Heating
is a multifunctional adjuvant that affects tumor microenvironment through
several intrinsic and extrinsic mechanisms, which could enhance immunotherapy
in the following ways: increasing vascular perfusion and blood flow to the
tumor occurring through both thermoregulatory signals, as well as changes in
tumor metabolism, leading to increased hypoxia-inducible factor-1 (HIF-1), which
leads to increased reactive oxygen species (ROS) production and VEGF
expression; increased trafficking of CD8+ T cells occurring through
heat-induced increases in E/P selectin and intercellular adhesion molecule 1
(ICAM-1) on tumor blood vessels; increased T-cell receptor (TCR) signaling and
differentiation of naïve T cells to effector cells; increased tumor
cell-surface expression of MHC class I ligand (MICA/B) and upregulation of the
ligand NKG2D on natural killer (NK) cells, increasing NK cell cytotoxic potential;
increased functional activity of macrophages and dendritic cells; and increased
release of HSPs into the extracellular environment, stimulating downstream
immune activity, and increasing antigen presentation. IL, interleukin.
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