Neuroinflammation and tumor microenvironment remodeling in brain tumors: Cellular interactions, immunometabolic adaptations, and therapeutic perspectives
Brain tumors remain among the most aggressive and therapeutically challenging malignancies due to their highly complex and immunosuppressive tumor microenvironment. Increasing evidence suggests that neuroinflammation plays a central role in tumor initiation, progression, angiogenesis, immune evasion, therapeutic resistance, and tumor recurrence. This review discusses the multifaceted role of neuroinflammatory signaling in primary and secondary brain tumors, with emphasis on the dynamic interactions between tumor cells, microglia, tumor-associated macrophages, neutrophils, dendritic cells, lymphocytes, and stromal components within the tumor microenvironment. Particular focus is placed on inflammatory cytokines and signaling pathways, including interleukin (IL)-6, tumor necrosis factor-alpha, transforming growth factor beta, programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1), nuclear factor kappa-light-chain-enhancer of activated B cells, signal transducer and activator of transcription 3, and hypoxia-associated hypoxia-inducible factor 1-alpha signaling, which collectively contribute to immunosuppression and tumor progression. The review further highlights the importance of metabolic adaptation, hypoxia-driven remodeling, oxidative stress, and immune exhaustion in shaping the inflammatory landscape of central nervous system tumors. Emerging evidence regarding nicotinamide adenine dinucleotide phosphate oxidases (NADPH oxidase 2 [NOX2], NOX4, and NOX5) and reactive oxygen species-mediated therapeutic resistance, particularly temozolomide resistance in glioblastoma, is also discussed. In addition, clinically relevant inflammatory biomarkers such as CD163+ tumor-associated macrophages, neutrophil-to-lymphocyte ratio, PD-L1 expression, and isocitrate dehydrogenase-associated immune phenotypes are examined for their potential prognostic and therapeutic significance. Recent advances in therapeutic strategies targeting neuroinflammation, including colony-stimulating factor 1 receptor inhibitors, IL-6 pathway blockade, immune checkpoint modulation, anti-angiogenic therapy, and tumor microenvironment reprogramming approaches, are reviewed along with their current translational limitations. Overall, this review provides an integrative overview of the relationship between neuroinflammation and tumor microenvironment remodeling in brain tumors and highlights the growing potential of biomarker-guided and microenvironment-directed therapeutic strategies in neuro-oncology.

- Akter F, Simon B, de Boer NL, Redjal N, Wakimoto H, Shah K. Pre-clinical tumor models of primary brain tumors: Challenges and Opportunities. Biochim Biophys Acta Rev Cancer. 2021;1875(1):188458. doi: 10.1016/j.bbcan.2020.188458
- Torp SH, Solheim O, Skjulsvik AJ. The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know—a minireview. Acta Neurochir (Wien). 2022;164(9):2453-2464.doi: 10.1007/s00701-022-05301-y
- Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro-Oncol. 2021;23(8):1231-1251. doi: 10.1093/neuonc/noab106
- Huang J, Li H, Yan H, Li FX, Tang M, Lu DL. The comparative burden of brain and central nervous system cancers from 1990 to 2019 between China and the United States and predicting the future burden. Front Public Health. 2022;10:1018836. doi: 10.3389/fpubh.2022.1018836
- Mousavi SE, Seyedmirzaei H, Shahrokhi Nejad S, Nejadghaderi SA. Epidemiology and socioeconomic correlates of brain and central nervous system cancers in Asia in 2020 and their projection to 2040. Sci Rep. 2024;14(1):21936. doi: 10.1038/s41598-024-73277-z
- Liu X, Cheng LC, Gao TY, Luo J, Zhang C. The burden of brain and central nervous system cancers in Asia from 1990 to 2019 and its predicted level in the next twenty-five years : Burden and prediction model of CNS cancers in Asia. BMC Public Health. 2023;23(1):2522. doi: 10.1186/s12889-023-17467-w
- Cómitre-Mariano B, Vellila-Alonso G, Segura-Collar B, Mondéjar-Ruescas L, Sepulveda JM, Gargini R. Sentinels of neuroinflammation: the crucial role of myeloid cells in the pathogenesis of gliomas and neurodegenerative diseases. J Neuroinflammation. 2024;21(1):1. doi: 10.1186/s12974-024-03298-y
- Kwon HS, Koh SH. Neuroinflammation in neurodegenerative disorders: the roles of microglia and astrocytes. Transl Neurodegener. 2020;9(1):42. doi: 10.1186/s40035-020-00221-2
- Adamu A, Li S, Gao F, Xue G. The role of neuroinflammation in neurodegenerative diseases: current understanding and future therapeutic targets. Front Aging Neurosci. 2024;16:1347987. doi: 10.3389/fnagi.2024.1347987
- Chen T, Dai Y, Hu C, et al. Cellular and molecular mechanisms of the blood–brain barrier dysfunction in neurodegenerative diseases. Fluids Barriers CNS. 2024;21:60. doi: 10.1186/s12987-024-00557-1
- Anand G, Lahariya R. Bloodstream Infection-induced Neuroinflammation: from Systemic Infection To Brain Invasion. Curr Microbiol. 2025;83(1):47. doi: 10.1007/s00284-025-04626-y
- Lahariya R, Sinha M, Kumari B, Subramanian KV, Anand G. Time-dependent neurovascular unit dysfunction in ischemic stroke: mechanisms of neurovascular uncoupling and its clinical impact. Int J Neurosci. 2026:1-12. doi: 10.1080/00207454.2026.2627246
- Tu S, Lin X, Qiu J, et al. Crosstalk Between Tumor-Associated Microglia/Macrophages and CD8-Positive T Cells Plays a Key Role in Glioblastoma. Front Immunol. 2021;12:650105. doi: 10.3389/fimmu.2021.650105
- Pan Y, Yu Y, Wang X, Zhang T. Tumor-Associated Macrophages in Tumor Immunity. Front Immunol. 2020;11:583084. doi: 10.3389/fimmu.2020.583084
- Nigam M, Mishra AP, Deb VK, et al. Evaluation of the association of chronic inflammation and cancer: Insights and implications. Biomed Pharmacother. 2023;164:115015. doi: 10.1016/j.biopha.2023.115015
- Zhao H, Wu L, Yan G, et al. Inflammation and tumor progression: signaling pathways and targeted intervention. Signal Transduct Target Ther. 2021;6:263. doi: 10.1038/s41392-021-00658-5
- Que H, Fu Q, Lan T, Tian X, Wei X. Tumor-associated neutrophils and neutrophil-targeted cancer therapies. Biochim Biophys Acta BBA - Rev Cancer. 2022;1877(5):188762. doi: 10.1016/j.bbcan.2022.188762
- de Visser KE, Joyce JA. The evolving tumor microenvironment: From cancer initiation to metastatic outgrowth. Cancer Cell. 2023;41(3):374-403. doi: 10.1016/j.ccell.2023.02.016
- Parker KH, Beury DW, Ostrand-Rosenberg S. Myeloid- Derived Suppressor Cells: Critical Cells Driving Immune Suppression in the Tumor Microenvironment. Adv Cancer Res. 2015;128:95-139. doi: 10.1016/bs.acr.2015.04.002
- García Morán GA, Parra-Medina R, García Cardona A, Quintero-Ronderos P, Rodríguez ÉG. Cytokines, chemokines and growth factors. In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et al., eds. Autoimmunity: From Bench to Bedside. El Rosario University Press; 2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459450/ [Last accessed on March 1, 2025].
- Wu Y, Yi M, Niu M, Mei Q, Wu K. Myeloid-derived suppressor cells: an emerging target for anticancer immunotherapy. Mol Cancer. 2022;21(1):184. doi: 10.1186/s12943-022-01657-y
- Li K, Shi H, Zhang B, et al. Myeloid-derived suppressor cells as immunosuppressive regulators and therapeutic targets in cancer. Signal Transduct Target Ther. 2021;6(1):362. doi: 10.1038/s41392-021-00670-9
- Franson A, McClellan BL, Varela ML, et al. Development of immunotherapy for high-grade gliomas: Overcoming the immunosuppressive tumor microenvironment. Front Med. 2022;9:966458. doi: 10.3389/fmed.2022.966458
- Reardon DA, Brandes AA, Omuro A, et al. Effect of Nivolumab vs Bevacizumab in Patients With Recurrent Glioblastoma. JAMA Oncol. 2020;6(7):1003. doi: 10.1001/jamaoncol.2020.1024
- Lang FF, Conrad C, Gomez-Manzano C, et al. Phase I Study of DNX-2401 (Delta-24-RGD) Oncolytic Adenovirus: Replication and Immunotherapeutic Effects in Recurrent Malignant Glioma. J Clin Oncol. 2018;36(14):1419-1427. doi: 10.1200/JCO.2017.75.8219
- Nassiri F, Patil V, Yefet LS, et al. Oncolytic DNX-2401 virotherapy plus pembrolizumab in recurrent glioblastoma: a phase 1/2 trial. Nat Med. 2023;29(6):1370-1378. doi: 10.1038/s41591-023-02347-y
- The Oncolytic Adenovirus DNX-2401 Has Antitumor Activity in Glioblastoma. Cancer Discov. 2018;8(4):382. doi: 10.1158/2159-8290.CD-RW2018-031
- Agosti E, Garaba A, Antonietti S, et al. CAR-T Cells Therapy in Glioblastoma: A Systematic Review on Molecular Targets and Treatment Strategies. Int J Mol Sci. 2024;25(13):7174. doi: 10.3390/ijms25137174
- Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2017;9(6):7204-7218. doi: 10.18632/oncotarget.23208
- Soliman AM, Barreda DR. Acute Inflammation in Tissue Healing. Int J Mol Sci. 2022;24(1):641. doi: 10.3390/ijms24010641
- Roh JS, Sohn DH. Damage-Associated Molecular Patterns in Inflammatory Diseases. Immune Netw. 2018;18(4):e27. doi: 10.4110/in.2018.18.e27
- Soares CLR, Wilairatana P, Silva LR, et al. Biochemical aspects of the inflammatory process: A narrative review. Biomed Pharmacother. 2023;168:115764. doi: 10.1016/j.biopha.2023.115764
- Megha KB, Joseph X, Akhil V, Mohanan PV. Cascade of immune mechanism and consequences of inflammatory disorders. Phytomedicine. 2021;91:153712. doi: 10.1016/j.phymed.2021.153712
- Dunkelberger JR, Song WC. Complement and its role in innate and adaptive immune responses. Cell Res. 2010;20(1):34-50. doi: 10.1038/cr.2009.139
- Markiewski MM, Lambris JD. The Role of Complement in Inflammatory Diseases From Behind the Scenes into the Spotlight. Am J Pathol. 2007;171(3):715-727. doi: 10.2353/ajpath.2007.070166
- Wu L, Saxena S, Singh RK. Neutrophils in the Tumor Microenvironment. Adv Exp Med Biol. 2020;1224:1-20. doi: 10.1007/978-3-030-35723-8_1
- Rosales C. Neutrophil: A Cell with Many Roles in Inflammation or Several Cell Types? Front Physiol. 2018;9:113. doi: 10.3389/fphys.2018.00113
- Lehman H, Segal BH. The role of neutrophils in host defense and disease. J Allergy Clin Immunol. 2020;145(6):1535-1544. doi: 10.1016/j.jaci.2020.02.038
- Shi C, Pamer EG. Monocyte recruitment during infection and inflammation. Nat Rev Immunol. 2011;11(11):762-774. doi: 10.1038/nri3070
- Sansbury BE, Spite M. Resolution of Acute Inflammation and the Role of Resolvins in Immunity, Thrombosis and Vascular Biology. Circ Res. 2016;119(1):113-130. doi: 10.1161/CIRCRESAHA.116.307308
- Kourtzelis I, Hajishengallis G, Chavakis T. Phagocytosis of Apoptotic Cells in Resolution of Inflammation. Front Immunol. 2020;11:553. doi: 10.3389/fimmu.2020.00553
- Carson MJ, Doose JM, Melchior B, Schmid CD, Ploix CC. CNS immune privilege: hiding in plain sight. Immunol Rev. 2006;213:48-65. doi: 10.1111/j.1600-065X.2006.00441.x
- Ampie L, McGavern DB. Immunological defense of CNS barriers against infections. Immunity. 2022;55(5):781-799. doi: 10.1016/j.immuni.2022.04.012
- Tavares GA, Louveau A. Meningeal Lymphatics: An Immune Gateway for the Central Nervous System. Cells. 2021;10(12):3385. doi: 10.3390/cells10123385
- Rego S, Sanchez G, Da Mesquita S. Current views on meningeal lymphatics and immunity in aging and Alzheimer’s disease. Mol Neurodegener. 2023;18(1):55. doi: 10.1186/s13024-023-00645-0
- Iwahori K. Cytotoxic CD8+ Lymphocytes in the Tumor Microenvironment. Adv Exp Med Biol. 2020;1224:53-62. doi: 10.1007/978-3-030-35723-8_4
- Mi Y, Guo N, Luan J, et al. The Emerging Role of Myeloid- Derived Suppressor Cells in the Glioma Immune Suppressive Microenvironment. Front Immunol. 2020;11:737.doi: 10.3389/fimmu.2020.00737
- Sarkaria JN, Hu LS, Parney IF, et al. Is the blood–brain barrier really disrupted in all glioblastomas? A critical assessment of existing clinical data. Neuro-Oncol. 2018;20(2):184-191. doi: 10.1093/neuonc/nox175
- Cordell EC, Alghamri MS, Castro MG, Gutmann DH. T lymphocytes as dynamic regulators of glioma pathobiology. Neuro-Oncol. 2022;24(10):1647-1657. doi: 10.1093/neuonc/noac055
- Haist M, Stege H, Grabbe S, Bros M. The Functional Crosstalk between Myeloid-Derived Suppressor Cells and Regulatory T Cells within the Immunosuppressive Tumor Microenvironment. Cancers. 2021;13(2):2. doi: 10.3390/cancers13020210
- Shi H, Li K, Ni Y, Liang X, Zhao X. Myeloid-Derived Suppressor Cells: Implications in the Resistance of Malignant Tumors to T Cell-Based Immunotherapy. Front Cell Dev Biol. 2021;9:707198. doi: 10.3389/fcell.2021.707198
- Galvão RP, Zong H. Inflammation and Gliomagenesis: Bi-Directional Communication at Early and Late Stages of Tumor Progression. Curr Pathobiol Rep. 2013;1(1):19-28. doi: 10.1007/s40139-012-0006-3
- Maiorino L, Daßler-Plenker J, Sun L, Egeblad M. Innate Immunity and Cancer Pathophysiology. Annu Rev Pathol. 2022;17:425-457. doi: 10.1146/annurev-pathmechdis-032221-115501
- Kim JH, Jenrow KA, Brown SL. Mechanisms of radiation-induced normal tissue toxicity and implications for future clinical trials. Radiat Oncol J. 2014;32(3):103-115. doi: 10.3857/roj.2014.32.3.103
- Spiotto M, Fu YX, Weichselbaum RR. The intersection of radiotherapy and immunotherapy: mechanisms and clinical implications. Sci Immunol. 2016;1(3):EAAG1266. doi: 10.1126/sciimmunol.aag1266
- Barker HE, Paget JTE, Khan AA, Harrington KJ. The Tumour Microenvironment after Radiotherapy: Mechanisms of Resistance and Recurrence. Nat Rev Cancer. 2015;15(7):409- 425. doi: 10.1038/nrc3958
- Jiang P, Jing S, Sheng G, Jia F. The basic biology of NK cells and its application in tumor immunotherapy. Front Immunol. 2024;15:1420205. doi: 10.3389/fimmu.2024.1420205
- Yang Y long, Yang F, Huang Z qing, et al. T cells, NK cells, and tumor-associated macrophages in cancer immunotherapy and the current state of the art of drug delivery systems. Front Immunol. 2023;14:1199173. doi: 10.3389/fimmu.2023.1199173
- Coënon L, Geindreau M, Ghiringhelli F, Villalba M, Bruchard M. Natural Killer cells at the frontline in the fight against cancer. Cell Death Dis. 2024;15(8):1-14. doi: 10.1038/s41419-024-06976-0
- Landskron G, De la Fuente M, Thuwajit P, Thuwajit C, Hermoso MA. Chronic Inflammation and Cytokines in the Tumor Microenvironment. J Immunol Res. 2014;2014:149185. doi: 10.1155/2014/149185
- Zhang S, Xiao X, Yi Y, et al. Tumor initiation and early tumorigenesis: molecular mechanisms and interventional targets. Signal Transduct Target Ther. 2024;9(1):1-36. doi: 10.1038/s41392-024-01848-7
- Lahariya R, Anand G, Kumari B, Priyadarshi K. Postbiotics and the gut-brain axis: A mechanistic review on modulating neuroinflammation and cognitive aging. J Neuroimmunol. 2026;413:578870. doi: 10.1016/j.jneuroim.2026.578870
- Li X, Zhong J, Deng X, et al. Targeting Myeloid-Derived Suppressor Cells to Enhance the Antitumor Efficacy of Immune Checkpoint Blockade Therapy. Front Immunol. 2021;12:754196. doi: 10.3389/fimmu.2021.754196
- Quail D, Joyce J. Microenvironmental regulation of tumor progression and metastasis. Nat Med. 2013;19(11):1423- 1437. doi: 10.1038/nm.3394
- Grivennikov SI, Greten FR, Karin M. Immunity, Inflammation, and Cancer. Cell. 2010;140(6):883-899. doi: 10.1016/j.cell.2010.01.025
- Du M, Sun L, Guo J, Lv H. Macrophages and tumor-associated macrophages in the senescent microenvironment: From immunosuppressive TME to targeted tumor therapy. Pharmacol Res. 2024;204:107198. doi: 10.1016/j.phrs.2024.107198
- Aguilar-Cazares D, Chavez-Dominguez R, Marroquin- Muciño M, et al. The systemic-level repercussions of cancer-associated inflammation mediators produced in the tumor microenvironment. Front Endocrinol. 2022;13:929572. doi: 10.3389/fendo.2022.929572
- Kichloo A, Albosta M, Dahiya D, et al. Systemic adverse effects and toxicities associated with immunotherapy: A review. World J Clin Oncol. 2021;12(3):150-163. doi: 10.5306/wjco.v12.i3.150
- Yi M, Li T, Niu M, et al. Targeting cytokine and chemokine signaling pathways for cancer therapy. Signal Transduct Target Ther. 2024;9(1):1-48.doi: 10.1038/s41392-024-01868-3
- Sevenich L. Brain-Resident Microglia and Blood-Borne Macrophages Orchestrate Central Nervous System Inflammation in Neurodegenerative Disorders and Brain Cancer. Front Immunol. 2018;9:697. doi: 10.3389/fimmu.2018.00697
- du Chatinier A, Velilla IQ, Meel MH, Hoving EW, Hulleman E, Metselaar DS. Microglia in pediatric brain tumors: The missing link to successful immunotherapy. Cell Rep Med. 2023;4(11):101246. doi: 10.1016/j.xcrm.2023.101246
- Li H, Li B, Zheng Y. Role of microglia/macrophage polarisation in intraocular diseases (Review). Int J Mol Med. 2024;53(5):1-19. doi: 10.3892/ijmm.2024.5369
- Qin J, Ma Z, Chen X, Shu S. Microglia activation in central nervous system disorders: A review of recent mechanistic investigations and development efforts. Front Neurol. 2023;14:1103416. doi: 10.3389/fneur.2023.1103416
- Smith JA, Das A, Ray SK, Banik NL. Role of pro-inflammatory cytokines released from microglia in neurodegenerative diseases. Brain Res Bull. 2012;87(1):10-20. doi: 10.1016/j.brainresbull.2011.10.004
- Ansari MA. Temporal profile of M1 and M2 responses in the hippocampus following early 24 h of neurotrauma. J Neurol Sci. 2015;357(1):41-49. doi: 10.1016/j.jns.2015.06.062
- Orihuela R, McPherson CA, Harry GJ. Microglial M1/ M2 polarization and metabolic states. Br J Pharmacol. 2016;173(4):649-665. doi: 10.1111/bph.13139
- Wang G, Zhong K, Wang Z, et al. Tumor-associated microglia and macrophages in glioblastoma: From basic insights to therapeutic opportunities. Front Immunol. 2022;13:964898. doi: 10.3389/fimmu.2022.964898
- Chen N, Peng C, Li D. Epigenetic Underpinnings of Inflammation: A Key to Unlock the Tumor Microenvironment in Glioblastoma. Front Immunol. 2022;13:869307. doi: 10.3389/fimmu.2022.869307
- Wu SY, Watabe K. The roles of microglia/macrophages in tumor progression of brain cancer and metastatic disease. Front Biosci Landmark Ed. 2017;22:1805-1829. doi: 10.2741/4573
- Buonfiglioli A, Hambardzumyan D. Macrophages and microglia: the cerberus of glioblastoma. Acta Neuropathol Commun. 2021;9(1):54. doi: 10.1186/s40478-021-01156-z
- You H, Baluszek S, Kaminska B. Immune Microenvironment of Brain Metastases—Are Microglia and Other Brain Macrophages Little Helpers? Front Immunol. 2019;10:1941. doi: 10.3389/fimmu.2019.01941
- Caffarel MM, Braza MS. Microglia and metastases to the central nervous system: victim, ravager, or something else? J Exp Clin Cancer Res. 2022;41(1):327. doi: 10.1186/s13046-022-02535-7
- Borst K, Dumas AA, Prinz M. Microglia: Immune and non-immune functions. Immunity. 2021;54(10):2194-2208. doi: 10.1016/j.immuni.2021.09.014
- Kim ND, Luster AD. The role of tissue resident cells in neutrophil recruitment. Trends Immunol. 2015;36(9):547- 555. doi: 10.1016/j.it.2015.07.007
- Tazzyman S, Lewis CE, Murdoch C. Neutrophils: key mediators of tumour angiogenesis. Int J Exp Pathol. 2009;90(3):222-231. doi: 10.1111/j.1365-2613.2009.00641.x
- Kotsafti A, Scarpa M, Castagliuolo I, Scarpa M. Reactive Oxygen Species and Antitumor Immunity—From Surveillance to Evasion. Cancers. 2020;12(7):1748. doi: 10.3390/cancers12071748
- Wang G, Wang J, Niu C, Zhao Y, Wu P. Neutrophils: New Critical Regulators of Glioma. Front Immunol. 2022;13:927233. doi: 10.3389/fimmu.2022.927233
- Lin YJ, Wei KC, Chen PY, Lim M, Hwang TL. Roles of Neutrophils in Glioma and Brain Metastases. Front Immunol. 2021;12:701383. doi: 10.3389/fimmu.2021.701383
- Huang X, Nepovimova E, Adam V, et al. Neutrophils in Cancer immunotherapy: friends or foes? Mol Cancer. 2024;23(1):107. doi: 10.1186/s12943-024-02004-z
- Poto R, Cristinziano L, Modestino L, et al. Neutrophil Extracellular Traps, Angiogenesis and Cancer. Biomedicines. 2022;10(2):431. doi: 10.3390/biomedicines10020431
- Karimi S, Vyas MV, Gonen L, et al. Prognostic significance of preoperative neutrophilia on recurrence-free survival in meningioma. Neuro-Oncol. 2017;19(11):1503-1510. doi: 10.1093/neuonc/nox089
- Wasiuk A, de Vries VC, Hartmann K, Roers A, Noelle RJ. Mast cells as regulators of adaptive immunity to tumours. Clin Exp Immunol. 2009;155(2):140-146.doi: 10.1111/j.1365-2249.2008.03840.x
- Dong H, Zhang X, Qian Y. Mast Cells and Neuroinflammation. Med Sci Monit Basic Res. 2014;20:200-206. doi: 10.12659/MSMBR.893093
- Huang X, Lan Z, Hu Z. Role and mechanisms of mast cells in brain disorders. Front Immunol. 2024;15:1445867. doi: 10.3389/fimmu.2024.1445867
- Polyzoidis S, Koletsa T, Panagiotidou S, Ashkan K, Theoharides TC. Mast cells in meningiomas and brain inflammation. J Neuroinflammation. 2015;12(1):170. doi: 10.1186/s12974-015-0388-3
- Skaper SD, Facci L. Mast cell–glia axis in neuroinflammation and therapeutic potential of the anandamide congener palmitoylethanolamide. Philos Trans R Soc B Biol Sci. 2012;367(1607):3312-3325. doi: 10.1098/rstb.2011.0391
- Zalpoor H, Aziziyan F, Liaghat M, et al. The roles of metabolic profiles and intracellular signaling pathways of tumor microenvironment cells in angiogenesis of solid tumors. Cell Commun Signal. 2022;20(1):186. doi: 10.1186/s12964-022-00951-y
- Ribatti D, Crivellato E. Mast cells, angiogenesis, and tumour growth. Biochim Biophys Acta BBA - Mol Basis Dis. 2012;1822(1):2-8. doi: 10.1016/j.bbadis.2010.11.010
- Bremnes RM, Al-Shibli K, Donnem T, et al. The Role of Tumor-Infiltrating Immune Cells and Chronic Inflammation at the Tumor Site on Cancer Development, Progression, and Prognosis: Emphasis on Non-small Cell Lung Cancer. J Thorac Oncol. 2011;6(4):824-833. doi: 10.1097/JTO.0b013e3182037b76
- Yi M, Li T, Niu M, et al. Exploiting innate immunity for cancer immunotherapy. Mol Cancer. 2023;22(1):187. doi: 10.1186/s12943-023-01885-w
- Sandhu JK, Kulka M. Decoding Mast Cell-Microglia Communication in Neurodegenerative Diseases. Int J Mol Sci. 2021;22(3):1093. doi: 10.3390/ijms22031093
- Lin Y, Xu J, Lan H. Tumor-associated macrophages in tumor metastasis: biological roles and clinical therapeutic applications. J Hematol Oncol. 2019;12(1):76. doi: 10.1186/s13045-019-0760-3
- Macrophage polarization in the tumor microenvironment: Emerging roles and therapeutic potentials. Biomed Pharmacother. 2024;177:116930. doi: 10.1016/j.biopha.2024.116930
- Zhu S, Luo Z, Li X, Han X, Shi S, Zhang T. Tumor-associated macrophages: role in tumorigenesis and immunotherapy implications. J Cancer. 2021;12(1):54-64. doi: 10.7150/jca.49692
- Basak U, Sarkar T, Mukherjee S, et al. Tumor-associated macrophages: an effective player of the tumor microenvironment. Front Immunol. 2023;14:1295257. doi: 10.3389/fimmu.2023.1295257
- Xiong J, Zhou X, Su L, et al. The two-sided battlefield of tumour-associated macrophages in glioblastoma: unravelling their therapeutic potential. Discov Oncol. 2024;15:590. doi: 10.1007/s12672-024-01464-5
- Proctor DT, Huang J, Lama S, Albakr A, Van Marle G, Sutherland GR. Tumor-associated macrophage infiltration in meningioma. Neuro-Oncol Adv. 2019;1(1):vdz018. doi: 10.1093/noajnl/vdz018
- Han C, Lin S, Lu X, Xue L, Wu ZB. Tumor-Associated Macrophages: New Horizons for Pituitary Adenoma Researches. Front Endocrinol. 2021;12:785050. doi: 10.3389/fendo.2021.785050
- de Vries M, Briaire-de Bruijn I, Malessy MJA, de Bruïne SFT, van der Mey AGL, Hogendoorn PCW. Tumor-associated macrophages are related to volumetric growth of vestibular schwannomas. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. 2013;34(2):347-352. doi: 10.1097/MAO.0b013e31827c9fbf
- Lin H, Liu C, Hu A, Zhang D, Yang H, Mao Y. Understanding the immunosuppressive microenvironment of glioma: mechanistic insights and clinical perspectives. J Hematol Oncol. 2024;17(1):31. doi: 10.1186/s13045-024-01544-7
- Liu K. Dendritic Cells. Encycl Cell Biol. 2016:741-749. doi: 10.1016/B978-0-12-394447-4.30111-0
- Del Prete A, Salvi V, Soriani A, et al. Dendritic cell subsets in cancer immunity and tumor antigen sensing. Cell Mol Immunol. 2023;20(5):432-447. doi: 10.1038/s41423-023-00990-6
- Kim W, Liau LM. Dendritic Cell Vaccines for Brain Tumors. Neurosurg Clin N Am. 2010;21(1):139-157. doi: 10.1016/j.nec.2009.09.005
- Lee-Chang C, Lesniak MS. Next-generation antigen-presenting cell immune therapeutics for gliomas. J Clin Invest. 133(3):e163449. doi: 10.1172/JCI163449
- Labani-Motlagh A, Ashja-Mahdavi M, Loskog A. The Tumor Microenvironment: A Milieu Hindering and Obstructing Antitumor Immune Responses. Front Immunol. 2020;11.doi: 10.3389/fimmu.2020.00940
- Motz GT, Coukos G. Deciphering and Reversing Tumor Immune Suppression. Immunity. 2013;39(1):61-73. doi: 10.1016/j.immuni.2013.07.005
- Chen J, Duan Y, Che J, Zhu J. Dysfunction of dendritic cells in tumor microenvironment and immunotherapy. Cancer Commun. 2024;44(9):1047-1070. doi: 10.1002/cac2.12596
- Gabrilovich DI, Nagaraj S. Myeloid-derived-suppressor cells as regulators of the immune system. Nat Rev Immunol. 2009;9(3):162-174. doi: 10.1038/nri2506
- Bronte V, Serafini P, De Santo C, et al. IL-4-Induced Arginase 1 Suppresses Alloreactive T Cells in Tumor-Bearing Mice1. J Immunol. 2003;170(1):270-278. doi: 10.4049/jimmunol.170.1.270
- Jou E, Chaudhury N, Nasim F. Novel therapeutic strategies targeting myeloid-derived suppressor cell immunosuppressive mechanisms for cancer treatment. Explor Target Anti-Tumor Ther. 2024;5(1):187–207. doi: 10.37349/etat.2024.00212
- Lindau D, Gielen P, Kroesen M, Wesseling P, Adema GJ. The immunosuppressive tumour network: myeloid-derived suppressor cells, regulatory T cells and natural killer T cells. Immunology. 2013;138(2):105-115. doi: 10.1111/imm.12036
- Krishnamoorthy M, Gerhardt L, Maleki Vareki S. Immunosuppressive Effects of Myeloid-Derived Suppressor Cells in Cancer and Immunotherapy. Cells. 2021;10(5):1170. doi: 10.3390/cells10051170
- Law AMK, Valdes-Mora F, Gallego-Ortega D. Myeloid- Derived Suppressor Cells as a Therapeutic Target for Cancer. Cells. 2020;9(3):561. doi: 10.3390/cells9030561
- Mohme M, Neidert MC. Tumor-Specific T Cell Activation in Malignant Brain Tumors. Front Immunol. 2020;11:205. doi: 10.3389/fimmu.2020.00205
- Mortezaee K, Majidpoor J. Mechanisms of CD8+ T cell exclusion and dysfunction in cancer resistance to anti- PD-(L)1. Biomed Pharmacother. 2023;163:114824. doi: 10.1016/j.biopha.2023.114824
- Xie Q, Ding J, Chen Y. Role of CD8+ T lymphocyte cells: Interplay with stromal cells in tumor microenvironment. Acta Pharm Sin B. 2021;11(6):1365-1378. doi: 10.1016/j.apsb.2021.03.027
- Jarnicki AG, Lysaght J, Todryk S, Mills KHG. Suppression of Antitumor Immunity by IL-10 and TGF-β-Producing T Cells Infiltrating the Growing Tumor: Influence of Tumor Environment on the Induction of CD4+ and CD8+ Regulatory T Cells1. J Immunol. 2006;177(2):896-904. doi: 10.4049/jimmunol.177.2.896
- Liu Q, Sun Z, Chen L. Memory T cells: strategies for optimizing tumor immunotherapy. Protein Cell. 2020;11(8):549-564. doi: 10.1007/s13238-020-00707-9
- Han J, Khatwani N, Searles TG, Turk MJ, Angeles CV. Memory CD8+ T cell responses to cancer. Semin Immunol. 2020;49:101435. doi: 10.1016/j.smim.2020.101435
- Liu Y, Zhou F, Ali H, Lathia JD, Chen P. Immunotherapy for glioblastoma: current state, challenges, and future perspectives. Cell Mol Immunol. 2024;21(12):1354-1375. doi: 10.1038/s41423-024-01226-x
- Watowich MB, Gilbert MR, Larion M. T cell exhaustion in malignant gliomas. Trends Cancer. 2023;9(4):270-292. doi: 10.1016/j.trecan.2022.12.008
- Rastogi I, Jeon D, Moseman JE, Muralidhar A, Potluri HK, McNeel DG. Role of B cells as antigen presenting cells. Front Immunol. 2022;13:954936. doi: 10.3389/fimmu.2022.954936
- Sharma P, Aaroe A, Liang J, Puduvalli VK. Tumor microenvironment in glioblastoma: Current and emerging concepts. Neuro-Oncol Adv. 2023;5(1):vdad009. doi: 10.1093/noajnl/vdad009
- Batlle E, Massagué J. Transforming Grown Factor-β Signaling in Immunity and Cancer. Immunity. 2019;50(4):924-940. doi: 10.1016/j.immuni.2019.03.024
- Xue VW, Chung JYF, Córdoba CAG, et al. Transforming Growth Factor-β: A Multifunctional Regulator of Cancer Immunity. Cancers. 2020;12(11):3099. doi: 10.3390/cancers12113099
- Wu KS, Jian TY, Sung SY, et al. Enrichment of Tumor- Infiltrating B Cells in Group 4 Medulloblastoma in Children. Int J Mol Sci. 2022;23(9):5287. doi: 10.3390/ijms23095287
- Anfossi N, André P, Guia S, et al. Human NK Cell Education by Inhibitory Receptors for MHC Class I. Immunity. 2006;25(2):331-342. doi: 10.1016/j.immuni.2006.06.013
- Yokoyama WM, Altfeld M, Hsu KC. Natural Killer Cells: Tolerance to Self and Innate Immunity to Viral Infection and Malignancy. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 2010;16(1 0):S97-S105. doi: 10.1016/j.bbmt.2009.10.009
- Cózar B, Greppi M, Carpentier S, Narni-Mancinelli E, Chiossone L, Vivier E. Tumor-infiltrating natural killer cells. Cancer Discov. 2021;11(1):34-44. doi: 10.1158/2159-8290.CD-20-0655
- Tie Y, Tang F, Wei Y quan, Wei X wei. Immunosuppressive cells in cancer: mechanisms and potential therapeutic targets. J Hematol Oncol. 2022;15:61. doi: 10.1186/s13045-022-01282-8
- Fares J, Davis ZB, Rechberger JS, et al. Advances in NK cell therapy for brain tumors. Npj Precis Oncol. 2023;7(1):1-17. doi: 10.1038/s41698-023-00356-1
- Balatsoukas A, Rossignoli F, Shah K. NK Cells in the Brain: Implications for Brain Tumor Development and Therapy. Trends Mol Med. 2022;28(3):194-209. doi: 10.1016/j.molmed.2021.12.008
- Varricchi G, Galdiero MR, Loffredo S, et al. Eosinophils: The unsung heroes in cancer? Oncoimmunology. 2017;7(2):e1393134. doi: 10.1080/2162402X.2017.1393134
- Ghaffari S, Rezaei N. Eosinophils in the tumor microenvironment: implications for cancer immunotherapy. J Transl Med. 2023;21:551. doi: 10.1186/s12967-023-04418-7
- Salvo-Romero E, Rodiño-Janeiro BK, Albert-Bayo M, et al. Eosinophils in the Gastrointestinal Tract: Key Contributors to Neuro-Immune Crosstalk and Potential Implications in Disorders of Brain-Gut Interaction. Cells. 2022;11(10):1644. doi: 10.3390/cells11101644
- Liu S, Wang W, Hu S, et al. Radiotherapy remodels the tumor microenvironment for enhancing immunotherapeutic sensitivity. Cell Death Dis. 2023;14(10):1-19. doi: 10.1038/s41419-023-06211-2
- Arango Duque G, Descoteaux A. Macrophage Cytokines: Involvement in Immunity and Infectious Diseases. Front Immunol. 2014;5:491. doi: 10.3389/fimmu.2014.00491
- Grisaru-Tal S, Rothenberg MarcE, Munitz A. Eosinophil– lymphocyte interactions in the tumor microenvironment and cancer immunotherapy. Nat Immunol. 2022;23(9):1309- 1316. doi: 10.1038/s41590-022-01291-2
- Riggan L, Shah S, O’Sullivan TE. Arrested development: suppression of NK cell function in the tumor microenvironment. Clin Transl Immunol. 2021;10(1):e1238. doi: 10.1002/cti2.1238
- Stefanik D. Vascular Endothelial Growth Factor in Malignant Disease of the Central Nervous System. In: VEGF and Cancer. Springer US; 2004:72-82. doi: 10.1007/978-1-4419-9148-5_9
- Walsh MJ, Ali LR, Lenehan P, et al. Blockade of innate inflammatory cytokines TNFα, IL-1β, or IL-6 overcomes virotherapy-induced cancer equilibrium to promote tumor regression. Immunother Adv. 2023;3(1):ltad011. doi: 10.1093/immadv/ltad011
- Ojaroodi AF, Shokravi S, Eskandarzadeh S, et al. The hypoxic tumor microenvironment: Functional and metabolic reprogramming of key immune populations. Pathol Res Pract. 2026;282:156443. doi: 10.1016/j.prp.2026.156443
- Zhao Y, Xing C, Deng Y, Ye C, Peng H. HIF-1α signaling: Essential roles in tumorigenesis and implications in targeted therapies. Genes Dis. 2023;11(1):234-251. doi: 10.1016/j.gendis.2023.02.039
- Andersen RS, Anand A, Harwood DSL, Kristensen BW. Tumor-Associated Microglia and Macrophages in the Glioblastoma Microenvironment and Their Implications for Therapy. Cancers. 2021;13(17):4255. doi: 10.3390/cancers13174255
- Wei G, Li B, Huang M, et al. Polarization of Tumor Cells and Tumor‐Associated Macrophages: Molecular Mechanisms and Therapeutic Targets. MedComm. 2025;6(9):e70372. doi: 10.1002/mco2.70372
- Park J, Hsueh PC, Li Z, Ho PC. Microenvironment-driven metabolic adaptations guiding CD8+ T cell anti-tumor immunity. Immunity. 2023;56(1):32-42. doi: 10.1016/j.immuni.2022.12.008
- Liang P, Li Z, Chen Z, et al. Metabolic Reprogramming of Glycolysis, Lipids, and Amino Acids in Tumors: Impact on CD8+ T Cell Function and Targeted Therapeutic Strategies. FASEB J Off Publ Fed Am Soc Exp Biol. 2025;39(8):e70520. doi: 10.1096/fj.202403019R
- Biserova K, Strumfa I. Glioblastoma Stem Cells and Tumour Microenvironment: Interactions Across Hypoxia, Vasculature and Immune Modulation. Int J Mol Sci. 2026;27(6):2557. doi: 10.3390/ijms27062557
- Chung J, Saad J, Kafri A, Rossignol J, Verbrugge M, Bakke J. Metabolism of glioblastoma: a review of metabolic adaptations and metabolic therapeutic interventions. Front Oncol. 15:1712576. doi: 10.3389/fonc.2025.1712576
- Colwell N, Larion M, Giles AJ, et al. Hypoxia in the glioblastoma microenvironment: shaping the phenotype of cancer stem-like cells. Neuro-Oncol. 2017;19(7):887-896. doi: 10.1093/neuonc/now258
- Fan H, Yang S, Lu Q, Chang L. Metabolic reprogramming and immunosenescence: a new sight for glioma therapy. Front Cell Dev Biol. 14:1754980. doi: 10.3389/fcell.2026.1754980
- Ma Y, Wang H, Dou X, Li Q. Diversity and function of tumor-associated macrophages in brain metastases: mechanisms and therapeutic prospects. Front Immunol. 2026;17:1756299. doi: 10.3389/fimmu.2026.1756299
- Monteiro AR, Hill R, Pilkington GJ, Madureira PA. The Role of Hypoxia in Glioblastoma Invasion. Cells. 2017;6(4):45. doi: 10.3390/cells6040045
- Park JH, Lee HK. Current Understanding of Hypoxia in Glioblastoma Multiforme and Its Response to Immunotherapy. Cancers. 2022;14(5):1176. doi: 10.3390/cancers14051176
- Tamimi AF, Juweid M. Epidemiology and Outcome of Glioblastoma. In: De Vleeschouwer S, ed. Glioblastoma. Codon Publications; 2017. doi: 10.15586/codon.glioblastoma.2017.ch8
- Neuropathology R. Glioblastoma IDH wild type. Radiopaedia.org. Published online 2015. doi: 10.53347/rID-41309
- Cahill KE, Morshed RA, Yamini B. Nuclear factor-κB in glioblastoma: insights into regulators and targeted therapy. Neuro-Oncol. 2016;18(3):329-339. doi: 10.1093/neuonc/nov265
- Puliyappadamba VT, Hatanpaa KJ, Chakraborty S, Habib AA. The role of NF-κB in the pathogenesis of glioma. Mol Cell Oncol. 2014;1(3):e963478. doi: 10.4161/23723548.2014.963478
- Vidotto T, Melo CM, Castelli E, Koti M, dos Reis RB, Squire JA. Emerging role of PTEN loss in evasion of the immune response to tumours. Br J Cancer. 2020;122(12):1732-1743. doi: 10.1038/s41416-020-0834-6
- Vidotto T, Melo CM, Lautert-Dutra W, Chaves LP, Reis RB, Squire JA. Pan-cancer genomic analysis shows hemizygous PTEN loss tumors are associated with immune evasion and poor outcome. Sci Rep. 2023;13(1):5049. doi: 10.1038/s41598-023-31759-6
- Pouyan A, Ghorbanlo M, Eslami M, et al. Glioblastoma multiforme: insights into pathogenesis, key signaling pathways, and therapeutic strategies. Mol Cancer. 2025;24(1):58. doi: 10.1186/s12943-025-02267-0
- Demkow U. Neutrophil Extracellular Traps (NETs) in Cancer Invasion, Evasion and Metastasis. Cancers. 2021;13(17):4495. doi: 10.3390/cancers13174495
- Sun C, Wang S, Ma Z, et al. Neutrophils in glioma microenvironment: from immune function to immunotherapy. Front Immunol. 2024;15:1393173. doi: 10.3389/fimmu.2024.1393173
- Pang L, Khan F, Heimberger AB, Chen P. Mechanism and Therapeutic Potential of Tumor-Immune Symbiosis in Glioblastoma. Trends Cancer. 2022;8(10):839-854. doi: 10.1016/j.trecan.2022.04.010
- Habashy KJ, Mansour R, Moussalem C, Sawaya R, Massaad MJ. Challenges in glioblastoma immunotherapy: mechanisms of resistance and therapeutic approaches to overcome them. Br J Cancer. 2022;127(6):976-987. doi: 10.1038/s41416-022-01864-w
- Pyonteck SM, Akkari L, Schuhmacher AJ, et al. CSF-1R inhibition alters macrophage polarization and blocks glioma progression. Nat Med. 2013;19(10):1264-1272. doi: 10.1038/nm.3337
- Kitzberger C, Shehzad K, Morath V, et al. Interleukin-6- controlled, mesenchymal stem cell-based sodium/iodide symporter gene therapy improves survival of glioblastoma-bearing mice. Mol Ther - Oncolytics. 2023;30:238-253. doi: 10.1016/j.omto.2023.08.004
- Jarmuzek P, Defort P, Kot M, Wawrzyniak-Gramacka E, Morawin B, Zembron-Lacny A. Cytokine Profile in Development of Glioblastoma in Relation to Healthy Individuals. Int J Mol Sci. 2023;24(22):16206. doi: 10.3390/ijms242216206
- Filley AC, Henriquez M, Dey M. Recurrent glioma clinical trial, CheckMate-143: the game is not over yet. Oncotarget. 2017;8(53):91779-91794. doi: 10.18632/oncotarget.21586
- Ser MH, Webb MJ, Sener U, Campian JL. Immune Checkpoint Inhibitors and Glioblastoma: A Review on Current State and Future Directions. J Immunother Precis Oncol. 2024;7(2):97-110. doi: 10.36401/JIPO-23-34
- National Cancer Institute. Oligodendroglioma and Other IDH-Mutated Tumors: Diagnosis and Treatment. Available from: https://www.cancer.gov/rare-brain-spine-tumor/ tumors/oligodendroglioma [Last accessed on March 1, 2025].
- Idbaih A, Touat M. 1p/19q Co-deletion in Glioma: ESMO Biomarker Factsheet. European Society for Medical Oncology. Published 2017. Available from: https:// oncologypro.esmo.org/education-library/factsheets-on-biomarkers/1p-19q-co-deletion-in-glioma [Last accessedon March 1, 2025].
- Du X, Hu H. The Roles of 2-Hydroxyglutarate. Front Cell Dev Biol. 2021;9:651317. doi: 10.3389/fcell.2021.651317
- Zhang L, Sorensen MD, Kristensen BW, Reifenberger G, McIntyre TM, Lin F. D-2-hydroxyglutarate is an intercellular mediator in IDH-mutant gliomas inhibiting complement and T cells. Clin Cancer Res Off J Am Assoc Cancer Res. 2018;24(21):5381-5391. doi: 10.1158/1078-0432.CCR-17-3855
- Haddad AF, Young JS, Oh JY, Okada H, Aghi MK. The immunology of low-grade gliomas. Neurosurg Focus. 2022;52(2):E2. doi: 10.3171/2021.11.FOCUS21587
- Laxton RC, Popov S, Doey L, et al. Primary glioblastoma with oligodendroglial differentiation has better clinical outcome but no difference in common biological markers compared with other types of glioblastoma. Neuro-Oncol. 2013;15(12):1635-1643. doi: 10.1093/neuonc/not125
- Simonetti G, Gaviani P, Botturi A, Innocenti A, Lamperti E, Silvani A. Clinical management of grade III oligodendroglioma. Cancer Manag Res. 2015;7:213-223. doi: 10.2147/CMAR.S56975
- van der Meulen M, Mason WP. First-line chemotherapeutic treatment for oligodendroglioma, WHO grade 3—PCV or temozolomide? Neuro-Oncol Pract. 2022;9(3):163-164. doi: 10.1093/nop/npac023
- Rudà R, Bruno F, Pellerino A, Soffietti R. Ependymoma: Evaluation and Management Updates. Curr Oncol Rep. 2022;24(8):985-993. doi: 10.1007/s11912-022-01260-w
- Donson AM, Bertrand KC, Riemondy KA, et al. Significant increase of high-risk chromosome 1q gain and 6q loss at recurrence in posterior fossa group A ependymoma: A multicenter study. Neuro-Oncol. 2023;25(10):1854-1867. doi: 10.1093/neuonc/noad096
- Griesinger AM, Witt DA, Grob ST, et al. NF-κB upregulation through epigenetic silencing of LDOC1 drives tumor biology and specific immunophenotype in Group A ependymoma. Neuro-Oncol. 2017;19(10):1350-1360. doi: 10.1093/neuonc/nox061
- Aubin RG, Troisi EC, Montelongo J, et al. Pro-inflammatory cytokines mediate the epithelial-to-mesenchymal-like transition of pediatric posterior fossa ependymoma. Nat Commun. 2022;13:3936. doi: 10.1038/s41467-022-31683-9
- Qi L, Yu H, Zhang Y, et al. IL-10 secreted by M2 macrophage promoted tumorigenesis through interaction with JAK2 in glioma. Oncotarget. 2016;7(44):71673-71685. doi: 10.18632/oncotarget.12317
- Chan AS, Leung SY, Wong MP, et al. Expression of vascular endothelial growth factor and its receptors in the anaplastic progression of astrocytoma, oligodendroglioma, and ependymoma. Am J Surg Pathol. 1998;22(7):816-826. doi: 10.1097/00000478-199807000-00004
- Rudà R, Reifenberger G, Frappaz D, et al. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro-Oncol. 2018;20(4):445-456. doi: 10.1093/neuonc/nox166
- Zuccato JA, Algan O, Nair VJ, et al. Resection and radiotherapy for intracranial ependymoma: a multiinstitutional 50-year experience. J Neurosurg. 2022;137(2):525-532. doi: 10.3171/2021.9.JNS211299
- Solomou G, Finch A, Asghar A, Bardella C. Mutant IDH in Gliomas: Role in Cancer and Treatment Options. Cancers. 2023;15(11):2883. doi: 10.3390/cancers15112883
- Cao C, Zhang L, Sorensen MD, et al. D-2-hydroxyglutarate regulates human brain vascular endothelial cell proliferation and barrier function. J Neuropathol Exp Neurol. 2023;82(11):921-933. doi: 10.1093/jnen/nlad072
- Jia W, Jackson-Cook C, Graf MR. Tumor-infiltrating, myeloid-derived suppressor cells inhibit T cell activity by nitric oxide production in an intracranial rat glioma + vaccination model. J Neuroimmunol. 2010;223(1-2):20-30. doi: 10.1016/j.jneuroim.2010.03.011
- Grishin AS, Achkasova KA, Kukhnina LS, Sharova VA, Ostapyuk MV, Yashin KS. Peritumoral Brain Zone in Astrocytoma: Morphology, Molecular Aspects, and Clinical Manifestations (Review). Mod Technol Med. 2024;16(2):79- 88. doi: 10.17691/stm2024.16.2.08
- McDonnell AM, Lesterhuis WJ, Khong A, et al. Tumor-infiltrating dendritic cells exhibit defective cross-presentation of tumor antigens, but is reversed by chemotherapy. Eur J Immunol. 2015;45(1):49-59. doi: 10.1002/eji.201444722
- Friedrich M, Hahn M, Michel J, et al. Dysfunctional dendritic cells limit antigen-specific T cell response in glioma. Neuro- Oncol. 2023;25(2):263-276. doi: 10.1093/neuonc/noac138
- Ma Y, Shurin GV, Peiyuan Z, Shurin MR. Dendritic Cells in the Cancer Microenvironment. J Cancer. 2012;4(1):36-44. doi: 10.7150/jca.5046
- Stiver SI. Angiogenesis and its role in the behavior of astrocytic brain tumors. Front Biosci-Landmark. 2004;9(1- 3):310. doi: 10.2741/1463
- Chen ML, Pittet MJ, Gorelik L, et al. Regulatory T cells suppress tumor-specific CD8 T cell cytotoxicity through TGF-β signals in vivo. Proc Natl Acad Sci. 2005;102(2):419- 424. doi: 10.1073/pnas.0408197102
- Kizilbash SH, Giannini C, Voss JSS, et al. The impact of concurrent temozolomide with adjuvant radiation and IDH mutation status among patients with anaplastic astrocytoma. J Neurooncol. 2014;120(1):85–93. doi: 10.1007/s11060-014-1520-4
- Miller JJ. Targeting IDH-Mutant Glioma. Neurotherapeutics. 2022;19(6):1724-1732. doi: 10.1007/s13311-022-01238-3
- Garzon-Muvdi T, Bailey DD, Pernik MN, Pan E. Basis for Immunotherapy for Treatment of Meningiomas. Front Neurol. 2020;11:945. doi: 10.3389/fneur.2020.00945
- Mankotia DS, Singh SK, Borkar SA, Sharma BS, Rajeshwari M, Sharma MC. Primary Giant Sphenotemporal Intradiploic Meningioma. Asian J Neurosurg. 2018;13(1):157–160. doi: 10.4103/1793-5482.181139
- Berghoff AS, Kresl P, Rajky O, et al. Analysis of the inflammatory tumor microenvironment in meningeal neoplasms. Clin Neuropathol. 2020;39(6):256–262. doi: 10.5414/NP301156
- Kalluri AL, Shah PP, Lim M. The Tumor Immune Microenvironment in Primary CNS Neoplasms: A Review of Current Knowledge and Therapeutic Approaches. Int J Mol Sci. 2023;24(3):2020. doi: 10.3390/ijms24032020
- Lotsch C, Warta R, Herold-Mende C. The Molecular and Immunological Landscape of Meningiomas. Int J Mol Sci. 2024;25(17):9631. doi: 10.3390/ijms25179631
- Klingler JH, Gläsker S, Bausch B, et al. Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment. Childs Nerv Syst. 2020;36(10):2537-2552. doi: 10.1007/s00381-020-04712-5
- Fridman WH, Meylan M, Pupier G, Calvez A, Hernandez I, Sautès-Fridman C. Tertiary lymphoid structures and B cells: An intratumoral immunity cycle. Immunity. 2023;56(10):2254-2269. doi: 10.1016/j.immuni.2023.08.009
- Philip M, Schietinger A. CD8+ T cell differentiation and dysfunction in cancer. Nat Rev Immunol. 2022;22(4):209- 223. doi: 10.1038/s41577-021-00574-3
- Slim E, Antoun J, Kourie HR, Schakkal A, Cherfan G. Intravitreal bevacizumab for retinal capillary hemangioblastoma: A case series and literature review. Can J Ophthalmol J Can Ophtalmol. 2014;49(5):450–457. doi: 10.1016/j.jcjo.2014.07.007
- Omar AI. Bevacizumab for the treatment of surgically unresectable cervical cord hemangioblastoma: a case report. J Med Case Reports. 2012;6(1):238. doi: 10.1186/1752-1947-6-238
- Marques P, Silva AL, López-Presa D, Faria C, Bugalho MJ. The microenvironment of pituitary adenomas: biological, clinical and therapeutical implications. Pituitary. 2022;25(3):363-382. doi: 10.1007/s11102-022-01211-5
- Chang M, Yang C, Bao X, Wang R. Genetic and Epigenetic Causes of Pituitary Adenomas. Front Endocrinol. 2021;11:596554. doi: 10.3389/fendo.2020.596554
- Caimari F, Korbonits M. Novel Genetic Causes of Pituitary Adenomas. Clin Cancer Res. 2016;22(20):5030-5042. doi: 10.1158/1078-0432.CCR-16-0452
- Ben-Shlomo A, Deng N, Ding E, et al. DNA damage and growth hormone hypersecretion in pituitary somatotroph adenomas. J Clin Invest. 2020;130(11):5738–5755. doi: 10.1172/JCI138540
- Reincke M, Sbiera S, Hayakawa A, et al. Mutations in the deubiquitinase gene USP8 cause Cushing’s disease. Nat Genet. 2015;47(1):31-38. doi: 10.1038/ng.3166
- Ma ZY, Song ZJ, Chen JH, et al. Recurrent gain-of-function USP8 mutations in Cushing’s disease. Cell Res. 2015;25(3):306–317. doi: 10.1038/cr.2015.20
- Sapochnik M, Haedo MR, Fuertes M, et al. Autocrine IL-6 mediates pituitary tumor senescence. Oncotarget. 2017;8(3):4690–4702. doi: 10.18632/oncotarget.13577
- Lu JQ, Adam B, Jack AS, Lam A, Broad RW, Chik CL. Immune Cell Infiltrates in Pituitary Adenomas: More Macrophages in Larger Adenomas and More T Cells in Growth Hormone Adenomas. Endocr Pathol. 2015;26(3):263–272. doi: 10.1007/s12022-015-9383-6
- Hilton DA, Hanemann CO. Schwannomas and TheirPathogenesis. Brain Pathol. 2014;24(3):205. doi: 10.1111/bpa.12125
- Hannan CJ, Lewis D, O’Leary C, et al. The inflammatory microenvironment in vestibular schwannoma. Neuro-Oncol Adv. 2020;2(1):vdaa023. doi: 10.1093/noajnl/vdaa023
- Rabenhorst A, Hartmann K. The role of mast cells in the microenvironment of tumors. European Mast Cell and Basophil Research Network. https://embrn.eu/the-role-of-mast-cells-in-the-microenvironment-of-tumors/ [Last accessed on March 1, 2025].
- Bunimovich YL, Keskinov AA, Shurin GV, Shurin MR. Schwann cells: a new player in the tumor microenvironment. Cancer Immunol Immunother CII. 2016;66(8):959–968. doi: 10.1007/s00262-016-1929-z
- Kölliker-Frers R, Udovin L, Otero-Losada M, et al. Neuroinflammation: An Integrating Overview of Reactive- Neuroimmune Cell Interactions in Health and Disease. Mediators Inflamm. 2021;2021:9999146. doi: 10.1155/2021/9999146
- Kumari B, Lahariya R. Evaluating lipid-driven insulin resistance via TyG index in breast cancer patients: Toward effective secondary prevention. Ger Med Sci GMS E-J. 2025;23:Doc11. doi: 10.3205/000347
- Segura-Collar B, Hiller-Vallina S, de Dios O, et al. Advanced immunotherapies for glioblastoma: tumor neoantigen vaccines in combination with immunomodulators. Acta Neuropathol Commun. 2023;11(1):79. doi: 10.1186/s40478-023-01569-y
- Rahman MA, Ali MM. Recent Treatment Strategies and Molecular Pathways in Resistance Mechanisms of Antiangiogenic Therapies in Glioblastoma. Cancers. 2024;16(17):2975. doi: 10.3390/cancers16172975
- Yasinjan F, Xing Y, Geng H, et al. Immunotherapy: a promising approach for glioma treatment. Front Immunol. 2023;14. doi: 10.3389/fimmu.2023.1255611
- Ghouzlani A, Kandoussi S, Tall M, Reddy KP, Rafii S, Badou A. Immune Checkpoint Inhibitors in Human Glioma Microenvironment. Front Immunol. 2021;12. doi: 10.3389/fimmu.2021.679425
- Sanders S, Debinski W. Challenges to Successful Implementation of the Immune Checkpoint Inhibitors for Treatment of Glioblastoma. Int J Mol Sci. 2020;21(8):2759. doi: 10.3390/ijms21082759
- Wang X, Guo G, Guan H, Yu Y, Lu J, Yu J. Challenges and potential of PD-1/PD-L1 checkpoint blockade immunotherapy for glioblastoma. J Exp Clin Cancer Res CR. 2019;38:87. doi: 10.1186/s13046-019-1085-3
- Xu S, Wang C, Yang L, et al. Targeting immune checkpoints on tumor-associated macrophages in tumor immunotherapy. Front Immunol. 2023;14:1199631. doi: 10.3389/fimmu.2023.1199631
- Liaw K, Reddy R, Sharma A, et al. Targeted systemic dendrimer delivery of CSF-1R inhibitor to tumor-associated macrophages improves outcomes in orthotopic glioblastoma. Bioeng Transl Med. 2021;6(2):e10205. doi: 10.1002/btm2.10205
- Sterner RC, Sterner RM. EGFRVIII and EGFR targeted chimeric antigen receptor T cell therapy in glioblastoma. Front Oncol. 2024;14. doi: 10.3389/fonc.2024.1434495
- Jiang H, Gao H, Kong J, et al. Selective Targeting of Glioblastoma with EGFRvIII/EGFR Bitargeted Chimeric Antigen Receptor T Cell. Cancer Immunol Res. 2018;6(11):1314-1326. doi: 10.1158/2326-6066.CIR-18-0044
- Das AK, Sinha M, Singh SK, et al. CAR T-cell therapy: a potential treatment strategy for pediatric midline gliomas. Acta Neurol Belg. 2024;124(4):1251-1261. doi: 10.1007/s13760-024-02519-8
- Lei FJ, Chiang JY, Chang HJ, et al. Cellular and exosomal GPx1 are essential for controlling hydrogen peroxide balance and alleviating oxidative stress in hypoxic glioblastoma. Redox Biol. 2023;65:102831. doi: 10.1016/j.redox.2023.102831
- Ludwig K, Le Belle JE, Muthukrishnan SD, et al. Nicotinamide Adenine Dinucleotide Phosphate Oxidase Promotes Glioblastoma Radiation Resistance in a Phosphate and Tensin Homolog-Dependent Manner. Antioxid Redox Signal. 2023;39(13-15):890-903. doi: 10.1089/ars.2022.0086
- Park Y, Park M, Kim J, et al. NOX2-Induced High Glycolytic Activity Contributes to the Gain of COL5A1-Mediated Mesenchymal Phenotype in GBM. Cancers. 2022;14(3):516. doi: 10.3390/cancers14030516
- Zhu W, Carney KE, Pigott VM, et al. Glioma-mediated microglial activation promotes glioma proliferation and migration: roles of Na+/H+ exchanger isoform 1. Carcinogenesis. 2016;37(9):839-851. doi: 10.1093/carcin/bgw068
- Li Y, Han N, Yin T, et al. Lentivirus-mediated Nox4 shRNA invasion and angiogenesis and enhances radiosensitivity in human glioblastoma. Oxid Med Cell Longev. 2014;2014:581732. doi: 10.1155/2014/581732
- Su IC, Su YK, Setiawan SA, et al. NADPH Oxidase Subunit CYBB Confers Chemotherapy and Ferroptosis Resistance in Mesenchymal Glioblastoma via Nrf2/SOD2 Modulation. Int J Mol Sci. 2023;24(9):7706. doi: 10.3390/ijms24097706
- García‐Gómez P, Golán I, S. Dadras M, et al. NOX4 regulates TGFβ‐induced proliferation and self‐renewal in glioblastoma stem cells. Mol Oncol. 2022;16(9):1891-1912. doi: 10.1002/1878-0261.13200
- Najem H, Khasraw M, Heimberger AB. Immune Microenvironment Landscape in CNS Tumors and Role in Responses to Immunotherapy. Cells. 2021;10(8):2032. doi: 10.3390/cells10082032
- Alorfi NM, Ashour AM, Alharbi AS, Alshehri FS. Targeting inflammation in glioblastoma: An updated review from pathophysiology to novel therapeutic approaches. Medicine (Baltimore). 2024;103(21):e38245. doi: 10.1097/MD.0000000000038245
- Cheng F, Ming Y, Pan Y, et al. The NLRP3 signaling pathway is a potential target for clinical translation in glioma treatment. SLAS Discov Adv Life Sci R D. 2025;36:100279. doi: 10.1016/j.slasd.2025.100279
- Saqib M, Zahoor A, Rahib A, Shamim A, Mumtaz H. Clinical and translational advances in primary brain tumor therapy with a focus on glioblastoma-A comprehensive review of the literature. World Neurosurg X. 2024;24:100399. doi: 10.1016/j.wnsx.2024.100399
- Li S, Wang C, Chen J, et al. Signaling pathways in brain tumors and therapeutic interventions. Signal Transduct Target Ther. 2023;8:8. doi: 10.1038/s41392-022-01260-z
- Mendez JS, Cohen AL, Eckenstein M, et al. Phase 1b/2 study of orally administered pexidartinib in combination with radiation therapy and temozolomide in patients with newly diagnosed glioblastoma. Neuro-Oncol Adv. 2024;6(1):vdae202. doi: 10.1093/noajnl/vdae202
- Butowski N, Colman H, De Groot JF, et al. Orally administered colony stimulating factor 1 receptor inhibitor PLX3397 in recurrent glioblastoma: an Ivy Foundation Early Phase Clinical Trials Consortium phase II study. Neuro- Oncol. 2016;18(4):557-564. doi: 10.1093/neuonc/nov245
- Șerban M, Toader C, Covache-Busuioc RA. Brain Tumors, AI and Psychiatry: Predicting Tumor-Associated Psychiatric Syndromes with Machine Learning and Biomarkers. Int J Mol Sci. 2025;26(17):8114. doi: 10.3390/ijms26178114
- Mariniello A, Migliorini D. CAR-T cell therapies are coming after glioblastoma: An overview of early phase clinical trials and future perspectives. iScience. 2026;29(2):114609. doi: 10.1016/j.isci.2025.114609
- Vamvoukaki R, Chrysoulaki M, Betsi G, Xekouki P. Pituitary Tumorigenesis-Implications for Management. Medicina (Mex). 2023;59(4):812. doi: 10.3390/medicina59040812
- Dorris K, Mettetal A, Hemenway M, et al. CP-12 Phase 0 and Feasibility single-institution clinical trial of intravenous Tocilizumab for Adamantinomatous Craniopharyngioma. Neuro-Oncol. 2024;26(Suppl 4):0.doi: 10.1093/neuonc/noae064.050
- Cao Z, Tong S, Wang Z, et al. Recurrent Glioblastoma and the Tumor Immune Landscape: Emerging Immunotherapeutic Strategies. ImmunoTargets Ther. 2026;15:581012. doi: 10.2147/ITT.S581012
- Mantica M, Drappatz J. Immunotherapy associated central nervous system complications in primary brain tumors. Front Oncol. 2023;13:1124198. doi: 10.3389/fonc.2023.1124198
- Webb LM, Okuno SH, Ransom RC, et al. Recurrent adamantinomatous craniopharyngioma stabilized with tocilizumab and bevacizumab: illustrative case. J Neurosurg Case Lessons. 2025;9(2):CASE24410. doi: 10.3171/CASE24410
- Wang N, Jain RK, Batchelor TT. New Directions in Anti- Angiogenic Therapy for Glioblastoma. Neurotherapeutics. 2017;14(2):321-332. doi: 10.1007/s13311-016-0510-y
- McGee MC, Hamner JB, Williams RF, et al. Improved intratumoral oxygenation through vascular normalization increases glioma sensitivity to ionizing radiation. Int J Radiat Oncol Biol Phys. 2010;76(5):1537–1545. doi: 10.1016/j.ijrobp.2009.12.010
- Di Tacchio M, Macas J, Weissenberger J, et al. Tumor Vessel Normalization, Immunostimulatory Reprogramming, and Improved Survival in Glioblastoma with Combined Inhibition of PD-1, Angiopoietin-2, and VEGF. Cancer Immunol Res. 2019;7(12):1910-1927. doi: 10.1158/2326-6066.CIR-18-0865
- Vredenburgh JJ, Cloughesy T, Samant M, et al. Corticosteroid Use in Patients with Glioblastoma at First or Second Relapse Treated with Bevacizumab in the BRAIN Study. The Oncologist. 2010;15(12):1329-1334. doi: 10.1634/theoncologist.2010-0105
- Kaley T, Nolan C, Carver A, Omuro A. Bevacizumab for acute neurologic deterioration in patients with glioblastoma. CNS Oncol. 2013;2(5):413–418. doi: 10.2217/cns.13.40
- Gilbert MR, Dignam JJ, Armstrong TS, et al. A Randomized Trial of Bevacizumab for Newly Diagnosed Glioblastoma. N Engl J Med. 2014;370(8):699-708. doi: 10.1056/NEJMoa1308573
- Lu KV, Bergers G. Mechanisms of evasive resistance to anti- VEGF therapy in glioblastoma. CNS Oncol. 2012;2(1):49– 65. doi: 10.2217/cns.12.36
- Yakes FM, Chen J, Tan J, et al. Cabozantinib (XL184), a novel MET and VEGFR2 inhibitor, simultaneously suppresses metastasis, angiogenesis, and tumor growth. Mol Cancer Ther. 2011;10(12):2298–2308. doi: 10.1158/1535-7163.MCT-11-0264
- Zhang J, Zhou Q, Gao G, et al. The effects of ponatinib, a multi-targeted tyrosine kinase inhibitor, against human U87 malignant glioblastoma cells. OncoTargets Ther. 2014;7:2013-2019. doi: 10.2147/OTT.S67556
- Sareddy GR, Geeviman K, Ramulu C, Babu PP. The nonsteroidal anti-inflammatory drug celecoxib suppresses the growth and induces apoptosis of human glioblastoma cells via the NF-κB pathway. J Neurooncol. 2012;106(1):99- 109. doi: 10.1007/s11060-011-0662-x
- Andreou KE, Soto MS, Allen D, et al. Anti-inflammatory Microglia/Macrophages As a Potential Therapeutic Target in Brain Metastasis. Front Oncol. 2017;7. doi: 10.3389/fonc.2017.00251
- Ragel BT, Jensen RL, Gillespie DL, Prescott SM, Couldwell WT. Ubiquitous expression of cyclooxygenase-2 in meningiomas and decrease in cell growth following in vitro treatment with the inhibitor celecoxib: potential therapeutic application. J Neurosurg. 2005;103(3):508-517. doi: 10.3171/jns.2005.103.3.0508
- National Cancer Institute. Steroids Impair Immunotherapy for Brain CancerI. Published 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/brain-cancer-immunotherapy-steroids-limit-effectiveness [Last accessed on March 1, 2025].
- Giles AJ, Hutchinson MKND, Sonnemann HM, et al. Dexamethasone-induced immunosuppression: mechanisms and implications for immunotherapy. J Immunother Cancer. 2018;6(1):51. doi: 10.1186/s40425-018-0371-5
- Zhang Q, Guo W, Di C, Lou M, Li H, Zhao Y. Effects of transforming growth factor-β inhibitor on the proliferation of glioma stem/progenitor cell. Pol J Pathol Off J Pol Soc Pathol. 2017;68(4):312-317. doi: 10.5114/pjp.2017.73927
- Tran TT, Uhl M, Ma JY, et al. Inhibiting TGF-β signaling restores immune surveillance in the SMA-560 glioma model. Neuro-Oncol. 2007;9(3):259–270. doi: 10.1215/15228517-2007-010
- Hjelmeland MD, Hjelmeland AB, Sathornsumetee S, et al. SB-431542, a small molecule transforming growth factor- β-receptor antagonist, inhibits human glioma cell line proliferation and motility. Mol Cancer Ther. 2004;3(6):737- 745. doi: 10.1158/1535-7163.737.3.6
- Xue H, Yuan G, Guo X, et al. A novel tumor-promoting mechanism of IL6 and the therapeutic efficacy of tocilizumab: Hypoxia-induced IL6 is a potent autophagy initiator in glioblastoma via the p-STAT3-MIR155-3p- CREBRF pathway. Autophagy. 2016;12(7):1129-1152. doi: 10.1080/15548627.2016.1178446
- Guo Q, Shen S, Guan G, et al. Cancer cell intrinsic TIM-3 induces glioblastoma progression. iScience. 2022;25(11):105329. doi: 10.1016/j.isci.2022.105329
- Burghardt I, Tritschler F, Opitz CA, Frank B, Weller M, Wick W. Pirfenidone inhibits TGF-beta expression in malignant glioma cells. Biochem Biophys Res Commun. 2007;354(2):542-547. doi: 10.1016/j.bbrc.2007.01.012
- Bogdahn U, Hau P, Stockhammer G, et al. Targeted therapy for high-grade glioma with the TGF-β2 inhibitor trabedersen: results of a randomized and controlled phase IIb study. Neuro-Oncol. 2010;13(1):132–142. doi: 10.1093/neuonc/noq142
