Tang Xuejia, Zuo Chenghai, Fang Pengchao, Liu Guojing, Qiu Yongyi, Huang Yi, Tang Rongrui
Department of Neurosurgery, University-Town Hospital of Chongqing Medical University, Chongqing, China.
Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China.
Front Oncol. 2021 Jul 8;11:701291. doi: 10.3389/fonc.2021.701291. eCollection 2021.
Glioblastoma (GBM) remains the most lethal and common primary brain tumor, even after treatment with multiple therapies, such as surgical resection, chemotherapy, and radiation. Although great advances in medical development and improvements in therapeutic methods of GBM have led to a certain extension of the median survival time of patients, prognosis remains poor. The primary cause of its dismal outcomes is the high rate of tumor recurrence, which is closely related to its resistance to standard therapies. During the last decade, glioblastoma stem cells (GSCs) have been successfully isolated from GBM, and it has been demonstrated that these cells are likely to play an indispensable role in the formation, maintenance, and recurrence of GBM tumors, indicating that GSCs are a crucial target for treatment. Herein, we summarize the current knowledge regarding GSCs, their related signaling pathways, resistance mechanisms, crosstalk linking mechanisms, and microenvironment or niche. Subsequently, we present a framework of targeted therapy for GSCs based on direct strategies, including blockade of the pathways necessary to overcome resistance or prevent their function, promotion of GSC differentiation, virotherapy, and indirect strategies, including targeting the perivascular, hypoxic, and immune niches of the GSCs. In summary, targeting GSCs provides a tremendous opportunity for revolutionary approaches to improve the prognosis and therapy of GBM, despite a variety of challenges.
胶质母细胞瘤(GBM)仍然是最致命且最常见的原发性脑肿瘤,即便经过手术切除、化疗和放疗等多种治疗后依然如此。尽管医学发展取得了巨大进步,GBM的治疗方法也有所改进,使得患者的中位生存时间有了一定延长,但预后仍然很差。其预后不佳的主要原因是肿瘤复发率高,这与它对标准疗法的耐药性密切相关。在过去十年中,胶质母细胞瘤干细胞(GSCs)已成功从GBM中分离出来,并且已经证明这些细胞可能在GBM肿瘤的形成、维持和复发中发挥不可或缺的作用,这表明GSCs是一个关键的治疗靶点。在此,我们总结了关于GSCs及其相关信号通路、耐药机制、相互联系机制以及微环境或生态位的现有知识。随后,我们基于直接策略提出了一个针对GSCs的靶向治疗框架,包括阻断克服耐药性或阻止其功能所需的通路、促进GSC分化、病毒疗法,以及间接策略,包括靶向GSCs的血管周围、缺氧和免疫生态位。总之,尽管存在各种挑战,但靶向GSCs为改善GBM的预后和治疗提供了革命性方法的巨大机会。