Trial Report Plasma cell targeting with the anti-CD38 antibody daratumumab in ME/CFS -a clinical pilot study, 2025, Fluge et al

We don't seem to have discussed the possibility that blocking CD38 on a whole load of other cells is what made people feel better.

Some other papers of potential interest relating to CD38 —

CD38 ecto-enzyme in immune cells is induced during aging and regulates NAD+ and NMN levels (2020)

Decreased NAD+ levels have been shown to contribute to metabolic dysfunction during aging. NAD+ decline can be partially prevented by knockout of the enzyme CD38. However, it is not known how CD38 is regulated during aging, and how its ecto-enzymatic activity impacts NAD+ homeostasis.

Here we show that an increase in CD38 in white adipose tissue (WAT) and the liver during aging is mediated by accumulation of CD38+ immune cells. Inflammation increases CD38 and decreases NAD+. In addition, senescent cells and their secreted signals promote accumulation of CD38+ cells in WAT, and ablation of senescent cells or their secretory phenotype decreases CD38, partially reversing NAD+ decline. Finally, blocking the ecto-enzymatic activity of CD38 can increase NAD+ through a nicotinamide mononucleotide (NMN)-dependent process.

Our findings demonstrate that senescence-induced inflammation promotes accumulation of CD38 in immune cells that, through its ecto-enzymatic activity, decreases levels of NMN and NAD+.

Web | PDF | Nature Metabolism | Paywall

Senescent cells promote tissue NAD+ decline during ageing via the activation of CD38+ macrophages (2020)

Declining tissue nicotinamide adenine dinucleotide (NAD) levels are linked to ageing and its associated diseases. However, the mechanism for this decline is unclear.

Here, we show that pro-inflammatory M1-like macrophages, but not naive or M2 macrophages, accumulate in metabolic tissues, including visceral white adipose tissue and liver, during ageing and acute responses to inflammation. These M1-like macrophages express high levels of the NAD-consuming enzyme CD38 and have enhanced CD38-dependent NADase activity, thereby reducing tissue NAD levels.

We also find that senescent cells progressively accumulate in visceral white adipose tissue and liver during ageing and that inflammatory cytokines secreted by senescent cells (the senescence-associated secretory phenotype, SASP) induce macrophages to proliferate and express CD38.

These results uncover a new causal link among resident tissue macrophages, cellular senescence and tissue NAD decline during ageing and offer novel therapeutic opportunities to maintain NAD levels during ageing.

Web | PDF | Nature Metabolism | Paywall

Nerve-associated macrophages control adipose homeostasis across lifespan and restrain age-related inflammation (2025)

Age-related inflammation or ‘inflammaging’ increases disease burden and controls lifespan. Adipose tissue macrophages (ATMs) are critical regulators of inflammaging; however, the mechanisms involved are not well understood in part because the molecular identities of niche-specific ATMs are unknown.

Using intravascular labeling to exclude circulating myeloid cells followed by single-cell sequencing with orthogonal validation via multiparametric flow cytometry, we define sex-specific changes and diverse populations of resident ATMs through lifespan in mice. Aging led to depletion of vessel-associated macrophages, expansion of lipid-associated macrophages and emergence of a unique subset of CD38+ age-associated macrophages in visceral adipose tissue with inflammatory phenotype.

Notably, CD169+CD11c− ATMs are enriched in a subpopulation of nerve-associated macrophages (NAMs) that declines with age. Depletion of CD169+ NAMs in aged mice increases inflammaging and impairs lipolysis suggesting catecholamine resistance in visceral adipose tissue.

Our findings reveal NAMs are a specialized ATM subset that control adipose homeostasis and link inflammation to tissue dysfunction during aging.

Web | PDF | Nature Aging | Open Access

CD38: An Immunomodulatory Molecule in Inflammation and Autoimmunity (2020)

CD38 is a molecule that can act as an enzyme, with NAD-depleting and intracellular signaling activity, or as a receptor with adhesive functions. CD38 can be found expressed either on the cell surface, where it may face the extracellular milieu or the cytosol, or in intracellular compartments, such as endoplasmic reticulum, nuclear membrane, and mitochondria.

The main expression of CD38 is observed in hematopoietic cells, with some cell-type specific differences between mouse and human. The role of CD38 in immune cells ranges from modulating cell differentiation to effector functions during inflammation, where CD38 may regulate cell recruitment, cytokine release and NAD availability. In line with a role in inflammation, CD38 appears to also play a critical role in inflammatory processes during autoimmunity, although whether CD38 has pathogenic or regulatory effects varies depending on the disease, immune cell, or animal model analyzed.

Given the complexity of the physiology of CD38 it has been difficult to completely understand the biology of this molecule during autoimmune inflammation. In this review, we analyze current knowledge and controversies regarding the role of CD38 during inflammation and autoimmunity and novel molecular tools that may clarify current gaps in the field.

Web | PDF | Frontiers in Immunology | Open Access

SARS-CoV-2 infection dysregulates NAD metabolism (2023)

INTRODUCTION
Severe COVID-19 results initially in pulmonary infection and inflammation. Symptoms can persist beyond the period of acute infection, and patients with Post-Acute Sequelae of COVID (PASC) often exhibit a variety of symptoms weeks or months following acute phase resolution including continued pulmonary dysfunction, fatigue, and neurocognitive abnormalities. We hypothesized that dysregulated NAD metabolism contributes to these abnormalities.

METHODS
RNAsequencing of lungs from transgenic mice expressing human ACE2 (K18-hACE2) challenged with SARS-CoV-2 revealed upregulation of NAD biosynthetic enzymes, including NAPRT1, NMNAT1, NAMPT, and IDO1 6 days post-infection.

RESULTS
Our data also demonstrate increased gene expression of NAD consuming enzymes: PARP 9,10,14 and CD38. At the same time, SIRT1, a protein deacetylase (requiring NAD as a cofactor and involved in control of inflammation) is downregulated. We confirmed our findings by mining sequencing data from lungs of patients that died from SARS-CoV-2 infection. Our validated findings demonstrating increased NAD turnover in SARS-CoV-2 infection suggested that modulating NAD pathways may alter disease progression and may offer therapeutic benefits. Specifically, we hypothesized that treating K18-hACE2 mice with nicotinamide riboside (NR), a potent NAD precursor, may mitigate lethality and improve recovery from SARS-CoV-2 infection. We also tested the therapeutic potential of an anti-monomeric NAMPT antibody using the same infection model. Treatment with high dose anti-NAMPT antibody resulted in significantly decreased body weight compared to control, which was mitigated by combining HD anti-NAMPT antibody with NR. We observed a significant increase in lipid metabolites, including eicosadienoic acid, oleic acid, and palmitoyl carnitine in the low dose antibody + NR group. We also observed significantly increased nicotinamide related metabolites in NR treated animals.

DISCUSSION
Our data suggest that infection perturbs NAD pathways, identify novel mechanisms that may explain some pathophysiology of CoVID-19 and suggest novel strategies for both treatment and prevention.

Web | PDF | Frontiers in Immunology | Open Access
 
So you’re essentially proposing that B and NK cells might be red herring correlations, and that the effect (if it exists) of Dara is mediated by T cells?

The NK cells might be very relevant if blocking CD38 shifted interactions between NK cells and T cells. Or maybe the culprits in ME/CFS were NK cells all along - just too many, or too active not the reverse. Maybe the original claims of being low were either mistakes or reflected diversion of active NK cells away from circulation.

All these cell populations interact, not least by killing each other when not wanted.
 
Other than trialling different drugs, how would we know if there's a better target?

Analyse the detailed pharmacodynamics from the Norwegians' studies.
If the daratumumab 'responses' are real then I think it very likely that the NK number findings are not coincidence. More detailed analysis of cell populations over time with daratumumab may point to other options.
 
Or maybe the culprits in ME/CFS were NK cells all along - just too many, or too active not the reverse. Maybe the original claims of being low were either mistakes or reflected diversion of active NK cells away from circulation.

Anecdotally, NK cells don't seem to be correlated with severity. Even looking at the SF-36 physical function at baseline vs NK cells at baseline in the dara trial, not all non-responders (highlighted because I did this on my phone which doesn't allow for a better graph) had the lowest physical function level. [Edit: do you mean NK cell toxicity when you talk about activity? Maybe it would be interesting to have data on that]

And what happens if someone's NK cells increase/decrease naturally over the course of their illness? I guess we don't know because it has never been tracked.

And what would this mean for people with low NK cells? That they can't be treated with dara and we don't have a suitable alternative to get rid of what little NK cells they have left?

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Anecdotally, NK cells don't seem to be correlated with severity.

I wouldn't expect any standard measures around NK cells to tell us much. In diseases like lupus, rheumatoid, Reiter's syndrome, psoriasis and ankylosing spondylitis where we know which cells are involved standard analyses of cell populations tend to show nothing useful. The disease isn't occurring in the bloodstream.
 
CD38 is on plasma cells but it has more than one important function in modulating T cell and NK responses. Maybe by chance this is the first trial of a T cell soothing treatment in ME/CF`S and it works. Nothing to do with antibodies.

Could this possibly explain why cyclophosphamide also was (possibly) effective with > 50% in Phase 2 trial ?
 
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Going back to this odd tweet.
We don't seem to have discussed the possibility that blocking CD38 on a whole load of other cells is what made people feel better.

CD38 is on plasma cells but it has more than one important function in modulating T cell and NK responses. Maybe by chance this is the first trial of a T cell soothing treatment in ME/CF`S and it works. Nothing to do with antibodies.

If that were the case perhaps Fluge and Mella have stumbled on a fast lane route to a rtional effective therapy. CD38 might not be the best target, although if it is then they are home and dry already.
so if blocking cd38 makes people feel better, and dara binds to cd38 regardless of NK cell count, does this explain the strongest finding in that NK cell baseline correlated with response?

because that is like the strongest correlation and it holds if you change the y variable to step count increase. and its very linear
 
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@Jonathan Edwards it's interesting to me that no T cell drugs have yet been trialed in ME/CFS in the way B cell drugs have been. I assume that is because they are dangerous and there has been no credible basic science or case studies as with cyclo that pointed that way. It would be a turn out for the books if cyclo and dara were acting on T cells after all!

On the subject of gamma delta t cells not expressing a lot of cd38 - is it markedly more than other t cells? - For example the DecodeME gene they are associated with also are associated with Tregs. And does the fact they don't express much put paid to your idea if in fact gamma delta were the culpable T cells? That is to say could anti cd38 hypothetically still have an effect on cells that do not have much of it?

On a related subject, if after all the data are in we still think the T cell theory has legs, would a theraputic experiment be the way to go, given that T cells operating in the way you have suggested are likely to be hard to detect?
 
@Jonathan Edwards it's interesting to me that no T cell drugs have yet been trialed in ME/CFS in the way B cell drugs have been. I assume that is because they are dangerous and there has been no credible basic science or case studies as with cyclo that pointed that way. It would be a turn out for the books if cyclo and dara were acting on T cells after all!
Actually @Jonathan Edwards has brought up Alemtuzumab (Campath)—a T cell depleting drug before as a possible/potential treatment.
 
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