Dendritic cell vaccines using monocyte-derived DCs (moDCs) have shown low toxicity, but limited clinical efficacy, perhaps due to extensive ex vivo processing. Recent developments in magnetic bead technology have allowed for the quick isolation of naturally circulating DC (nDC) subsets (pDCs and cDC2s, with ongoing efforts to isolate CD141+ cDC1s), which may retain more functionality than moDCs. Thus far, nDCs have been used in 9 clinical trials, though available data is still limited. Additional ways of improving DC vaccines include optimizing the dosing and mode of administration, using neoantigens for loading, and designing rational combinations.
Dendritic cells (DCs) can initiate and direct adaptive immune responses. This ability is exploitable in DC vaccination strategies, in which DCs are educated ex vivo to present tumor antigens and are administered into the patient with the aim to induce a tumor-specific immune response. DC vaccination remains a promising approach with the potential to further improve cancer immunotherapy with little or no evidence of treatment-limiting toxicity. However, evidence for objective clinical antitumor activity of DC vaccination is currently limited, hampering the clinical implementation. One possible explanation for this is that the most commonly used monocyte-derived DCs may not be the best source for DC-based immunotherapy. The novel approach to use naturally circulating DCs may be an attractive alternative. In contrast to monocyte-derived DCs, naturally circulating DCs are relatively scarce but do not require extensive culture periods. Thereby, their functional capabilities are preserved, the reproducibility of clinical applications is increased, and the cells are not dysfunctional before injection. In human blood, at least three DC subsets can be distinguished, plasmacytoid DCs, CD141(+) and CD1c(+) myeloid/conventional DCs, each with distinct functional characteristics. In completed clinical trials, either CD1c(+) myeloid DCs or plasmacytoid DCs were administered and showed encouraging immunological and clinical outcomes. Currently, also the combination of CD1c(+) myeloid and plasmacytoid DCs as well as the intratumoral use of CD1c(+) myeloid DCs is under investigation in the clinic. Isolation and culture strategies for CD141(+) myeloid DCs are being developed. Here, we summarize and discuss recent clinical developments and future prospects of natural DC-based immunotherapy.