Tumor-associated macrophages (TAMs) represent a key component of the tumor microenvironment and are generally associated with immunosuppression and poor prognosis. TREM2 is a transmembrane receptor of the immunoglobulin superfamily expressed in myeloid cells. TREM2 has been extensively studied in microglia and neurodegenerative diseases and recently emerged as a marker of pro-tumorigenic macrophages. The accumulation of TREM2-expressing TAMs was reported across numerous cancer patients and tumor models. TREM2 genetic blockade or TREM2 targeting with antibodies resulted in improved tumor control, enhanced response to anti-PD1, and significant changes in the tumor immune landscape. Preclinical studies paved the way for an ongoing clinical trial with a TREM2 depleting antibody and inspired further exploration of TREM2 targeting therapies. Here, we review the current knowledge about the impact of TREM2 in cancer, with an emphasis on the TREM2⁺ macrophage signature across different cancer types, the contribution of TREM2 to TAM phenotype and function, and the promising effects of TREM2 modulation.

The gut microbiota and tumor-associated macrophages (TAMs) affect tumor responses to anti–programmed cell death protein 1 (PD-1) immune checkpoint blockade. Reprogramming TAM by either blocking or deleting the macrophage receptor triggering receptor on myeloid cells 2 (TREM2) attenuates tumor growth, and lack of functional TREM2 enhances tumor elimination by anti–PD-1. Here, we found that anti–PD-1 treatment combined with TREM2 deficiency in mice induces proinflammatory programs in intestinal macrophages and a concomitant expansion of Ruminococcus gnavus in the gut microbiota. Gavage of wild-type mice with R. gnavus enhanced anti–PD-1–mediated tumor elimination, recapitulating the effect occurring in the absence of TREM2. A proinflammatory intestinal environment coincided with expansion, increased circulation, and migration of TNF-producing CD4 ⁺ T cells to the tumor bed. Thus, TREM2 remotely controls anti–PD-1 immune checkpoint blockade through modulation of the intestinal immune environment and microbiota, with R. gnavus emerging as a potential probiotic agent for increasing responsiveness to anti-PD-1.

Tumor-associated macrophages (TAM) constitute a prominent immune cell population within various solid cancers, playing a pivotal role in disease progression. Their increased numbers and frequencies often strongly correlate with resistance to therapy and reduced overall survival rates. Within the complex ecosystem of the tumor microenvironment (TME), activated cancer-associated fibroblasts (CAF) are expanded and contribute significantly to tumor growth and metastasis and chemotherapy or immunotherapy resistance. CAFs exert a critical influence on TAM phenotypes and functions by orchestrating the reprogramming of tissue-infiltrating monocytes, thereby modulating their survival and differentiation. This reciprocal interaction between TAMs and CAFs forms a crucial axis in fostering a suppressive crosstalk within the TME, mediated by a diverse array of signals exchanged between these cell types. Recent advancements in single-cell RNA sequencing technologies and spatial transcriptomics have enhanced our comprehension of the signaling dynamics at the interface between TAMs and CAFs, including their spatial distribution within the tissue. In this review, we delve into the latest discoveries elucidating the biology of TAM and CAF crosstalk. We examine the complexity of TAM–CAF and CAF–TAM interactions within the TME of solid cancers, with particular focus on ligand–receptor interactions and clinically significant targets for novel therapeutic strategies.