At the Interface of Tumor-Associated Macrophages and Fibroblasts: Immune-Suppressive Networks and Emerging Exploitable Targets

Tumor-associated macrophages (TAM) constitute a prominent immune cell population within various solid cancers, playing a pivotal role in disease progression. Their increased numbers and frequencies often strongly correlate with resistance to therapy and reduced overall survival rates. Within the complex ecosystem of the tumor microenvironment (TME), activated cancer-associated fibroblasts (CAF) are expanded and contribute significantly to tumor growth and metastasis and chemotherapy or immunotherapy resistance. CAFs exert a critical influence on TAM phenotypes and functions by orchestrating the reprogramming of tissue-infiltrating monocytes, thereby modulating their survival and differentiation. This reciprocal interaction between TAMs and CAFs forms a crucial axis in fostering a suppressive crosstalk within the TME, mediated by a diverse array of signals exchanged between these cell types. Recent advancements in single-cell RNA sequencing technologies and spatial transcriptomics have enhanced our comprehension of the signaling dynamics at the interface between TAMs and CAFs, including their spatial distribution within the tissue. In this review, we delve into the latest discoveries elucidating the biology of TAM and CAF crosstalk. We examine the complexity of TAM-CAF and CAF-TAM interactions within the TME of solid cancers, with particular focus on ligand-receptor interactions and clinically significant targets for novel therapeutic strategies.