“…Under the influence of tumor-derived type-2 cytokines, colony-stimulating factor 1 (CSF-1 or M-CSF), CCL2, and CCL4, adjacent lymphocytes become Th2-shifted, while tissue-resident macrophages and blood monocytes are attracted and converted to the M2 phenotype [40-44], as demonstrated by analysis of human lung cancer specimens and in vitro studies. The phenotypic switch of macrophages appears to rely on epigenetic changes [45] and Wnt signaling [46] and is of key importance, because tumor-associated M2 macrophages (TAMs) orchestrate several vicious cycles in the TME [47, 48] to promote: (i) tumor-cell growth by secretion of epidermal growth factor (EGF), matrix metallopeptidases, Wnt family member (WNT) 5A, cathepsin B, semaphorin 4D, and IL-1β [49]; (ii) DNA damage by suppressing p53 through macrophage migration inhibitory factor [50]; (iii) angiogenesis, tumor-endothelial cell dysfunction, and lymphangiogenesis by secretion of VEGF, IL-8, and matrix metallopeptidase-9 [51-53]; (iv) invasion, epithelial-to-mesenchymal transition, and metastasis [54-57]. Besides, TAM-derived TGFβ and chemokines synergize with contact signals from tumor cells to convert tissue-resident fibroblasts, mast cells, and blood-derived neutrophils to smooth-muscle actin-α-expressing cancer-associated fibroblasts (CAFs), tumor-associated mast cells (TAMCs), and tumor-associated neutrophils (TANs), respectively, whose secretome amplifies all tumorigenic effects [58-60].…”