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GD2 (Disialoganglioside GD2) is a glycosphingolipid (ganglioside) primarily expressed on the surface of cells derived from the neuroectoderm [1, 2, 13, 15]. While its expression in healthy adults is highly restricted to the central nervous system (cerebellum), peripheral nerves, and skin melanocytes, it is abundantly overexpressed in various malignancies, most notably neuroblastoma, melanoma, and osteosarcoma [1, 5, 6, 11, 15, 21]. Biologically, GD2 plays a critical role in tumor cell adhesion, migration, and signal transduction, often promoting a more aggressive and metastatic phenotype [1, 2, 5, 6, 18]. It also functions as an immune checkpoint by interacting with Siglec-7 on NK cells to suppress anti-tumor immunity [1, 2]. Due to its high tumor specificity and stable surface expression, GD2 has become a premier target for cancer immunotherapy [1, 2, 3, 7]. Therapeutic strategies include monoclonal antibodies like dinutuximab and naxitamab, which eliminate tumor cells through antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) [1, 3, 7, 8, 14, 21]. However, the presence of GD2 on peripheral nerve fibers leads to significant treatment-related side effects, most notably severe neuropathic pain, which often requires intensive analgesic management during therapy [3, 8, 11, 16].
Drugs targeting GD2 primarily work through antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) to induce tumor cell lysis [1, 3, 7, 8, 14, 21]. Some antibodies also induce direct apoptosis by interfering with survival signaling pathways like FAK and mTOR, or by causing mitochondrial damage [1, 2, 5, 10]. Chimeric antigen receptor (CAR) T-cell therapies are also being developed to provide direct T-cell mediated killing of GD2-positive cells [1, 7, 11].
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