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Acknowledgements We are grateful to University College Dublin for providing plasma, serum and urine samples for this study

In PAH, DNA methylation mediates CpG site methylation in gene promoters and enhancer regions via DNA methyltransferases (DNMTs), leading to hypermethylation or hypomethylation of immune-metabolic related genes such as EIF2AK4, TCF7, and SOCS3 with concomitant abnormal expression, which enriches functions like T cell differentiation and participates in the pathological process of PAH ( Histone modification plays a crucial role in epigenetic regulation

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