Dual-faced CXCL5 holds the key to unlocking immunotherapy in obese pancreatic cancer.

Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest malignancies, characterized by a profoundly immunosuppressive tumor microenvironment and resistance to immunotherapy. Obesity, a modifiable risk factor that increases PDAC incidence, exacerbates this immune evasion through metabolic inflammation and adipokine-driven signaling. Recent studies have implicated CXC chemokines, particularly CXCL5, as central mediators in shaping the immune landscape of PDAC. In a pivotal study, Walsh et al delineated a novel mechanism wherein adipocyte-derived cytokines (interleukin-1β and tumor necrosis factor) induce tumor-derived CXCL5 expression, thereby promoting myeloid-driven immunosuppression in obese PDAC models. Their findings demonstrated that CXCL5 ablation enhances CD8⁺ T-cell infiltration yet paradoxically increases monocytic myeloid-derived suppressor cell accumulation and arginase-1 expression, underscoring the complexity of chemokine signaling. Notably, only combinatorial targeting of CXCL5 and programmed cell death protein-1 yields therapeutic benefit, emphasizing the necessity of multiaxis interventions. This commentary synthesizes the mechanistic insights and translational implications of these findings, highlighting CXCL5 as a pivotal node linking metabolic dysfunction to immune resistance and a promising target for combinatorial immunotherapy in PDAC.