NTF4 (neurotrophin 4) is a growth factor that primarily functions as a target-derived survival factor for peripheral sensory and sympathetic neurons 1. Beyond its classical neurotrophin role, emerging evidence reveals NTF4's unexpected involvement in multiple cancer types through distinct mechanisms. In cancer, NTF4 demonstrates a context-dependent dual functionality. In breast cancer, NTF4 paradoxically inhibits primary tumor proliferation and promotes apoptosis while simultaneously promoting epithelial-mesenchymal transition (EMT), metastatic progression, and invasiveness through PRKDC/AKT and ANXA1/NF-κB pathway activation 2. In non-small-cell lung cancer, gastric cancer, and colorectal cancer, NTF4 consistently promotes tumor development by negatively regulating FOXL1 and suppressing autophagy, with high NTF4 expression associated with poor prognosis and advanced disease stage 3456. Regarding glaucoma susceptibility, NTF4 mutations show population-specific associations. Chinese cohorts identified rare functional mutations (p.Gly157Ala, p.Ala182Val) in primary open-angle glaucoma (POAG) patients with impaired protein solubility 7, while Indian populations showed no significant association between NTF4 variants and glaucoma 8. Overall, NTF4 appears to function as an oncogene in solid tumors and a potential genetic risk factor for POAG.