{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T13:24:46Z","timestamp":1791552286956,"version":"4.3.4"},"reference-count":112,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T00:00:00Z","timestamp":1651017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","award":["GNT1173892"],"award-info":[{"award-number":["GNT1173892"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Diffuse midline glioma (DMG), including those of the brainstem (diffuse intrinsic pontine glioma), are pediatric tumors of the central nervous system (CNS). Recognized as the most lethal of all childhood cancers, palliative radiotherapy remains the only proven treatment option, however, even for those that respond, survival is only temporarily extended. DMG harbor an immunologically \u201ccold\u201d tumor microenvironment (TME) with few infiltrating immune cells. The mechanisms underpinning the cold TME are not well understood. Low expression levels of immune checkpoint proteins, including PD-1, PD-L1, and CTLA-4, are recurring features of DMG and likely contribute to the lack of response to immune checkpoint inhibitors (ICIs). The unique epigenetic signatures (including stem cell-like methylation patterns), a low tumor mutational burden, and recurring somatic mutations (H3K27M, TP53, ACVR1, MYC, and PIK3CA), possibly play a role in the reduced efficacy of traditional immunotherapies. Therefore, to circumvent the lack of efficacy thus far seen for the use of ICIs, adoptive cell transfer (including chimeric antigen receptor T cells) and the use of oncolytic viruses, are currently being evaluated for the treatment of DMG. It remains an absolute imperative that we improve our understanding of DMG\u2019s intrinsic and TME features if patients are to realize the potential benefits offered by these sophisticated treatments. Herein, we summarize the limitations of immunotherapeutic approaches, highlight the emerging safety and clinical efficacy shown for sophisticated cell-based therapies, as well as the evolving knowledge underpinning the DMG-immune axis, to guide the development of immunotherapies that we hope will improve outcomes.<\/jats:p>","DOI":"10.1093\/neuonc\/noac117","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T13:32:48Z","timestamp":1650979968000},"page":"1408-1422","source":"Crossref","is-referenced-by-count":89,"title":["The intrinsic and microenvironmental features of diffuse midline glioma: Implications for the development of effective immunotherapeutic treatment strategies"],"prefix":"10.1093","volume":"24","author":[{"given":"Mika L","family":"Persson","sequence":"first","affiliation":[{"name":"Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, New South Wales , Australia"},{"name":"Precision Medicine Program, Hunter Medical Research Institute , New Lambton Heights, New South Wales , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia M","family":"Douglas","sequence":"additional","affiliation":[{"name":"Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, New South Wales , Australia"},{"name":"Precision Medicine Program, Hunter Medical Research Institute , New Lambton Heights, New South Wales , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Alvaro","sequence":"additional","affiliation":[{"name":"Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, New South Wales , Australia"},{"name":"Precision Medicine Program, Hunter Medical Research Institute , New Lambton Heights, New South Wales , Australia"},{"name":"John Hunter Children\u2019s Hospital , New Lambton Heights, New South Wales , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pouya","family":"Faridi","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , Melbourne, Victoria , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin R","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology and Biochemistry, Protein Research Group, University of Southern Denmark , Odense , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta M","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Navarra , Pamplona , Spain"},{"name":"Program in Solid Tumors and Biomarkers, Foundation for Applied Medical Research (CIMA) , Pamplona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A","family":"Vitanza","sequence":"additional","affiliation":[{"name":"Ben Towne Center for Childhood Cancer Research, Seattle Children\u2019s Research Institute , Seattle, Washington , USA"},{"name":"Department of Pediatrics, Seattle Children\u2019s Hospital, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9063-5370","authenticated-orcid":false,"given":"Matthew D","family":"Dun","sequence":"additional","affiliation":[{"name":"Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle , Callaghan, New South Wales , Australia"},{"name":"Precision Medicine Program, Hunter Medical Research Institute , New Lambton Heights, New South Wales , 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