Frontiers | Glioblastoma stem cell–immune microenvironment crosstalk: molecular mechanisms and therapeutic opportunities
www.frontiersin.org
Oct. 17, 2026, 7:11 a.m.
Glioblastoma remains a highly aggressive and treatment-resistant primary brain malignancy with limited long-term survival improvements despite multimodal therapeutic advances. Glioblastoma stem cells (GSCs) drive tumor initiation, recurrence, and therapeutic resistance through complex interactions with the tumor immune microenvironment (TIME). This comprehensive review examines the molecular and cellular mechanisms of GSC-TIME crosstalk, focusing on key immune populations including tumor-associated macrophages, myeloid-derived suppressor cells, T cells, regulatory T cells, natural killer cells, and neutrophils. Critical signaling pathways are identified, including B2M/TGF-β1, IL8/CXCR2, IFI35/NF-κB, lactate/lactylation, and m6A/LOXL2, alongside extracellular vesicle-mediated communication. These interactions sustain GSC stemness, enable metabolic adaptation, facilitate immune escape, and confer resistance to radiotherapy, temozolomide, and targeted therapies. The review evaluates emerging therapeutic strategies including TAM/MDSC reprogramming, metabolic and epigenetic interventions, immune checkpoint blockade, bispecific antibodies, CAR-T/NK cell therapy, and extracellular vesicle-based delivery. Understanding GSC-TIME crosstalk is essential for developing precision therapies that address the spatial heterogeneity and blood-brain barrier challenges inherent to glioblastoma treatment.