Role of Macrophage Ferroptosis in Immune Evasion of Hepatocellular Carcinoma and Research Progress on Traditional Chinese Medicine Intervention
10.3971/j.issn.1000-8578.2026.25.0926
- VernacularTitle:肿瘤相关巨噬细胞铁死亡在肝细胞癌免疫逃逸中的作用及中医药调控研究进展
- Author:
Jinxiang PENG
1
;
Xiaojuan LI
2
;
Man LU
3
;
Xinhua XU
3
;
Mengxian SHU
4
;
Feng WU
4
Author Information
1. Medical Department, Hubei Enshi College, Enshi 445000, China;School of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China.
2. School of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China;Hubei Shizhen Laboratory, Wuhan 430060, China.
3. Medical Department, Hubei Enshi College, Enshi 445000, China.
4. Department of Pulmonary Disease Diabetes Mellitus, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.
- Publication Type:REVIEWS
- Keywords:
Hepatocellular carcinoma;
Tumor-associated macrophages;
Ferroptosis;
Immune escape;
Traditional Chinese medicine
- From:
Cancer Research on Prevention and Treatment
2026;53(4):316-324
- CountryChina
- Language:Chinese
-
Abstract:
Hepatocellular carcinoma (HCC) develops within a profoundly immunosuppressive tumor immune microenvironment (TIME), which limits the efficacy of immunotherapy. Polarization of tumor-associated macrophages (TAMs) toward a pro-tumorigenic M2 phenotype is a major driver of immune escape. Ferroptosis, an iron-dependent regulated cell death program, intersects with hepatic iron metabolism and immune regulation and thus offers promising points of therapeutic intervention. This review systematically elucidates the mechanistic role of TAM ferroptosis in HCC immune evasion and highlights a “bidirectional regulation” intervention strategy grounded in the Traditional Chinese medicine (TCM) principle of “fortifying healthy qi and eliminating pathogens” (Fuzheng Quxie). This strategy employs “eliminating pathogens” (Quxie) approaches to exploit the metabolic vulnerability of M2-like TAMs and precisely induce their ferroptosis. Moreover, it utilizes “fortifying healthy qi” (Fuzheng) approaches to protect M1-like TAMs and CD8+ T cells from oxidative damage. This parallel “induction-protection” paradigm demonstrates the unique advantages of TCM in systemically remodeling TIME through multitarget synergistic actions. Accordingly, precision regulation of TAM ferroptosis based on the Fuzheng Quxie theory represents a promising integrative Chinese-Western medicine strategy for overcoming current bottlenecks in HCC immunotherapy, although its clinical translational potential warrants further validation.
