How the interplay among the tumor microenvironment and the gut microbiota influences the stemness of colorectal cancer cells

Figure 2 The interplay among the tumor microenvironment and the gut microbiota influences the stemness of colorectal cancer cells. (1) Gut microorganisms and/or their derived products in a dysbiosis context influence the restructuration of tumor microenvironment (TME), favoring the release of several factors (growth factors, cytokines, non-coding ribonucleic acids and enzymes), immunological changes and an inflammatory environment; (2) The factors released by TME cells impact on intestinal microbiota promoting the growth of unhealthy microorganisms and their sustained unbalance; (3) Moreover, these TME factors can modulate the properties and behavior of colorectal cancer stem cells (CCSC) promoting effects such as their growth, survival, maintenance and tumorigenic potential; (4) In this context, CCSC response expressing factors that enable them to communicate with stromal cells and also influence a TME restructuration; (5) Microorganisms and/or their derived products can directly modulate the features and properties of CCSC, which in response; and (6) Probably affect the intestinal microbiota. All these associated events contribute to colorectal cancer progression. CCSC: Colorectal cancer stem cells; TME: Tumor microenvironment.