BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson and Anna-Luisa Di StefanoDeciphering diffuse glioma immune microenvironment as a key to improving immunotherapy resultsPicca, Albertoa; Finocchiaro, Gaetanob Author Information aSorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013 Paris, France. Equipe labellisée LNCC bDepartment of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy Correspondence to Dr Gaetano Finocchiaro, Department of Neurology and Disease Unit of Neuro-Oncology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy. Tel: +39 02 2643 5258; e-mail: [email protected] Current Opinion in Oncology 34(6):p 653-660, November 2022. | DOI: 10.1097/CCO.0000000000000895 Buy Metrics Abstract Purpose of review Immunotherapeutic approaches have yet to demonstrate their clinical efficacy in diffuse gliomas. Evidence is mounting that the central nervous system is subject to immune surveillance, but brain tumours manage to escape due to factors intrinsic to their tumoral immune microenvironment (TME). This review aims to discuss the recently characterized molecular bases of the glioma TME and the potentially actionable targets to improve immunotherapeutic results in these hard-to-treat cancers. Recent findings Single-cell studies defined the composition of the glioma immune TME and its peculiarities compared with other solid cancers. In isocitrate dehydrogenase (IDH) wildtype gliomas, the TME is enriched in myeloid cells (monocyte-derived macrophages and resident microglia) with mainly immunosuppressive functions. Lymphocytes can infiltrate the glioma TME, but are exposed to multiple immunomodulating signals that render them in a state of deep exhaustion. IDH mutant gliomas produce the oncometabolite D-2-hydroxyglutarate with negative effects on leukocyte recruitment and function, resulting in the induction of an ‘immune-desert’ TME. Summary Several molecular pathways have been recently identified in the induction of an ‘immune-hostile’ microenvironment in diffuse gliomas, unravelling potential vulnerabilities to targeted immunotherapies. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.