Akasaki Yasuharu, Black Keith L, Yu John S
Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Front Biosci. 2005 Sep 1;10:2908-21. doi: 10.2741/1747.
Despite dramatic advances in surgical technique, imaging, and adjuvant radiotherapy or chemotherapy, the prognosis for patients with malignant glial tumors remains dismal. Based on the current knowledge regarding immune responses in the healthy central nervous system (CNS) and glioma-bearing hosts, we discuss dendritic cell (DC)-based immunotherapeutic approaches for malignant gliomas and the relevance of recent clinical trials and their outcomes. It is now recognized that the CNS is not an immunologically tolerated site, and clearance of arising glioma cells is a routine physiological function of the normal, non-compromised immune system. To escape from immune surveillance, however, clinically apparent gliomas develop complex mechanisms that suppress tumoricidal immune responses. Although the use of DCs for the treatment of glioma patients may be the most appropriate approach, an effective treatment paradigm for these tumors may eventually require the use of several types of treatment. Additionally, given the heterogeneity of this disease process and an immune-refractory tumor cell population, the series use of rational multiple modalities that target different tumor characteristics may be the most effective therapeutic strategy to treat malignant gliomas.
尽管在手术技术、影像学以及辅助放疗或化疗方面取得了显著进展，但恶性胶质瘤患者的预后仍然不容乐观。基于目前对健康中枢神经系统（CNS）和荷瘤宿主免疫反应的认识，我们讨论了基于树突状细胞（DC）的恶性胶质瘤免疫治疗方法以及近期临床试验的相关性及其结果。现在已经认识到，中枢神经系统并非免疫耐受部位，清除新生的胶质瘤细胞是正常、未受损免疫系统的常规生理功能。然而，为了逃避免疫监视，临床上明显的胶质瘤会发展出复杂的机制来抑制杀瘤免疫反应。虽然使用树突状细胞治疗胶质瘤患者可能是最合适的方法，但针对这些肿瘤的有效治疗模式最终可能需要使用多种类型的治疗方法。此外，鉴于该疾病过程的异质性和免疫难治性肿瘤细胞群体，系列使用针对不同肿瘤特征的合理多种模式可能是治疗恶性胶质瘤最有效的治疗策略。
