CR1(+) tumor-associated macrophages orchestrate an immunosuppressive niche in hepatocellular carcinoma: a genetic and multi-omics dissection
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Abstract
Background: Hepatocellular carcinoma (HCC) remains a major global health burden and a leading cause of cancer-related mortality. Advanced disease is characterized by a profoundly immunosuppressive tumor microenvironment (TME) and limited durable responses to therapy. However, the upstream genetic determinants that drive tumor-associated macrophage (TAM) dysfunction in HCC remain poorly defined. Using an integrative genetic and multi-omics framework, we investigated complement receptor 1 (CR1) as a candidate regulator of this immunosuppressive niche. Methods: We combined Mendelian randomization (MR) and metabolite mediation analyses with bulk, single-cell, and spatial transcriptomics to define the role of CR1 in HCC. Public datasets included the TCGA-HCC cohort, a single-cell RNA-sequencing dataset comprising 53,474 high-quality cells from 21 samples, and two spatially profiled HCC sections. Clinical validation was performed in 30 paired HCC and adjacent liver tissues. Functional assays were conducted in THP-1-derived macrophages using CR1 gain- and loss-of-function approaches, phagocytosis assays, and macrophage-CD8 + T-cell co-culture experiments. Results: MR analyses implicated CR1 in HCC susceptibility at both the protein and transcript levels. pQTL analysis linked genetically predicted circulating CR1 levels to HCC risk (IVW OR = 1.403, p = 0.017), and mediation analysis identified specific metabolites as candidate intermediates. Integrative multi-omics analyses showed that CR1 was preferentially enriched in TAMs, spatially co-localized with the M2 marker CD206, and associated with reduced CD8 + T-cell infiltration, enhanced T-cell exhaustion signatures, advanced clinicopathological features, and poorer survival. In 30 paired clinical samples, CR1-high tumors exhibited increased M2-like macrophage accumulation and reduced CD8 + T-cell infiltration. Functionally, CR1 overexpression drove macrophages toward an M2-like phenotype, enhanced phagocytic activity, increased PD-L1 expression, and suppressed CD8 + T-cell proliferation as well as IFN-gamma and granzyme B production, whereas CR1 knockdown produced the opposite phenotype. Conclusions: Our study provides the first integrated genetic, spatial, and functional evidence that CR1 + TAMs constitute a clinically relevant immunoregulatory axis in HCC. These findings extend current understanding of complement-associated immunosuppression beyond canonical complement cascade activity and support CR1 as a candidate biomarker and therapeutic target for macrophage reprogramming, with potential translational relevance for combination strategies involving immune checkpoint blockade.
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- Authors
- Wang, Z., Wang, Z., Ji, X., Zhao, L., Zheng, K., Yu, W., Zhang, H., Chang, H., & Liu, F.
- Affiliations
- Shandong Provincial Hospital (CN)
- Shandong University (CN)
- Third People's Hospital of Yunnan Province (CN)
- Corresponding author
- Liu, Fangfeng
- Venue
- Journal of Translational Medicine
- Published
- 2026-05-25
- Volume
- 24
- Issue
- 1
- ISSN
- 1479-5876 (ISSN-L)
- OpenAlex
- W7162335162
- Cited by
- 0
- References
- 64
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Translational Medicine (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Immune cells in cancer
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Keywords
- hepatocellular carcinoma, tumor-associated macrophages, complement receptor 1, immunosuppressive tumor microenvironment, M2 macrophage polarization, CD206, CD8+ T cell exhaustion, PD-L1, phagocytosis, complement system, genetic susceptibility, single-cell transcriptomics, spatial transcriptomics, CD8+ T cell infiltration
- MeSH terms
- Tumor-Associated Macrophages, T-Cell Exhaustion, Multiomics, Carcinoma, Hepatocellular, Humans, Immunosuppression Therapy, Liver Neoplasms, Macrophages, Phagocytosis, Receptors, Complement, Gene Expression Regulation, Neoplastic, CD8-Positive T-Lymphocytes, Tumor Microenvironment
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