Figure 12.

Role of AChE from tumor initiation to progression to metastasis. A balance between ACh levels and AChE activity in normal tissue favors tissue homeostasis. During the initial stages of the tumor, AChE levels increase, causing a decrement in ACh concentrations that affect the tumor microenvironment. This allows both the inflammation and TAMs to increase, favoring tumor development. As the MAPK and Akt pathways are hyperactivated, they induce a decrease in AChE that is also potentiated by DNMT1-mediated hypermethylation in aggressive tumors. A reduction in AChE activity increases ACh levels, directly affecting the tumor and inducing cell proliferation, survival, and metastasis. TAMs: tumor-associated macrophages. Created with Biorender.com (accessed on 12 June 2023).