Mechanistic role of FTO in cancer pathogenesis, immune evasion, chemotherapy resistance, and immunotherapy response.

Fat mass and obesity-associated protein (FTO), an N6-methyladenosine (m6A) RNA demethylase, plays a key role in cancer biology by regulating mRNA modifications. Its deregulation affects tumor cell proliferation, metastasis, immune evasion, and therapeutic resistance. By removing m6A methylation marks, FTO can alter the stability and translation of key oncogenes and tumor suppressor genes. These modifications directly influence essential cellular pathways involved in cancer progression, such as the phosphatidylinositol 3-kinases/ protein kinase B (PI3K/AKT), Wnt/β-catenin, and mammalian target of rapamycin (mTOR) signaling pathways. This review explores the mechanistic roles of FTO in cancer pathogenesis, focusing on its dual impact on immune regulation and chemotherapy response. In terms of immunity, FTO has been shown to promote immune evasion by modulating the expression of immune checkpoints and influencing the tumor microenvironment. Additionally, FTO's influence on autophagy, glycolysis, and apoptosis resistance further complicates the effectiveness of chemotherapy treatments. By discussing the molecular details of how FTO regulates these processes, we provide insights into how FTO could serve as a promising therapeutic target to overcome cancer-related challenges, including immune resistance and chemotherapy failure. Finally, we evaluate current and emerging strategies for targeting FTO in cancer therapy, highlighting its potential to enhance immunotherapy and chemotherapy outcomes.