Research progress on tumor extracellular matrix stiffness and immunosuppression

Tumor matrix stiffness, a pivotal physical attribute of the tumor microenvironment, has evolved from a passive physical barrier to an active immunoregulatory platform, profoundly impacting the initiation and effector phases of anti-tumor immune responses. This review systematically elaborates on the dual mechanisms that drive immunosuppression. Directly, stiffness attenuates T-cell and natural killer (NK) cell functions by activating pathways such as Yes-associated protein (YAP)/Transcriptional co-activator with PDZ-binding motif (TAZ) and Piezo-type mechanosensitive ion channel component 1 (Piezo1). It also drives the polarization of macrophages and dendritic cells towards immunosuppressive phenotypes. Indirectly, stiffness fosters an immune escape ecosystem by persistently activating cancer-associated fibroblasts, inducing tumor cell epithelial-mesenchymal transition, and upregulating immune checkpoints. Consequently, strategies such as enzymatic degradation, targeting mechanotransduction pathways, employing anti-fibrotic drugs, and developing intelligent combination therapies have emerged, aiming to soften tumors and reverse immunosuppression. Clinical studies confirm that high expression of the mechanosignaling hub Yes-associated protein 1 (YAP1) is associated with resistance to immunotherapy. In the future, integrating mechanobiology, immunometabolism, and smart materials to develop precise multimodal combination strategies holds promise for reversing the "cold tumor" microenvironment and opening new avenues to overcome immunotherapy resistance in solid tumors.