Compared with those in the LDL-C trajectory of low-stable decrease, participants with medium-fluctuant trajectory, whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease, were negatively associated with osteoporosis risk (OR = 2.451, 95% CI: 1.152-5.216). And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk (OR = 0.718, 95% CI: 0.212-2.437).
CONCLUSIONS
Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men. Early controlling a stable level of LDL-C is also essential for bone health.
9.Buzhong Yiqitang Regulates Mitochondrial Homeostasis of Skeletal Muscle via PINK1 Pathways to Resist Exercise-induced Fatigue
Huani WEI ; Ting JIANG ; Juan PENG ; Chunxiang JING ; Wei LIU ; Huashan PAN ; Daorui CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):31-39
ObjectiveTo explore the effect of Buzhong Yiqitang on exercise-induced fatigue and its potential mechanism. MethodsSixty male SPF-grade C57BL/6J mice were randomized into blank, model, low-, medium-, high-dose (4.1, 8.2, 16.4 g·kg-1, respectively) Buzhong Yiqitang, and vitamin C (0.04 g·kg-1) groups. The blank and model groups were administrated with normal saline. Each group was administrated with corresponding agents by gavage at a dose of 0.2 mL once a day. Except the blank group, other groups underwent a 6-weeks exhaustive swimming test under negative gravity. At the end of the experiment, blood was collected, and the thymus, spleen, liver, and kidney weights were measured. Serum levels of lactic acid (LD), blood urea nitrogen (BUN), creatine kinase (CK), and malondialdehyde (MDA) were assessed by kits to evaluate fatigue. Hematoxylin-eosin staining was performed to observe pathological changes in the skeletal muscle. Electron microscopy was used to examine the skeletal muscle cell ultrastructure, with a focus on mitochondrial morphological changes. The adenosine triphosphate (ATP) content and activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ in skeletal muscle were determined by kits. The expression levels of key genes and proteins in the PTEN-induced putative kinase 1 (PINK1)-mediated mitochondrial homeostasis pathways in the skeletal muscle were evaluated via Real-time PCR and Western blot, respectively. ResultsCompared with the blank group, the model group showed reductions in weight gain rate (P<0.01) and thymus index (P<0.01), rises in serum levels of LD, BUN, MDA, and CK (P<0.01), disarrangement of skeletal muscle, broken muscle fibers, inflammatory cell infiltration in muscle fiber gaps, abnormal morphological changes (increased vacuolated mitochondria and disappearance of cristae) of mitochondria in skeletal muscle cells, and decreased mitochondria. In addition, the skeletal muscle in the model group showed reduced content of ATP, weakened activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05), up-regulated mRNA levels of PINK1, E3 ubiquitin-protein ligase (Parkin), hairy/enhancer-of-split related with YRPW motif 1 (HEY1), dynamin-related protein 1 (Drp1), sequestosome 1 (p62), and hypoxia-inducible factor 1 alpha (HIF-1α) (P<0.05), and down-regulated protein level of microtubule-associated protein 1-light chain 3B (LC3B) (P<0.01). Compared with the model group, Buzhong Yiqitang prolonged the swimming exhaustion time (P<0.01), increased the weight gain rate (P<0.01) and thymus index (P<0.01), lowered the serum levels of LD, BUN, MDA, and CK (P<0.05, P<0.01). The skeletal muscle in the Buzhong Yiqitang groups showed neat arrangement, reduced inflammatory cells, intact mitochondria with dense cristae, and increased mitochondria. In addition, the skeletal muscle in the Buzhong Yiqitang groups showcased increased ATP content, enhanced activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05, P<0.01), up-regulated protein levels of PINK1, Parkin, HEY1, LC3B, and Drp1 and mRNA level of HIF-1α (P<0.05, P<0.01), and down-regulated expression level of p62 (P<0.05, P<0.01). ConclusionBuzhong Yiqitang can prevent and treat exercise-induced fatigue by regulating the mitochondrial homeostasis of skeletal muscle via the HIF-1α/PINK1/Parkin and HIF-1α/HEY1/PINK1 signaling pathways.
10.Analysis of the association between pre- and post-treatment genetic mutation status and treatment efficacy and survival in patients with newly diagnosed myelodysplastic syndromes with excess blasts receiving hypomethylating agent therapy
Ting ZHONG ; Tiejun QIN ; Zefeng XU ; Lijuan PAN ; Shiqiang QU ; Meng JIAO ; Qingyan GAO ; Zhijian XIAO ; Bing LI
Chinese Journal of Hematology 2025;46(5):417-424
Objective:To investigate the association between pre- and post-treatment gene mutation profiles and clinical outcomes (treatment response and prognosis) in patients with myelodysplastic syndromes with excess blasts (MDS-EB) receiving hypomethylating agent (HMA) monotherapy.Methods:The clinical characteristics, treatment efficacy, and survival outcomes of 69 treatment-naive patients with MDS-EB who underwent next-generation sequencing (NGS) before treatment and completed at least 4 cycles of HMA monotherapy at the Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, between June 2016 and September 2023, were retrospectively analyzed.Results:① The cohort comprised 47 males and 22 females with a median age of 62 years (range: 41-80). Thirty-nine patients were classified as MDS-EB1 and 30 as MDS-EB2. The median number of treatment cycles was 6 (range: 4-35). The median follow-up duration was 22 months (range: 5-72), and the median overall survival (OS) was 32 months (95% CI: 27-43). ② The presence of DTA (DNMT3A, TET2, or ASXL1) mutations, signaling pathway mutations, transcription factor mutations, or splicing factor mutations before HMA treatment showed no significant association with the best response within 4 treatment cycles, duration of response (DOR), or OS. TP53 mutation status was significantly associated with DOR and shorter OS. The median DOR was 3 months (95% CI: 1-10) for patients with biallelic TP53 mutations, 10 months (95% CI: 3-34) for those with monoallelic TP53 mutations, and 16 months (95% CI: 8-27) in patients without TP53 mutations ( P=0.032). The median OS was 16 months (95% CI: 7-38), 15 months (95% CI: 6-40), and 35 months (95% CI: 14-91), respectively ( P<0.001). ③ Neither the Revised International Prognostic Scoring System (IPSS-R) nor the Molecular International Prognostic Scoring System (IPSS-M) could predict the best response within 4 treatment cycles or DOR in patients receiving HMA therapy. ④ Among patients without TP53 mutations, the median OS was 55 months (95% CI: 9-106) for the major clone significant clearance group ( n=14) and 31 months (95% CI: 16-184) for the major clone non-significant clearance group ( n=10) ( P=0.013). For patients who responded to HMA treatment and had significant major clone clearance, the 3-year OS rate reached (77.8±13.9) %. Conclusion:For MDS-EB patients receiving HMA monotherapy, single gene mutations, IPSS-R, and IPSS-M could not effectively predict treatment outcomes before therapy. However, for patients without TP53 mutations, monitoring the degree of major clone clearance by NGS during treatment may predict the long-term efficacy in MDS patients receiving HMA therapy.

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