OnCo
ideasIdea

Train the bone marrow to make better anti-tumour immune cells

Certain vaccines and fungal sugars reprogramme the bone marrow so it produces more aggressive immune cells for months. That could be used before immunotherapy.

Trained immunityepigenetic reprogramming of haematopoietic progenitors by BCG or beta-glucan — produces durable changes in myeloid output and reduced tumour growth in mouse models, and BCG's efficacy in bladder cancer is the oldest immunotherapy in use. Priming the marrow before checkpoint therapy or cell therapy is a cheap, generic intervention that has never been formally tested in solid tumours.

Hypothesis
Systemic beta-glucan or BCG priming before checkpoint blockade shifts circulating monocyte epigenetic and functional profiles and increases response rates in cold tumours.
Rationale
The mechanism operates upstream, on progenitor cells, so it could change the whole myeloid compartment rather than one tumour. Both priming agents are cheap, widely available and have decades of safety data.
What would test it
A randomised window trial measuring monocyte functional and epigenetic reprogramming after priming, with tumour myeloid composition on biopsy as the mechanistic endpoint before any efficacy trial.
Maturity
preclinical evidence
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
8
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