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Diab et al. J Cancer Metastasis Treat 2022;8:42 Journal of Cancer
DOI: 10.20517/2394-4722.2022.60
Metastasis and Treatment

Review Open Access

The heterogeneity of CAFs and immune cell
populations in the tumor microenvironment of

pancreatic adenocarcinoma

1
Maria Diab , Bassel F. El-Rayes 2
1
Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA.
2
Division of Hematology and Oncology, University of Alabama, Birmingham, AL 35294 USA.
Correspondence to: Dr. Maria Diab, Department of Hematology and Oncology, Winship Cancer Institute of Emory University,
1365 Clifton Rd NE Atlanta, Atlanta, GA 30322, USA. E-mail: maria.diab@emory.edu

How to cite this article: Diab M, El-Rayes BF. The heterogeneity of CAFs and immune cell populations in the tumor
microenvironment of pancreatic adenocarcinoma. J Cancer Metastasis Treat 2022;8:42. https://dx.doi.org/10.20517/2394-
4722.2022.60
Received: 24 May 2022 First Decision: 8 Jul 2022 Revised: 29 Jul 2022 Accepted: 19 Sep 2022 Published: 27 Sep 2022

Academic Editors: Antonio Facciorusso, Yogesh Vashist Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Over the past decade, researchers have identified and characterized the diverse cell populations within the tumor
microenvironment of pancreatic cancer. The interplay between these cells in the TME either promotes or inhibits
the malignant behavior of pancreatic cancer cells. Cancer-associated fibroblasts, previously thought to be one main
subset, can now be broadly subclassified into three main types: inflammatory, myofibroblastic, and antigen-
presenting, with the former and the latter two exerting pro-tumoral and anti-tumoral functions, respectively.
Myeloid cells include myeloid-derived suppressor cells and tumor-associated macrophages. Myeloid-derived
suppressor cells can be further divided into polymorphonuclear and monocytic and exhibit pro-tumoral activities.
Tumor-associated macrophages exhibit M1 (anti-tumoral) or M2 (pro-tumoral) phenotypes, which are present in a
dynamic fashion between the two phenotypes. Other constituents of the immune make-up of the tumor
microenvironment include T and B cells and less described subsets which include natural killer cells, γδ T cells, and
group 2 innate lymphoid cells. This review provides an overview of the studies that lead to the discovery of those
cellular populations and highlights the recent efforts to utilize them as therapeutic targets in pancreatic cancer.

Keywords: Tumor microenvironment, pancreatic cancer, cancer-associated fibroblast, myeloid cells, T cells

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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