There was notable upregulation of tumour immunity signatures, including TIGIT, CD8 T-cells, inflammatory chemokines, and IDO1, alongside downregulation of proliferation, homologous recombination deficiency (HRD), TP53 surrogate mutational status signature, and ER-signalling in the POAI group (Fig. 2a). This evidence concerns the gene CD8A and hypoparathyroidism-retardation-dysmorphism syndrome.