Figure 2.

Key players within the MPM microenvironment. The complex landscape of MPM-TME is characterized by the interconnection between cancer and stromal/immune cells to create a permissive and pro-tumorigenic environment. Hypoxic conditions and oxidative stress, chronic inflammation, and soluble factors trigger metabolic reprogramming. Moreover, also aberrant signaling and DNA damage pathways, as well as mutations in specific genes such as BAP1, contribute to a switch toward glycolytic metabolism (Warburg effect) in tumor and in immune cells, promoting MPM cell growth and progression. Lactate and immunosuppressive molecules, including IDO and ADO excreted in the microenvironment, lead to MPM cells’ adaptation, survival, metastatization, and escape from immune control. See main text for abbreviations. Created with BioRender.com.