Al-Kharboosh Rawan, ReFaey Karim, Lara-Velazquez Montserrat, Grewal Sanjeet S, Imitola Jaime, Quiñones-Hinojosa Alfredo
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.
Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences (Neuroscience Track), Regenerative Sciences Training Program, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 5;4(4):443-459. doi: 10.1016/j.mayocpiqo.2020.04.006. eCollection 2020 Aug.
Glioblastoma is the most aggressive malignant primary brain tumor, with a dismal prognosis and a devastating overall survival. Despite aggressive surgical resection and adjuvant treatment, average survival remains approximately 14.6 months. The brain tumor microenvironment is heterogeneous, comprising multiple populations of tumor, stromal, and immune cells. Tumor cells evade the immune system by suppressing several immune functions to enable survival. Gliomas release immunosuppressive and tumor-supportive soluble factors into the microenvironment, leading to accelerated cancer proliferation, invasion, and immune escape. Mesenchymal stem cells (MSCs) isolated from bone marrow, adipose tissue, or umbilical cord are a promising tool for cell-based therapies. One crucial mechanism mediating the therapeutic outcomes often seen in MSC application is their tropism to sites of injury. Furthermore, MSCs interact with host immune cells to regulate the inflammatory response, and data points to the possibility of using MSCs to achieve immunomodulation in solid tumors. Interleukin 1β, interleukin 6, tumor necrosis factor α, transforming growth factor β, and stromal cell-derived factor 1 are notably up-regulated in glioblastoma and dually promote immune and MSC trafficking. Mesenchymal stem cells have widely been regarded as hypoimmunogenic, enabling this cell-based administration across major histocompatibility barriers. In this review, we will highlight (1) the bidirectional communication of glioma cells and tumor-associated immune cells, (2) the inflammatory mediators enabling leukocytes and transplantable MSC migration, and (3) review preclinical and human clinical trials using MSCs as delivery vehicles. Mesenchymal stem cells possess innate abilities to migrate great distances, cross the blood-brain barrier, and communicate with surrounding cells, all of which make them desirable "Trojan horses" for brain cancer therapy.
胶质母细胞瘤是最具侵袭性的原发性恶性脑肿瘤,预后极差,总体生存率令人沮丧。尽管进行了积极的手术切除和辅助治疗,平均生存期仍约为14.6个月。脑肿瘤微环境是异质性的,由多种肿瘤细胞、基质细胞和免疫细胞组成。肿瘤细胞通过抑制多种免疫功能来逃避免疫系统以实现存活。胶质瘤向微环境中释放免疫抑制和肿瘤支持性可溶性因子,导致癌症加速增殖、侵袭和免疫逃逸。从骨髓、脂肪组织或脐带中分离出的间充质干细胞(MSC)是基于细胞疗法的一种有前景的工具。介导MSC应用中常见治疗效果的一个关键机制是它们对损伤部位的趋向性。此外,MSC与宿主免疫细胞相互作用以调节炎症反应,并且有数据表明使用MSC在实体瘤中实现免疫调节的可能性。白细胞介素1β、白细胞介素6、肿瘤坏死因子α、转化生长因子β和基质细胞衍生因子1在胶质母细胞瘤中显著上调,并双重促进免疫细胞和MSC的迁移。间充质干细胞被广泛认为具有低免疫原性,使得这种基于细胞的给药能够跨越主要组织相容性屏障。在本综述中,我们将重点介绍(1)胶质瘤细胞与肿瘤相关免疫细胞的双向通讯,(2)使白细胞和可移植MSC迁移的炎症介质,以及(3)回顾使用MSC作为递送载体的临床前和人体临床试验。间充质干细胞具有远距离迁移、穿过血脑屏障以及与周围细胞通讯的固有能力,所有这些特性使其成为脑癌治疗中理想的“特洛伊木马”。