{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:52:31Z","timestamp":1791175951205,"version":"4.1.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Human cytomegalovirus (CMV), Epstein\u2013Barr virus (EBV), and human herpesvirus 6 (HHV-6) remain important causes of morbidity after allogeneic hematopoietic cell transplantation (HCT), yet biomarkers predicting viral reactivation are lacking. Extracellular vesicles (EVs) have emerged as promising liquid-biopsy tools in inflammatory and infectious diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this exploratory biomarker discovery study, 32 consecutive recipients of haploidentical HCT with post-transplant cyclophosphamide were prospectively enrolled. EV surface marker profiles were assessed by flow cytometry before transplantation and at predefined time points during the first three months post-HCT. Associations between EV phenotypes and viral reactivation were evaluated using logistic regression and time-varying Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CMV, EBV, and HHV-6 reactivation occurred in 20, 11, and 17 patients, respectively. Multivariable analyses showed that different EV phenotypic patterns were associated with CMV, EBV, and HHV-6 reactivation. CMV reactivation was associated with increased EV expression of CD44, CD86, CD140a, and CD144. EBV reactivation correlated with reduced CD30-positive EV concentrations and increased KRT18 expression. HHV-6 reactivation was associated with altered CD26, CD86, CD120a, and CD144 EV profiles. These associations remained significant after adjustment for acute graft-versus-host disease and concomitant viral infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Collectively, these exploratory findings support further validation of circulating EV phenotypes as candidate biomarkers for predicting and monitoring viral reactivation after haploidentical HCT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1937675","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:30:42Z","timestamp":1791174642000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracellular vesicle phenotypic patterns associated with CMV, EBV and HHV-6 reactivation after haploidentical transplantation with post-transplant cyclophosphamide"],"prefix":"10.3389","volume":"17","author":[{"given":"Giuseppe","family":"Lia","sequence":"first","affiliation":[{"name":"Division of Hematology, Department of Oncology, A.O.U. 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