Mingzhen Bai, Ping Yue, Wenkang Fu, Ruyang Zhong, Chongfei Huang, Ningzu Jiang, Long Gao, Ningning Mi, Haidong Ma, Yawen Lu, Liang Tian, Jinyu Zhao, Ziang Zhang, Yong Zhang, Jinduo Zhang, Yanxian Ren, Haiying Yu, Jia Yao, Dewei Li, Yanyan Lin, Wenbo Meng
Acta Pharmaceutica Sinica B. 2026, 16(5): 3074-3089.
Cholangiocarcinoma (CCA) is a markedly desmoplastic tumor, with extrahepatic CCA (eCCA) being the most prevalent subtype. The nonspecific clinical manifestation and early metastatic potential result in a persistently poor overall prognosis. Cancer-associated fibroblasts (CAFs) are one of the major components of the tumor microenvironment implicated in tumor progression and treatment resistance. To faithfully recapitulate the eCCA microenvironment, we established a comprehensive patient-derived preclinical platform comprising CAFs, eCCA primary cells, organoids, and patient-derived xenograft (PDX) models. We found that CAFs facilitated eCCA cell growth, migration, and invasion in vivo and in vitro. Cytokine profiling revealed that HGF is a key paracrine factor produced by CAFs. CAF-derived HGF activates c-MET signaling to drive gemcitabine resistance in eCCA. Therapeutically, pharmacologic inhibition of c-MET partially resensitized eCCA cells to gemcitabine in preclinical models and suppressed tumor progression. In conclusion, our data provides subtype-specific translational evidence that therapeutically targeting the CAF-HGF-c-MET pathway represents a rational strategy to enhance gemcitabine efficacy and improve treatment outcomes in eCCA.