Abstract
Oncolytic viruses (OVs) are a class of viruses capable of specifically infecting and killing tumor cells. They exert antitumor effects through direct lysis of tumor cells, activation of the immune system, and disruption of tumor vasculature. Neutrophils, which originate from the bone marrow, are the most abundant leukocytes in peripheral blood and the immune system and play a dual regulatory role in oncolytic virotherapy. In different TME, neutrophils can polarize into two phenotypes: N1 and N2. N1 neutrophils, owing to their chemotaxis and tumor-homing capabilities, can serve as delivery vehicles for OVs, enhance the therapeutic efficacy of oncolytic virotherapy, and activate host immune responses. In contrast, N2 neutrophils impair the efficacy of OVs through their antiviral activity and immunosuppressive functions. Therefore, an in-depth understanding of the mechanisms underlying the role of neutrophils in oncolytic virotherapy is of great significance for optimizing OV-based therapies and improving their clinical application outcomes.
Impact statement
Neutrophils exert a dual regulatory role in oncolytic virotherapy but remain poorly understood, limiting clinical translation. This review systematically clarifies N1/N2 phenotypic polarization, pro-tumor/anti-tumor mechanisms, and interactions with the TME. It integrates key molecular pathways and emerging intervention strategies to guide rational optimization of OV regimens. This work advances targeted immunovirotherapy, supports precise neutrophil modulation, and promotes safer, more effective clinical application of OV therapy.
Introduction
The earliest reports of oncolytic viruses (OVs) date back to 1904, when scientists observed an unexpected remission of leukemia symptoms in a female chronic leukemia patient following infection with the influenza virus []. Subsequently, in 1912, Italian physician Depace reported spontaneous regression and shrinkage of cervical cancer in a patient after administration of an attenuated rabies vaccine []. These observations spurred interest in the potential oncolytic properties of viruses. The evolution of OV research can be broadly divided into three stages. The first stage primarily involved the direct use of wild-type viruses. As early as a century ago, physicians attempted to inject live viruses into cancer patients, aiming to combat tumors through a “poison against poison” strategy. Although these early efforts yielded transient oncolytic effects, they often resulted in significant toxicities due to wild-type virus infection []. In the 1990s, advances in gene editing enabled targeted modification of wild-type viral genomes, allowing for tumor-specific replication. While most of these modified OVs exhibited limited efficacy, their toxicity profiles were markedly reduced, thereby establishing a safety foundation for subsequent development. The third stage, initiated in the current century, is characterized by the insertion of exogenous genes into OV to enhance their therapeutic effects. In 2015, Talimogene laherparepvec became the first OV therapy to receive regulatory approval worldwide [], and since then, an increasing number of OV candidates have entered clinical trials.
Overview of oncolytic viruses
OVs are defined as viruses capable of specifically infecting and replicating within tumor cells, ultimately inducing tumor cell lysis and death. The fundamental principle of this therapeutic approach lies in the selective infection of tumor cells by OVs. Beyond their direct cytolytic effect on tumor cells [], these viruses can further potentiate antitumor immunity by activating the host immune system []. Compared with conventional treatment modalities, OVs therapy offers precise targeting of tumor tissues while causing minimal damage to adjacent healthy tissues. Additionally, OVs can remodel the tumor immune microenvironment and enhance the host’s immune response [] as shown as Figure 1. Collectively, these properties position OV therapy as a promising strategy capable of achieving more durable and broad-spectrum efficacy in cancer treatment. Currently, a variety of OVs have entered clinical trials, as summarized in Supplementary Table 1.
FIGURE 1
OVs can be categorized based on their nucleic acid composition into double-stranded DNA viruses, double-stranded RNA viruses, positive-sense single-stranded RNA viruses, and negative-sense single-stranded RNA viruses [
Overview of neutrophils
Neutrophils (also known as neutrophil granulocytes or neutrophilic leukocytes) originate from the bone marrow [
Oncolytic virus mechanism
Direct oncolytic effect
Genetically engineered OVs are capable of specifically targeting tumor cells and selectively replicating within them, ultimately inducing tumor cell lysis. For instance, Teserpaturev (G47Δ), an OV approved for clinical use in Japan, exerts its direct oncolytic effect by targeting aberrant signaling pathways in gliomas [
Immunostimulatory effects
As pathogen-associated molecular patterns, OVs can activate innate immune cells, including macrophages and natural killer cells, thereby stimulating a non-specific immune response in the host [
Vascular destructive effects
OV can directly infect and lyse tumor vascular endothelial cells by recognizing specific surface receptors, such as CD46 and CD155, thereby inducing the collapse of vascular structures. For example, the EV-A71-miR124T nanocapsules developed by the team at the Wuhan Institute of Virology are capable of crossing the blood–brain barrier and selectively releasing OVs at the tumor site. This strategy enables precise delivery of OVs to the vascular endothelial cells of gliomas, disrupting tumor blood vessels while preserving the integrity of vessels in normal brain tissue, thus achieving targeted killing of glioma cells [
The core regulatory role of neutrophils
Positive regulation mechanism
Enhancing the delivery and replication of oncolytic viruses in vivo
Neutrophils, with their inherent chemotactic and tumor-homing abilities [
FIGURE 2

Enhancing the delivery and in vivo replication of oncolytic viruses. Created with BioGDP.com [
Tumor-killing enhancement
In a mouse model of lung melanoma metastasis, treatment with orf virus (ORFV) significantly increased the number of white blood cells, predominantly neutrophils, in the peripheral blood, peritoneal cavity, spleen, liver, and TME. These systemic neutrophils were capable of migrating into the TME and exhibited predominantly an immature phenotype (CD101-), with high expression of the chemokine receptor CXCR2 and the activation marker CD69. ORFV-activated neutrophils directly killed tumor cells through the secretion of TNF-α. In vitro experiments demonstrated that ORFV-treated neutrophils displayed markedly enhanced cytotoxicity against B16F10 melanoma cells. Moreover, in addition to retaining their intrinsic antigen-presenting capacity, these neutrophils expressed major histocompatibility complex class II(MHC-II), thereby contributing to immunomodulatory functions within the TME [
Similarly, vaccinia virus-based oncolytic therapy enhances the secretion of TNF-α and interferon-gamma at the tumor site, inducing the activation and recruitment of neutrophils, eosinophils, and lymphocytes into tumor tissues, thereby potentiating the immune response to eliminate tumor cells [
FIGURE 3

Mechanisms of neutrophil-enhanced tumor killing. Created with BioGDP.com [
Activation of immune response
In a study on the treatment of pancreatic ductal adenocarcinoma using VSV, researchers found that VSV-S, constructed by inserting a Smac expression cassette into the VSV genome, could induce remodeling of the TME. This remodeling was primarily characterized by a marked increase in neutrophil infiltration, alongside significant reductions in myeloid-derived suppressor cells (MDSCs) and macrophages. Furthermore, the levels of immunosuppressive factors such as arginase I, TGF-β, and interleukin-10 were substantially decreased. Collectively, these changes shifted the TME from an immunosuppressive to an immunostimulatory state, thereby enhancing the antitumor immune response [
TABLE 1
| Oncolytic virus | Mechanisms of neutrophil-mediated anti-tumor effects | References |
|---|---|---|
| VSV | Increasing tumor infiltration of neutrophils TME shifted toward immune activation | [ |
| Ad-cab | Enhances tumor cell killing by activating neutrophils through IgG1/IgA1 engagement | [ |
| MV | Raji model: neutrophils releasing TRAIL and multiple antitumor cytokines to induce tumor cell apoptosis | [ |
| Breast cancer: Recruits and activates neutrophils and other immune cells, induces Th1 polarization and pro-inflammatory cytokine release | [ | |
| Adf35 | Recruits and activates neutrophils and other immune cells to reverse the immunosuppressive tumor microenvironment | [ |
| ADVNE | Differentiate into antigen-presenting cells within the tumor microenvironment to present tumor antigens to T cells | [ |
| MVA | CCR1 and CXCR2 induce neutrophil migration and enhance adaptive immunity | [ |
| JX-594 | Elevated neutrophil levels recruit immune cells | [ |
Mechanisms of immune response activation by neutrophils.
Negative regulation mechanism
Antiviral activity
As the first line of defense in the immune system [
Neutrophils can also suppress the activity of OVs through the release of neutrophil extracellular traps (NET) [
FIGURE 4

Mechanisms of neutrophil antiviral activity. Created with BioGDP.com [
Mediating immunosuppressive microenvironment
Neutrophils in the TME induce the expansion of regulatory T cells (Tregs), thereby inhibiting the anti-tumor immune response [
FIGURE 5

Mechanisms of neutrophil-mediated immunosuppressive microenvironment. Created with BioGDP.com [
Discussion
Neutrophils serve as the first line of defense in the immune system. The recently proposed consensus roadmap for neutrophil classification indicates that these cells are not a homogeneous population, but can depart from their intrinsic developmental trajectories and undergo deterministic reprogramming within specific local microenvironments. During the TME remodeling induced by OV therapy, tumor-infiltrating neutrophils not only shift from their original antiviral state but can also be polarized into antitumor effector cells capable of directly killing tumor cells or highly expressing MHC-II molecules and co-stimulatory markers. The mechanistic role of neutrophils in OV therapy is dual-edged. On one hand, neutrophils can ferry OVs across physiological barriers and activate anti-tumor immune responses. On the other hand, they can inactivate OVs through the release of NETs and collaborate with Tregs and MDSCs to establish an immunosuppressive network that undermines OV therapeutic efficacy. A study reported that neutrophil depletion using anti-Ly6G antibodies significantly prolongs the half-life of OVs in the peripheral blood and substantially enhances their targeted delivery to tumor sites [
Future translational research should focus on potential regulatory directions, including temporally dynamic regulation of neutrophil functions, spatial blockade of their pathological recruitment to tumor sites, synergistic combination with immune checkpoint inhibitors, and clinically precise patient stratification based on neutrophil-related biomarkers. A thorough mechanistic understanding of neutrophil behavior in the context of OV therapy is importance for optimizing this therapeutic modality and advancing its clinical applicability.
Statements
Author contributions
BH prepared the draft manuscript. RW, CZ, BH, and QY revised and edited the manuscript. All authors contributed to the article and approved the submitted version.
Funding
The author(s) declared that financial support was received for this work and/or its publication. This study was supported by grants from the National Natural Science Foundation of China (No. 32202770), Foshan Science and Technology Innovation Project (2320001007516). The funding sources had no role in the study design, data collection, data analysis, interpretation or writing of the report.
Acknowledgments
We are grateful to Shuai Jiang for providing Generic Diagramming Platform. We declare that we have not used AI-generated work in this manuscript.
Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.ebm-journal.org/articles/10.3389/ebm.2026.11192/full#supplementary-material
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Summary
Keywords
immune response, N1/N2 phenotypes, neutrophils, oncolytic viruses, tumor microenvironment
Citation
Huang B, Yang Q, Wang R and Zhao C (2026) The role and mechanism of neutrophils in oncolytic virus therapy. Exp. Biol. Med. 251:11192. doi: 10.3389/ebm.2026.11192
Received
13 May 2026
Revised
08 June 2026
Accepted
16 June 2026
Published
06 August 2026
Volume
251 - 2026
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© 2026 Huang, Yang, Wang and Zhao.
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*Correspondence: Ruixue Wang, wangruixue39854@126.com; Chaochao Zhao, zhaochaochao@fosu.edu.cn
‡ These authors have contributed equally to this work
ORCID: Chaochao Zhao, orcid.org/0000-0002-6698-241X
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