STRESS-INDUCED CHANGES IN ANTITUMOR IMMUNITY

Authors

DOI:

https://doi.org/10.15407/oncology.2025.03.161

Keywords:

стрес, рак, катехоламіни, глюкокортикоїди, мікроелементи, протипухлинний імунітет

Abstract

Summary. The results of experimental and clinical studies point to a significant modifying effect of stress on the functioning of both individual physiological systems and the body as a whole, which not only increases the risk of malignant neoplasms, but can also negatively affect the treatment outcomes of cancer patients. In this review article, the authors present an analysis of data from the up to date scientific literature on the relationship between stress and oncogenesis, as well as stress-induced changes in the content of essential trace elements (copper, iron, zinc, ferrum, calcium) which play a key role in many biological processes. Considerable attention is paid to changes in the functions of immunocompetent cells that are part of the tumour microenvironment and mediate the antitumour immune response under conditions of acute and chronic stress.

References

Orive M, Barrio I, Lázaro S, et al. Five-year follow-up mor- tality prognostic index for colorectal patients. Int J Colo- rectal Dis 2023; 38: 64. https://doi.org/10.1007/s00384- 023-04358-0.

Yang T, Qiao Y, Xiang S, et al. Work stress and the risk of cancer: A meta-analysis of observational studies. Int J Can- cer 2019; 144 (10): 2390–400. https://doi.org/10.1002/ ij 1955.

Wu Y, Zhou L, Zhang X, et al. Psychological distress and eustress in cancer and cancer treatment: Advances and perspectives. Sci Adv 2022; 8: eabq7982. https://doi.org/10. 1126/sciadv.abq7982.

Mravec B, Tibensky M, Horvathova L. Stress and cancer. Part I: Mechanisms mediating the eff of stressors on cancer. J Neuroimmunol 2020; 346: 577311. https://doi. org/10.1016/j.jneuroim.2020.577311.

Lempesis IG, Georgakopoulou VE, Papalexis P, et al. Role of stress in the pathogenesis of cancer (Review). Int J Oncol 2023; 63 (5): 124. https://doi.org/10.3892/ij 3.5572.

Liu Y, Tian S, Ning B, et al. Stress and cancer: The mecha- nisms of immune dysregulation and management. Front Im- munol 2022; 13: 1032294. https://doi.org/10.3389/fi mu. 2022.1032294.

Ungvari Z, Fekete M, Buda, A, et al. Depression increases cancer mortality by 23–83%: a meta-analysis of 65 studies across fi e major cancer types. GeroScience 2025. https:// doi.org/10.1007/s11357-025-01676-9.

Yan J, Chen Y, Luo M, et al. Chronic stress in solid tumor development: from mechanisms to interventions. J Biomed Sci 2023; 30 (1): 8. https://doi.org/10.1186/s12929-023- 00903-9.

Chekhun VF, Naleskina LA, Kunska LM, Lukianova NY. The driving force of exogenous and endogenous stress as an important factor of metastatic progression of breast can- cer. The role of gelatinases in implementation of invasive and migration processes. Oncology 2024; 26 (3): 157–164. https://doi.org/10.15407/oncology.2024.03.157. (in Ukrai- nian)

Chekhun V, Burda T, Mushii O, et al. Stress-induced modu- lation of the tumor microenvironment: mechanisms and implications for cancer progression. Exp Oncol 2025; 47 (2): 127–142. https://doi.org/10.15407/exp-oncology.2025. 02.127.

Zadvornyi TV, Burda TS, Mushii OM, et al. The role of stress factors in modulating the expression and functional acti- vity of matrix metalloproteinases. Oncology 2025; 27 (2): 111–118. https://doi.org/10.15407/oncology.2025.02.111. (in Ukrainian)

Chekhun VF, Lukianova NY, Kunska LM, et al. Integrated manifestations of cellular stress as a trigger of tumor pro- gression. Cytol Genet 2025; 59: 388–396. https://doi.org/ 10.3103/S0095452725040048.

Predko VV, Somova OO. The influence of the war on the stress level and the strategies for preserving the hardiness of ukrainians. Vcheni zapysky TNU imeni VI Vernadsʹkoho. Seriya: Psykholohiya 2022; 33 (4): 89–98. https://doi.org/ 10.32782/2709-3093/2022.4/16. (in Ukrainian)

Jawad M, Millett C, Sullivan R, et al. The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: A systematic review. Ecancer- medicalscience 2020; 14: 1039. https://doi.org/10.3332/ ecancer.2020.1039.

Korda-Vidić V, Vasilj I, Babić D. The stress of war and breast cancer incidence. Psychiatr Danub 2015; 27 (2): 571–7.

Bøg M, Filges T, Jørgensen AMK. Deployment of person- nel to military operations: impact on mental health and social functioning. Campbell Syst Rev 2018; 14 (1): 1–127. https://doi.org/10.4073/csr.2018.6.

Roberts AL, Huang T, Koenen KC, et al. Posttraumatic stress disorder is associated with increased risk of ovarian cancer: A prospective and retrospective longitudinal cohort study. Cancer Res 2019; 79 (19): 5113–20. https://doi.org/10. 1158/0008-5472.CAN-19-1222.

Yang J, Jiang W. A meta-analysis of the association between post-traumatic stress disorder and cancer risk. Front Psy- chiatry 2023; 14: 1281606. https://doi.org/10.3389/fpsyt. 2023.1281606.

Naugolnyk LB. Psychology of stress: a textbook. Lʹviv: Lʹvivsʹkyy derzhavnyy universytet vnutrishnikh sprav, 2015. 324 р. (in Ukrainian)

Kanczkowski W, Sue M, Wlodarczyk A, Chrousos GP. Hy- pothetical involvement of stress hormones-induced repro-graming of adult stem/progenitor cells in tumorigenesis. Explor Endocr Metab Dis 2024; 1: 122–57. https://doi. org/10.37349/eemd.2024.00012.

Falcinelli M, Thaker PH, Lutgendorf SK, et al. The role of psy- chologic stress in cancer initiation: Clinical relevance and po- tential molecular mechanisms. Cancer Res 2021; 81 (20): 5131– 40. https://doi.org/10.1158/0008-5472.Can-21-0684.

Acevedo-Rodriguez A, Kauffman AS, Cherrington BD, et al. Emerging insights into hypothalamic-pituitary-gonadal axis regulation and interaction with stress signalling. J Neuroen- docrinol 2018; 30 (10): e12590. https://doi.org/10.1111/ jne.12590.

Eckerling A, Ricon-Becker I, Sorski L, et al. Stress and cancer: Mechanisms, significance and future directions. Nat Rev Cancer 2021; 21: 767–85. https://doi.org/10.1038/ s41568-021-00395-5.

Russell G, Lightman S. The human stress response. Nat Rev Endocrinol 2019; 15 (9): 525–34. https://doi.org/10.1038/ s41574-019-0228-0.

Tausk F. Psychoneuro-oncology: How chronic stress grows cancer. Clin Dermatol 2023; 41 (1): 95–104. https://doi. org/10.1016/j.clindermatol.2023.03.008.

Juszczyk G, Mikulska J, Kasperek K, et al. Chronic stress and oxidative stress as common factors of the pathogenesis of depression and alzheimer's disease: The role of antioxidants in prevention and treatment. Antioxidants (Basel) 2021; 10 (9): 1439. https://doi.org/10.3390/antiox10091439.

Reddy VP. Oxidative stress in health and disease. Biomedi- cines 2023; 11 (11): 2925. https://doi.org/10.3390/biomedi- cines11112925.

Spiers JG, Tan LS, Anderson ST, et al. Hepatic homeostasis of metal ions following acute repeated stress exposure in rats. Antioxidants (Basel, Switzerland) 2021; 11 (1): 85. https://doi.org/10.3390/antiox11010085.

Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci 2014; 19 (2): 164–74. 25

Bastian TW, Rao R, Tran PV, Georgieff MK. The eff

of early-life iron deficiency on brain energy metabolism. Neurosci Insights 2020; 15: 2633105520935104. https://

doi.org/10.1177/2633105520935104.

Reid BM, Georgieff MK. The interaction between psycho- logical stress and iron status on early-life neurodevelop- mental outcomes. Nutrients 2023; 15 (17): 3798. https:// doi.org/10.3390/nu15173798.

Wang L, Wang H, Li L, et al. Corticosterone induces dys- regulation of iron metabolism in hippocampal neurons in vitro. Biol Trace Elem Res 2010; 137 (1): 88–95. https:// doi.org/10.1007/s12011-009-8565-9.

Ingale S, Rathored J, Shende S, Wankhade S. The role of calcium homeostasis in modulating the immune response in cancer and infectious diseases. Multidisciplinary Re- views 2024; 8 (2): 2025034. https://doi.org/10.31893/mul- tirev.2025034.

Amantini C, Morelli MB. Editorial: Calcium signaling in can- cer immunity. Front Immunol 2023; 14: 1315490. https:// doi.org/10.3389/fi 3.1315490.

Diercks BP. The importance of Ca2+ microdomains for the adaptive immune response. Biochim Biophys Acta Mol Cell Res 2024; 1871 (5): 119710. https://doi.org/10.1016/j. bbamcr.2024.119710.

Szopa A, Herbet M, Poleszak E, et al. Evaluation of antide- pressive-like behaviours and oxidative stress parameters in mice receiving imipramine-zinc complex compound. Int J Mol Sci 2023; 24 (18): 14157. https://doi.org/10.3390/ ijms241814157.

Jafari F, Mohammadi H, Amani R. The effect of zinc supple- mentation on brain derived neurotrophic factor: A meta-analysis. J Trace Elem Med Biol 2021; 66: 126753. https:// doi.org/10.1016/j.jtemb.2021.126753.

Yosaee S, Soltani S, Esteghamati A, et al. Eff of zinc, vitamin D, and their co-supplementation on mood, serum cortisol, and brain-derived neurotrophic factor in patients with obesity and mild to moderate depressive symptoms: A phase II, 12-wk, 2 × 2 factorial design, double-blind, randomized, placebo-controlled trial. Nutrition 2020; 71: 110601. https://doi.org/10.1016/j.nut.2019.110601.

Michalczyk K, Cymbaluk-Płoska A. The role of zinc and copper in gynecological malignancies. Nutrients 2020; 12 (12): 3732. https://doi.org/10.3390/nu12123732.

Szwiec M, Marciniak W, Derkacz R, et al. Serum levels of copper and zinc and survival in breast cancer patients. Nutrients 2024; 16 (7): 1000. https://doi.org/10.3390/ nu16071000.

Escudero-Cernuda S, Clases D, Eiro N, et al. Quantitative distribution of essential elements and non-essential metals in breast cancer tissues by LA-ICP-TOF-MS. Analytical and bioanalytical chemistry 2025; 417 (2): 361–71. https:// doi.org/10.1007/s00216-024-05652-8.

Saleh SAK, Adly HM, Abdelkhaliq AA, Nassir AM. Serum levels of selenium, zinc, copper, manganese, and iron in prostate cancer patients. Current urology 2020; 14 (1): 44–9. https://doi.org/10.1159/000499261.

Lossow K, Schwarz M, Kipp AP. Are trace element concent- rations suitable biomarkers for the diagnosis of cancer? Redox biology 2021; 42: 101900. https://doi.org/10.1016/j. redox.2021.101900.

Skrajnowska D, Bobrowska-Korczak B. Role of zinc in im- mune system and anti-cancer defense mechanisms. Nutri- ents 2019; 11 (10): 2273. https://doi.org/10.3390/nu1110 2273.

Mandarano AH, McGargill MA. The critical role of copper homeostasis during the immune response. J Immunol 2023; 210 (1): 148.13. https://doi.org/10.4049/jimmunol.210. supp.148.13.

Dhabhar FS. The short-term stress response — Mother na- ture's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol 2018; 49: 175–92. https://doi.org/ 10.1016/j.yfrne.2018.03.004.

Alotiby A. Immunology of stress: A review article. J Clin Med 2024; 13 (21): 6394. https://doi.org/10.3390/jcm1321 6394.

Dohi A, Noguchi T, Yamashita M, et al. Acute stress tran- siently activates macrophages and chemokines in cervical lymph nodes. Immunol Res 2024; 72 (2): 212–24. https:// doi.org/10.1007/s12026-023-09409-w.

Vignjević Petrinović S, Milošević MS, Marković D, Mo- mčilović S. Interplay between stress and cancer — A focus on inflammation. Front Physiol 2023; 14: 1119095. https:// doi.org/10.3389/fphys.2023.1119095.

Dantzer R. Neuroimmune interactions: from the brain to the immune system and vice versa. Physiol Rev 2018; 98 (1): 477–504. https://doi.org/10.1152/physrev.00039.2016.

Wu K, Liu Z, Liang J, et al. Discovery of a glucocorticoid receptor (GR) activity signature correlates with immune cell infiltration in adrenocortical carcinoma. J Immunother Cancer 2023; 11 (10): e007528. https://doi.org/10.1136/ jitc-2023-007528.

Shimba A, Ikuta K. Control of immunity by glucocorticoids in health and disease. Semin Immunopathol 2020; 42 (6): 669–80. https://doi.org/10.1007/s00281-020-00827-8.

Taves MD, Ashwell JD. Glucocorticoids in T cell develop- ment, differentiation and function. Nat Rev Immunol 2021; 21 (4): 233–43. https://doi.org/10.1038/s41577-020- 00464-0.

Chhatar S, Lal G. Role of adrenergic receptor signalling in neuroimmune communication. Curr Res Immunol 2021; 2: 202–17. https://doi.org/10.1016/j.crimmu.2021.11.001.

Lorton D, Bellinger DL. Molecular mechanisms underlying β-adrenergic receptor-mediated cross-talk between sympa- thetic neurons and immune cells. Int J Mol Sci 2015; 16 (3): 5635–65. https://doi.org/10.3390/ij 6035635.

Albitre A, Reglero C, González-Muñoz T, Penela P. The stress connection in cancer: the adrenergic fuelling of breast tumors. Current Opinion Physiology 2023; 36: 100720. https://doi.org/10.1016/j.cophys.2023.100720.

Lei Y, Liao F, Tian Y, et al. Investigating the crosstalk be- tween chronic stress and immune cells: implications for enhanced cancer therapy. Front Neurosci 2023; 17: 1321176. https://doi.org/10.3389/fnins.2023.1321176.

Sanders VM. The beta2-adrenergic receptor on T and B lymphocytes: do we understand it yet? Brain Behav Im- mun 2012; 26 (2): 195–200. https://doi.org/10.1016/j.bbi. 2011.08.001.

Somvanshi PR, Mellon SH, Yehuda R, et al. Role of en- hanced glucocorticoid receptor sensitivity in infl tion in PTSD: insights from computational model for circadian- neuroendocrine-immune interactions. Am J Physiol Endo- crinol Metab 2020; 319 (1): E48–E66. https://doi.org/10. 1152/ajpendo.00398.2019.

Khedri M, Samei A, Fasihi-Ramandi M, Taheri RA. The im- munopathobiology of T cells in stress condition: a review. Cell Stress Chaperones 2020; 25 (5): 743–52. https://doi. org/10.1007/s12192-020-01105-0.

Antoni MH, Dhabhar FS. The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer 2019; 125 (9): 1417–31.

Bader JE, Voss K, Rathmell JC. Targeting metabolism to improve the tumor microenvironment for cancer immu- notherapy. Mol Cell 2020; 78 (6): 1019–33.

Zhao Y, Jia Y, Shi T, et al. Depression promotes hepatocel- lular carcinoma progression through a glucocorticoid-me- diated upregulation of PD-1 expression in tumor-infiltrating NK cells. Carcinogenesis 2019; 40 (9): 1132–41. https:// doi.org/10.1093/carcin/bgz017.

Chen L, Jondal M, Yakimchuk K. Regulatory effects of dexamethasone on NK and T cell immunity. Infl op- harmacol 2018; 26 (5): 1331–8. https://doi.org/10.1007/ s10787-017-0418-0.

Capellino S, Claus M, Watzl C. Regulation of natural killer cell activity by glucocorticoids, serotonin, dopamine, and epinephrine. Cell Mol Immunol 2020; 17 (7): 705–11. https://doi.org/10.1038/s41423-020-0477-9.

Rocamora-Reverte L, Villunger A, Wiegers GJ. Cell-specific immune regulation by glucocorticoids in murine models of infection and infl tion. Cells 2022; 11 (14): 2126. https://doi.org/10.3390/cells11142126.

Dai S, Mo Y, Wang Y, et al. Chronic stress promotes cancer development. Front Oncol 2020; 10: 1492. https://doi.org/ 10.3389/fonc.2020.01492.

Capelle CM, Chen A, Zeng N, et al. Stress hormone signal- ling inhibits Th1 polarization in a CD4 T-cell-intrinsic manner via mTORC1 and the circadian gene PER1. Im- munology 2022; 165 (4): 428–44. https://doi.org/10.1111/ imm.13448.

Marik PE, Flemmer M. The immune response to surgery and trauma: Implications for treatment. J Trauma Acute Care Surg 2012; 73 (4): 801–8. https://doi.org/10.1097/ TA.0b013e318265cf87.

Kumar P, Bhattacharya P, Prabhakar BS. A comprehensive review on the role of co-signaling receptors and Treg ho- meostasis in autoimmunity and tumor immunity. J Autoim- mun 2018; 95: 77–99.

Bucsek MJ, Hylander BL, Barbi JJ, Repasky EA. Chronic adrenergic stress contributes to metabolic dysfunction and an exhausted phenotype in T cells in the tumor microenvi- ronment. Cancer Immunol Res 2021; 9 (6): 651–64. https:// doi.org/10.1158/2326-6066.CIR-20-0445.

Qiao G, Chen M, Mohammadpour H, et al. Chronic adrener- gic stress contributes to metabolic dysfunction and an ex- hausted phenotype in T cells in the tumor microenviron- ment. Cancer Immunol Res 2021; 9 (6): 651–64.

Acharya N, Madi A, Zhang H, et al. Endogenous gluco- corticoid signaling regulates CD8+ T cell differentiation and development of dysfunction in the tumor microenvi- ronment. Immunity 2020; 53 (3): 658–71.e6. https://doi. org/10.1016/j.immuni.2020.08.005.

Pilipović I, Vujnović I, Stojić-Vukanić Z, et al. Noradrenaline modulates CD4+ T cell priming in rat experimental autoim- mune encephalomyelitis: a role for the α1-adrenoceptor. Immunol Res 2019; 67 (2–3): 223–40. https://doi.org/10. 1007/s12026-019-09082-y.

Mantovani A, Allavena P, Marchesi F, Garlanda C. Mac- rophages as tools and targets in cancer therapy. Nat Rev Drug Discov 2022; 21 (11): 799–820. https://doi.org/10. 1038/s41573-022-00520-5.

Cassetta L, Pollard JW. A timeline of tumour-associated macrophage biology. Nat Rev Cancer 2023; 23 (4): 238–57. https://doi.org/10.1038/s41568-022-00547-1.

Wu Y, Luo X, Zhou Q, et al. The disbalance of LRP1 and SIRPα by psychological stress dampens the clearance of tumor cells by macrophages. Acta Pharm Sin B 2022; 12 (1): 197–209. https://doi.org/10.1016/j.apsb.2021.06.002.

Cheng Y, Tang XY, Li YX, et al. Depression-induced neu- ropeptide Y secretion promotes prostate cancer growth by recruiting myeloid cells. Clin Cancer Res 2019; 25 (8): 2621–32. https://doi.org/10.1158/1078-0432.CCR-18- 2912.

Yuki K. The immunomodulatory mechanism of dexmedeto- midine. Int Immunopharmacol 2021; 97: 107709. https:// doi.org/10.1016/j.intimp.2021.107709.

Sun JX, Xu XH, Jin L. Effects of metabolism on macrophage polarization under different disease backgrounds. Front Im- munol 2022; 13: 880286. https://doi.org/10.3389/fi 2022.880286.

Guo Q, Jin Y, Chen X, et al. NF-κB in biology and targeted therapy: new insights and translational implications. Signal Transduct Target Ther 2024; 9 (1): 53. https://doi.org/ 10.1038/s41392-024-01757-9.

Е. Qin JF, Jin FJ, Li N, et al. Adrenergic receptor β2 activa- tion by stress promotes breast cancer progression through macrophages M2 polarization in tumor microenvironment. BMB Rep 2015; 48 (5): 295–300. https://doi.org/10.5483/ bmbrep.2015.48.5.008.

Park HJ, Lee SC, Park SH. Norepinephrine stimulates M2 macrophage polarization via β2-adrenergic receptor- mediated IL-6 production in breast cancer cells. Biochem Biophys Res Commun 2024; 741: 151087. https://doi.org/ 10.1016/j.bbrc.2024.151087.

Ağaç D, Estrada LD, Maples R, Hooper LV, Farrar JD. The β2-adrenergic receptor controls infl tion by driv- ing rapid IL-10 secretion. Brain Behav Immun 2018; 74: 176–85. https://doi.org/10.1016/j.bbi.2018.09.004.

Sommershof A, Scheuermann L, Koerner J, Groettrup M. Chronic stress suppresses anti-tumor T(CD8+) responses and tumor regression following cancer immunotherapy in a mouse model of melanoma. Brain Behav Immun 2017; 65: 140–9. https://doi.org/10.1016/j.bbi.2017.04.021.

Hunzeker JT, Elftman MD, Mellinger JC, et al. A marked reduction in priming of cytotoxic CD8+ T cells mediated by stress-induced glucocorticoids involves multiple defi ien- cies in cross-presentation by dendritic cells. J Immunol 2011; 186 (1): 183–94. https://doi.org/10.4049/jimmu- nol.1001737.

Pawelec G, Picard E, Bueno V, et al. MDSCs, ageing and infl ing. Cell Immunol 2021; 362: 104297. https:// doi.org/10.1016/j.cellimm.2021.104297.

Mohammadpour H, MacDonald CR, McCarthy PL, et al. β2-adrenergic receptor signaling regulates metabolic path- ways critical to myeloid-derived suppressor cell function within the TME. Cell Rep 2021; 37 (4): 109883. https:// doi.org/10.1016/j.celrep.2021.109883.

An J, Feng L, Ren J, et al. Chronic stress promotes breast carcinoma metastasis by accumulating myeloid-derived suppressor cells through activating β-adrenergic signaling. Oncoimmunol 2021; 10 (1): 2004659. https://doi.org/10. 1080/2162402X.2021.2004659.

Lu Y, Liu H, Bi Y, et al. Glucocorticoid receptor promotes the function of myeloid-derived suppressor cells by suppressing HIF1α-dependent glycolysis. Cell Mol Immunol 2018; 15 (6): 618–29. doi: 10.1038/cmi.2017.5.

Li X, Chen J, Chen YJ, et al. Dexamethasone and lactofer- rin induced PMN-MDSCs relieved inflammatory adverse events of anti-cancer therapy without tumor promotion. Commun Biol 2021; 4: 252. https://doi.org/10.1038/s42003- 021-01769-z.

Zhao Y, Shen X-F, Cao K, et al. Dexamethasone-induced myeloid-derived suppressor cells prolong allo cardiac graft survival through iNOS- and glucocorticoid receptor-depen- dent mechanism. Front Immunol 2018; 9: 282. https://doi. org/10.3389/fi 18.00282.

Zhang Y, Lv N, Li M, et al. Cancer-associated fibroblasts: tumor defenders in radiation therapy. Cell Death Dis 2023; 14 (8): 541. https://doi.org/10.1038/s41419-023-06060-z.

Jia H, Chen X, Zhang L, et al. Cancer associated fibroblasts in cancer development and therapy. J Hematol Oncol 2025; 18: 36. https://doi.org/10.1186/s13045-025-01688-0.

Shan T, Cui X, Li W, et al. Novel regulatory program for norepinephrine-induced epithelial-mesenchymal transition in gastric adenocarcinoma cell lines. Cancer Sci 2014; 105 (7): 847–56. https://doi.org/10.1111/cas.12438.

Nagaraja AS, Dood RL, Armaiz-Pena G, et al. Adrenergic- mediated increases in INHBA drive CAF phenotype and collagens. JCI Insight 2017; 2 (16): e93076. https://doi. org/10.1172/jci.insight.93076.

Published

2025-12-02

How to Cite

Fedosova, N., Gogol, S., Virych, P., Voyeykova, I., & Chekhun, V. (2025). STRESS-INDUCED CHANGES IN ANTITUMOR IMMUNITY. Oncology, 27(3), 161–171. https://doi.org/10.15407/oncology.2025.03.161