i3S - Institute of Research and Innovation in Health, University of Porto, Porto, Portugal.
Biomater Sci. 2021 May 4;9(9):3209-3227. doi: 10.1039/d0bm01984d.
Chitosan (Ch) has recently been used in different studies as a vaccine adjuvant with an ability to modulate the tumor microenvironment (TME). This systematic review aims to elucidate the added value of using Ch-based therapies for immunotherapeutic strategies in cancer treatment, through the exploration of different Ch-based formulations, their capacity to modulate immune cells in vitro and in vivo, and their translational potential for clinical settings. A systematic review was conducted on PubMed, following both inclusion and exclusion steps. Original articles which focused on the immunomodulatory role of Ch-based formulations in the TME were included, as well as its usage as a delivery vehicle for other immunomodulatory molecules. This review illustrates the added value of Ch-based systems to reshape the TME, through the modulation of immune cells using different Ch formulations, namely solutions, films, gels, microneedles and nanoparticles. Generally, Ch-based formulations increase the recruitment and proliferation of cells associated with pro-inflammatory abilities and decrease cells which exert anti-inflammatory activities. These effects correlated with a decreased tumor weight, reduced metastases, reversion of the immunosuppressive TME and increased survival in vivo. Overall, Ch-based formulations present the potential for immunotherapy in cancer. Nevertheless, clinical translation remains challenging, since the majority of the studies use Ch in formulations with other components, implicating that some of the observed effects could result from the combination of the individual effects. More studies on the use of different Ch-based formulations, complementary to standardization and disclosure of the Ch properties used are required to improve the immunomodulatory effects of Ch-based formulations in cancer.
壳聚糖（Ch）最近在不同的研究中被用作疫苗佐剂，具有调节肿瘤微环境（TME）的能力。本系统评价旨在通过探索不同的壳聚糖基制剂、它们在体外和体内调节免疫细胞的能力以及它们在临床环境中的转化潜力，阐明壳聚糖基疗法在癌症治疗中的免疫治疗策略中的附加价值。在 PubMed 上进行了系统评价，遵循纳入和排除步骤。纳入了专注于壳聚糖基制剂在 TME 中免疫调节作用的原始文章，以及将其用作其他免疫调节分子的递送载体的文章。本综述说明了壳聚糖基系统通过使用不同的壳聚糖制剂（即溶液、薄膜、凝胶、微针和纳米颗粒）来调节免疫细胞，从而重塑 TME 的附加价值。一般来说，壳聚糖基制剂增加了与促炎能力相关的细胞的募集和增殖，并减少了发挥抗炎活性的细胞。这些效果与肿瘤重量降低、转移减少、免疫抑制性 TME 逆转以及体内存活率提高相关。总的来说，壳聚糖基制剂在癌症的免疫治疗中具有潜力。然而，临床转化仍然具有挑战性，因为大多数研究都将壳聚糖用于与其他成分的制剂中，这意味着观察到的一些效果可能是由于各个效果的组合。需要更多关于使用不同壳聚糖基制剂的研究，补充标准化和披露所用壳聚糖特性，以提高壳聚糖基制剂在癌症中的免疫调节作用。
