The stress hormone epinephrine is known to elicit multiple systemic effects that include changes in cardiovascular parameters and immune responses. However, information about its direct action on cancer cells is limited. Here we provide evidence that epinephrine reduces sensitivity of cancer cells to apoptosis through interaction with  2 -adrenergic receptors. The antiapoptotic mechanism of epinephrine primarily involves phosphorylation and inactivation of the proapoptotic protein BAD by cAMP-dependent protein kinase. Moreover, BAD phosphorylation was observed at epinephrine concentrations found after acute and chronic psychosocial stress. Antiapoptotic signaling by epinephrine could be one of the mechanisms by which stress promotes tumorigenesis and decreases the efficacy of anti-cancer therapies.Epinephrine levels are sharply increased in response to acute stress and can be continuously elevated during persistent stress and depression (1, 2). Sustained increases of epinephrine were implicated in pathogenesis of stress-related immunosuppression proposed as the primary mechanism by which stress and depression may increase tumor incidence and promote metastatic growth (2, 3). However, several reports have questioned whether immunosuppression alone is sufficient to explain stress-induced tumor growth, and some studies have found no correlation between stress and cancer (2, 4). Thus, more information about the mechanisms by which stress hormones affect tumors is necessary to resolve the controversy over the connection between stress and cancer. One potential mechanism may involve direct effects of epinephrine on cancer cells.Cancer cell lines of various origins, including prostate tumors, express  2 -adrenergic receptors ( 2 -ARs) 4 that bind epinephrine and norepinephrine (5-7).  2 -ARs belong to superfamily A of seven-transmembrane G protein-coupled receptors (GPCRs) (8). Epinephrine binding leads to activation of GTPase and dissociation of ␣ and ␥ subunits of heterotrimeric G proteins. Depending on the cell context, this may trigger multiple signaling pathways, including the Ras/extracellular signal-regulated kinase, NFB, and cAMP-dependent protein kinase (PKA) pathways, which regulate diverse cellular responses, such as proliferation, differentiation, secretion, or apoptosis (9).Since resistance to apoptosis has been implicated in cancer pathogenesis (10), we decided to analyze the effects of the  2 -AR agonist epinephrine on apoptosis in prostate cancer cells. In this paper, we demonstrate that epinephrine reduces sensitivity of prostate cancer cells to apoptosis via  2 -AR/PKA signaling that triggers BAD phosphorylation at S112. This antiapoptotic mechanism operates in the prostate cancer cell lines LNCaP and C4-2 and in the breast cancer cell line MDA-MB231. Our findings suggest that stress may contribute to cancer etiology and therapeutic resistance by decreasing sensitivity of cancer cells to apoptosis.
EXPERIMENTAL PROCEDURESCell Lines and Transfection-LNCaP and C4-2 cells were a gift from Leland C...