Progress on irreversible electroporation combined with immunotherapy in the treatment of solid tumors

The advent of medical engineering technologies such as electromagnetism, acoustics or optics tumor ablation technology coupled with their clinical applications has gained a lot of interest among scientists. Irreversible electroporation (IRE), a novel physical ablation technique. is widely utilized to ablate the unresectable solid tumors and demonstrates a favorable safety and high efficacy in clinical applications. which is a promising therapy in clinical cancer treatment. As opposed to thermal ablative techniques. IRE induces cell death by the delivery of high-voltage electrical pulses, which possesses several advantages as a non-thennal ablation method: (1) Less collateral thermal damage, especially for the vital nerves/vessels and luminal structure; (2) no heat sink effect, it avoids the energy' reduction caused by blood flow that would lead to the incomplete ablation; (3) preservation of extracellular matrix (ECM) scaffold. it is important for promoting rapid postoperative recovery'. While a major drawback, the challenge for IRE. is the susceptibility to recurrence resulting from the incomplete ablation, which limits the clinical application of IRE. However, IRE utilizes electric pulses to alter the transmembrane voltage on the cell membrane. which causes nanometer-sized membrane defects or pores in the cells and leads to loss of cell homeostasis. IRE has been demonstrated to not only kill tumor cells directly, but also promote the massive release of intracellular concealed tumor antigens that become an in situ "tumor vaccine", inducing a potential anti-tumor immune response to kill residual tumor cells after ablation and inhibiting the local recurrence of tumors. Therefore, IRE can be regarded as a potential immunomodulatory therapy. IRE combined with immunotherapy will be a promising therapeutic strategy for malignant tumors. Recently, researchers paid much more attention to studying the immune response induced by IRE. And several studies have confirmed that IRE can induce a significant immune response in tumor-bearing organisms and significantly improve the anti-tumor efficacy of IRE. Additionally, cancer treatment has entered the era of clinical multidisciplinary comprehensive treatment, and the prognosis of patients with different tumor has been significantly improved. Thus, IRE combined with immunotherapy may have a synergistic effect on malignant tumor treatment. This article reviewed the characteristics of local and systemic immune response induced by IRE in tumor-bearing organisms, and its related mechanisms, and the research progress on the efficiency of IRE combined with immunotherapy in the treatment of solid tumors. The review aimed at elucidating the characteristics of IRE-induced immune response, and the mechanism behind it, and its potential in combination with immunotherapy for the treatment of solid tumors. It will provide a theoretical and practical guidance for clinical application of IRE combined with immunotherapy in the treatment of solid tumors.