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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2025.1633315</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Immune microenvironment regulation and clinical immunotherapy strategies of metastatic liver cancer</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Dan</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Mingzhu</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liang</surname>
<given-names>Ying</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Fang</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Runtian</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Sun</surname>
<given-names>Yang</given-names>
</name>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/3072458/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
</contrib-group>
<aff id="aff1">
<institution>Department of Biology, College of Basic Medicine, Heilongjiang University of Chinese Medicine</institution>, <addr-line>Harbin</addr-line>,&#xa0;<country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1957524/overview">Raquel Alarcon Rodriguez</ext-link>, University of Almeria, Spain</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/558328/overview">Yan-wei Cheng</ext-link>, Henan Provincial People&#x2019;s Hospital, China</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3096895/overview">Hua Ge</ext-link>, First People&#x2019;s Hospital of Zunyi, China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Yang Sun, <email xlink:href="mailto:yangsun795A@163.com">yangsun795A@163.com</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>09</day>
<month>09</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>16</volume>
<elocation-id>1633315</elocation-id>
<history>
<date date-type="received">
<day>22</day>
<month>05</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>19</day>
<month>08</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Liu, Li, Liang, Xu, Li and Sun.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Liu, Li, Liang, Xu, Li and Sun</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Metastatic liver cancer (MLC) remains a leading cause of cancer-related mortality due to the liver&#x2019;s unique immunotolerant microenvironment and high vascularization. Key mechanisms involve KC-mediated fibronectin deposition, neutrophil extracellular traps (NETs), and MDSC-driven T-cell exhaustion. Clinically, therapeutic strategies targeting the tumor microenvironment (TME) such as CSF1R inhibition, CCR2/CCR5 blockade, and CD40 agonism show promise in preclinical and early-phase trials, especially when combined with immunotherapy. However, challenges remain in overcoming systemic immunosuppression. This review summarizes the dual roles of hepatic immune cells including Kupffer cells (KCs), neutrophils, and myeloid-derived suppressor cells (MDSCs) in either suppressing or promoting metastatic colonization. We elucidate how the liver&#x2019;s immunological balance, governed by innate and adaptive responses, shifts toward immunosuppression during metastasis, fostering a pro-tumor niche. This synthesis of immunological insights underscores the potential of TME-modulating therapies to improve outcomes in MLC.</p>
</abstract>
<kwd-group>
<kwd>metastatic liver cancer</kwd>
<kwd>tumor microenvironment</kwd>
<kwd>innate immune cells</kwd>
<kwd>adaptive immunity</kwd>
<kwd>Kupffer cells</kwd>
<kwd>immunotherapy</kwd>
</kwd-group>
<counts>
<fig-count count="1"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="154"/>
<page-count count="10"/>
<word-count count="3384"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Cancer Immunity and Immunotherapy</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>Metastatic liver cancer (MLC) is a secondary malignancy arising from both gastrointestinal and non-gastrointestinal primary tumors. Gastrointestinal-derived metastases, though originating in the digestive tract, frequently disseminate to distant organs via hematogenous routes (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B2">2</xref>). Due to the liver&#x2019;s unique anatomical position and portal circulation, it serves as the predominant site for metastatic seeding in gastrointestinal cancers (<xref ref-type="bibr" rid="B3">3</xref>). MLC significantly contributes to cancer-related mortality (<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B5">5</xref>), with hepatic metastases conferring poor prognoses across malignancies, including breast, renal, and lung cancers. Notably, 25% of newly diagnosed CRC patients and 40%&#x2013;50% with advanced CRC develop liver metastases (<xref ref-type="bibr" rid="B6">6</xref>).</p>
<p>The liver&#x2019;s high metastatic susceptibility stems from its dual blood supply and hemodynamic architecture, which promote tumor cell homing (<xref ref-type="bibr" rid="B7">7</xref>). Beyond vascular mechanisms, the hepatic microenvironment critically supports metastatic colonization, making therapeutic targeting of the tumor microenvironment (TME) a key research focus (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>). This review summarizes the roles of hepatic immune cells, including Kupffer cells (KCs), neutrophils, and myeloid-derived suppressor cells (MDSCs), in either suppressing or promoting metastatic colonization. By synthesizing hepatic immune responses, microenvironmental dynamics, and clinical evidence, we explore TME modulation as a potential strategy for MLC prevention and therapy.</p>
</sec>
<sec id="s2">
<label>2</label>
<title>The unique hepatic immune microenvironment dictates the fate of metastatic cancer cells</title>
<sec id="s2_1">
<label>2.1</label>
<title>Innate immune responses in the liver</title>
<p>The liver&#x2019;s immune system is uniquely adapted to maintain tolerance to portal vein-derived antigens under homeostasis (<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B11">11</xref>), yet it can mount robust immune responses against acute threats like metastatic invasion (<xref ref-type="bibr" rid="B12">12</xref>). Upon entering the liver, cancer cells encounter a specialized cellular milieu that orchestrates antigen presentation, pathogen recognition, and targeted elimination (<xref ref-type="bibr" rid="B13">13</xref>). Natural killer (NK) cells dominate the hepatic lymphocyte population (<xref ref-type="bibr" rid="B14">14</xref>), playing a pivotal role in immune surveillance. Unlike adaptive immune cells, NK cells detect targets lacking MHC-I&#x2014;a common evasion strategy employed by tumors and pathogens (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>). The liver also harbors invariant natural killer T (iNKT) cells, a unique subset derived from thymic CD4<sup>-</sup>CD8<sup>-</sup> precursors that mature into CD4<sup>+</sup>CD8<sup>+</sup> effectors (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>). These cells express chemokine receptors (CCR5/CXCR3) and patrol liver sinusoids via CD1d-dependent interactions with liver sinusoidal endothelial cells (LSECs) and macrophages, enabling rapid anti-tumor responses (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B20">20</xref>). However, during metastatic progression, iNKT cells exhibit functional impairment (<xref ref-type="bibr" rid="B21">21</xref>). Studies have shown that tumor-induced immunosuppressive cytokines, such as IL - 10 and TGF-&#x3b2;, downregulate their cytotoxic capacity and IFN-&#x3b3; production. Additionally, the altered expression of CD1d and co-stimulatory molecules on antigen-presenting cells in the metastatic liver microenvironment diminishes iNKT cell activation (<xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>). This dysfunction facilitates immune evasion by metastatic cells and contributes to the establishment of an immunosuppressive niche. Beyond the resident Kupffer cells (KCs), the liver recruits CCR2<sup>+</sup>Ly6C<sup>+</sup> monocytes from the bone marrow during inflammation (<xref ref-type="bibr" rid="B24">24</xref>). These monocytes are significantly upregulated in pathological states of the liver, and studies in CCR2<sup>-/-</sup> mice have demonstrated that their absence mitigates hepatic inflammation (<xref ref-type="bibr" rid="B25">25</xref>). Neutrophils are also actively recruited to sites of hepatic inflammation (<xref ref-type="bibr" rid="B26">26</xref>). These cells express adhesion molecules such as CD44, Siglec-9 (<xref ref-type="bibr" rid="B27">27</xref>), Siglec-10 (<xref ref-type="bibr" rid="B28">28</xref>), and very late antigen-4 (VLA - 4) (<xref ref-type="bibr" rid="B29">29</xref>), which mediate their adherence to vascular adhesion molecules on LSECs.</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Adaptive immune responses in the liver</title>
<p>The liver maintains a delicate immunological equilibrium, balancing tolerance to dietary and microbial antigens with defense against pathogens and malignancies. This balance is orchestrated by hepatic antigen-presenting cells (APCs), which under steady-state conditions drive tolerogenic T cell responses, facilitating transplantation tolerance and chronic viral infections such as HBV and HCV (<xref ref-type="bibr" rid="B30">30</xref>, <xref ref-type="bibr" rid="B31">31</xref>). LSECs function as tolerogenic APCs by expressing PD-L1 and inducing T cell exhaustion, suppressing Th1 differentiation while favoring IL - 4<sup>+</sup> Th2 polarization. Meanwhile, KCs that resident liver macrophages exhibit low MHC II and co-stimulatory molecule (B7 - 1/2) expression, thereby limiting T cell activation and fostering immunosuppression via PD-L1 and cytokine secretion (<xref ref-type="bibr" rid="B32">32</xref>). However, upon stimulation with inflammatory cues such as TLR ligands, cytokines, and PolyI:C, KCs transition to an immunogenic phenotype, upregulating MHC II and activating iNKT cells, suggesting the existence of functionally distinct KC subsets (<xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B34">34</xref>).</p>
<p>Hepatic dendritic cells (DCs), including CD11b<sup>+</sup>, CD11c<sup>high</sup>, CD1c<sup>+</sup>, myeloid DCs (mDCs), and plasmacytoid DCs (pDCs), generally suppress T cell activation. In mice, subsets like CD11c<sup>+</sup>CD8<sup>+</sup> and CD11c<sup>+</sup>NK1.1<sup>+</sup> DCs also exist but remain poorly characterized (<xref ref-type="bibr" rid="B32">32</xref>, <xref ref-type="bibr" rid="B35">35</xref>). Hepatic mDCs and pDCs secrete IL - 10 and are regulated by macrophage colony-stimulating factor (M-CSF), which enhances IL - 10 while suppressing IL - 12 (<xref ref-type="bibr" rid="B36">36</xref>). pDCs also produce IL - 27 and IDO, promoting Treg expansion and immunosuppression (<xref ref-type="bibr" rid="B37">37</xref>, <xref ref-type="bibr" rid="B38">38</xref>). Their low Delta4/Jagged1 Notch ligand ratio biases toward Th2 differentiation and CD4<sup>+</sup> T cell apoptosis, reinforced by Treg-mediated inhibition and PD-L1&#x2013;PD-1 signaling (<xref ref-type="bibr" rid="B39">39</xref>). Lipid-poor DCs tend to be tolerogenic; however, CD11c<sup>+</sup>CD8<sup>+</sup> DCs elicit strong Th1 responses via IL - 12 and TNF-&#x3b1;, while CD11c<sup>+</sup>NK1.1<sup>+</sup> DCs exhibit cytolytic activity and stimulate T cell immunity. Hepatocytes also present antigens via MHC II, contributing to antiviral defense, though their antitumor role remains uncertain (<xref ref-type="bibr" rid="B40">40</xref>). Hepatic stellate cells (HSCs), residing in the space of Disse, act as APCs and play a significant immunomodulatory role in the hepatic immune microenvironment. They express immune checkpoint molecules such as PD-L1 and secrete immunosuppressive mediators including IL - 6, IL - 10, and TGF-&#x3b2;, which collectively promote the expansion of regulatory T cells (Tregs) and contribute to the exhaustion of effector T cells (<xref ref-type="bibr" rid="B41">41</xref>&#x2013;<xref ref-type="bibr" rid="B44">44</xref>). In addition, HSCs can express indoleamine 2,3-dioxygenase (IDO), further suppressing T cell proliferation and cytokine production through tryptophan depletion and kynurenine accumulation, thereby reinforcing immune tolerance (<xref ref-type="bibr" rid="B45">45</xref>, <xref ref-type="bibr" rid="B46">46</xref>). Through CD44-dependent signaling, HSCs also convert recruited monocytes into myeloid-derived suppressor cells (MDSCs), exacerbating local immunosuppression and facilitating metastatic colonization (<xref ref-type="bibr" rid="B47">47</xref>). Overall, hepatic antigen presentation often favors immunosuppression, shaped by the dynamic interplay of tolerogenic and immunogenic signals within the hepatic microenvironment (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Immune microenvironment in metastatic liver cancer.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-16-1633315-g001.tif">
<alt-text content-type="machine-generated">Diagram depicting interactions between innate and adaptive immune responses in metastatic liver cancer. The innate immune section highlights the Thymus, precursors, and anti-tumor pathways via CCR5, CXCR3, iNK, TAM, LSECs, and neutrophils. Recruitment processes involve CD44, Siglec-9, Siglec-10, and VLA-4. The adaptive immune section includes T cell exhaustion, LSECs interactions, and roles of KCs, DCs, mDC, pDC, and Treg. Pathways involve PD-L1, IL-4, IL-10, IL-27, IDO, Th1 differentiation, and immunosuppression through T cell activation suppression.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec id="s3">
<label>3</label>
<title>Pro-metastatic tumor microenvironment of the liver</title>
<sec id="s3_1">
<label>3.1</label>
<title>Role of Kupffer cells in cancer cell metastasis</title>
<p>KCs, the liver&#x2019;s resident macrophages, regulate cholesterol metabolism, pathogen clearance, and immune responses (<xref ref-type="bibr" rid="B48">48</xref>, <xref ref-type="bibr" rid="B49">49</xref>). Originating from yolk sac-derived progenitors, KCs are replenished by bone marrow-derived precursors during hepatic injury or infection (<xref ref-type="bibr" rid="B50">50</xref>). They detect pathogens via diverse receptors, secreting cytokines to initiate innate immune responses (<xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B51">51</xref>). KCs facilitate metastasis by forming a pre-metastatic niche. In pancreatic cancer, KCs internalize tumor-derived exosomes containing macrophage migration inhibitory factor, triggering TGF-&#x3b2; secretion and hepatic stellate cell (HSC)-mediated fibronectin production, promoting metastatic cell adhesion (<xref ref-type="bibr" rid="B52">52</xref>). Circulating tumor cells bind fibronectin via Talin-1, enhancing colonization (<xref ref-type="bibr" rid="B53">53</xref>). KCs exhibit dual roles in metastasis: early cytolysis versus later pro-tumor support. Depleting KCs increases metastatic burden, suggesting initial tumoricidal activity (<xref ref-type="bibr" rid="B54">54</xref>&#x2013;<xref ref-type="bibr" rid="B56">56</xref>). KCs phagocytose tumor cells via Dectin-2 or other receptors, though post-internalization viability remains unclear (<xref ref-type="bibr" rid="B57">57</xref>). Cytotoxic NO, NK cell activation, and TNF-&#x3b1; secretion further limit early metastasis (<xref ref-type="bibr" rid="B58">58</xref>, <xref ref-type="bibr" rid="B59">59</xref>). However, KC-derived cytokines may aid surviving tumor cells post-extravasation. Myeloid cell recruitment complicates KC-specific roles, as depletion strategies often affect other phagocytes. Thus, early-phase studies are critical to delineate KC contributions (<xref ref-type="bibr" rid="B57">57</xref>).</p>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Role of neutrophils in cancer cell metastasis</title>
<p>One of the earliest pathological responses to hepatic cancer cell infiltration is neutrophil recruitment (<xref ref-type="bibr" rid="B60">60</xref>, <xref ref-type="bibr" rid="B61">61</xref>). Normally, neutrophils migrate to inflamed sites by rolling along vascular endothelium via low-affinity binding to P-/E-selectins, followed by integrin-mediated firm adhesion and arrest, primarily in post-sinusoidal venules, though CD44-hyaluronan interactions are not involved in hepatic sinusoids (<xref ref-type="bibr" rid="B62">62</xref>). Tumor-associated neutrophils (TANs), like Kupffer cells, exhibit dual pro- and anti-metastatic roles (<xref ref-type="bibr" rid="B63">63</xref>). In colorectal liver metastases (CRLM), neutrophils promote progression, with elevated neutrophil-to-lymphocyte ratio (NLR) correlating with worse outcomes, though absolute neutrophil counts yield conflicting data (<xref ref-type="bibr" rid="B64">64</xref>). Higher neutrophil numbers generally predict poorer prognosis (<xref ref-type="bibr" rid="B65">65</xref>). Experimental models reveal neutrophils facilitate multiple metastatic steps (<xref ref-type="bibr" rid="B66">66</xref>). In pancreatic cancer GEMMs, they aid pre-metastatic niche formation, while neutrophil extracellular traps (NETs) enhance early cancer cell retention by physically ensnaring circulating tumor cells within the hepatic vasculature. Mechanistically, NETs release high-mobility group box 1 (HMGB1), which activates TLR9 signaling in tumor cells, promoting their proliferation and metastatic competency (<xref ref-type="bibr" rid="B67">67</xref>, <xref ref-type="bibr" rid="B68">68</xref>). Moreover, NET-associated proteases such as neutrophil elastase and matrix metalloproteinase 9 (MMP9) degrade extracellular matrix (ECM) components, thereby facilitating tissue invasion and the establishment of a pro-metastatic niche (<xref ref-type="bibr" rid="B69">69</xref>, <xref ref-type="bibr" rid="B70">70</xref>). Post-colonization, neutrophils accelerate growth via fibroblast growth factor 2 (FGF2), with FGF2 inhibition reducing metastatic burden (<xref ref-type="bibr" rid="B71">71</xref>). Neutrophils also modulate CD8<sup>+</sup> T cell responses in metastatic liver cancer (MLC) and exhibit heterogeneous N1/N2 phenotypes regulated by TGF-&#x3b2; and IGF1, influencing pro- or anti-tumor effects (<xref ref-type="bibr" rid="B72">72</xref>, <xref ref-type="bibr" rid="B73">73</xref>). Notably, transforming growth factor-&#x3b2; (TGF-&#x3b2;), secreted by metastatic tumor cells and Kupffer cells within the liver, is a key immunosuppressive cytokine that drives the polarization of neutrophils toward a pro-tumor phenotype (<xref ref-type="bibr" rid="B74">74</xref>, <xref ref-type="bibr" rid="B75">75</xref>). TGF-&#x3b2; signaling inhibits neutrophil cytotoxicity and reactive oxygen species (ROS) production, while promoting the expression of matrix metalloproteinases MMP - 9 and vascular endothelial growth factor (VEGF) (<xref ref-type="bibr" rid="B76">76</xref>&#x2013;<xref ref-type="bibr" rid="B79">79</xref>), thereby enhancing tumor angiogenesis and extracellular matrix remodeling. Moreover, TGF-&#x3b2; suppresses neutrophil-mediated stimulation of CD8<sup>+</sup> T cell responses, further contributing to immune evasion in the metastatic tumor microenvironment (<xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B81">81</xref>). In addition, IGF1 has been shown to further modulate the polarization of neutrophils, especially in liver metastasis, acting as a significant driver of the neutrophil polarization in this organ (<xref ref-type="bibr" rid="B82">82</xref>, <xref ref-type="bibr" rid="B83">83</xref>). Thus, neutrophils drive metastasis at multiple stages, with TGF-&#x3b2; and IGF1 synergistically enhancing their pro-metastatic functions in liver metastases.</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>Recruitment of monocytes/macrophages and myeloid-derived suppressor cells to metastatic sites</title>
<p>Bone marrow-derived cells, including monocytic MDSCs (M-MDSCs) and granulocytic MDSCs (G-MDSCs), are recruited to the liver, facilitating metastatic expansion (<xref ref-type="bibr" rid="B84">84</xref>&#x2013;<xref ref-type="bibr" rid="B86">86</xref>). In colorectal liver metastasis, macrophage infiltration is predominantly mediated by CCL9 and CCL15, which recruit CCR1<sup>+</sup> macrophages, whereas granulocytic MDSCs are recruited via CCR2 (<xref ref-type="bibr" rid="B87">87</xref>, <xref ref-type="bibr" rid="B88">88</xref>). Tumor-associated macrophages (TAMs) promote MLC growth, and their depletion reduces metastatic foci. Chemotactic factors drive macrophage recruitment, and blocking these signals attenuates metastasis. Kitamura et&#xa0;al. (<xref ref-type="bibr" rid="B89">89</xref>) identified CCL9 and CCL15 as CRC-secreted chemokines recruiting CCR1<sup>+</sup> macrophages; CCR1 inhibition impairs infiltration and suppresses metastasis.</p>
<p>TAMs support metastasis via immune-dependent and independent mechanisms (<xref ref-type="bibr" rid="B90">90</xref>). They promote angiogenesis via VEGFR1, responding to tumor-derived VEGF and complement factors. CRC cells produce C5a, binding macrophage C5aR to enhance recruitment and M2 polarization, fostering metastasis. Conversely, C5aR ablation reduces M2 accumulation and metastatic burden (<xref ref-type="bibr" rid="B91">91</xref>, <xref ref-type="bibr" rid="B92">92</xref>). In pancreatic cancer, macrophages secrete granulin, activating hepatic stellate cells (HSCs) to produce ECM and support metastasis. Lim et&#xa0;al. (<xref ref-type="bibr" rid="B93">93</xref>) found macrophage depletion upregulated S100A8/S100A9 and downregulated ANGPTL7 in cancer cells, altering metastatic potential. S100A8/A9 silencing reduced MLC formation, while ANGPTL7 overexpression suppressed it, indicating macrophage-mediated tumor reprogramming. Hypoxia in metastases enhances macrophage pro-metastatic functions (<xref ref-type="bibr" rid="B94">94</xref>). In HCC, hypoxia and necrosis induce HIF - 1&#x3b1; and TLR4 in macrophages, boosting IL - 1&#x3b2; production, ECM deposition, and metastasis (<xref ref-type="bibr" rid="B95">95</xref>). Cirrhotic mice show increased metastasis with reduced NO, while high-fat diet (HFD)-fed mice exhibit non-alcoholic fatty liver disease (NAFLD)-linked metastasis and M2 macrophage infiltration. NLRC4 deficiency abrogates HFD effects, and NAFLD-associated IL - 1&#x3b2; promotes HCC metastasis (<xref ref-type="bibr" rid="B96">96</xref>). Distinguishing resident from monocyte-derived macrophages is critical for therapy (<xref ref-type="bibr" rid="B97">97</xref>). Tumor secretomes homogenize macrophage populations toward pro-tumor phenotypes (<xref ref-type="bibr" rid="B98">98</xref>, <xref ref-type="bibr" rid="B99">99</xref>), though ontogeny influences function, as CSF1R blockade affects brain microglia differently (<xref ref-type="bibr" rid="B100">100</xref>).</p>
<p>MDSCs suppress innate and adaptive immunity in metastasis (<xref ref-type="bibr" rid="B101">101</xref>, <xref ref-type="bibr" rid="B102">102</xref>). M-MDSCs are often associated with immunosuppressive functions and T-cell inhibition, primarily through the production of arginase-1 and IDO, which impair T-cell function and promote Treg expansion (<xref ref-type="bibr" rid="B103">103</xref>). These M-MDSCs are frequently localized at the tumor stroma or the tumor periphery, where they interact with KCs and other stromal cells to suppress effector immune responses (<xref ref-type="bibr" rid="B104">104</xref>, <xref ref-type="bibr" rid="B105">105</xref>). In contrast, G-MDSCs, which are typically characterized by the expression of Ly6G, mediate their immunosuppressive effects through neutrophil extracellular trap (NET) formation (<xref ref-type="bibr" rid="B106">106</xref>, <xref ref-type="bibr" rid="B107">107</xref>). This mechanism facilitates the entrapment of circulating tumor cells in the hepatic vasculature and promotes tumor cell adhesion. Additionally, the release of HMGB1 by NETs activates TLR9 signaling in tumor cells, enhancing their metastatic potential (<xref ref-type="bibr" rid="B108">108</xref>). G-MDSCs are predominantly localized to microvascular niches within the hepatic sinusoids during early metastatic colonization, where they exert their pro-metastatic functions by altering the extracellular matrix (ECM) and promoting angiogenesis (<xref ref-type="bibr" rid="B109">109</xref>, <xref ref-type="bibr" rid="B110">110</xref>). Recruited via LSEC/KC/HSC chemokines, their hepatic accumulation in female mice is estrogen-dependent and TNFR2-mediated (<xref ref-type="bibr" rid="B111">111</xref>). Tumor-derived VEGF induces macrophage CXCL1, recruiting MDSCs (<xref ref-type="bibr" rid="B112">112</xref>). STAT3 activation via sphingosine-1-phosphate receptor 1 (S1PR1) drives IL - 6-mediated MDSC accumulation (<xref ref-type="bibr" rid="B113">113</xref>), though signals preventing their maturation remain unclear (<xref ref-type="bibr" rid="B114">114</xref>). MDSCs are identified by CD11b, Ly6G, and Ly6C, but marker overlap with TAMs/TANs complicates characterization (<xref ref-type="bibr" rid="B115">115</xref>) (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Key immune cell populations in the hepatic metastatic niche and their functional roles.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="left">Cell Type</th>
<th valign="middle" align="left">Subsets</th>
<th valign="middle" align="left">Pro-Metastatic Mechanisms</th>
<th valign="middle" align="left">Anti-Metastatic Mechanisms</th>
<th valign="middle" align="left">Clinical Targeting Strategies</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="left">Kupffer Cells (KCs)</td>
<td valign="middle" align="left">Resident (yolk sac-derived), BM-derived</td>
<td valign="middle" align="left">Pre-metastatic niche formation via TGF-&#x3b2;/fibronectin; cytokine support post-extravasation.</td>
<td valign="middle" align="left">Early-phase tumor phagocytosis (Dectin-2), NO/TNF-&#x3b1; secretion, NK cell activation</td>
<td valign="middle" align="left">CSF1R inhibitors (pexidartinib), CD40 agonists</td>
</tr>
<tr>
<td valign="middle" align="left">Neutrophils</td>
<td valign="middle" align="left">N1 (anti-tumor), N2 (pro-tumor)</td>
<td valign="middle" align="left">NETs enhance colonization; FGF2-driven growth; NLR correlates with poor prognosis</td>
<td valign="middle" align="left">Limited direct cytotoxicity; N1 phenotype inhibits metastasis under TGF-&#x3b2; blockade</td>
<td valign="middle" align="left">CXCR2/CXCR4 inhibition (BL - 8040), NET disruption</td>
</tr>
<tr>
<td valign="middle" align="left">Monocytes<break/>/Macrophages</td>
<td valign="middle" align="left">TAMs (M1/M2), CCR2<sup>+</sup>Ly6C<sup>+</sup> inflammatory monocytes</td>
<td valign="middle" align="left">CCL9/CCL15-CCR1 recruitment; VEGFR1 angiogenesis; C5aR-mediated M2 polarization</td>
<td valign="middle" align="left">M1 phenotype exerts phagocytic activity; TLR activation may restore antitumor function</td>
<td valign="middle" align="left">CCR2/CCR5 antagonists (maraviroc), CCL2/CXCL12 axis blockade</td>
</tr>
<tr>
<td valign="middle" align="left">MDSCs</td>
<td valign="middle" align="left">PMN-MDSCs (CD11b<sup>+</sup>Ly6G<sup>+</sup>), M-MDSCs (CD11b<sup>+</sup>Ly6C<sup>+</sup>)</td>
<td valign="middle" align="left">STAT3/IL-6-driven expansion; S1PR1-mediated immunosuppression; estrogen-dependent recruitment</td>
<td valign="middle" align="left">None identified in metastasis</td>
<td valign="middle" align="left">CXCR4 inhibitors, PD - 1/CTLA-4 combo therapy</td>
</tr>
<tr>
<td valign="middle" align="left">iNKT Cells</td>
<td valign="middle" align="left">CD4<sup>+</sup>CD8<sup>+</sup> double-positive</td>
<td valign="middle" align="left">Rarely pro-tumor; may promote fibrosis via HSC interaction</td>
<td valign="middle" align="left">CD1d-dependent cytotoxicity; IFN-&#x3b3; secretion against MHC-I<sup>-</sup> targets</td>
<td valign="middle" align="left">&#x3b1;-GalCer analogs to activate iNKT cells (phase I/II trials)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>Metabolic constraints of the tumor microenvironment impair immune effector functions</title>
<p>The immunosuppressive TME in metastatic liver cancer is not only shaped by cellular interactions but also by profound metabolic reprogramming that impairs cytotoxic immune responses (<xref ref-type="bibr" rid="B116">116</xref>, <xref ref-type="bibr" rid="B117">117</xref>). Tumor cells consume glucose at a high rate through aerobic glycolysis (the Warburg effect), leading to glucose depletion in the hepatic niche (<xref ref-type="bibr" rid="B118">118</xref>, <xref ref-type="bibr" rid="B119">119</xref>). Since both NK cells and cytotoxic CD8<sup>+</sup> T cells rely on glucose-driven oxidative phosphorylation and aerobic glycolysis to sustain their effector functions, nutrient scarcity results in cellular exhaustion and reduced cytokine secretion (IFN-&#x3b3;, TNF-&#x3b1;) (<xref ref-type="bibr" rid="B120">120</xref>, <xref ref-type="bibr" rid="B121">121</xref>). Additionally, lactate&#x2014;a byproduct of tumor glycolysis&#x2014;is exported via MCT4 into the extracellular space (<xref ref-type="bibr" rid="B122">122</xref>, <xref ref-type="bibr" rid="B123">123</xref>). Its accumulation acidifies the TME and is taken up by immune cells, causing intracellular acidosis that disrupts signaling pathways such as NFAT and mTOR, thereby suppressing IFN-&#x3b3; production in NK and T cells (<xref ref-type="bibr" rid="B124">124</xref>). Moreover, hypoxia, a hallmark of the liver metastatic TME, stabilizes HIF - 1&#x3b1; in NK and T cells, shifting their metabolism toward anaerobic pathways and impairing mitochondrial function, proliferation, and cytolytic activity (<xref ref-type="bibr" rid="B120">120</xref>, <xref ref-type="bibr" rid="B125">125</xref>). Collectively, these metabolic stressors within the TME undermine the survival and effector potency of immune cells, further favoring metastatic colonization.</p>
</sec>
</sec>
<sec id="s4">
<label>4</label>
<title>Clinical trials targeting TAMs and MDSCs</title>
<p>TAMs and MDSCs critically sustain the immunotolerant milieu of metastatic liver cancer (MLC), making them prime therapeutic targets (<xref ref-type="bibr" rid="B126">126</xref>, <xref ref-type="bibr" rid="B127">127</xref>). The CSF1/CSF1R axis regulates macrophage differentiation, recruitment, and survival. CSF1R inhibitors reduce CD68<sup>+</sup>/CD163<sup>+</sup> macrophage infiltration in normal liver tissue. In colorectal cancer (CRC) models, CSF1R blockade elevates cytotoxic T cells while suppressing FoxP3<sup>+</sup> Tregs (<xref ref-type="bibr" rid="B128">128</xref>). Though limited as monotherapy (<xref ref-type="bibr" rid="B129">129</xref>), CSF1R inhibition synergizes with PD - 1/PD-L1 inhibitors or chemotherapy. A phase I trial (NCT02777710) combining durvalumab (PD-L1 inhibitor) and pexidartinib (CSF1R inhibitor) in advanced CRC/pancreatic cancer showed 21% achieving stable disease &#x2265;2 months (<xref ref-type="bibr" rid="B130">130</xref>). This limited efficacy of CSF1R blockade as monotherapy may stem from compensatory mechanisms that sustain TAM survival and function (<xref ref-type="bibr" rid="B131">131</xref>, <xref ref-type="bibr" rid="B132">132</xref>). In particular, GM-CSF and G-CSF signaling pathways can support macrophage viability and polarization in the absence of CSF1R signaling, enabling the persistence of pro-tumoral macrophage populations despite CSF1R inhibition (<xref ref-type="bibr" rid="B133">133</xref>, <xref ref-type="bibr" rid="B134">134</xref>). Additionally, tumors may circumvent CSF1R blockade by recruiting alternative immunosuppressive cell types, including tumor-associated neutrophils (TANs), MDSCs, and tolerogenic dendritic cells, which collectively reinforce an immunosuppressive microenvironment (<xref ref-type="bibr" rid="B135">135</xref>). These compensatory pathways highlight the need for combination therapies that simultaneously target multiple immunoregulatory axes within the tumor microenvironment.</p>
<p>Disrupting TAM/MDSC recruitment offers another strategy. CCL2, CXCL12, and CCL5 mediate hepatic infiltration by these cells (<xref ref-type="bibr" rid="B136">136</xref>, <xref ref-type="bibr" rid="B137">137</xref>). In CRC models, CCL2 correlates with MLC progression. CCR2 knockout mice exhibit reduced TAMs, increased CD8<sup>+</sup>/CD4<sup>+</sup> T cells, and improved survival (<xref ref-type="bibr" rid="B138">138</xref>). Clinically, the CCR2 antagonist CCX872 plus FOLFIRINOX improved survival in metastatic pancreatic cancer, with ~33% alive at 18 months (<xref ref-type="bibr" rid="B139">139</xref>). An ongoing trial (NCT03184870) is testing the CCR2/CCR5 antagonist BMS - 813160 with chemo/immunotherapy in metastatic pancreatic/CRC. The CXCL12/CXCR4 axis also recruits immunosuppressive cells to the liver (<xref ref-type="bibr" rid="B140">140</xref>). In CRC models, CXCR4 inhibition reduced MLC/MDSC accumulation (<xref ref-type="bibr" rid="B141">141</xref>) and enhanced PD - 1 blockade efficacy, elevating CD8<sup>+</sup> T cell/Treg ratios and tumor regression (<xref ref-type="bibr" rid="B142">142</xref>). A trial combining the CXCR4 inhibitor BL - 8040 with FOLFIRI/pembrolizumab in refractory pancreatic cancer yielded 4 partial responses among 15 patients (<xref ref-type="bibr" rid="B143">143</xref>). Further trials (NCT02907099) will clarify its role in MLC.</p>
<p>The CCL5/CCR5 axis drives metastasis by mobilizing MDSCs and polarizing M2 macrophages (<xref ref-type="bibr" rid="B144">144</xref>, <xref ref-type="bibr" rid="B145">145</xref>). In CRLM, CCR5<sup>+</sup> tumors exhibit elevated Treg: CTL ratios and PD - 1/CTLA-4 (<xref ref-type="bibr" rid="B146">146</xref>). Preclinical data show CCL5 boosts TAM-derived MMPs, accelerating progression, while maraviroc (CCR5 inhibitor) reprograms TAMs to an antitumoral phenotype. A phase I trial (MARACON) in CCR5<sup>+</sup> mCRC saw 3/11 patients respond post-chemotherapy (<xref ref-type="bibr" rid="B147">147</xref>). Ongoing studies (NCT03274804, NCT03631407) are testing CCR5/PD-1 co-blockade in MSS mCRC. Reprogramming TAMs toward antitumor states is another approach. CD47-SIRP&#x3b1; signaling inhibits macrophage phagocytosis, and CD47 upregulation helps tumors evade immunity (<xref ref-type="bibr" rid="B148">148</xref>). In models, CD47 inhibition reduced MLC (<xref ref-type="bibr" rid="B149">149</xref>), prompting phase I trials of CD47 blockers alone (NCT04257617, NCT03763149) or combined (NCT02953782). CD40 agonists activate macrophages via T cell-dependent/independent pathways, inducing IFN production and ECM remodeling (<xref ref-type="bibr" rid="B150">150</xref>). A phase Ib trial combining gemcitabine/nab-paclitaxel/CD40 agonist &#xb1; nivolumab in metastatic pancreatic cancer achieved a 58% response rate (<xref ref-type="bibr" rid="B151">151</xref>). Other agents promoting M1 polarization include TLR agonists, PI3K&#x3b3; inhibitors, and HDAC inhibitors (<xref ref-type="bibr" rid="B152">152</xref>&#x2013;<xref ref-type="bibr" rid="B154">154</xref>). The liver&#x2019;s immunotolerant microenvironment is shaped by bone marrow/lymphoid-derived immunosuppressive cells, fostering metastasis and impairing systemic immunity. Overcoming this requires multimodal strategies, with current research focusing on enhancing immunotherapy efficacy in MLC.</p>
</sec>
<sec id="s5" sec-type="conclusions">
<label>5</label>
<title>Conclusion</title>
<p>Metastatic liver cancer (MLC) represents a formidable clinical challenge, where the liver&#x2019;s unique immunotolerant microenvironment actively facilitates tumor colonization and progression. Our review highlights the dual roles of hepatic immune cells - initially serving as a defense barrier but ultimately being co-opted to support metastatic growth through multiple mechanisms. Kupffer cells transition from tumoricidal effectors to pro-metastatic facilitators, while recruited neutrophils and MDSCs establish immunosuppressive networks via NETosis, cytokine secretion, and metabolic competition. These cellular interactions create a self-reinforcing niche that promotes immune evasion and treatment resistance.</p>
<p>To overcome these challenges, future therapeutic strategies must integrate TME-modulating agents with immunotherapy and chemotherapy, guided by comprehensive immune profiling. Emphasis should be placed on identifying predictive biomarkers and understanding spatiotemporal immune evolution during metastasis. By elucidating the complex immunobiology of liver metastasis, this review highlights the potential of combinatorial approaches to transform MLC treatment and improve patient outcomes.</p>
</sec>
</body>
<back>
<sec id="s6" sec-type="author-contributions">
<title>Author contributions</title>
<p>DL: Writing &#x2013; original draft. ML: Writing &#x2013; original draft. YL:&#xa0;Writing &#x2013; original draft. FX: Writing &#x2013; original draft. RL:&#xa0;Writing &#x2013; original draft. YS: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing.</p>
</sec>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research and/or publication of this article. This work was supported by National Natural Science Foundation of China (81704054).</p>
</sec>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors&#xa0;and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
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