IntroductionThe concept of tumor "immunosurveillance," whereby the host immune system is thought to protect against the development of primary cancers, has been debated for decades and has been recently resurrected. 1 Evidence in support of tumor immunosurveillance includes observations in mice that lymphocytes and molecules essential for immune function, such as interferon-␥ (IFN␥) and perforin, collaborate to protect against the development of certain cancers. Additional corroboration has come from identification of numerous human tumor-associated or tumor-specific antigens recognized by T cells and from isolation of tumor antigenspecific T cells from metastatic lesions. Furthermore, infiltration of certain human cancers by T cells may correlate with dramatically improved survival. 2 The accumulating evidence in favor of tumor immunosurveillance indicates that immunotherapies or "vaccines" may prove effective for the treatment of cancer. Indeed, numerous published reports have shown that vaccination of cancer patients with killed tumor cells, tumor cell lysates or tumor antigen proteins, peptides or DNA administered with cytokines or adjuvants can produce immunologic and clinical responses. However, the immune responses to these vaccines are often weak, and clinical responses are rarely complete and long lasting. [3][4][5] Dendritic cells (DCs) are bone marrow-derived antigenpresenting cells (APCs) that play a critical role in the induction and regulation of immune responses. It has been proposed that the manipulation of DCs as a "natural" vaccine adjuvant may prove to be a particularly effective way to stimulate antitumor immunity. 6,7 This hypothesis has been supported by experiments in mice. However, published reports of DC-based vaccine trials in humans have yet to demonstrate improved potency of DC vaccines over more traditional vaccine preparations. 5,8,9 In this review we discuss the pitfalls of current DC vaccine approaches in the context of recent advances in DC biology and how improved understanding of DC biology can be applied to develop more effective immunotherapies for cancer.
DC biology DC differentiation and subtypesDCs are a heterogeneous population of cells produced in the bone marrow in response to growth and differentiation factors fms-like tyrosine kinase-3 ligand (Flt3L) and granulocyte-macrophage colony-stimulating factor (GM-CSF). There are 3 generally accepted stages of differentiation for all DC subtypes: DC precursors, immature DCs, and mature DCs. 10 In human blood, immature DCs and DC precursors are lineage-negative (CD3 Ϫ CD14 Ϫ CD19 Ϫ CD56 Ϫ ) HLA-DR ϩ mononuclear cells 6 and are traditionally divided into 2 populations by staining with antibodies to CD11c and CD123 (interleukin 3 receptor ␣ [IL-3R␣]). CD11c ϩ CD123 lo DCs have a monocytoid appearance and are called "myeloid DCs" (MDCs), whereas CD11c Ϫ CD123 hi DCs have morphologic features similar to plasma cells and are thus called "plasmacytoid DCs" (PDCs). Although commonly used, this nomenclature is somewhat misleading. E...