Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by producing remarkable clinical outcomes for patients with various cancer types. However, only a subset of patients benefits from immunotherapeutic interventions due to the primary and acquired resistance to ICIs. Myeloid-derived suppressor cells (MDSCs) play a crucial role in creating an immunosuppressive tumor microenvironment (TME) and contribute to resistance to immunotherapy. V-domain Ig suppressor of T cell activation (VISTA), a negative immune checkpoint protein highly expressed on MDSCs, presents a promising target for overcoming resistance to current ICIs. This article provides an overview of the evidence supporting VISTA's role in regulating MDSCs in shaping the TME, thus offering insights into how to overcome immunotherapy resistance.

HBV infection is a key risk factor for the development and progression of hepatocellular carcinoma (HCC), a highly invasive tumor, and is characterized by its persistent immunosuppressive microenvironment. This review provides an in-depth analysis of HBV-related HCC and explores the interactions between neutrophils, natural killer cells, and dendritic cells, examining their roles in regulating tumor-associated macrophages and CD8+ T cells and shaping the tumor microenvironment. Two critical players in the immunosuppressive milieu of HBV-related HCC are CD8+ T cells and tumor-associated macrophages (TAMs). The study explores how TAMs, initially recruited to combat infection, transform, adopting a tumor-promoting phenotype, turning against the body, promoting tumor cell proliferation, suppressing anti-tumor immunity, and assisting in the spread of cancer. Meanwhile, CD8+ T cells, crucial for controlling HBV infection, become dysfunctional and exhausted in response to persistent chronic viral inflammation. The review then dissects how TAMs manipulate this immune response, further depleting CD8+ T cell functions through mechanisms like arginine deprivation and creating hypoxic environments that lead to exhaustion. Finally, it explores the challenges and promising therapeutic avenues that target TAMs and CD8+ T cells, either separately or in combination with antiviral therapy and personalized medicine approaches, offering hope for improved outcomes in HBV-related HCC.

Liver cancer continues to be a significant challenge among malignancies today. Hepatocellular carcinoma is one of the cancers that exhibits a marked upregulation of AKR1B10, an enzyme involved in cellular metabolism. The advancement of HCC treatment indicates that immunotherapy and molecular targeted therapies exhibit potential efficacy. However, the primary targets for liver cancer are not yet well-defined. Therefore, this study investigates the mechanism of AKR1B10 to assess its potential as a prognostic biomarker in liver cancer. Genetic changes, genomic expression, and methylation analyses were sourced from the TCGA, CPTAC, UALCAN, HPA, cBioPortal, and MethSurv databases. The gene expression is validated by qPCR. The diagnostic and prognostic significance of AKR1B10 in LIHC was assessed using data from ROC analysis and KM-plotter. Functional analyses were performed utilizing the GeneMANIA and STRING databases, along with gene-gene and PPI networks, GO terms, and KEGG pathway analyses. The relationship with immune escape was explored through analyses conducted using the TIMER, TISIDB, and GEPIA databases. Additionally, GSCALite was utilized to analyze drug sensitivity in relation to AKR1B10 expression in tumors. AKR1B10 expression was found to be statistically significantly higher in HCC cells than in their corresponding normal control cells, according to qPCR analysis. ROC analysis identified AKR1B10 as a novel biomarker for diagnosing LIHC. Univariate Cox regression analysis indicated AKR1B10 association with poor LIHC patient prognosis. Integrative analyses, including genetic alterations, gene-gene interactions, PPI networks, and enrichment analyses, support a novel role for AKR1B10 in HCC progression. Hypermethylation of AKR1B10 at various CpG sites was associated with improved or diminished OS in LIHC, and AKR1B10 exhibited a robust correlation with the top 25 genes that were either hypo- or hypermethylated. Furthermore, the findings indicated that AKR1B10 may affect the TME and is associated with immune checkpoints. This study’s comprehensive analyses indicate AKR1B10 as a novel biomarker for LIHC. The online version contains supplementary material available at 10.1007/s12672-025-03017-w.