As mentioned above, autophagy in cancer cells is subjected to fluctuations depending on extracellular stimuli, the availability of oxygen and nutrients, and also on the actual expression of certain microRNAs. Ovarian cancer cells release chemotactic cytokines and growth factors that recruit fibroblasts, endothelial cells and macrophages, which in turn contribute with their own secretions to form a dynamic tumor microenvironment
[
74,
75]. A number of inflammatory-related proteins abnormally present in the tumor context or in the ascitic fluid, and associated with ovarian cancer progression, could directly or indirectly affect autophagy. For instance, TNFα, a cytokine involved in ovarian cancer growth and metastasis
[
74], is a potent activator of NF-kB, which in turn activates the anti-apoptotic and anti-autophagic Akt/mTOR pathway. IL-6 is a pro-inflammatory cytokine highly expressed in the tumor context of type-2 ovarian cancers and in ascitic fluid, and its level correlates with poor prognosis in ovarian cancer patients
[
76,
77]. IL-6 promotes VEGF-mediated vasculogenesis and angiogenesis, especially in aggressive type-2 ovarian cancers
[
77]. Lysophosphatidic acid (LPA), abundantly released by ovarian cancer cells, is known to contribute to ovarian cancer aggressiveness by stimulating the synthesis of IL-6 and of VEGF
[
78,
79], among others. Of note, while IL-6 acts as an inducer
[
80], LPA was shown to inhibit autophagy induced by serum deprivation in prostate cancer cells
[
81]. These data outline how the microenvironment and the cytokine network dynamically affect autophagy in ovarian cancer cells. In the epigenetic control of autophagy, a further level of complexity is brought by the dynamic changes in the expression of miRNAs. The profile of miRNAs pattern in ovarian cancer cells varies during development and progression phases
[
82‐
84]. Although a thorough analysis of miRNA-mediated regulation of autophagy in ovarian cancer cells has not yet been performed, we can speculate in this sense based on the information available. For instance, miR-30a, which negatively regulates the expression of Beclin 1
[
37], was found down-regulated in samples from relapsing patients diagnosed with stage I ovarian cancer
[
85]; and miR-101, which represses the expression of the autophagy protein Atg4
[
39], was found down-regulated in ovarian cancer compared to normal tissue
[
86]. MiR-101 targets also the mRNA of STMN1 and RAB5A
[
39]. Of note, stathmin over-expression showed a significant association with poor prognosis in ovarian cancer patients
[
87], and Rab5A was shown to promote cell proliferation in ovarian cancer
[
88]. Finally, miR-214 and mir-21, respectively associated with the chemoresistant phenotype
[
89] and the metastatic potential of ovarian cancer cells
[
90], have been shown to target PTEN, the oncosuppressor known to positively regulate autophagy and to be mutated or deleted in a vast majority of ovarian carcinomas. With regard to the transcriptional level of epigenetic regulation of autophagy in ovarian cancer, the oncosuppressors PTEN, ARH1 and DAPk (Death-associated protein kinase) merit to be mentioned. The hyper-methylation of PTEN promoter is not a frequent finding in ovarian cancer specimen
[
91]. By contrast, ARH1 and DAPk are among the most frequently down-regulated tumor suppressors in ovarian cancers due to promoter methylation
[
35,
91]. Under stressful conditions, DAPk phosphorylates beclin-1, promoting its dissociation from bcl-2, and thus inducing autophagy
[
92].