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FL9-SA (also known as FL9-68) is an engineered 9-mer peptide superagonist designed to mobilize and activate MHC class Ib-restricted regulatory CD8 T cells (CD8 Tregs). Developed by researchers at the Dana-Farber Cancer Institute and Brigham and Women's Hospital, FL9-SA binds to the non-classical MHC class Ib molecule Qa-1 (the murine homolog of human HLA-E). This interaction strongly activates and expands CD8 Tregs, which selectively target and eliminate activated, pathogenic CD4+ T follicular helper (Tfh) cells that upregulate Qa-1-self-peptide complexes during immune responses. In preclinical models of fully mismatched heart and kidney transplantation, vaccination with FL9-SA, either alone or in combination with an mTOR inhibitor, significantly suppresses donor-specific antibody (DSA) production, reduces graft pathology (such as C4d deposition), and prolongs allograft survival, highlighting its therapeutic potential for promoting transplant tolerance and treating autoimmune disorders.
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