TGFB1 and neoplasm: TDEs frequently carry immunosuppressive factors such as PD-L1 and TGF-β, which inhibit T cell activation and promote the accumulation of Tregs, contributing to immune tolerance and tumor escape.148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164 In some cases, TDEs may complicate immunotherapy efficacy by perpetuating immune suppression within the TME, which can limit the effectiveness of treatments.