Re-engineering CD154 blockade for transplantation: Fc-free design to separate thrombotic risk from therapeutic function. (PubMed, Clin Transplant Res) - Sep 23, 2026 - "Size-based carriers recover only the second: conjugation of polyethylene glycol (PEG) to an anti-CD154 Fab' extends its half-life from hours to weeks, as in dapirolizumab pegol, but leaves FcRn recycling unaddressed, while uncertainties remain regarding long-term PEG exposure. Albumin recovers both through FcRn-dependent recycling and its own molecular size, without engaging Fcγ receptors. Dazodalibep, an Fc-free albumin-fusion CD154 antagonist, was administered with belatacept to kidney transplant recipients in a single-arm phase 2a trial without thrombotic events, but the prespecified composite efficacy endpoint was not met."
Journal • Review • Cardiovascular • Transplant Rejection • Transplantation • CD40 • CD40LG
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Junho Chung; Miyeon Chun; Siwon Hwang
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