Immunosuppressive MFAP2+ cancer associated fibroblasts conferred unfavorable prognosis and therapeutic resistance in gastric cancer.

Purpose: To explore the predictive merit of MFAP2⁺ cancer associated fibroblasts (CAFs) infiltration for clinical outcomes and adjuvant chemotherapy or immunotherapy responsiveness in gastric cancer (GC).

Methods: In this study, several independent cohorts were included respectively to dissect the relationship of clinical outcomes, therapeutic responses and tumor microenvironment with different MFAP2⁺ CAFs infiltration. Drug sensitivity analysis was conducted to predict the relationship between MFAP2⁺ CAFs infiltration and targeted drug response. Kaplan-Meier curves and the log-rank test were used to compare clinical outcomes of patients with different MFAP2⁺ CAFs infiltration.

Results: High MFAP2⁺ CAFs infiltration yielded inferior prognosis in terms of overall survival, progress free survival and recurrence free survival in GC. Patients with low MFAP2⁺ CAFs infiltration were more likely to gain benefit from adjuvant therapy. Moreover, low MFAP2⁺ CAFs infiltration could predict a promising response to immunotherapy in GC patients. MFAP2⁺ CAFs with immunosuppressive features were highly relevant to immune evasive contexture characterized by the dysfunction of CD8⁺ T cells. We found that MFAP2⁺ CAFs communicated with T cells, B cells and Macrophages through releasing macrophage migration inhibitor factor (MIF), which further suggested that MFAP2⁺ CAFs might promote therapeutic resistance through regulating T cells dysfunction and M2 macrophages polarization.

Conclusion: Immunosuppressive MFAP2⁺ CAFs constructed an immune evasive tumor microenvironment characterized by incapacitated immune effector cells, consequently predicting inferior clinical outcomes and response on adjuvant therapy and immunotherapy in patients with GC. The potential of immunosuppressive MFAP2⁺ CAFs as a therapeutic target for GC deserved thoroughly exploration.