<?xml version="1.0" encoding="UTF-8"?>
<data xmlns="http://www.aopkb.org/aop-xml">
  <chemical id="8356e330-8ed8-4db1-87c2-63e3aaba37c8">
    <casrn>11056-06-7</casrn>
    <jchem-inchi-key></jchem-inchi-key>
    <indigo-inchi-key></indigo-inchi-key>
    <preferred-name>Bleomycin</preferred-name>
    <synonyms>
      <synonym>Bleo</synonym>
      <synonym>Bleocin</synonym>
      <synonym>Blenamax</synonym>
      <synonym>Bleo-Kyowa</synonym>
      <synonym>Bleomycins</synonym>
      <synonym>NSC 125066</synonym>
    </synonyms>
    <dsstox-id>DTXSID1030862</dsstox-id>
  </chemical>
  <biological-object id="5f1e902d-7c0a-4c1c-97b8-9f2885fd15e2">
    <source-id>D048031</source-id>
    <source>MESH</source>
    <name>JNK Mitogen-Activated Protein Kinases</name>
  </biological-object>
  <biological-object id="34de5743-0445-480b-9a32-e7a61353b131">
    <source-id>PR:000000046</source-id>
    <source>PR</source>
    <name>TGF-beta</name>
  </biological-object>
  <biological-object id="07a5ff1c-ea99-4c77-97ef-7e9fe3f9ec2c">
    <source-id>FMA:66768</source-id>
    <source>FMA</source>
    <name>Epithelial cell</name>
  </biological-object>
  <biological-process id="53588d09-4ffb-4085-aafc-5947cca22113">
    <source-id>GO:0023052</source-id>
    <source>GO</source>
    <name>signaling</name>
  </biological-process>
  <biological-process id="1811efb0-722d-4be4-afde-0c14bcc901ee">
    <source-id>GO:0001837</source-id>
    <source>GO</source>
    <name>epithelial to mesenchymal transition</name>
  </biological-process>
  <biological-action id="d14bb85a-5969-4832-a3f9-5bb8d90f8f86">
    <source-id>1</source-id>
    <source>WIKI</source>
    <name>increased</name>
  </biological-action>
  <biological-action id="ee06848a-748b-42a4-a155-c1f95e8719d7">
    <source-id>3</source-id>
    <source>WIKI</source>
    <name>occurrence</name>
  </biological-action>
  <stressor id="aaf3a56f-1997-4a81-b4e2-4d078a08b036">
    <name>Bleomycin</name>
    <description>&lt;p&gt;&lt;strong&gt;Bleomycin&lt;/strong&gt; is a potent anti-tumour drug, routinely used for treating various types of human cancers (Umezawa et al., 1967; Adamson, 1976). Lung injury and lung fibrosis are the major adverse effects of this drug in humans (Hay J et al., 1991). Bleomycin is shown to induce lung fibrosis in experimental animals - in dogs (Fleischman et al., 1971), mice (Adamson IY and Bowden DH, 1974), hamsters (Snider GL et al., 1978) and is widely used as a model chemical to study the mechanisms of fibrosis in humans (reviewed in &lt;strong&gt;Moeller&lt;/strong&gt; et al., &lt;strong&gt;2008;&lt;/strong&gt; Gilhodes et al., 2017).&lt;/p&gt;

&lt;ol&gt;
	&lt;li&gt;Adamson, I. (1976). Pulmonary Toxicity of Bleomycin. Environmental Health Perspectives, 16, p.119.&lt;/li&gt;
	&lt;li&gt;Adamson, IYR. and Bowden, DH. (1974). The Pathogenesis of Bleomycin-Induced Pulmonary Fibrosis in Mice. &lt;em&gt;The American Journal of Pathology&lt;/em&gt;. 77(2), pp185-198.&lt;/li&gt;
	&lt;li&gt;Fleischman, R., Baker, J., Thompson, G., Schaeppi, U., Illievski, V., Cooney, D. and Davis, R. (1971). Bleomycin-induced interstitial pneumonia in dogs. Thorax, 26(6), pp.675-682.&lt;/li&gt;
	&lt;li&gt;Gilhodes, J., Jul&amp;eacute;, Y., Kreuz, S., Stierstorfer, B., Stiller, D. and Wollin, L. (2017). Quantification of Pulmonary Fibrosis in a Bleomycin Mouse Model Using Automated Histological Image Analysis. PLOS ONE, 12(1), p.e0170561.&lt;/li&gt;
	&lt;li&gt;Hay, J., Shahzeidi, S. and Laurent, G. (1991). Mechanisms of bleomycin-induced lung damage. Archives of Toxicology, 65(2), pp.81-94.&lt;/li&gt;
	&lt;li&gt;Moeller, A., Ask, K., Warburton, D., Gauldie, J. and Kolb, M. (2008). The bleomycin animal model: A useful tool to investigate treatment options for idiopathic pulmonary fibrosis?. The International Journal of Biochemistry &amp;amp; Cell Biology, 40(3), pp.362-382.&lt;/li&gt;
	&lt;li&gt;Snider GL., Celli, BR., Goldstein, RH., O&amp;#39;Brien, JJ. and Lucey, EC. (1978). Chronic interstitial pulmonary fibrosis produced in hamsters by endotracheal bleomycin. Lung volumes, volume-pressure relations, carbon monoxide uptake, and arterial blood gas studied. &lt;em&gt;Am Rev Respir Dis.&lt;/em&gt; Feb; 117(2). pp289-97.&lt;/li&gt;
	&lt;li&gt;Umezawa, H., Ishizuka, M., Maeda, K. and Takeuchi, T. (1967). Studies on bleomycin. Cancer, 20(5), pp.891-895.&lt;/li&gt;
&lt;/ol&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p dir="LTR"&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p dir="LTR"&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p dir="LTR"&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p dir="LTR"&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p dir="LTR"&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;
</description>
    <chemicals>
      <chemical-initiator chemical-id="8356e330-8ed8-4db1-87c2-63e3aaba37c8" user-term="Bleomycin"/>
    </chemicals>
    <exposure-characterization></exposure-characterization>
    <creation-timestamp>2018-01-01T16:45:53</creation-timestamp>
    <last-modification-timestamp>2019-10-29T13:08:19</last-modification-timestamp>
  </stressor>
  <stressor id="90ec81f1-62cf-42ef-8fdd-46dd962b5a1e">
    <name>Carbon nanotubes, Multi-walled carbon nanotubes, single-walled carbon nanotubes, carbon nanofibres</name>
    <description>&lt;p&gt;&amp;nbsp;&lt;/p&gt;

&lt;p&gt;Julie Mullera, Franc&amp;cedil;ois Huauxa, Nicolas Moreaub, Pierre Missona, Jean-Franc&amp;cedil;ois Heiliera,&lt;/p&gt;

&lt;p&gt;Monique Delosc, Mohammed Arrasa, Antonio Fonsecab, Janos B. Nagyb, Dominique Lison&lt;/p&gt;

&lt;p&gt;Julie Mullera, Franc&amp;cedil;ois Huauxa, Nicolas Moreaub, Pierre Missona, Jean-Franc&amp;cedil;ois Heiliera,&lt;/p&gt;

&lt;p&gt;Monique Delosc, Mohammed Arrasa, Antonio Fonsecab, Janos B. Nagyb, Dominique Lison&lt;/p&gt;
</description>
    <exposure-characterization></exposure-characterization>
    <creation-timestamp>2018-01-01T17:51:04</creation-timestamp>
    <last-modification-timestamp>2018-01-01T17:52:30</last-modification-timestamp>
  </stressor>
  <taxonomy id="a8612cec-e8cc-4fbb-8cec-6b5d9664724d">
    <source-id>WCS_9606</source-id>
    <source>common toxicological species</source>
    <name>humans</name>
  </taxonomy>
  <taxonomy id="b363f1b0-e2a4-4453-979b-21df1cda7081">
    <source-id>10090</source-id>
    <source>NCBI</source>
    <name>mouse</name>
  </taxonomy>
  <taxonomy id="6c09aea5-b153-4f3f-88b2-53c0e1a99cc6">
    <source-id>10116</source-id>
    <source>NCBI</source>
    <name>rat</name>
  </taxonomy>
  <key-event id="deed2217-bf0f-41f5-afc3-cad3700f4591">
    <title>Toll-like receptor 4 activation</title>
    <short-name>TLR4 activation</short-name>
    <biological-organization-level>Molecular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <applicability>
    </applicability>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2020-07-09T02:59:35</creation-timestamp>
    <last-modification-timestamp>2020-07-09T02:59:35</last-modification-timestamp>
  </key-event>
  <key-event id="fd139dac-d348-41d4-aa4b-f89945b586d4">
    <title>Inactivation of PPARγ</title>
    <short-name>Inactivation of PPARγ</short-name>
    <biological-organization-level>Molecular</biological-organization-level>
    <description>&lt;p&gt;Following pulmonary exposure, the stressor interacts with cellular membranes of alveolar macrophages, other inflammatory cells, epithelial cells and proteins (lung surfactants) in the lung space.&lt;/p&gt;

&lt;p&gt;The stressor acts as an antagonist of PPAR&amp;gamma; of epithelial and inflammatory cells in the lung.&lt;/p&gt;
</description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <applicability>
    </applicability>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2017-02-15T02:43:41</creation-timestamp>
    <last-modification-timestamp>2017-12-26T02:12:06</last-modification-timestamp>
  </key-event>
  <key-event id="8a8d1a60-0c83-4b36-aaae-07964de28dc4">
    <title>Activation, JNK</title>
    <short-name>Activation, JNK</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <cell-term>
      <source-id>CL:0000255</source-id>
      <source>CL</source>
      <name>eukaryotic cell</name>
    </cell-term>
    <applicability>
    </applicability>
    <biological-events>
      <biological-event object-id="5f1e902d-7c0a-4c1c-97b8-9f2885fd15e2" process-id="53588d09-4ffb-4085-aafc-5947cca22113" action-id="d14bb85a-5969-4832-a3f9-5bb8d90f8f86"/>
    </biological-events>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2017-02-15T04:43:20</creation-timestamp>
    <last-modification-timestamp>2017-09-16T10:17:47</last-modification-timestamp>
  </key-event>
  <key-event id="27d51418-42db-4e74-836e-c749c21d741e">
    <title>Activator protein 1 activation</title>
    <short-name>AP-1 activation</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <applicability>
    </applicability>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2020-07-09T03:07:53</creation-timestamp>
    <last-modification-timestamp>2020-07-09T03:07:53</last-modification-timestamp>
  </key-event>
  <key-event id="4bcd969d-b9c1-407a-83b6-0682b9768597">
    <title>Pin-1 activation</title>
    <short-name>Pin-1 activation</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <applicability>
    </applicability>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2020-07-09T03:10:16</creation-timestamp>
    <last-modification-timestamp>2020-07-09T03:10:16</last-modification-timestamp>
  </key-event>
  <key-event id="cb79129b-bcff-4a2c-b632-5913757746c8">
    <title>Latent Transforming growth Factor beta expression</title>
    <short-name>TGFbeta expression</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <applicability>
    </applicability>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2020-07-09T03:14:13</creation-timestamp>
    <last-modification-timestamp>2020-07-09T03:14:13</last-modification-timestamp>
  </key-event>
  <key-event id="d59d9751-8d13-4f76-ac6a-5cf99db70e36">
    <title>Activation, TGF-beta pathway</title>
    <short-name>Activation, TGF-beta pathway</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description></description>
    <measurement-methodology></measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <cell-term>
      <source-id>CL:0000255</source-id>
      <source>CL</source>
      <name>eukaryotic cell</name>
    </cell-term>
    <applicability>
    </applicability>
    <biological-events>
      <biological-event object-id="34de5743-0445-480b-9a32-e7a61353b131" process-id="53588d09-4ffb-4085-aafc-5947cca22113" action-id="d14bb85a-5969-4832-a3f9-5bb8d90f8f86"/>
    </biological-events>
    <references></references>
    <source>AOPWiki</source>
    <creation-timestamp>2017-02-15T03:51:12</creation-timestamp>
    <last-modification-timestamp>2017-09-16T10:17:45</last-modification-timestamp>
  </key-event>
  <key-event id="b3a0377d-12aa-440a-a67e-bf432252e573">
    <title>Epithelial Mesenchymal Transition</title>
    <short-name>EMT</short-name>
    <biological-organization-level>Cellular</biological-organization-level>
    <description>&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;Epithelial-mesenchymal transition (EMT) is a phenomenon in which the cells transit from epithelial-like into mesenchymal-like phenotypes (Huan et al., 2022; Tanabe, 2017; Tanabe et al., 2015). In cancer, cells exhibiting EMT features contribute to metastasis and drug resistance.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;It is known that D-2-hydroxyglurate induces EMT&amp;nbsp;(Guerra et al., 2017; Jia et al., 2018; Mishra et al., 2018; Sciacovelli &amp;amp; Frezza, 2017). D-2-hydroxyglurate, an inhibitor of Jumonji-family histone demethylase, increased the trimethylation of histone H3 lysine 4 (H3K4) in the promoter region of the zinc finger E-box-binding homeobox 1 (ZEB1), followed by the induction of EMT&amp;nbsp;(Colvin et al., 2016).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;Wnt5a induces EMT and metastasis in non-small-cell lung cancer&amp;nbsp;(Wang et al., 2017).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;EMT is related to Wnt/beta-catenin signaling and is important for treatment-resistant cancer (Tanabe et al., 2016).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;TGFbeta induces EMT&amp;nbsp;(Wendt et al., 2010).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;ZEB is one of the critical transcription factors for EMT regulation (Zhang et al., 2015).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;SNAI1 (Snail) is an important transcription factor for cell differentiation and survival. The phosphorylation and nuclear localization of Snail1 induced by Wnt signaling pathways are critical for the regulation of EMT (Kaufhold &amp;amp; Bonavida, 2014).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;Transcription factors SNAI1 and TWIST1 induce EMT&amp;nbsp;(Hodge et al., 2018)&amp;nbsp;(Mani et al., 2008).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p style="text-align:start"&gt;&lt;span style="font-size:medium"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;&lt;span style="color:#000000"&gt;&lt;span style="color:black"&gt;It is suggested that Sp1, a transcription factor involved in cell growth and metastasis, is induced by cytochrome P450 1B1 (CYP1B1), and promotes EMT, which leads to cell proliferation and metastasis (Kwon et al., 2016).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;table cellspacing="0" class="MsoTableGrid" style="border-collapse:collapse; border:none; width:601px"&gt;
	&lt;tbody&gt;
		&lt;tr&gt;
			&lt;td style="background-color:#eaf1dd; border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:601px"&gt;
			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;strong&gt;&lt;span style="color:black"&gt;Biological state&lt;/span&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&amp;nbsp;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;An epithelial-mesenchymal transition (EMT) is a biologic process in which epithelial cells are polarized, interact through their basal surface with basement membrane, and undergo biochemical changes to assume a mesenchymal cell phenotype. &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;This phenotypic transformation has various characters such as enhanced migratory capacity, high invasiveness, elevated resistance to apoptosis, and greatly increased production of ECM components (Kalluri,&amp;nbsp; R.,&amp;nbsp; and&amp;nbsp; Neilson,&amp;nbsp; E.G.&amp;nbsp; 2003). The completion of an EMT is signalled by the degradation of the underlying basement membrane and the formation of a mesenchymal cell that can migrate away from the epithelial layer in which it originated.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&amp;nbsp;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;&amp;nbsp;EMT has a number of distinct molecular processes like activation of transcription factors, expression of specific cell surface proteins, reorganization and expression of cytoskeletal proteins, production of ECM-degrading enzymes, and changes in the expression of specific microRNAs. These factors are used as biomarkers to demonstrate the passage of a&amp;nbsp; cell through an EMT. &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&amp;nbsp;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;strong&gt;&lt;span style="color:black"&gt;Biological compartment &lt;/span&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;Cellular&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;strong&gt;&lt;span style="color:black"&gt;Role in General Biology:&lt;/span&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;Excessive proliferation of epithelial cells and angiogenesis mark the initiation and early growth of primary epithelial cancers. (Hanahan, D., and Weinberg, R.A. 2000). The subsequent acquisition of invasiveness, initially manifest by invasion through the basement membrane, is thought&amp;nbsp; to herald the onset of the last stages of the multi-step process that&amp;nbsp; leads eventually to metastatic dissemination, with life-threatening&amp;nbsp; consequences. &amp;nbsp;There has been an intense research going on in the genetic controls and biochemical mechanisms underlying the acquisition of the invasive phenotype and the subsequent systemic spread of the cancer cell. &amp;nbsp;Activation of an EMT program has been proposed as the critical mechanism for the acquisition of malignant phenotypes by epithelial cancer cells (Thiery, J.P. 2002).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;&amp;nbsp;Pre-clinical experiments such as mice models and cell culture experiments&amp;nbsp; has demonstrated &amp;nbsp;that carcinoma cells can acquire a mesenchymal phenotype and express mesenchymal markers such as &lt;/span&gt;&lt;span style="color:black"&gt;&amp;alpha;&lt;/span&gt;&lt;span style="color:black"&gt;-SMA, FSP1, vimentin,&amp;nbsp; and desmin (Yang,&amp;nbsp; J.,&amp;nbsp; and&amp;nbsp; Weinberg,&amp;nbsp; R.A.&amp;nbsp; 2008). These cells &amp;nbsp;are seen at the invasive front&amp;nbsp; of primary tumors and are considered to be the cells that eventually&amp;nbsp; enter into subsequent steps of the invasion-metastasis cascade, i.e.,&amp;nbsp; intravasation, transport through the circulation, extravasation, formation of micro metastases, and ultimately colonization (the growth&amp;nbsp; of small colonies into macroscopic metastases) (Thiery, J.P. 2002, Fidler, I.J., and Poste, G. 2008, Brabletz, T., et al. 2001).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;An&amp;nbsp; apparent&amp;nbsp; paradox&amp;nbsp; comes&amp;nbsp; from&amp;nbsp; the&amp;nbsp; observation&amp;nbsp; that&amp;nbsp; the&amp;nbsp; EMT-derived migratory cancer cells typically establish secondary colonies at distant sites that resemble, at the histopathological &amp;nbsp;level, the primary tumor from which they arose; accordingly,&amp;nbsp; they no longer exhibit the mesenchymal phenotypes ascribed to&amp;nbsp; metastasizing&amp;nbsp; carcinoma&amp;nbsp; cells.&amp;nbsp; Reconciling this behaviour with the proposed role of EMT as a facilitator of metastatic dissemination requires the additional notion that metastasizing cancer cells must shed their mesenchymal phenotype via a MET during&amp;nbsp; the course of secondary tumor formation (Zeisberg, M et al 2005). The tendency of&amp;nbsp; disseminated cancer cells to undergo EMT likely reflects the local&amp;nbsp; microenvironments that they encounter after extravasation into&amp;nbsp; the parenchyma of a distant organ, quite possibly the absence of&amp;nbsp; the heterotypic signals they experienced in the primary tumor that&amp;nbsp; were responsible for inducing the EMT in the first place (Thiery, J.P. 2002, Jechlinger, M et al 2002, Bissell, M.J et al 2002). These evidences indicate that induction of an EMT is likely to be a centrally important mechanism for the progression of carcinomas to a metastatic stage and implicates MET during the subsequent colonization process. However, many steps of this mechanistic model still require direct experimental validation. It remains unclear at present whether these phenomena and molecular mechanisms relate to and explain the metastatic dissemination of non-epithelial cancer cells.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;&lt;span style="color:black"&gt;The entire spectrum of signaling agents that contribute to EMTs of carcinoma cells remains unclear. One &amp;nbsp;theory suggests that &amp;nbsp;the genetic and epigenetic alterations undergone by cancer cells during the course of primary tumor formation render them especially responsive to EMT-inducing heterotypic signals originating in the tumor-associated stroma. Oncogenes induce senescence, and recent studies suggest that cancer cell EMTs may also play a role in preventing senescence induced by oncogenes, thereby facilitating subsequent aggressive dissemination (Smit, M.A., and Peeper, D.S. 2008, Ansieau, S., et al. 2008, Weinberg, R.A. 2008).&amp;nbsp; In&amp;nbsp; the case of many carcinomas, EMT-inducing signals emanating&amp;nbsp; from the tumor-associated stroma, notably HGF, EGF, PDGF,&amp;nbsp; and TGF-&lt;/span&gt;&lt;span style="color:black"&gt;&amp;beta;&lt;/span&gt;&lt;span style="color:black"&gt;, appear to be responsible for the induction or functional&amp;nbsp; activation&amp;nbsp; in&amp;nbsp; cancer&amp;nbsp; cells&amp;nbsp; of&amp;nbsp; a&amp;nbsp; series&amp;nbsp; of&amp;nbsp; EMT-inducing&amp;nbsp; transcription factors, notably Snail, Slug, zinc finger E-box binding homeobox 1 (ZEB1), Twist, Goosecoid, and FOXC2 (Thiery, J.P. 2002, Jechlinger, M&amp;nbsp; et al 2002, Shi, Y., and Massague, J. 2003, Niessen, K., et al. 2008, Medici, D et al 2008, Kokudo,&amp;nbsp; T.,&amp;nbsp; et&amp;nbsp; al.&amp;nbsp; 2008). Once expressed and activated, each of these transcription factors can act pleiotropically to choreograph the complex EMT program, more often than not with the help of other members of this cohort of transcription factors. The actual implementation by these cells of their EMT program depends on a series of&amp;nbsp; intracellular signaling networks involving, among other signal- transducing&amp;nbsp; proteins,&amp;nbsp; ERK,&amp;nbsp; MAPK,&amp;nbsp; PI3K,&amp;nbsp; Akt,&amp;nbsp; Smads,&amp;nbsp; RhoB,&amp;nbsp; &lt;/span&gt;&lt;span style="color:black"&gt;&amp;beta;&lt;/span&gt;&lt;span style="color:black"&gt;-catenin, lymphoid enhancer binding factor (LEF), Ras, and c-Fos&amp;nbsp; as well as cell surface proteins such as &lt;/span&gt;&lt;span style="color:black"&gt;&amp;beta;&lt;/span&gt;&lt;span style="color:black"&gt;4 integrins, &lt;/span&gt;&lt;span style="color:black"&gt;&amp;alpha;&lt;/span&gt;&lt;span style="color:black"&gt;5&lt;/span&gt;&lt;span style="color:black"&gt;&amp;beta;&lt;/span&gt;&lt;span style="color:black"&gt;1 integrin, and &lt;/span&gt;&lt;span style="color:black"&gt;&amp;alpha;&lt;/span&gt;&lt;span style="color:black"&gt;V&lt;/span&gt;&lt;span style="color:black"&gt;&amp;beta;&lt;/span&gt;&lt;span style="color:black"&gt;6 integrin (Tse,&amp;nbsp; J.C.,&amp;nbsp; and&amp;nbsp; Kalluri,&amp;nbsp; R.&amp;nbsp; 2007). Activation of EMT programs is also facilitated by the disruption of cell-cell adherens junctions and the cell-ECM adhesions mediated by integrins (Yang,&amp;nbsp; J.,&amp;nbsp; and&amp;nbsp; Weinberg,&amp;nbsp; R.A.&amp;nbsp; 2008, Weinberg, R.A. 2008, Gupta, P.B&amp;nbsp; et al 2005, Yang,&amp;nbsp; J et al 2006, Mani, S.A., et al. 2007, Mani, S.A., et al. 2008, Hartwell, K.A., et al. 2006, Taki, M et al 2006)..&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
		&lt;/tr&gt;
	&lt;/tbody&gt;
&lt;/table&gt;
</description>
    <measurement-methodology>&lt;p&gt;Loss of &lt;a href="https://en.wikipedia.org/wiki/E-cadherin"&gt;E-cadherin&lt;/a&gt; and cell polarity is considered to be a fundamental event in epithelial-mesenchymal transition. The simultaneous expression of epithelial (e.g. E-cadherin) and mesenchymal markers (e.g. N-cadherin and vimentin) within the airway epithelium are indicative for ongoing transition (Borthwick et al. 2009, 2010).&lt;/p&gt;

&lt;table cellspacing="0" class="MsoTableGrid" style="border-collapse:collapse; border:none; width:586px"&gt;
	&lt;tbody&gt;
		&lt;tr&gt;
			&lt;td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:58px"&gt;
			&lt;p style="text-align:justify"&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:155px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Method/ measurement referenc&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:73px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Reliability&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p style="text-align:justify"&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:68px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Strength of evidence&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p style="text-align:justify"&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:63px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Assay fit for purpose&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p style="text-align:justify"&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:102px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Repeatability/ reproducibility&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p style="text-align:justify"&gt;&amp;nbsp;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:67px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Direct measure&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
		&lt;/tr&gt;
		&lt;tr&gt;
			&lt;td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:58px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Human cell line&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:155px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;qRT-PCR,cell viability assay,&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Western blotting,EdU incorporation assay&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:73px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;+&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:68px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Strong&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:63px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:102px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:67px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
		&lt;/tr&gt;
		&lt;tr&gt;
			&lt;td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:58px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Human&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:155px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;IHC,micro array,qPCR, SNP array&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:73px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;+&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:68px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Moderate&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:63px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:102px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
			&lt;td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:67px"&gt;
			&lt;p style="text-align:justify"&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Yes &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
			&lt;/td&gt;
		&lt;/tr&gt;
	&lt;/tbody&gt;
&lt;/table&gt;

&lt;ul&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;EMT can be detected by immunostaining with pro-surfactant protein-C (pro-SPC) and N-cadherin in idiopathic pulmonary fibrosis (IPF) lung&amp;nbsp;&lt;em&gt;in vivo&lt;/em&gt;&amp;nbsp;(Kim et al., 2006).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;EMT can be detected by immunostaining with vimentin in lung alveola&amp;nbsp;&lt;em&gt;in vivo&lt;/em&gt;&amp;nbsp;(Kim et al., 2006).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;EMT can be detected as the increased level of the transcription factors, zinc finger E-box-binding homeobox (ZEB), Twist and Snail (Huang et al., 2022).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;

&lt;p&gt;&amp;nbsp;&lt;/p&gt;
</measurement-methodology>
    <evidence-supporting-taxonomic-applicability>&lt;p style="text-align:left"&gt;The key event&amp;nbsp;is applicaple in &lt;em&gt;Homo sapiens&lt;/em&gt;:&lt;/p&gt;

&lt;ul&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;Wnt5a expression leads to epithelial-mesenchymal transition (EMT) and metastasis in non-small-cell lung cancer in&amp;nbsp;&lt;em&gt;Homo sapiens&lt;/em&gt;&amp;nbsp;(Wang et al., 2017).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;WNT2 expression lead to EMT induction in&amp;nbsp;&lt;em&gt;Homo sapiens&lt;/em&gt;&amp;nbsp;(Zhou et al., 2016).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
	&lt;li style="text-align:left"&gt;&lt;span style="font-size:10.5pt"&gt;&lt;span style="color:black"&gt;&lt;span style="font-family:游明朝,serif"&gt;&lt;span style="font-size:12pt"&gt;&lt;span style="font-family:&amp;quot;ＭＳ Ｐゴシック&amp;quot;,sans-serif"&gt;EMT is induced in cancer and involved in cancer metastasis in&amp;nbsp;&lt;em&gt;Homo sapiens&lt;/em&gt;&amp;nbsp;(Suarez-Carmona, Lesage, Cataldo, &amp;amp; Gilles, 2017) (Du &amp;amp; Shim, 2016).&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;

&lt;p&gt;&lt;span style="font-size:11pt"&gt;&lt;span style="font-family:Calibri,sans-serif"&gt;Regulation of miRNA expression by DNA replication,damage and repair responses,transcription and translation has been proved in animals like mice,canine and cell line experiments.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
</evidence-supporting-taxonomic-applicability>
    <organ-term>
      <source-id>UBERON:0000062</source-id>
      <source>UBERON</source>
      <name>organ</name>
    </organ-term>
    <cell-term>
      <source-id>CL:0000066</source-id>
      <source>CL</source>
      <name>epithelial cell</name>
    </cell-term>
    <applicability>
      <sex>
        <evidence>Not Specified</evidence>
        <sex>Unspecific</sex>
      </sex>
      <life-stage>
        <evidence>Not Specified</evidence>
        <life-stage>Not Otherwise Specified</life-stage>
      </life-stage>
      <taxonomy taxonomy-id="a8612cec-e8cc-4fbb-8cec-6b5d9664724d">
        <evidence>High</evidence>
      </taxonomy>
    </applicability>
    <biological-events>
      <biological-event object-id="07a5ff1c-ea99-4c77-97ef-7e9fe3f9ec2c" process-id="1811efb0-722d-4be4-afde-0c14bcc901ee" action-id="ee06848a-748b-42a4-a155-c1f95e8719d7"/>
    </biological-events>
    <references>&lt;p&gt;Borthwick, L. A., Parker, S. M., Brougham, K. A., Johnson, G. E., Gorowiec, M. R., Ward, C., &amp;hellip; Fisher, A. J. (2009). Epithelial to mesenchymal transition (EMT) and airway remodelling after human lung transplantation. &lt;em&gt;Thorax&lt;/em&gt;, &lt;em&gt;64&lt;/em&gt;(9), 770&amp;ndash;777. &lt;a href="https://doi.org/10.1136/thx.2008.104133"&gt;&lt;u&gt;https://doi.org/10.1136/thx.2008.104133&lt;/u&gt;&lt;/a&gt;&lt;/p&gt;

&lt;p&gt;Borthwick, L. A., McIlroy, E. I., Gorowiec, M. R., Brodlie, M., Johnson, G. E., Ward, C., &amp;hellip; Fisher, A. J. (2010). Inflammation and epithelial to mesenchymal transition in lung transplant recipients: Role in dysregulated epithelial wound repair. &lt;em&gt;American Journal of Transplantation&lt;/em&gt;, &lt;em&gt;10&lt;/em&gt;(3), 498&amp;ndash;509. &lt;a href="https://doi.org/10.1111/j.1600-6143.2009.02953.x"&gt;&lt;u&gt;https://doi.org/10.1111/j.1600-6143.2009.02953.x&lt;/u&gt;&lt;/a&gt;&lt;/p&gt;

&lt;p&gt;Al Saleh, S., Al Mulla, F., &amp;amp; Luqmani, Y. A. (2011). Estrogen receptor silencing induces epithelial to mesenchymal transition in human breast cancer cells. PloS one, 6(6), e20610.&lt;/p&gt;

&lt;p&gt;Bissell, M. J., Radisky, D. C., Rizki, A., Weaver, V. M., &amp;amp; Petersen, O. W. (2002). The organizing principle: microenvironmental influences in the normal and malignant breast. Differentiation, 70(9-10), 537-546.&lt;/p&gt;

&lt;p&gt;Bouris, P., Skandalis, S. S., Piperigkou, Z., Afratis, N., Karamanou, K., Aletras, A. J., ... &amp;amp; Karamanos, N. K. (2015). Estrogen receptor alpha mediates epithelial to mesenchymal transition, expression of specific matrix effectors and functional properties of breast cancer cells. Matrix Biology, 43, 42-60.&lt;/p&gt;

&lt;p&gt;Brabletz, T., Jung, A., Reu, S., Porzner, M., Hlubek, F., Kunz-Schughart, L. A., ... &amp;amp; Kirchner, T. (2001). Variable &amp;beta;-catenin expression in colorectal cancers indicates tumor progression driven by the tumor environment. Proceedings of the National Academy of Sciences, 98(18), 10356-10361.&lt;/p&gt;

&lt;p&gt;Brabletz, T., Jung, A., Reu, S., Porzner, M., Hlubek, F., Kunz-Schughart, L. A., ... &amp;amp; Kirchner, T. (2001). Variable &amp;beta;-catenin expression in colorectal cancers indicates tumor progression driven by the tumor environment. Proceedings of the National Academy of Sciences, 98(18), 10356-10361.&lt;/p&gt;

&lt;p&gt;Colvin, H., Nishida, N., Konno, M., Haraguchi, N., Takahashi, H., Nishimura, J., . . . Ishii, H. (2016). Oncometabolite D-2-Hydroxyglurate Directly Induces Epithelial-Mesenchymal Transition and is Associated with Distant Metastasis in Colorectal Cancer.&amp;nbsp;Sci Rep, 6, 36289. doi:10.1038/srep36289&lt;/p&gt;

&lt;p&gt;Du, B., &amp;amp; Shim, J. S. (2016). Targeting Epithelial-Mesenchymal Transition (EMT) to Overcome Drug Resistance in Cancer.&amp;nbsp;Molecules, 21(7). doi:10.3390/molecules21070965&lt;/p&gt;

&lt;p&gt;Fang, C. X., Ma, C. M., Jiang, L., Wang, X. M., Zhang, N., Ma, J. N., . . . Zhao, Y. D. (2018). p38 MAPK is Crucial for Wnt1- and LiCl-Induced Epithelial Mesenchymal Transition.&amp;nbsp;Curr Med Sci, 38(3), 473-481. doi:10.1007/s11596-018-1903-4&lt;/p&gt;

&lt;p&gt;Fidler, I. J., &amp;amp; Poste, G. (2008). The &amp;ldquo;seed and soil&amp;rdquo; hypothesis revisited. The lancet oncology, 9(8), 808.&lt;/p&gt;

&lt;p&gt;Guerra, F., Guaragnella, N., Arbini, A. A., Bucci, C., Giannattasio, S., &amp;amp; Moro, L. (2017).&amp;nbsp;Mitochondrial Dysfunction: A Novel Potential Driver of Epithelial-to-Mesenchymal Transition in Cancer.&amp;nbsp;&lt;em&gt;Front Oncol, 7&lt;/em&gt;, 295. doi:10.3389/fonc.2017.00295&lt;/p&gt;

&lt;p&gt;Gupta, P. B., Mani, S., Yang, J., Hartwell, K., &amp;amp; Weinberg, R. A. (2005, January). The evolving portrait of cancer metastasis. In Cold Spring Harbor symposia on quantitative biology (Vol. 70, pp. 291-297). Cold Spring Harbor Laboratory Press.&lt;/p&gt;

&lt;p&gt;Hanahan, D., and Weinberg, R.A. (2000). The hall- marks of cancer. Cell. 100:57&amp;ndash;70.&lt;/p&gt;

&lt;p&gt;Hartwell, K. A., Muir, B., Reinhardt, F., Carpenter, A. E., Sgroi, D. C., &amp;amp; Weinberg, R. A. (2006). The Spemann organizer gene, Goosecoid, promotes tumor metastasis. Proceedings of the National Academy of Sciences, 103(50), 18969-18974.&lt;/p&gt;

&lt;p&gt;Jechlinger, M., Gr&amp;uuml;nert, S., &amp;amp; Beug, H. (2002). Mechanisms in epithelial plasticity and metastasis: insights from 3D cultures and expression profiling. Journal of mammary gland biology and neoplasia, 7(4), 415-432.&lt;/p&gt;

&lt;p&gt;Hodge, D. Q., Cui, J., Gamble, M. J., &amp;amp; Guo, W. (2018). Histone Variant MacroH2A1 Plays an Isoform-Specific Role in Suppressing Epithelial-Mesenchymal Transition.&amp;nbsp;Sci Rep, 8(1), 841. doi:10.1038/s41598-018-19364-4&lt;/p&gt;

&lt;p&gt;Huan, Z., Zhang, Z., Zhou, C., Liu, L., Huang, C. (2022). Epithelial-mesenchymal transition: The history, regulatory mechanism, and cancer therapeutic opportunities. MedComm. 2022 May 18;3(2):e144. doi: 10.1002/mco2.144&lt;/p&gt;

&lt;p&gt;Jia, D., Park, J. H., Jung, K. H., Levine, H., &amp;amp; Kaipparettu, B. A. (2018). Elucidating the Metabolic Plasticity of Cancer: Mitochondrial Reprogramming and Hybrid Metabolic States.&amp;nbsp;&lt;em&gt;Cells, 7&lt;/em&gt;(3). doi:10.3390/cells7030021&lt;/p&gt;

&lt;p&gt;Kalluri, R., &amp;amp; Neilson, E. G. (2003). Epithelial-mesenchymal transition and its implications for fibrosis. The Journal of clinical investigation, 112(12), 1776-1784.&lt;/p&gt;

&lt;p&gt;Kaufhold, S., &amp;amp; Bonavida, B. (2014). Central role of Snail1 in the regulation of EMT and resistance in cancer: a target for therapeutic intervention.&amp;nbsp;J Exp Clin Cancer Res, 33, 62. doi:10.1186/s13046-014-0062-0&lt;/p&gt;

&lt;p&gt;Kim, K. K., Kugler, M. C., Wolters, P. J., Robillard, L., Galvez, M. G., Brumwell, A. N., . . . Chapman, H. A. (2006). Alveolar epithelial cell mesenchymal transition develops&amp;nbsp;in vivo&amp;nbsp;during pulmonary fibrosis and is regulated by the extracellular matrix.&amp;nbsp;PNAS, 103(35), 13180-13185. doi:10.1073/pnas.0605669103&lt;/p&gt;

&lt;p&gt;Kwon, Y. J., Baek, H. S., Ye, D. J., Shin, S., Kim, D., &amp;amp; Chun, Y. J. (2016). CYP1B1 Enhances Cell Proliferation and Metastasis through Induction of EMT and Activation of Wnt/beta-Catenin Signaling via Sp1 Upregulation.&amp;nbsp;&lt;em&gt;PLoS One, 11&lt;/em&gt;(3), e0151598. doi:10.1371/journal.pone.0151598&lt;/p&gt;

&lt;p&gt;Kokudo, T., Suzuki, Y., Yoshimatsu, Y., Yamazaki, T., Watabe, T., &amp;amp; Miyazono, K. (2008). Snail is required for TGF&amp;beta;-induced endothelial-mesenchymal transition of embryonic stem cell-derived endothelial cells. Journal of cell science, 121(20), 3317-3324.&lt;/p&gt;

&lt;p&gt;Lin, H. Y., Liang, Y. K., Dou, X. W., Chen, C. F., Wei, X. L., Zeng, D., ... &amp;amp; Zhang, G. J. (2018). Notch3 inhibits epithelial&amp;ndash;mesenchymal transition in breast cancer via a novel mechanism, upregulation of GATA-3 expression. Oncogenesis, 7(8), 1-15.&lt;/p&gt;

&lt;p&gt;Liu, Y., Liu, R., Fu, P., Du, F., Hong, Y., Yao, M., ... &amp;amp; Zheng, S. (2015). N1-Guanyl-1, 7-diaminoheptane sensitizes estrogen receptor negative breast cancer cells to doxorubicin by preventing epithelial-mesenchymal transition through inhibition of eukaryotic translation initiation factor 5A2 activation. Cellular Physiology and Biochemistry, 36(6), 2494-2503.&lt;/p&gt;

&lt;p&gt;Mani, S. A., Yang, J., Brooks, M., Schwaninger, G., Zhou, A., Miura, N., ... &amp;amp; Weinberg, R. A. (2007). Mesenchyme Forkhead 1 (FOXC2) plays a key role in metastasis and is associated with aggressive basal-like breast cancers. Proceedings of the National Academy of Sciences, 104(24), 10069-10074.&lt;/p&gt;

&lt;p&gt;Mani, S. A., Guo, W., Liao, M. J., Eaton, E. N., Ayyanan, A., Zhou, A. Y., ... &amp;amp; Weinberg, R. A. (2008). The epithelial-mesenchymal transition generates cells with properties of stem cells. Cell, 133(4), 704-715.&lt;/p&gt;

&lt;p&gt;Medici, D., Hay, E. D., &amp;amp; Olsen, B. R. (2008). Snail and Slug promote epithelial-mesenchymal transition through &amp;beta;-catenin&amp;ndash;T-cell factor-4-dependent expression of transforming growth factor-&amp;beta;3. Molecular biology of the cell, 19(11), 4875-4887.&lt;/p&gt;

&lt;p&gt;Mishra, P., Tang, W., Putluri, V., Dorsey, T. H., Jin, F., Wang, F., . . . Ambs, S. (2018). ADHFE1 is a breast cancer oncogene and induces metabolic reprogramming.&amp;nbsp;&lt;em&gt;J Clin Invest, 128&lt;/em&gt;(1), 323-340. doi:10.1172/JCI93815&lt;/p&gt;

&lt;p&gt;Niessen, K., Fu, Y., Chang, L., Hoodless, P. A., McFadden, D., &amp;amp; Karsan, A. (2008). Slug is a direct Notch target required for initiation of cardiac cushion cellularization. The Journal of cell biology, 182(2), 315-325.&lt;/p&gt;

&lt;p&gt;Sciacovelli, M., &amp;amp; Frezza, C. (2017). Metabolic reprogramming and epithelial-to-mesenchymal transition in cancer.&amp;nbsp;&lt;em&gt;FEBS J, 284&lt;/em&gt;(19), 3132-3144. doi:10.1111/febs.14090&lt;/p&gt;

&lt;p&gt;Shi, Y., &amp;amp; Massagu&amp;eacute;, J. (2003). Mechanisms of TGF-&amp;beta; signaling from cell membrane to the nucleus. cell, 113(6), 685-700.&lt;/p&gt;

&lt;p&gt;Smit, M. A., &amp;amp; Peeper, D. S. (2008). Deregulating EMT and senescence: double impact by a single twist. Cancer cell, 14(1), 5-7.&lt;/p&gt;

&lt;p&gt;Suarez-Carmona, M., Lesage, J., Cataldo, D., &amp;amp; Gilles, C. (2017). EMT and inflammation: inseparable actors of cancer progression.&amp;nbsp;Mol Oncol, 11(7), 805-823. doi:10.1002/1878-0261.12095&lt;/p&gt;

&lt;p&gt;Sun, J., Yang, X., Zhang, R., Liu, S., Gan, X., Xi, X., . . . Sun, Y. (2017). GOLPH3 induces epithelial-mesenchymal transition via Wnt/beta-catenin signaling pathway in epithelial ovarian cancer.&amp;nbsp;Cancer Med, 6(4), 834-844. doi:10.1002/cam4.1040&lt;/p&gt;

&lt;p&gt;Taki, M., Verschueren, K., Yokoyama, K., Nagayama, M., &amp;amp; Kamata, N. (2006). Involvement of Ets-1 transcription factor in inducing matrix metalloproteinase-2 expression by epithelial-mesenchymal transition in human squamous carcinoma cells. International journal of oncology, 28(2), 487-496.&lt;/p&gt;

&lt;p&gt;Tanabe, S. (2017). Molecular markers and networks for cancer and stem cells.&amp;nbsp;J Embryol Stem Cell Res, 1(1).&lt;/p&gt;

&lt;p&gt;Tanabe, S., Kawabata, T., Aoyagi, K., Yokozaki, H., &amp;amp; Sasaki, H. (2016). Gene expression and pathway analysis of CTNNB1 in cancer and stem cells.&amp;nbsp;World J Stem Cells, 8(11), 384-395. doi:10.4252/wjsc.v8.i11.384&lt;/p&gt;

&lt;p&gt;Tanabe, S., Komatsu, M., Kazuhiko, A., Yokozaki, H., &amp;amp; Sasaki, H. (2015). Implications of epithelial-mesenchymal transition in gastric cancer.&amp;nbsp;Translational Gastrointestinal Cancer, 4(4), 258-264&lt;/p&gt;

&lt;p&gt;Thiery, J. P. (2002). Epithelial&amp;ndash;mesenchymal transitions in tumour progression. Nature reviews cancer, 2(6), 442-454.&lt;/p&gt;

&lt;p&gt;Tse, J. C., &amp;amp; Kalluri, R. (2007). Mechanisms of metastasis: epithelial‐to‐mesenchymal transition and contribution of tumor microenvironment. Journal of cellular biochemistry, 101(4), 816-829.&lt;/p&gt;

&lt;p&gt;Wang, B., Tang, Z., Gong, H., Zhu, L., &amp;amp; Liu, X. (2017).&amp;nbsp;Wnt5a promotes epithelial-to-mesenchymal transition and metastasis in non-small-cell lung cancer.&amp;nbsp;&lt;em&gt;Biosci Rep, 37&lt;/em&gt;(6). doi:10.1042/BSR20171092&lt;/p&gt;

&lt;p&gt;Weinberg, R. A. (2008). Twisted epithelial&amp;ndash;mesenchymal transition blocks senescence. Nature cell biology, 10(9), 1021-1023.&lt;/p&gt;

&lt;p&gt;Wendt, M. K., Smith, J. A., &amp;amp; Schiemann, W. P. (2010). Transforming growth factor-beta-induced epithelial-mesenchymal transition facilitates epidermal growth factor-dependent breast cancer progression.&amp;nbsp;&lt;em&gt;Oncogene, 29&lt;/em&gt;(49), 6485-6498. doi:10.1038/onc.2010.377&lt;/p&gt;

&lt;p&gt;Wik, E., R&amp;aelig;der, M. B., Krakstad, C., Trovik, J., Birkeland, E., Hoivik, E. A., ... &amp;amp; Salvesen, H. B. (2013). Lack of estrogen receptor-&amp;alpha; is associated with epithelial&amp;ndash;mesenchymal transition and PI3K alterations in endometrial carcinoma. Clinical Cancer Research, 19(5), 1094-1105.&lt;/p&gt;

&lt;p&gt;Yang, J., &amp;amp; Weinberg, R. A. (2008). Epithelial-mesenchymal transition: at the crossroads of development and tumor metastasis. Developmental cell, 14(6), 818-829.&lt;/p&gt;

&lt;p&gt;Yang, J., Mani, S. A., &amp;amp; Weinberg, R. A. (2006). Exploring a new twist on tumor metastasis. Cancer research, 66(9), 4549-4552.&lt;/p&gt;

&lt;p&gt;Ye, Y., Xiao, Y., Wang, W., Yearsley, K., Gao, J. X., Shetuni, B., &amp;amp; Barsky, S. H. (2010). ER&amp;alpha; signaling through slug regulates E-cadherin and EMT. Oncogene, 29(10), 1451-1462.&lt;/p&gt;

&lt;p&gt;Zeisberg, M., Shah, A. A., &amp;amp; Kalluri, R. (2005). Bone morphogenic protein-7 induces mesenchymal to epithelial transition in adult renal fibroblasts and facilitates regeneration of injured kidney. Journal of Biological Chemistry, 280(9), 8094-8100.&lt;/p&gt;

&lt;p&gt;Zeng, Q., Zhang, P., Wu, Z., Xue, P., Lu, D., Ye, Z., ... &amp;amp; Yan, X. (2014). Quantitative proteomics reveals ER-&amp;alpha; involvement in CD146-induced epithelial-mesenchymal transition in breast cancer cells. Journal of proteomics, 103, 153-169.&lt;/p&gt;

&lt;p&gt;Zhang, P., Sun, Y., &amp;amp; Ma, L. (2015). ZEB1: at the crossroads of epithelial-mesenchymal transition, metastasis and therapy resistance.&amp;nbsp;&lt;em&gt;Cell Cycle, 14&lt;/em&gt;(4), 481-487. doi:10.1080/15384101.2015.1006048&lt;/p&gt;

&lt;p&gt;Zhou, Y., Huang, Y., Cao, X., Xu, J., Zhang, L., Wang, J., . . . Zheng, M. (2016). WNT2 Promotes Cervical Carcinoma Metastasis and Induction of Epithelial-Mesenchymal Transition.&amp;nbsp;&lt;em&gt;PLoS One, 11&lt;/em&gt;(8), e0160414. doi:10.1371/journal.pone.0160414&lt;/p&gt;
</references>
    <source>AOPWiki</source>
    <creation-timestamp>2017-07-26T19:11:33</creation-timestamp>
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  <key-event id="9fefc217-0a07-49cc-8ee4-18b49089c500">
    <title>Pulmonary fibrosis</title>
    <short-name>Pulmonary fibrosis</short-name>
    <biological-organization-level>Organ</biological-organization-level>
    <description>&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;Pulmonary fibrosis is broadly defined as the thickening or scarring of lung tissue, due to excessive deposition of extracellular matrix. In the normal human lung, the nasopharynx and the conducting airways are mainly covered by epithelium composed of ciliated, mucous secreting cells in direct contact with the basement membrane with submucosal glands containing goblet, duct, and serous cells also contributing to the fluid balance and mucous production (Koval and&amp;nbsp;Sidhaye, 2017). Within this epithelium, basal cells are found which are stimulated to proliferate and differentiate in response to injury (Koval and&amp;nbsp;Sidhaye, 2017). Further down the lung, in the terminal bronchiole region, the epithelium does not contain submucosal glands, but instead contains club cells which produce pulmonary surfactant and can differentiate into bronchiolar or alveolar epithelial cells (AECs). Finally, in the terminal airspaces, the epithelium is made up entirely of type I and type II AECs. In between the two adjacent alveoli are two layers of alveolar epithelium resting on basement membrane, which consists of interstitial space, pulmonary capillaries, elastin and collagen fibres. Thus, the alveolar capillary membrane (ACM), where gas exchange takes place, is made up of the alveolar epithelium and alveolar endothelium (Gracey et al, 1968). In pulmonary fibrosis, damage to the pulmonary epithelium results in excessive deposition of collagen by constitutively activated myofibroblasts during the wound healing response. This causes a pronounced decrease in the number of capillaries within the alveolar septa with asymmetric deposition of collagen and cells between part of the surface of a capillary and the nearby alveolar lining. In areas where capillaries are not present, the ACM is occupied with collagen and cells. &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
</description>
    <measurement-methodology>&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;&lt;em&gt;In vivo&lt;/em&gt;, histopathological analysis is used for assessing fibrotic lung disease. Morphometric analysis of the diseased area versus total lung area is used to quantitatively stage the fibrotic disease. Although, some inconsistencies can be introduced during the analysis due to the experience of the individual scoring the disease, the histological stain, etc., a numerical scale with grades from 0 to 8, originally developed by Ashcroft et al., 1988 is assigned to indicate the amount of fibrotic tissue in histological samples. This scale is applied to diagnose lung fibrosis in both human and animal samples. Modifications to this scoring system were proposed (Hubner et al., 2008), which enables morphological distinctions thus enabling a better grading of the disease. Using the modified scoring system, bleomycin induced lung fibrosis in rats was scored as follows: Grade 0 &amp;ndash; normal lung, Grade 1 &amp;ndash; isolated alveolar septa with gentle fibrotic changes, Grade 2 &amp;ndash; knot like formation in fibrotic areas in alveolar septa, Grade 3 &amp;ndash; contiguous fibrotic walls of alveolar septa, Grade 4 &amp;ndash; single fibrotic masses, Grade 5 &amp;ndash; confluent fibrotic masses, Grade 6 &amp;ndash; large contiguous fibrotic masses, Grade 7 &amp;ndash; air bubbles and Grade 8 &amp;ndash; fibrotic obliteration. Further morphometric analysis can be conducted to quantify the total disease area (Nikota et al., 2017).&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;Lungs are formalin fixed and paraffin embedded such that an entire cross section of lung can be presented on a slide. The entire cross section is captured in a series of images using wide field light microscope. Areas of alveolar epithelium thickening and consolidated air space are identified. ImageJ software (freely available) is used to trace the total area (green line) and the diseased area (red line) imaged and quantified. The diseased area is equal to disease area/total area (Nikota et al., 2017).&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;&lt;em&gt;In vitro&lt;/em&gt;, there is no single assay that can measure the alveolar thickness. However, a combination of assays spanning various KEs described above provide a measure of the extent of fibrogenesis potential of tested substances. Real-time reverse transcription-polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assays&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;(ELISA)&amp;nbsp;measuring increased collagen, Transforming growth factor beta 1 (TGF-&amp;beta;1) and various pro-inflammatory mediators are used as sensitive markers of potential of substances to induce the adverse outcome of lung fibrosis.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
</measurement-methodology>
    <evidence-supporting-taxonomic-applicability></evidence-supporting-taxonomic-applicability>
    <organ-term>
      <source-id>UBERON:0002048</source-id>
      <source>UBERON</source>
      <name>lung</name>
    </organ-term>
    <applicability>
      <sex>
        <evidence>High</evidence>
        <sex>Unspecific</sex>
      </sex>
      <life-stage>
        <evidence>High</evidence>
        <life-stage>Adults</life-stage>
      </life-stage>
      <taxonomy taxonomy-id="a8612cec-e8cc-4fbb-8cec-6b5d9664724d">
        <evidence>High</evidence>
      </taxonomy>
      <taxonomy taxonomy-id="b363f1b0-e2a4-4453-979b-21df1cda7081">
        <evidence>High</evidence>
      </taxonomy>
      <taxonomy taxonomy-id="6c09aea5-b153-4f3f-88b2-53c0e1a99cc6">
        <evidence>High</evidence>
      </taxonomy>
    </applicability>
    <references>&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;1. Ashcroft T, Simpson JM, Timbrell V. Simple method of estimating severity of pulmonary fibrosis on a numerical scale. J Clin Pathol. 1988 Apr;41(4):467-70. doi: 10.1136/jcp.41.4.467.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;2.&amp;nbsp;Gracey DR, Divertie MB, Brown AL Jr. Alveolar-capillary membrane in idiopathic interstitial pulmonary fibrosis. Electron microscopic study of 14 cases. Am Rev Respir Dis. 1968 Jul;98(1):16-21. doi: 10.1164/arrd.1968.98.1.16.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;3.&amp;nbsp;H&amp;uuml;bner RH, Gitter W, El Mokhtari NE, Mathiak M, Both M, Bolte H, Freitag-Wolf S, Bewig B. Standardized quantification of pulmonary fibrosis in histological samples. Biotechniques. 2008 Apr;44(4):507-11, 514-7. doi: 10.2144/000112729.&amp;nbsp;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;4.&amp;nbsp;Koval M, Sidhaye VK. Introduction: The Lung Epithelium. In: Sidhaye VK, Koval M, editors. Lung Epithelial Biology in the Pathogenesis of Pulmonary Disease. Boston: Academic Press; 2017. p. xiii-xviii. Elsevier.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;span style="font-size:16px"&gt;&lt;span style="font-family:Arial,Helvetica,sans-serif"&gt;5.&amp;nbsp;Nikota J, Banville A, Goodwin LR, Wu D, Williams A, Yauk CL, Wallin H, Vogel U, Halappanavar S. Stat-6 signaling pathway and not Interleukin-1 mediates multi-walled carbon nanotube-induced lung fibrosis in mice: insights from an adverse outcome pathway framework. Part Fibre Toxicol. 2017 Sep 13;14(1):37. doi: 10.1186/s12989-017-0218-0.&amp;nbsp;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;
</references>
    <source>AOPWiki</source>
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