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Conversely, we define Treg exhaustion more specifically as a state induced by chronic inflammation, characterized by persistent expression of inhibitory receptors (e.g., PD-1/TIGIT), metabolic insufficiency, epigenetic and lineage instability (such as FOXP3 destabilization), and a decline in suppressive capacity, particularly in the context of continuous antigenic and cytokine stimulation

10.1016/j.ejmech.2017.04.020 23 SalinasG

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And regulators get demand flowing through channels they can actually monitor. His read on the FDA vote is simple: whichever way the advisory committee goes, the demand doesnt go away, so the real fight is over whether that demand flows through a regulated, doctor-led system or stays in the gray market