Le carcinome hépatocellulaire (CHC) est la deuxième cause de mortalité par cancer dans le monde. Plusieurs études attestent du rôle du microenvironnement tumoral (MET) comme acteur fondamental de la carcinogenèse. A l’aide de modèles murins mimant un sous groupe de CHC fréquent, notre équipe avait identifié la molécule LECT2 comme un effecteur moléculaire important du MET dans le contrôle de l’agressivité tumorale.L'objectif de ma thèse a été d’adresser le rôle fonctionnel de LECT2 dans le microenvironnement immunitaire au cours du CHC.A l’aide de modèles murins, nous observons que l’absence de LECT2 entraine une accumulation importante de cellules myéloïdes dans le MET. Nous montrons que ces cellules myéloïdes sont immatures, arborent des capacités immunosuppressives puissantes vis-à-vis des lymphocytes T et ont un programme transcriptionnel permettant une action promotrice de tumeurs. De façon intéressante, l’accumulation de ces acteurs dans le microenvironnement est associée à l’émergence de nodules tumoraux indifférenciés exprimant des marqueurs de transition épithélio-mésenchymateuse/cellules progénitrices/métastases.D’un point de vue mécanistique, nous avons démontré une perte de différenciation plus importante des hépatocytes en absence de LECT2 dans des conditions d’activation de la signalisation β-caténine. Nous montrons également par des expériences de co-culture que les cellules myéloïdes infiltrant les tumeurs en absence de LECT2 ont une forte capacité à induire une perte de différenciation des hépatocytes.Enfin, nous avons analysé l'expression de LECT2 dans une vaste cohorte d’échantillons humains de CHC. Nous montrons que la diminution d’expression de LECT2 corrèle fortement avec 1)- la présence d’invasion vasculaire, 2)- la perte de différenciation des hépatocytes tumoraux et 3)- la présence d’infiltrats inflammatoires.L’ensemble de ces données démontre que LECT2 agit comme un régulateur essentiel dans la cancérogénèse hépatique à travers son action double sur les hépatocytes et sur la fonction des cellules myéloïdes infiltrant les tumeurs. Ainsi, ces travaux identifient LECT2 comme un biomarqueur potentiel ouvrant de nouvelles perspectives de traitement du CHC. / Hepatocellular carcinoma (HCC) is the second cause of cancer-rel ated death worldwide. Several studies highlighted the tumor microenvironment (TEM) as a key player in cancer from initiation to progression steps of tumorigenesis. Using relevant HCC mouse models, our team identified the chemokine-like LECT2 as a critical actor of liver TEM in the control of tumor aggressiveness.The aim of my thesis was to address functionally the role of LECT2 in the immune microenvironment during HCC.Using mouse models, we observed that the absence of LECT2 induces a significant accumulation of myeloid cells in the TEM. We showed that these myeloid cells were immature, harbored strong immunosuppressive capabilities on T cells and expressed a transcriptional program sustaining tumor progression. Interestingly, the accumulation of these actors in the microenvironment is associated with the emergence of poorly differentiated tumor nodules expressing epithelial-to-mesenchymal transition / progenitor / metastasis markers.Mechanistically, we demonstrated that LECT2-deficient hepatocytes in the context of β-catenin activation were able to perform EMT like WT hepatocytes do after TGF-β1 challenge. In co-culture experiments, we demonstrated that tumor-infiltrating myeloid cells in the absence of LECT2 have a strong ability to induce hepatocyte EMT.Finally, we analyzed the expression of LECT2 in a vast cohort of HCC liver samples and found that downregulation of LECT2 expression strongly correlates with 1) - the presence of vascular invasion, 2) – histological grade and 3) - the presence of inflammatory infiltrates.Altogether, our data demonstrate that LECT2 acts as a strong regulator of liver tumor aggressiveness through its dual action on hepatocytes and impact on the function of tumor infiltrating myeloid cells. This work identifies LECT2 as a new biomarker for HCC and pave the way to new therapeutic strategies.

Solid tumors are complex structures comprising besides the cancer cells vasculature, extracellular matrix (ECM), soluble molecules and a plethora of various other cell types. These components form a so-called tumour microenvironment. From the numerous cell types that are part of tumor microenvironment, tumor infiltrating lymphocytes (TILs) play a major role in patient prognosis. Their presence is also of major importance with regard to new biological therapies based on immune checkpoint inhibitors. Crucial role of TILs is also reflected by the new approaches in cancer diagnostics namely by Immunoscore method (currently used in clinical settings). Immunoscore is based on localization and quantification of CD3+ and CD8+ TILs in thin histological sections of tumor tissue. The question remains to which extent the information obtained from 2D slices reflects the situation in tumor microenvironment considering its spatial heterogeneity. The development of new methodological approaches allowing evaluation of histological information in 3D is the key to answer this question. The theoretical part of this work first describes the heterogeneity of the tumor microenvironment and the role of immune cells within it. Then, the role of spatial heterogeneity and its possible influence on the histopathological...

Head and neck cancers are etiologically associated with smoking and alcohol consumption. Part of these tumors is induced by HPV and their incidence is increasing in the last decade. Patients with virally induced tumors have better prognosis even though they are usually diagnosed with tumors in advanced stage. One of the possible explanations may be better stimulation of the immune system by viral antigens. Macrophages are cells of the innate immune system which belong to professional phagocytes. They are called TAM upon infiltration to the tumor where they represent heterogeneous group of cells. Two main phenotypes are antitumor M1 and protumor M2 macrophages. TAMs are a major component of tumor microenvironment of many types of tumors, one of them are also head and neck cancers. In my thesis I focused on the immunohistochemical detection of M1 and M2 macrophages in the head and neck tumors of viral and non-viral etiology and at the same time RT-qPCR analyses of gene expression of macrophage-associated and/or immunosuppressive genes IDO1, ARG1, CD163, NOS2 a PTGS2 was performed. My data showed that HPV- negative tumors had higher number of M2 macrophages with typical markers CD163, ARG1 and PTGS2. It is known that patients with these tumors have worse prognosis of the disease. Due to high...

L’objectif de ce travail a consisté à évaluer le rôle d’un microenvironnement avec une haplo-insuffisance hétérozygote du gène BRCA1 dans les événements précoces de la transformation tumorale du cancer du sein. Dans ce but, nous avons modélisé un stroma BRCA1-muté en utilisant des cellules souches / stromales mésenchymateuses (MSCs) obtenues par différenciation de cellules souches pluripotentes induites (iPSCs) issues d’une patiente porteuse de la mutation (MSCs BRCA1+/-). Ces cellules mutées pour BRCA1 ont été comparées à des MSCs sans la mutation (MSCs BRCA1+/+) générées à partir d’iPSCs BRCA1+/+. Ce travail de thèse a porté sur l’influence du stroma BRCA1-muté à travers deux axes : le caractère pro-angiogénique des MSCs BRCA1+/- et l’induction d’une transition épithélio-mésenchymateuse (TEM) sur des cellules mammaires normales (HME1).Nous montrons que les MSCs BRCA1-muté présentent des propriétés pro-angiogéniques significativement augmentées en surexprimant le facteur hypoxique HIF-1α et des facteurs de la famille du VEGF, PDGF et Angpt se traduisant par des capacités augmentées à former des structures vasculaires in vitro et in vivo. Les MSCs BRCA1-muté présentent également des capacités migratoires supérieures en produisant et sécrétant la périostine (POSTN), une protéine de la matrice extracellulaire impliquée dans l’adhésion, la motilité et la migration cellulaires. Ces capacités ont été validées par une approche de siRNA spécifique pour la POSTN. In vivo, nous montrons que la co-injection de MSCs BRCA1-muté et de cellules malignes mammaires murines (4T1-Luc-GFP) a permis d’augmenter significativement la croissance tumorale et la formation de métastases pulmonaires. Ces résultats sont corrélés avec la détection de la POSTN in situ et avec la formation d’un réseau vasculaire tumoral développé, quantifié par marquage du CD34. Par ailleurs nous avons démontré qu’un surnageant de MSCs BRCA1+/- peut induire une TEM des cellules HME1 en favorisant l’acquisition d’un phénotype souche cancéreux (CD24Low/CD44High) et en accélérant leur migration. Enfin nous avons initié la production in vitro d’organoïdes mammaires en utilisant des MSCs et des HME1 afin d’étudier plus précisément les mécanismes moléculaires de cette TEM après contact et des possibles événements précoces de la transformation maligne. Nos résultats indiquent que les MSCs peuvent participer à l’initiation tumorale et à la progression métastatique dans un contexte d’une mutation hétérozygote du gène BRCA1. La POSTN pourrait représenter à la fois un marqueur pronostique mais également une cible thérapeutique pour ces cancers du sein héréditaires. / The aim of this study was to evaluate the role of a BRCA1 heterozygous haplo-deficient microenvironment in the early events of tumour transformation of breast cancer. For this purpose we modeled a BRCA1-mutated stroma using mesenchymal stem / stromal cells (MSCs) obtained by differentiation of induced pluripotent stem cells (iPSCs) from a patient carrying the mutation (MSCs BRCA1+/-). These BRCA1-mutated cells were compared to MSCs without the mutation (MSCs BRCA1+/+) generated from iPSCs BRCA1+/+. This study focuses on two aspects of BRCA1-mutated stroma, namely the pro-angiogenic properties of BRCA1+/- MSCs and the induction of an epithelial-mesenchymal transition (EMT) on normal breast cells (HME1).We have shown that BRCA1-mutated MSCs exhibit enhanced pro-angiogenic properties by overexpressing the hypoxic factor HIF-1α and factors from VEGF, PDGF and Angpt families resulting in increased capacities to form vascular structures in vitro and in vivo. BRCA1-mutated MSCs exhibit also higher migratory capabilities by production and secretion of periostin (POSTN), an extracellular matrix protein, which is involved in cell adhesion, motility and migration. These capacities have been validated by a specific siRNA approach for POSTN. In vivo, the coinjection of BRCA1-mutated MSCs with murine breast cancer cell line (4T1-Luc-GFP) promotes tumour growth and the formation of lung metastases. These results are correlated with in situ POSTN detection and with the formation of a developed tumour vascular network, quantified by CD34 staining. We also demonstrated that supernatant of BRCA1+/- MSCs can induce an EMT on HME1 cells by promoting the acquisition of stemness properties (CD24Low/CD44High) and accelerating their migration. Finally we initiated the in vitro production of mammary organoids using MSCs and HME1 in order to study more precisely the molecular mechanisms of this EMT after contact and possible early events of the malignant transformation. These results indicate that MSCs can participate to tumour initiation and metastatic progression in heterozygous BRCA1-mutated background. POSTN could represent a prognostic marker and a therapeutic target for these hereditary breast cancers.

Les tumeurs rhabdoïdes (TR) constituent un rare cancer indifférencié du jeune enfant et du nourrisson, avec un âge médian au diagnostic de 20 mois. Ces tumeurs sont caractérisées par une inactivation biallélique du gène suppresseur de tumeur SMARCB1, un des membres du complexe SWI/SNF, acteur majeur du remodelage de la chromatine, sans autre altération génomique récurrente. Le pronostic des TR est péjoratif, le taux de survie globale atteignant 30% dans la plupart des séries, malgré des approches thérapeutiques conventionnelles particulièrement agressives. Les approches d’immunothérapies ont obtenu un succès certain dans certains cancers de l’adulte, et récentes analyses de l’infiltrat immun des cancers pédiatriques ne montrent pas un fort taux de tumeurs infiltrées à l’exception de rare types de cancers dont les TR intracrâniennes. Nous avons donc procédé à une analyse multimodale de l’infiltrat immun de cohortes de patients ainsi que d’un modèle de TR murines établi dans notre laboratoire. Nous avons identifié une forte proportion de tumeurs infiltrées dans certains sous-groupes de TR. Cet infiltrat était composé à la fois de cellules myéloïdes incluant des populations au phénotype immunosuppresseur, et lymphocytaires T notamment de phénotype résident mémoire caractérisées par une forte expansion clonale probablement spécifique d’un antigène tumoral. Nous avons identifié des cibles thérapeutiques communes aux tumeurs humaines et au modèle murin syngénique, et trouvé que cibler l’infiltrat lymphocytaire T ou myéloïde était susceptible d’induire une réponse tumorale complète avec induction d’une mémoire immunitaire, confirmant le caractère immunogénique des TR, et apportant de nouvelles stratégies thérapeutiques utiles en clinique. Enfin, nous avons identifié que les TR étaient le site d’une réexpression de rétrovirus endogènes, dépendante de celle de SMARCB1, avec activation des voies de l’interféron, apportant une base à une immunogénicité des TR issue du génome non codant. / Rhabdoid tumors (RT) are highly undifferentiated cancers occurring in infancy and early childhood, with a median age at diagnosis about 20 months. These tumors are characterized by the biallelic inactivation of SMARCB1 tumor suppressor gene, core member of the SWI/SNF complex, one major chromatin remodeling actor, in an otherwise highly stable genome. The prognosis of RT is dismal with overall survival hardly reaching 30% in most series, despite particularly aggressive conventional treatment. Immunotherapy approaches has gained a striking success within some adult cancer types and recent analyses of immune cell content of pediatric cancers don’t reveal a high rate of infiltrated tumors, except in few tumor types such as intracranial rhabdoid tumors. Then, we conducted a comprehensive analysis of the immune context of both human RT cohorts and a mouse RT model, including at single cell level. We identified a high recurrence of infiltrated tumors, in a RT-subgroup related manner, composed of both myeloid cells including cells with immune suppressive phenotypes, and T cells with notably a tissue resident memory phenotype demonstrating a high clonal expansion highly suggestive of immunogenicity. We identified common targetable immune populations between human and mouse RTs, and found that targeting both T and myeloid infiltrating cells was able to induce complete anti-tumor response with induced memory, confirming the immunogenic properties of RTs, and identifying new therapeutic strategies of clinical relevance. We finally identified that RTs were the site of SMARCB1-dependent endogenous retroviruses reexpression, with subsequent activation of interferon signaling, likely triggering the immune response in the context of RT, and providing a basis of non-coding genome-driven immunogenicity for these tumors.

L’objectif de ce travail était de comprendre l’état moléculaire des cellules dendritiques (CD) dans le microenvironnement tumoral. En intégrant l’analyse de tumeurs humaines par cytométrie en flux, de transcriptome, de secretome tumoral et l’analyse d’une base de données d’interaction CD-lymphocyte T générées in vitro, j’ai obtenus 2 résultats majeurs. Tout d’abord, nous proposons une nouvelle classification de CD activées humaines, qui sont soit « secrétantes », c’est-à-dire spécialisées dans la production de cytokines et chemokines, soit « aidantes » c’est-à-dire spécialisées dans l’induction de la sécrétion de nombreuses cytokines T helper après co-culture. Les CD infiltrant les tumeurs ORL inflammées correspondaient au type « sécrétantes ». Au-delà du nouveau concept biologique, cette classification est base théorique importante pour l’immunothérapie à base d’adjuvants. Deuxièmement, nous avons montré que l’inflammation tumorale n’était pas un facteur pronostic majeur des cancers ORL, mais que MMP2 et l’effraction extra-capsulaire étaient des facteurs pronostiques indépendants de la survie liée à la maladie. Nous avons pu classer les patients en 4 niveaux de risque et montré qu’ils avaient des chances équivalentes de réponse à l’immunothérapie. Nos données sont une base pour un essai clinique dirigé par biomarqueur, proposant de la chimiothérapie ou de l’immunothérapie néoadjuvantes, dans le but de diminuer le pourcentage de patients présentant des récidives sévères et précoces / The objective of the thesis was to decipher the molecular state of tumor infiltrating dendritic cell (DC) and their relation to the tumor microenvironment. By combining the analysis of human tumor samples by flow cytometry and RNA sequencing, of tumor secretome and of a large dataset of in vitro DC-Tcell interactions I obtained 2 main findings. First, we reported a novel classification of human activated DC, that are either “secretory” that is specialized in secreting cytokines and chemokines, or “helper” that is specialized at inducing the secretion of a broad range of T helper cytokines after cell co-culture. DC infiltrating inflamed human head and neck cancer matched the “secretory” phenotypic and transcriptomic signatures. Beyond this novel biological concept, this classification is of importance as a theoretical basis for adjuvant-based immunotherapy. Secondly, we showed that tumor inflammation was not the main prognostic factor for oral cavity cancer (OCC) patients, but that MMP2 and the presence of extra-nodal extension were independent predictors of reduced disease-specific survival. We could stratify OCC into 4 prognostic groups and showed that they had similar expected rates of response to immunotherapy. Our data may serve to design a biomarker-driven clinical trial proposing neoadjuvant chemotherapy or immunotherapy to high-risk patients, with the goal of reducing the percentage of OCC patients that will present with early and severe recurrences.

Fibroblasts are stromal cells ubiquitously present in the human body. They often appear in a quiescent state and can become activated in response to tissue remodeling signals. Activated fibroblasts acquire biosynthetic, pro-inflammatory and contractile properties, key functions for wound healing. In addition, the presence of permanently activated fibroblasts is one of the hallmarks of cancer. The purpose of this work is to investigate the differences between newborn and adult fibroblasts and keratinocytes in their implication in scarless wound healing, the origin of cancer associated fibroblasts (CAF)s and the influence of fibroblasts in melanoma invasion. Evidence suggests that wounds heal almost without scar in newborns. To understand the mechanisms that contribute to scarless wound healing we focused on the differences between newborn and adult fibroblasts and keratinocytes, which are cells present in human skin and participating in wound healing process. A comparison of the expression profile between newborn and adult fibroblasts showed differentially regulated genes related to the acute phase of the inflammatory response and ECM organization, traits involved in wound healing. We also found that newborn fibroblast showed higher differentiation potential, exhibited markers of pluripotency and...

Glioblastoma (GBM) is the most common primary brain tumor in adults and represents one of the most aggressive tumor types. Despite treatment GBM remains incurable and when treated the tumor recurs more aggressive and treatment resistant than before. The understanding of the underlying pathophysiology of GBM has increased in recent years, yet the high mortality with a 5-year survival rate of less than 10% remains. Previous studies from the research group, have shown that complement protein C3 is upregulated in stromal and glioma cells in lower oxygen tensions, and this indicates that C3 might play a role in certain GBM tumor microenvironment (TME) niches. For this reason, it is of great interest to investigate how glioma cells are affected when stimulated with C3. With cell proliferation-, migration assays and gene expression analysis with real time quantitative polymerase chain reaction (qPCR) it was possible to investigate how glioma cells respond to treatment with C3 and C3a-receptor antagonist. By optimizing an antibody panel for detection of macrophages/microglia, astrocytes and tumor cells we made it possible to study the modulation of immune parameters during treatment with C3A-receptor antagonist in mice. / Glioblastom (GBM) är den vanligaste primära hjärntumören hos vuxna och representerar en av de mest aggressiva tumörtyperna. Trots behandling förblir GBM obotlig och efter behandling återkommer tumören mer aggressiv och behandlingsresistent än tidigare. Förståelsen för den underliggande patofysiologin för GBM har ökat de senaste åren, trots detta kvarstår den höga dödligheten med en 5-årig överlevnadsprognos under 10%. Tidigare studier från forskningsgruppen har också visat att komplementprotein C3 är uppreglerat i gliomceller under lågt syretryck, vilket indikerar att C3 kan spela en roll i olika miljöer som finns i GBM. Av denna anledning är det av stort intresse att undersöka hur gliomceller påverkas när de stimuleras med C3. Med cellproliferation-, migrerings analyser och genuttrycksanalys med real time quantitative polymerase chain reaction (qPCR) var det möjligt att undersöka hur gliomceller, men även andra komponenter av tumor microenvironment (TME) svarar på behandling av C3 och C3A-receptor antagonist. Genom att optimera en antikroppspanel, med detektion av makrofager/ mikroglia, astrocyter och tumörceller har vi nu gjort det möjligt att studera moduleringen av immun parametrar vid behandling av C3A-receptor antagonist i möss.

Glioblastoma is the fastest-growing, and the most common malignant brain tumour in adults. It is normally treated with surgery and radio- or chemotherapy, but the approximate life expectancy is of 15 months with a high probability of cancer recurring. Therefore, there is a need for decreasing its severity. Bulk and single-cell RNA sequencing allow the identification of cellular states in tumours affected by cell-intrinsic and extrinsic factors. Four different cellular states have been identified in glioblastoma: neural progenitor-like, oligodendrocyte progenitor-like, astrocyte-like, and mesenchymal-like. As glioblastoma is an immunosuppressive tumour, it can alter the immune system and increase the tumour's immune escaping by segregating immunosuppressive factors or interacting with the brain microenvironment.Two datasets were used in this study to explore if the localization of the tumour in the brain microenvironment and the tendency of glioblastomas to activate microglial cells are due to particular ligand-receptor interactions. Data quality control was applied to both datasets and SingleCellSignalR and CellphoneDB packages were used to predict the possible interactions. A total of seven experiments were designed for this study. The first dataset, GBmap, allowed us to do a comparison between tumour cells and microglia, tumour cells and other cell types in the brain, and the four cellular states of glioblastoma with microglia and macrophages. Next, healthy microglia from GBmap was used to compare with the tumour bulk data from the second dataset, HGCC. The bootstrap technique was performed to compare bulk data vs single-cell data, and a comparison between tumour cells and microglia or other cell types was analysed.Results showed specific and shared interactions between cell types or cellular states, revealing the different localization of the tumour cells depends on the expressed ligand-receptor pairs. Also, a total of four patterns of interactions were found in the 50 samples to have a different tendency to activate microglial cells, which are promising results to further explore drugs to interfere with or how these interactions are related to patient survival. Furthermore, even if glioblastoma is a heterogenous disease, more interactions were predicted with microglial/macrophage cells without a uniform pattern between patients, and therefore, this study is a starting point upon which further in vitro studies would be needed to study the predicted interactions as potential targets to stop the progression of this type of cancer.

Le mélanome est caractérisé par un remodelage métabolique important, participant à la métastase et à la résistance aux traitements. Les coactivateurs 1 du récepteur activé par le proliférateur du peroxisome (PPARγ), ou PGC-1s, constituent une famille de coactivateurs qui potentialisent la transcription de gènes du métabolisme et de la biogenèse mitochondriale, participant ainsi à la reprogrammation métabolique des cellules cancéreuses. Les différents cancers de la peau expriment des niveaux variables de PGC-1s et les tumeurs qui expriment fortement les PGC-1s présentent un profil pro-inflammatoire et immunosuppresseur favorisant l’évasion immunitaire. Ceci suggère un rôle des PGC-1s dans la réponse à l’immunothérapie. Nous montrons d’abord que la déplétion en PGC-1β diminue la prolifération de lignées cellulaires de mélanome en plus d’induire l’expression de cytokines pro-inflammatoires et de transcrits immunosuppresseurs. À ce jour, les mécanismes permettant de réguler l’expression et l’activité des PGC-1s demeurent inconnus. Nous montrons que différents stress cellulaires affectant des procédés métaboliques, épigénétiques ou la traduction diminuent l’expression des PGC-1s et la viabilité de lignées cellulaires de mélanome. Nous montrons également un mécanisme de régulation de PGC-1β par une protéine de liaison à l’ARN soutenant le rôle de PGC-1β dans la réponse à différents stress et la survie des cellules de mélanome. Cette régulation serait importante pour l’immunosuppression du mélanome et dicterait la réponse à l’immunothérapie. En conclusion, ces travaux illustrent bien le rôle de PGC-1β dans la reprogrammation métabolique et la réponse au stress du mélanome, ces processus pouvant influencer l’inflammation et l’immunosuppression du microenvironnement afin d’assurer la progression tumorale. / Melanoma is characterized by a significant metabolic remodeling, which contributes to metastasis and treatment resistance. Peroxisome proliferator-activated receptor gamma (PPARγ) coactivators 1, or PGC-1s, are a family of coactivators that potentiate the transcription of genes involved metabolism and mitochondrial biogenesis, thus participating in the metabolic reprogramming of cancer cells. Different skin cancers express varying levels of PGC-1s and tumors that strongly express PGC-1s exhibit a proinflammatory and immunosuppressive profile that favors immune evasion. This suggests that PGC-1s play a role in melanoma response to immunotherapy. We first show that PGC-1β knockdown decreases the proliferation of melanoma cell lines. Moreover, it induces the expression of proinflammatory cytokines and immunosuppressive transcripts. To date, the mechanisms that regulate the expression and activity of PGC-1s remain unknown. We show that different cellular stresses affecting metabolic and epigenetic processes or translation decrease PGC-1s expression and the viability of melanoma cell lines. We also show a mechanism of regulation of PGC-1β by an RNA-binding protein enhencing the role of PGC-1β in the response to different stresses and the survival of melanoma cells. This regulation could contribute to melanoma immunosuppression and determine the tumor’s response to immunotherapy. In conclusion, this work illustrates well the role of PGC-1β in melanoma metabolic reprogramming and stress response, processes that regulate inflammation and create an immunosuppressive tumor microenvironment in order to ensure tumor progression.