Highlights  Monocyte-derived TAM gradually replace resident peritoneal macrophages in metastatic ovarian cancer  Ovarian cancer cells promote membrane-cholesterol efflux in TAM  Cholesterol-efflux depletes lipid rafts and increases IL-4 signaling in TAM  Inhibition of ABC transporters reverts the tumor-promoting functions of TAM in ovarian cancer eTOC blurb Goossens et al. show that cancer cells scavenge membrane cholesterol from macrophages in tumors which reprogrammes them towards an immune-suppressive and tumor-promoting phenotype and makes them resistant to activation by anti-tumor cytokines. SummaryTumor-associated macrophages (TAM) have been shown to have important roles in the malignant progression of various cancers. However, macrophages also posses intrinsic tumoricidal activity, but rapidly adopt an alternative phenotype within tumors associated with immune-suppression and trophic functions supporting tumor growth. The mechanisms that promote TAM polarization remain poorly understood, these mechanisms may represent important therapeutic targets to block the tumor-promoting functions of TAM and restore their anti-tumor potential. Here we have characterized TAM in a mouse model of metastatic ovarian cancer. We show that ovarian cancer cells promote membrane-cholesterol efflux and depletion of lipid rafts from macrophages. Increased cholesterol efflux promoted IL-4 mediated reprogramming while inhibiting IFN-induced gene expression. These studies reveal an unexpected role for membrane-cholesterol efflux in driving the tumor-promoting functions of TAM, while rendering them refractory to pro-inflammatory stimuli. Thus, preventing cholesterol efflux in TAM may represent a novel therapeutic strategy to block pro-tumor functions and restore anti-tumor immunity.

Experimental and clinical evidence suggests that tumor-associated macrophages (TAMs) play important roles in cancer progression. Here, we have characterized the ontogeny and function of TAM subsets in a mouse model of metastatic ovarian cancer that is representative for visceral peritoneal metastasis. We show that the omentum is a critical premetastatic niche for development of invasive disease in this model and define a unique subset of CD163+ Tim4+ resident omental macrophages responsible for metastatic spread of ovarian cancer cells. Transcriptomic analysis showed that resident CD163+ Tim4+ omental macrophages were phenotypically distinct and maintained their resident identity during tumor growth. Selective depletion of CD163+ Tim4+ macrophages in omentum using genetic and pharmacological tools prevented tumor progression and metastatic spread of disease. These studies describe a specific role for tissue-resident macrophages in the invasive progression of metastatic ovarian cancer. The molecular pathways of cross-talk between tissue-resident macrophages and disseminated cancer cells may represent new targets to prevent metastasis and disease recurrence.