Extracellular Matrix Remodeling in Tumors: Forces Beyond Fibroblasts

Aberrant extracellular matrix (ECM) remodeling in tumors is characterized by altered deposition, enzymatic cross-linking, degradation, and organization of matrix molecules that in turn can contribute directly to tumor invasiveness, immune evasion, and resistance to therapy. Traditionally, cancer-associated fibroblasts (CAFs) have been considered the principal architects of ECM remodeling in tumors. However, the role of non-fibroblast cell populations in modulating ECM structure and function and how these processes intersect with immune regulation, metabolism, and metastasis is also crucial but currently underappreciated. Challenging the prevailing fibroblast-centric paradigm, this review provides an overview of how non-fibroblast cell types engage in dynamic crosstalk and collectively shape the biochemical and biomechanical landscape of tumors. Therapeutic strategies targeting these alternative stromal players could disrupt pro-tumor ECM dynamics, enhance anti-tumor immunity, and restore tissue homeostasis. Thus, a comprehensive understanding of the intricate network of non-fibroblast stromal cells within the tumor microenvironment (TME) can help elucidate opportunities for precision medicine and personalized cancer care, leading to the development of innovative therapeutic interventions targeting the TME.