This reprogramming enhances the anti-tumor abilities of CD8+ T cells and NK cells.562 Additionally, studies have shown that macrophages can regulate nicotinamide metabolism in fibroblasts by secreting exosomes (EVs) containing NAMPT, which inhibit NNMT expression in fibroblasts through the SIRT1/NICD axis, thereby enhancing the cytotoxicity of CD8+ T cells.534 This cholinergic metabolic communication mediated by EVs enhances the efficacy of anti-PD-1 therapy. This evidence concerns the gene CD8A and neoplasm.