Accumulation of suppressive leukocytes is the hallmark of several pathological conditions, including tumors. Among these leukocytes, myeloid-derived suppressor cells (MDSCs) are thought to play a major role in regulating antitumor immunity. MDSCs encompass a heterogeneous population characterized by its myeloid origin and ability to suppress T-cell responses. The suppressive activity of these cells has been shown to be both dependent and independent on l-arginine metabolism. In this chapter, we describe and address the complex role of MDSCs in cancer, including their origin, phenotype, interaction in other immune regulatory networks, and mechanisms they use to exert their suppressive activity. Furthermore, we discuss the possibilities to convert the suppressive nature of these cells and combine this approach with immunotherapy in order to enhance therapeutic gain in cancer.
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