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Sympathetic nervous system regulation of the tumour microenvironment
Open accessAbstract
The peripheral autonomic nervous system (ANS) is known to regulate gene expression in primary tumours and their surrounding microenvironment. Activation of the sympathetic division of the ANS in particular modulates gene expression programmes that promote metastasis of solid tumours by stimulating macrophage infiltration, inflammation, angiogenesis, epithelial-mesenchymal transition and tumour invasion, and by inhibiting cellular immune responses and programmed cell death. Haematological cancers are modulated by sympathetic nervous system (SNS) regulation of stem cell biology and haematopoietic differentiation programmes. In addition to identifying a molecular basis for physiologic stress effects on cancer, these findings have also identified new pharmacological strategies to inhibit cancer progression in vivo.
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“Parallel findings in animal and in vitro models support these data [11, 16–22].”
From Living Well: Protocol for a web-based program to improve quality of life in rural and urban ovarian cancer survivors (2024) · cites this paper as [22]
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“By α and β adrenergic receptors, the SNS can impact various molecular processes involved in tumor progression, including DNA damage repair, inflammation, angiogenesis, and tumor cell migration and invasion (Cole et al., 2015 ).”
BackgroundPositive Psychosocial Factors and Oxytocin in the Ovarian Tumor Microenvironment
Cuneo, M. G., Szeto, A., Schrepf, A., Thaker, P. H., Goodheart, M. J., Cole, S. W., Sood, A. K., McCabe, P. M., Mendez, A. J., & Lutgendorf, S. K. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000935 · Cited by 6
“In previous research, stress-related psychosocial factors have been shown to influence tumor progression through a variety of pathways, including sympathetic innervation of tumors and β-adrenergic signaling (1).”
BackgroundInfluentialSelf-citationTibenský, M., Černáčková, A., Horváthová, Ľ., Macejová, D., Tillinger, A., & Mravec, B. (2021) · Anti-Cancer Drugs · doi:10.1097/cad.0000000000001113 · Cited by 8
Dash, S., Yoder, S., Mesa, T., Smith, A., Cen, L., Eschrich, S. A., Armaiz-Peña, G. N., & Monteiro, Á. N. A. (2021) · Scientific Reports · doi:10.1038/s41598-021-93506-z · Cited by 7
Bioinformatic-based genetic characterizations of neural regulation in skin cutaneous melanoma
Wang, F., Cheng, F., & Zheng, F. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1166373 · Cited by 6
Shiralkar, J., Anthony, T., McCallum, G. A., & Durand, D. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297281 · Cited by 6
Liu, X., Dai, C., Jia, G., Xu, S., Fu, Z., Xu, J., Li, Q., Ruan, H., & Xu, P. (2017) · Oncology Reports · doi:10.3892/or.2017.5741 · Cited by 6
“various studies have reported that the sympathetic nervous system is important in the tumor microenvironment (30,31), and autonomic nerve development promotes cancer progression (32).”
BackgroundShi, J., Xu, J., Li, Y., Li, B., Ming, H., Nice, E. C., Huang, C., Li, Q., & Wang, C. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.990665 · Cited by 6
Shen, Y., Park, J. B., Lee, S. Y., Han, S. K., & Ryu, P. D. (2018) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00225.2018 · Cited by 6
“These GABAergic inhibitory circuits could be also targeted for therapeutic interventions in other diseases accompanied by sympathetic hyperactivation, such as hypertension (1), metabolic syndrome (19), cancer (3), and aging (13).”
BackgroundBarr, J. L., Walz, A., Restaino, A. C., Amit, M., Barclay, S. M., Vichaya, E. G., Spanos, W. C., Dantzer, R., Talbot, S., & Vermeer, P. D. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.10.18.562990 · Cited by 6
Bustamante, C., Bonilla, L. B. P., & Restrepo, J. C. (2024) · Frontiers in Integrative Neuroscience · doi:10.3389/fnint.2024.1417856 · Cited by 5
“Furthermore, regulatory effects on gene expression in tumors and their surrounding microenvironment have been observed (Cole et al., 2015).”
BackgroundArneth, B. (2025) · Nutrition and Diabetes · doi:10.1038/s41387-025-00383-w · Cited by 5
“Therefore, obesity is related to an increased level of leptin, which supports in fl ammation and activates Th1 cells and the production of proin fl ammatory cytokines.”
Liu, J., Liu, S., Gao, L., Li, G., Xu, J., Sun, Y., Wang, J., & Shi, B. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.696208 · Cited by 5
Biobehavioral Factors Predict an Exosome Biomarker of Ovarian Carcinoma Disease Progression
Lutgendorf, S., Thaker, P., Goodheart, M., Arevalo, J., Chowdhury, M. A., Noble, A. E., Dahmoush, L., Slavich, G. M., Penedo, F., Sood, A., et al. (2022) · Cancer · doi:10.1002/cncr.34496 · Cited by 6
Self-citationAxonFinder: Automated segmentation of tumor innervating neuronal fibers
Ait-Ahmad, K., Ak, Ç., Thibault, G., Chang, Y. H., & Eksi, S. E. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e41209 · Cited by 5
“Automated segmentation of tumor-innervating axons can be used to investigate the specific impact of neuronal innervation on cancer progression [25] paving the way for novel insights into cancer biology.”
Modelomics to Investigate Cancer Bone Metastasis
Shafiee, A., & Hutmacher, D. W. (2018) · Current Molecular Biology Reports · doi:10.1007/s40610-018-0094-x · Cited by 5
Pavlova, O., Shirokov, A. A., Fomin, A. S., Наволокин, Н. А., Terskov, A. V., Khorovodov, A. P., Nаmykin, A. A., Павлов, А. Н., Tuchin, V. V., & Semyachkina-Glushkovskaya, O. V. (2018) · Journal of Innovative Optical Health Sciences · doi:10.1142/s1793545818500256 · Cited by 5
Benbenishty, A., Segev‐Amzaleg, N., Shaashua, L., Melamed, R., Ben‐Eliyahu, S., & Blinder, P. (2017) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2017.02.012 · Cited by 5
Heemelaar, J. C., Krol, A. D. G., Louwerens, M., Beeres, S. L. M. A., Holman, E. R., Schalij, M. J., & Antoni, M. L. (2021) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2021.100830 · Cited by 5
Social Genomics Model of Health Disparities
Carlos, R. C. (2023) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2023.06.001 · Cited by 5
Feng, J., Sharma, S., Rao, E., Li, X., Zhang, Q., Liao, F., He, J., Han, D. C., & Rao, J. (2019) · Science China Materials · doi:10.1007/s40843-018-9383-3 · Cited by 5
Temperature Plays an Essential Regulatory Role in the Tumor Immune Microenvironment
Zhang, B., Wang, Y., Zhao, Z., Han, B., Yang, J. B., Sun, Y., Zhang, B., Zang, Y., & Guan, H. (2021) · Journal of Biomedical Nanotechnology · doi:10.1166/jbn.2021.3030 · Cited by 5
Recalde‐Percaz, L., la Guia-Lopez, I. D., Linzoain-Agos, P., Noguera‐Castells, A., Rodrigo‐Faus, M., Jauregui, P., López‐Plana, A., Fernández‐Nogueira, P., Iniesta‐González, M., Cueto‐Remacha, M., et al. (2025) · Neoplasia · doi:10.1016/j.neo.2025.101220 · Cited by 7
“In recent years, the contribution of nerves and neural derived factors to the regulation of tumor progression has emerged as an important component of the TME [11,12].”
Chronic stress in cancer development and progression
Niu, X., Wu, T. H., Zeng, L., Wang, F., Lv, W., Zhang, L., & Zhou, F. (2025) · 中国科学通报:英文版 · doi:10.1016/j.scib.2025.09.034 · Cited by 7
Chronic stress-related neuroendocrine mediators and ovarian cancer
Du, H., Yu, G., Hu, R., Du, J., & Liu, C. (2025) · Discover Oncology · doi:10.1007/s12672-025-04012-x · Cited by 4
“The SNS releases catecholamines, primarily E, NE, and DA, which serve as key signaling molecules in stress response through sympathetic nerve terminals [17].”
Kubatka, P., Kapinová, A., Bojková, B., Joseph, V., Horňák, S., Kajo, K., Büsselberg, D., Šmejkal, K., Goncharenko, V., Mrazova, B., et al. (2026) · The EPMA Journal · doi:10.1007/s13167-026-00447-6 · Cited by 4
“When neuroinflammation is the predominant mecha - nism, systemic interventions (e.g., beta-adrenergic receptor (β-AR) antagonists or anti-inflammatory agents) can disrupt the self-reinforcing circuit between the nervous and immune system that fuels cancer progression [16, 98].”
Macrophage-mediated brain-bone marrow crosstalk promotes chronic stress-induced glioma growth
Yang, Z., Zhou, J., Fei, F., Zheng, B., Yang, S. X., Pearce, T. M., Zhang, P. C., Huang, L., Yue, J., Shen, Q., et al. (2026) · Cancer Cell · doi:10.1016/j.ccell.2026.05.018 · Cited by 5
Dong, M. P., Dharmaraj, N., Kaminagakura, E., Xue, J., Leach, D. G., Hartgerink, J. D., Zhang, M., Hanks, H.-J. E., Ye, Y., Aouizerat, B. E., et al. (2024) · Biomedicines · doi:10.3390/biomedicines12040920 · Cited by 4
“STINGel-mediated antinociception was likely mediated by the regulation of neuron development and TGF-β signaling to PNS macrophages.”
BackgroundSleep, Circadian Rhythms, and Lung Cancer
Cooper, D. H., Almendros, I., & Kendzerska, T. (2025) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/a-2531-1059 · Cited by 5
“105 Sleep arousals related to OSA, SF, and IH, and their effects on catecholamines, likely also reduce sleep duration and quality, both of which were discussed as risk factors for cancer development and progression/survival above in the sleep architecture section.”
Miller, C. P., Le, T., Amburn, T., Sevilimedu, V., Tadros, A. B., Downs‐Canner, S., Plitas, G., Barrio, A. V., Morrow, M., & Goel, N. (2025) · Annals of Surgery · doi:10.1097/sla.0000000000006828 · Cited by 4
“7,10,14 Combined, these transcription factor alterations have been shown to cultivate a prometastatic niche and were associated with shorter recurrence-free survival, re fl ective of more aggressive tumor biology.”
Bustamante, C., Pinilla, L., & Amaris, Ó. (2023) · Clinical Medicine Insights Case Reports · doi:10.1177/11795476231159584 · Cited by 4
“…including the immune response, 14 and current evidence confirms the findings of the modulation of the nervous system in all cellular processes, such as cell division, cell differentiation, 34 regulation of gene expression, 35 tissue metabolism, and modulation of acute and chronic inflammation.”
BackgroundSympathetic Nervous Influences Are Negative Prognostic Factors in Stomach Cancer
Petrescu, M., Târtea, G. C., Udriștoiu, I., Militaru, F., Petrescu, A.-R., Ciurea, A.-M., Petrescu, A., Obleagă, C. V., & Vere, C. C. (2024) · Life · doi:10.3390/life14030368 · Cited by 4
“The sympathetic nervous system (SNS) controls the activity of all human organ systems by releasing catecholamines from sympathetic nerve terminals in specific areas and by circulating catecholamines from the adrenal gland throughout the body [17].”
Background
Metadata
- Authors
- Cole, S. W., Nagaraja, A. S., Lutgendorf, S. K., Green, P. A., & Sood, A. K.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- University of Iowa (US)
- National Cancer Institute (US)
- Venue
- Nature Reviews Cancer
- Published
- 2015-08-24
- Volume
- 15
- Issue
- 9
- Pages
- 563-572
- ISSN
- 1474-175X (ISSN-L)
- 1474-1768
- PMC
- PMC4828959
- OpenAlex
- W1959055352
- Cited by
- 576
- References
- 132
- Citations by year
- 2026: 66 · 2025: 53 · 2024: 47 · 2023: 63 · 2022: 66 · 2021: 57 · 2020: 67 · 2019: 57 · 2018: 43 · 2017: 32 · 2016: 22 · 2015: 3
- FWCI
- 4.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature reviews. Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (AG017265, R37AG033590, AG033590, R01AG033590, P30AG017265)
- National Cancer Institute (CA 109298, CA177909, P50CA098258, U54CA151668, R01CA177909, CA083639, CA-104825, R01CA109298, CA140933, R01CA116778, R01CA104825, CA151668, CA-116778, R01CA140933, P50CA083639, CA098258, P30CA016672)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Stress, Anesthesia, and Immune Response
- Life Sciences › Immunology and Microbiology › Immunology › Immune cells in cancer
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- sympathetic nervous system, tumor microenvironment, peripheral autonomic nervous system, beta-adrenergic signaling, physiological stress, metastasis, macrophage infiltration, tumor inflammation, angiogenesis, epithelial-mesenchymal transition, tumor invasion, antitumor immunity, hematologic cancer, cancer stem cells, hematopoietic differentiation
- MeSH terms
- Cell Differentiation, Humans, Neoplasms, Neovascularization, Pathologic, Sympathetic Nervous System, Gene Expression Regulation, Neoplastic, Epithelial-Mesenchymal Transition, Tumor Microenvironment
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