Harnessing bacteria for tumor therapy: Current advances and challenges

After a century of standstill, bacteria-based tumor therapy has resurged recently benefiting from the revolution of tumor immunotherapy, which provides unique solutions to tackle the obstacles of traditional tumor treatments. Obligate and facultative anaerobes with active tropism can selectively colonize at tumor sites and suppress tumor growth via different mechanisms, serving as attractive tools for tumor treatment either as a monotherapy or combining with other therapies for synergistic anti-tumor effects. In this critical review, we introduce the recent advances of bacteria-based tumor therapy from the following aspects. First, the general properties of bacteria are reviewed emphasizing on their structural components related to tumor immunotherapy, and the main bacteria that have been used in tumor therapy are listed. Then, the benefits of bacteria for tumor therapy are illustrated, such as tumor targetability, deep penetration, and facile genetic engineering for attenuation, enhanced efficacy, as well as bioimaging. Next, anti-tumor mechanisms of bacteria are summarized, which refer to intrinsic tumoricidal activities, immune activation, bacteria metabolism, and their capability to regulate gut microbiota homeostasis. Moreover, bacteria could act as carriers to deliver various types of therapeutics to achieve combination therapy with improved efficacy. In addition, several challenges for anti-tumor applications of bacteria are discussed regarding the delivery, efficacy and safety issues, and potential solutions are also provided. Finally, the possible improvements and perspectives are discussed in the end, which provide a guideline for the design of advanced bacteria-based tumor therapeutics in the future.