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Stimulating immune checkpoint proteins weaken the immune system in contrast to inhibitory pathways, and co-stimulatory molecules may fight malignant cells by enhancing the immune response. Malignant cells usually promote tumorigenesis by inhibiting the co-stimulatory pathway. Checkpoint stimulatory molecules such as OX40, GITR, ICOS, 4-1BB, CD40 play a key role in regulating T cell effector function, and activation of the co-stimulatory pathway may enhance checkpoint inhibition effect and lead to durable anti-tumor response.
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