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Myeloid-derived suppressor cells in the tumor microenvironment: expect the unexpected
Douglas Marvel, Dmitry I. Gabrilovich
Douglas Marvel, Dmitry I. Gabrilovich
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Review Series

Myeloid-derived suppressor cells in the tumor microenvironment: expect the unexpected

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Abstract

Our understanding of the role of myeloid-derived suppressor cells (MDSCs) in cancer is becoming increasingly complex. In addition to their eponymous role in suppressing immune responses, they directly support tumor growth, differentiation, and metastasis in a number of ways that are only now beginning to be appreciated. It is because of this increasingly complex role that these cells may become an important factor in the treatment of human cancer. In this Review, we discuss the most pertinent and controversial issues of MDSC biology and their role in promoting cancer progression and highlight how these cells may be used in the clinic, both as prognostic factors and as therapeutic targets.

Authors

Douglas Marvel, Dmitry I. Gabrilovich

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Figure 3

Therapeutic strategies targeting MDSCs.

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Therapeutic strategies targeting MDSCs.
MDSCs can be targeted in one of ...
MDSCs can be targeted in one of three broadly defined ways. First, they can be directly killed. Low-dose gemcitabine, 5-fluorouracil, and TRAIL receptor ligation have shown efficacy in doing so, both clinically and preclinically. The second category of therapeutic is functional inhibition of MDSC-suppressive machinery. PDE-5 inhibitors, such as taldalafil, as well as NO-releasing aspirin and synthetic triterpenoids act effectively in this manner, in part by reducing the expression of ROS, reactive nitrogen species, and arginase, all central to the ability of MDSCs to inhibit immune responses. Finally, myelopoeisis can be skewed such that MDSC accumulation is inhibited and/or MDSCs are forcefully differentiated into more terminally differentiated, immunostimulatory myeloid cells such as DCs and macrophages. Sunitinib and ATRA have shown efficacy in these two functions, respectively.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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