Fructose drives colorectal cancer progression by regulating crosstalk between cancer-associated fibroblasts and tumour cells

Background Fructose has been identified as a potential alternative energy source for cancer cells, facilitated by the fructose-specific transporter GLUT5. Elevated GLUT5 expression in cancer cells has been associated with increased tumour aggressiveness. However, the role of fructose in remodelling the tumour microenvironment, particularly in modulating cancer-associated fibroblast (CAF) behaviour, remains underexplored. Objective This study aimed to elucidate the regulatory effects and molecular mechanisms of fructose-mediated CAF reprogramming in colorectal cancer (CRC) progression. Design The effects of fructose and fructose-cultured tumour cells on biological function of CAFs were detected. Metabolomics and transcriptomic analyses were used to characterise the fructose-regulated crosstalk network of tumour cells and CAFs. Furthermore, the relationships between GLUT5 expression level in CAFs and clinicopathological features and prognosis of patients with CRC were analysed. Results We demonstrate that fructose plays a dual role in promoting CRC progression by influencing both tumour cells and CAFs. GLUT5 is expressed in both CRC cells and CAFs, with its expression correlating with more advanced tumour stages and poorer outcomes in patients. Fructose metabolism in CAFs enhances their proliferation, migration and activation, while fructose utilisation by CRC cells leads to the release of nucleotides and amino acids. These metabolites activate CAFs and upregulate the expression of the chemokine CXCL14. This, in turn, promotes tumour cell migration and metastasis. Conclusions These findings reveal a novel mechanism by which fructose fosters tumour progression through the modulation of tumour-stroma interactions, and highlight the therapeutic potential of targeting fructose metabolism in CRC to disrupt the tumour-stroma crosstalk that drives malignancy.