A subset of cancer-associated fibroblasts (FAP + /CAF-S1) mediates immunosuppression in breast cancers, but its heterogeneity and its impact on immunotherapy response remain unknown. Here, we identify 8 CAF-S1 clusters by analyzing more than 19,000 single CAF-S1 fibroblasts from breast cancer. We validate the five most abundant clusters by flow cytometry and in silico analyses in other cancer types, highlighting their relevance. Myofibroblasts from clusters 0 and 3, characterized by extracellular matrix proteins and TGFβ signaling, respectively, are indicative of primary resistance to immunotherapies. Cluster 0/ecm-myCAF upregulates PD-1 and CTLA4 protein levels in regulatory T lymphocytes (Tregs), which, in turn, increases CAF-S1 cluster 3/TGFβ-myCAF cellular content. Thus, our study highlights a positive feedback loop between specific CAF-S1 clusters and Tregs and uncovers their role in immunotherapy resistance. SIgnIFICAnCe:Our work provides a significant advance in characterizing and understanding FAP + CAF in cancer. We reached a high resolution at single-cell level, which enabled us to identify specific clusters associated with immunosuppression and immunotherapy resistance. Identification of cluster-specific signatures paves the way for therapeutic options in combination with immunotherapies.

No abstract

IntroductionMesenchymal stromal cells (MSCs) are multipotent stem cells able to differentiate into mesoderm-derived cells, 1 and exhibit immunoregulatory properties. 2 MSCs have been used in the context of allogeneic hematopoietic stem cell transplantation to improve hematopoietic engraftment, to prevent graft failure, and to reduce the incidence or severity of acute graft-versus-host disease (GVHD). [3][4][5] MSCs obtained from bone marrow (BM) can undergo in vitro expansion in medium containing either fetal calf serum (FCS), with or without fibroblast growth factor (FGF-2), or platelet lysate (PL). 6 However, little is known about the effect of donor selection or culture conditions on the functional properties and therapeutic potential of clinical-grade MSCs.Recent studies have suggested that MSCs can contribute to tumor growth and metastasis. 7 A related concern is the capacity of MSCs for oncogenic transformation. Mouse MSCs show chromosomal abnormalities and are highly susceptible to transformation associated with an increased telomerase activity and myc expression, and a loss of p53 and p16. [8][9][10] In contrast, human MSCs are more resistant to transformation in vitro with no genomic instability detected and no tumor induced after long-term in vivo transfer. [11][12][13][14][15] After 20 to 50 population doublings (PDs), human MSCs undergo replicative senescence, with telomere shortening and increased p16 expression. 16 They require the same steps to achieve transformation as for differentiated cells, suggesting that they are not prone to spontaneous transformation. 17 Nevertheless, one recent study described the transformation of human adipose tissue-derived MSCs with up-regulation of myc, repression of p16, acquisition of telomerase activity, 18 and generation of carcinoma in mice. 19 We investigated the immune properties and resistance to transformation of MSCs produced in 4 cell therapy facilities during 2 multicenter clinical trials designed to evaluate the capacity of BM-MSCs to prevent acute GVHD or to treat irradiationinduced lesions. MethodsDetails regarding methods are provided in the supplemental data (available on the Blood website; see the Supplemental Materials link at the top of the online article). For personal use only. on March 28, 2019. by guest www.bloodjournal.org From (1A to 11A) were done for the GVHD prevention clinical trial, and 4 (12A, 13A2) to treat accidentally irradiated patients. For irradiated patients, 5 supplemental MSC productions (12B to 16B) were done using human PL. 6 MSC production Growth kinetics and MSC characterizationGrowth kinetics was assessed by studying total fold increase, total number of PDs, and colony-forming unit-fibroblast. MSCs were screened for the expression of CD45, CD73, CD105, CD90, and human leukocyte antigen-DR (HLA-DR) and were also checked for their capacity to stimulate the growth of allogeneic peripheral blood mononuclear cells (PBMCs) and to inhibit alloantigen-driven proliferation of PBMCs. Cytogenetic analysisAt the end of the first (P ...