Publications

Non-small cell lung cancer (NSCLC) is the most common lung cancer type and one of the deadliest neoplasias worldwide. NSCLC is histologically classified into adenocarcinoma, squamous cell carcinoma, and other less frequent subtypes. Both subtypes and other solid tumors are increasingly regarded as abnormal organs, highlighting the critical role of the desmoplastic tumor stroma rich in cancer-associated fibroblasts (CAFs) in driving tumor progression and therapeutic resistance. This tumor stroma resembles a chronic fibrotic wound and is largely formed by activated/myofibroblast-like alpha-SMA+ CAFs (myCAFs), which are strongly associated with immunosuppression and poor prognosis. Despite the dominance of the myCAF phenotype, we reported a decade ago phenotypic alterations in NSCLC with a strong dependence on the histologic subtype. Subsequent studies using functional assays, single-cell techniques, and in vivo models have refined these initial observations, enhancing our understanding of the biology of both normal fibroblasts/myofibroblasts and CAFs in NSCLC and other cancer types, including their origins, subclassification, and physiopathologic functions. Notably, increasing evidence supports that CAFs can exhibit tumor-restraining or tumor-promoting effects, and current therapeutic efforts aim to shift the balance towards tumor-restraining phenotypes. Here, we review major advances in our understanding of tumor stromagenesis and CAF heterogeneity in both primary tumors and metastasis, including emerging consensus, with a special focus on NSCLC and its frequent dissemination to the brain. We also highlight the critical role of smoking through epigenetic reprogramming of the TGF-beta/SMAD3 pathway. These advances are beginning to delineate how CAF heterogeneity depends on the stage and histologic subtype in NSCLC.

JTD Keywords: Accumulation, Activation, Cancer-associated fibroblasts, Carcinoma-associated-fibroblasts, Desmoplasia, Differentiation, Generation, Localization, Metastasis, Microenvironment, Myofibroblast, Myofibroblasts, Non-small cell lung cancer, Progression, Stroma, Stromagenesis

Lung cancer is the leading cause of cancer-related death worldwide. The desmoplastic stroma of lung cancer and other solid tumors is rich in tumor-associated fibroblasts (TAFs) exhibiting an activated/myofibroblast-like phenotype. There is growing awareness that TAFs support key steps of tumor progression and are epigenetically reprogrammed compared to healthy fibroblasts. Although the mechanisms underlying such epigenetic reprogramming are incompletely understood, there is increasing evidence that they involve interactions with either cancer cells, pro-fibrotic cytokines such as TGF-β, the stiffening of the surrounding extracellular matrix, smoking cigarette particles and other environmental cues. These aberrant interactions elicit a global DNA hypomethylation and a selective transcriptional repression through hypermethylation of the TGF-β transcription factor SMAD3 in lung TAFs. Likewise, similar DNA methylation changes have been reported in TAFs from other cancer types, as well as histone core modifications and altered microRNA expression. In this review we summarize the evidence of the epigenetic reprogramming of TAFs, how this reprogramming contributes to the acquisition and maintenance of a tumor-promoting phenotype, and how it provides novel venues for therapeutic intervention, with a special focus on lung TAFs.

JTD Keywords: cancer-associated fibroblasts, desmoplasia, dna methylation, epigenetics, expression, genomic dna, lung cancer, mechanical memory, myofibroblast differentiation, pulmonary fibroblasts, smoking, stromal fibroblasts, tgf-?, tgf-beta, tgf-β, transforming growth-factor-beta-1, tumor stroma, Cancer-associated fibroblasts, Carcinoma-associated fibroblasts, Desmoplasia, Epigenetics, Lung cancer, Smoking, Tgf-β, Tumor stroma