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Chronic stress is associated with increased risk of metastasis and poor survival in cancer patients, yet the reasons are unclear. We show that chronic stress increases lung metastasis from disseminated cancer cells 2- to 4-fold in mice. Chronic stress significantly alters the lung microenvironment, with fibronectin accumulation, reduced T cell infiltration, and increased neutrophil infiltration. Depleting neutrophils abolishes stress-induced metastasis. Chronic stress shifts normal circadian rhythm of neutrophils and causes increased neutrophil extracellular trap (NET) formation via glucocorticoid release. In mice with neutrophil-specific glucocorticoid receptor deletion, chronic stress fails to increase NETs and metastasis. Furthermore, digesting NETs with DNase I prevents chronic stress-induced metastasis. Together, our data show that glucocorticoids released during chronic stress cause NET formation and establish a metastasis-promoting microenvironment. Therefore, NETs could be targets for preventing metastatic recurrence in cancer patients, many of whom will experience chronic stress due to their disease. [Display omitted] • Chronic stress increases metastasis in mice • Chronic stress establishes a pro-metastatic lung microenvironment • Deleting the neutrophil-glucocorticoid receptor abolishes stress-induced metastasis • Chronic stress induces metastasis-promoting neutrophil extracellular traps Chronic stress is linked to increased metastasis in cancer patients, but the underlying mechanisms remain unclear. In this study, He et al. show that chronic stress increases metastasis by affecting neutrophils. Chronic stress, via glucocorticoids, alters neutrophils' circadian rhythm and establishes a metastasis-promoting microenvironment by inducing neutrophil extracellular trap formation. [ABSTRACT FROM AUTHOR]

Lung metastasis is the major cause of breast cancer-related mortality. The neutrophil-associated inflammatory microenvironment aids tumor cells in metastatic colonization in lungs. Here, we show that tumor-secreted protease cathepsin C (CTSC) promotes breast-to-lung metastasis by regulating recruitment of neutrophils and formation of neutrophil extracellular traps (NETs). CTSC enzymatically activates neutrophil membrane-bound proteinase 3 (PR3) to facilitate interleukin-1β (IL-1β) processing and nuclear factor κB activation, thus upregulating IL-6 and CCL3 for neutrophil recruitment. In addition, the CTSC-PR3-IL-1β axis induces neutrophil reactive oxygen species production and formation of NETs, which degrade thrombospondin-1 and support metastatic growth of cancer cells in the lungs. CTSC expression and secretion are associated with NET formation and lung metastasis in human breast tumors. Importantly, targeting CTSC with compound AZD7986 effectively suppresses lung metastasis of breast cancer in a mouse model. Overall, our findings reveal a mechanism of how tumor cells regulate neutrophils in metastatic niches and support CTSC-targeting approaches for cancer treatment. • Tumor-secreted CTSC promotes breast-to-lung metastasis by regulating neutrophils • CTSC activates membrane-bound PR3 of neutrophils to upregulate IL-1β secretion • CTSC enhances neutrophil recruitment into metastatic niches and induces NETosis • Targeting CTSC with AZD7986 effectively inhibits lung metastasis in mice Neutrophils play critical roles in cancer metastasis. Xiao et al. report the dual role of a tumor-secreted protease, CTSC, in recruiting neutrophils to metastatic niches and inducing neutrophils to form extracellular traps (NETs). These promote lung colonization of breast cancer and targeting CTSC inhibits lung metastasis in mice. [ABSTRACT FROM AUTHOR]