Therapeutic manipulation and spatial quantification of the tumor microenvironment in colorectal cancer

Mulholland-Illingworth EJ., Moore JW., Lin M., Amirkhah R., Grzesiak L., Ligeza A., Bull JA., Boen J., Valbuena GN., Gillespie MA., Lannagan TRM., Gilroy K., Mills ML., Corry SM., Ridgway RA., Belnoue-Davis HL., Dunne PD., Sansom OJ., Byrne HM., Leedham SJ.

Colorectal cancer (CRC) is a complex ecosystem shaped by bidirectional interactions between epithelium and the tumor microenvironment, prominently mediated by TGFβ signaling. Cancer-associated fibroblasts (CAFs) are regulators of epithelial plasticity and immune cell recruitment; yet, their diversity has impacted translationally applicable spatial analysis. Here, we distil the fibroblast continuum into two overarching CAF populations that are largely transcriptomically distinct and are marked by PDGFRA+ and ACTA2+ expression, enabling robust spatial identification using single immunohistochemical markers. We show that TGFβ signaling drives dynamic transitions between these states. In a preclinical model, selective ALK5 inhibition remodels CAF composition in vivo, reconfiguring local immune neighborhoods and indirectly altering epithelial stem cell states. Finally, we demonstrate that multiscale spatial analysis provides a quantitative readout of stromal-immune-epithelial remodeling following therapy. These findings establish a simplified, translationally relevant CAF framework and highlight spatially resolved stromal dynamics as measurable indicators of therapeutic response in CRC.

DOI

10.1016/j.isci.2026.115193

Type

Journal article

Publication Date

2026-04-17T00:00:00+00:00

Volume

29

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