グリオブラストーマの免疫抑制性微小環境：メカニズム、臨床的課題、および将来の展望

Glioblastoma (GBM) remains highly lethal due to intrinsic and extrinsic mechanisms, of which the immunosuppressive tumour microenvironment (TME) collectively limits treatment efficacy. This review synthesises recent advances in understanding how metabolic reprogramming, epigenetic remodelling and immune cell dysfunction converge to establish a stable immunosuppressive network dominated by tumour-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), regulatory T cells and exhausted T cells. We further summarise emerging therapeutic strategies, including myeloid-targeting agents, epigenetic modulators, metabolic inhibitors and combination immunotherapy, and discuss their clinical potential in overcoming GBM immune resistance. These insights provide a mechanistic and translational framework for developing next-generation multimodal treatment approaches.