Roula Antoon, Nina Overdevest, Amr H Saleh, Armand Keating
5 min
Mesenchymal stromal cells (MSCs) are multipotent progenitor cells found in various tissues, including bone marrow, fat, and umbilical cord blood. While they are often studied for their regenerative potential, this review highlights their complex and often contradictory role within the tumor microenvironment (TME). Rather than acting as passive bystanders, MSCs are frequently recruited to tumor sites by inflammatory signals—often described as "wounds that do not heal." Once present, they are co-opted by the tumor to support its growth, survival, and spread.
MSCs support cancer progression through several sophisticated mechanisms. They release a variety of growth factors (such as IL-6, IL-8, and VEGF) and extracellular vesicles (EVs) that stimulate tumor cell proliferation, angiogenesis, and resistance to chemotherapy. Furthermore, MSCs can induce epithelial-to-mesenchymal transition (EMT) in cancer cells, a process that enables tumor cells to become more motile and invasive. MSCs also play a critical role in creating an immunosuppressive niche by inhibiting the function of T cells and natural killer (NK) cells, while simultaneously promoting the polarization of macrophages toward an anti-inflammatory, pro-tumorigenic M2 phenotype.
Evidence suggests that tumor cells can actively reprogram naïve MSCs into cancer-associated MSCs (CA-MSCs) or cancer-associated fibroblasts (CAFs). These reprogrammed cells are more potent drivers of tumor progression than their healthy counterparts. However, the field faces significant challenges regarding the heterogeneity of MSCs. Differences in tissue origin, donor health, and isolation techniques mean that MSCs are not a uniform population, and their functional impact on a tumor can vary widely. While many studies confirm their role in supporting malignancy, others have observed that MSCs can inhibit tumor growth under specific conditions, suggesting that their therapeutic potential remains a subject of intense investigation.
Mesenchymal stromal cells (MSCs) are important cellular constituents of tumor stroma that play an active role in tumor development. Complex interactions between MSCs and cancer promote tumor progression by creating a favorable milieu for tumor cell proliferation, angiogenesis, motility, invasion, and metastasis. The cellular heterogeneity, source of origin, diversity in isolation methods, culture techniques and model systems of MSCs, together with the different tumor subtypes, add to the complexity of MSC-tumor interactions. In this review, we discuss the mechanisms of MSC-mediated tumor promotion and evaluate cell-stromal interactions between cancer cells, MSCs, cells of the tumor microenvironment (TME), and the extracellular matrix (ECM). A more thorough understanding of tumor-MSC interactions is likely to lead to better cancer management.
Sam: And presumably the intrinsic state of the MSCs matters too — not just the signals they receive?
Alex: Exactly. The paper flags mutational status as a key variable. MSCs carrying p53 deficiency, for instance, can flip into a markedly more aggressive pro-tumorigenic state. So you have a two-sided plasticity problem: the tumor microenvironment shapes MSC behavior, but the MSCs' own genomic background shapes how far that reprogramming can go.
Sam: Which means the same MSC preparation could behave very differently depending on donor genetics and the specific tumor context it encounters.
Alex: That's the crux of it. And it's the reason the paper pushes back against treating MSCs as a stable, predictable reagent. Their behavior is a function of the dialogue between their intrinsic state and the signals the tumor is broadcasting. Ignore that plasticity and you're flying blind in any clinical application.
Sam: So where does this leave the therapeutic use of MSCs? Is the paper essentially arguing for a moratorium, or something more nuanced?
Alex: More nuanced. The argument isn't that MSCs are categorically dangerous — it's that any protocol deploying them needs to account for the malignant landscape the patient may be carrying, knowingly or not. That means better pre-screening, but also a more sophisticated mechanistic understanding of which signaling axes are driving the pro-tumorigenic conversion, because those are also potential intervention points. If you can block TGF-beta-driven transdifferentiation, for example, you might preserve the therapeutic utility while neutralizing the risk.
Sam: That's a more constructive read than "don't use them." It reframes the problem as one of context-awareness rather than categorical avoidance.
Alex: Precisely. The paper's contribution is less a set of definitive findings and more a mechanistic framework for asking better questions — about donor MSC genetics, about the cytokine milieu of the target tissue, about whether the therapeutic window can be separated from the pro-tumorigenic one. Those are tractable experimental questions, even if the answers aren't in hand yet.
Sam: A useful reminder that a well-constructed conceptual framework can be as valuable as a clean dataset, especially in a field where the variables are this entangled.
Alex: Well put. And on that note, thanks for listening to ResearchPod.