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The gut microbiota not only directly regulates the activity and function of immune cells to affect the efficacy of ICIs but also regulates the immune system of the body through the gut-brain axis, affecting ICI efficacy against tumors ( Research has shown that the gut microbiota can downregulate granulocyte-macrophage colony-stimulating factor signaling through the gut-brain axis, leading to significant expression of reactive oxygen species in activated immature myeloid cells, thereby increasing the inhibitory activity of MDSCs on T cells and enhancing ICI therapy ( Enterococcus -Type 4 tumor antigens also exhibit high similarity, which can activate CD8+ T cells and improve the effectiveness of PD-1 blockade therapy ( 6 Role of the gut microbiota and gut-brain axis in regulating ICI therapy for GBM Over the years, researchers have found that the brain has immune functions and functional lymphatic vessels, challenging the view that the brain is an immune-privileged organ ( Recent studies have shown that the gut microbiota plays an important role in ICI therapy for GBM and that appropriate microbial activity can reduce immune suppression in glioma models and improve the response to ICI therapy

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In addition to TAMs, the proliferation and metabolic activities of T lymphocytes and B lymphocytes within the TME are also critically dependent on glutamine