Small cell lung cancer (SCLC) is a highly aggressive type of lung cancer, characterized by rapid proliferation, early metastatic spread, frequent early relapse and a high mortality rate. Recent evidence has suggested that innervation has an important role in the development and progression of several types of cancer. Cancer-to-neuron synapses have been reported in gliomas, but whether peripheral tumours can form such structures is unknown. Here we show that SCLC cells can form functional synapses and receive synaptic transmission. Using in vivo insertional mutagenesis screening in conjunction with cross-species genomic and transcriptomic validation, we identified neuronal, synaptic and glutamatergic signalling gene sets in mouse and human SCLC. Further experiments revealed the ability of SCLC cells to form synaptic structures with neurons in vitro and in vivo. Electrophysiology and optogenetic experiments confirmed that cancer cells can receive NMDA receptor- and GABA receptor-mediated synaptic inputs. Fitting with a potential oncogenic role of neuron-SCLC interactions, we showed that SCLC cells derive a proliferation advantage when co-cultured with vagal sensory or cortical neurons. Moreover, inhibition of glutamate signalling had therapeutic efficacy in an autochthonous mouse model of SCLC. Therefore, following malignant transformation, SCLC cells seem to hijack synaptic signalling to promote tumour growth, thereby exposing a new route for therapeutic intervention.

Sensory neurons innervating the lower airway provide essential feedback information that regulates respiratory physiology. These neurons synapse with second-order neurons in the central nervous system, which project directly or indirectly to the respiratory and autonomic centers. Both primary sensory neurons and second-order neurons within these circuits exhibit significant heterogeneity, and the precise roles of individual neuronal subtypes in coding the airway's internal states and modulating respiratory and autonomic outputs remain incompletely understood. In this review, we summarize recent advances in understanding the neuronal diversity along sensory circuits of the lower airway and their physiological functions. We also highlight the challenges in elucidating the roles of specific neuronal subtypes due to the extensive molecular and anatomical diversity among these neurons. Improving targeting specificity for neuronal manipulation, combined with the development of a comprehensive connectivity map, will be critical for revealing the coding and wiring logics that underlie the precise control of respiratory physiology.