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Epithelial-mesenchymal transition leads to Resistant gastric cancer
Key Event Relationship Overview
AOPs Referencing Relationship
|AOP Name||Adjacency||Weight of Evidence||Quantitative Understanding||Point of Contact||Author Status||OECD Status|
|Increases in cellular reactive oxygen species and chronic reactive oxygen species leading to human treatment-resistant gastric cancer||adjacent||Moderate||Moderate||Shihori Tanabe (send email)||Open for comment. Do not cite||EAGMST Under Review|
|Homo sapiens||Homo sapiens||High||NCBI|
Life Stage Applicability
|All life stages||High|
Key Event Relationship Description
Some population of the cells exhibiting EMT demonstrates the feature of cancer stem cells (CSCs), which are related to cancer malignancy (Shibue & Weinberg, 2017; Shihori Tanabe, 2015a, 2015b; Tanabe, Aoyagi, Yokozaki, & Sasaki, 2015).
EMT phenomenon is related to cancer metastasis and cancer therapy resistance (Smith & Bhowmick, 2016; Tanabe, 2013). The increased expression of enzymes that degrade the extracellular matrix components and the decrease in adhesion to the basement membrane in EMT induces the cell to escape from the basement membrane and metastasis (Smith & Bhowmick, 2016). Morphological changes observed during EMT are associated with therapy resistance (Smith & Bhowmick, 2016).
Evidence Collection Strategy
Evidence Supporting this KER
The morphological and physiological changes associated with EMT are involved in invasiveness and drug resistance (Shibue & Weinberg, 2017). The EMT-activated particular carcinoma cells in primary tumors invade the surrounding stroma (Shibue & Weinberg, 2017). The EMT –activated carcinoma cells interact with the surrounding extracellular matrix protein to induce focal adhesion kinase and extracellular signal-related kinase activation, followed by the transforming growth factor-beta (TGFbeta) and canonical and/or noncanonical Wnt pathways to induce cancer stem cell (CSC) properties which contribute to the drug resistance (Shibue & Weinberg, 2017).
EMT-associated down-regulation of multiple apoptotic signaling pathways induces drug efflux and slows cell proliferation to induce the general resistance of carcinoma cells to anti-cancer drugs (Shibue & Weinberg, 2017).
Snail, an EMT-related transcription factor, induces the expression of the AXL receptor tyrosine kinase, which enables the cancer cells to survive by the activation of AXL signaling triggered by the binding of its ligand growth arrest-specific protein 6 (GAS6)(Shibue & Weinberg, 2017).
The EMT-activated cells evade the lethal effect of cytotoxic T cells, which include the elevated expression of programmed cell death 1 ligand (PD-L1) which binds to the programmed cell death protein 1 (PD-1) inhibitory immune-checkpoint receptor on the cell surface of cytotoxic T cells (Shibue & Weinberg, 2017).
Uncertainties and Inconsistencies
The reversing process of EMT, which names as a mesenchymal-epithelial transition (MET), maybe one of the candidates for the anti-cancer therapy, where the plasticity of the cell phenotype is of importance and under investigation (Shibue & Weinberg, 2017).
Known modulating factors
ABC transporters that are related to drug resistance are overexpressed in the EMT-activated cells (Saxena et al., 2011). The expression of PD-L1, which binds to the PD-1 on the cytotoxic T cells, is up-regulated in EMT-activated cells, which results in the inhibition of cancer immunity and the resistance to cancer therapy (Shibue & Weinberg, 2017).
Induction of EMT by TGFbeta and Twist increases the gene expression of EMT markers such as Snail, Vimentin, N-cadherin, and ABC transporters including ABCA3, ABCC1, ABCC3, and ABCC10 (Saxena et al., 2011).
Human mammary epithelial cells (HMLE) stably expressing Twist, FOXC2 or Snail demonstrates the increased cell viability compared to control HMLE in the treatment with about 0.3, 3, 30 mM of doxorubicin, dose-dependently (Saxena et al., 2011).
The treatment with doxorubicin for 48 hours demonstrates the increase in the cell viability in Twist/FOXC2/Snail overexpressed HMLE compared to control HMLE (Saxena et al., 2011).
The inhibition of Twist or Zeb1 with small interference RNA (siRNA) induced the inhibition of cell viability compared to control MDAMB231 cells treated with doxorubicin for 48 hours (Saxena et al., 2011).
Known Feedforward/Feedback loops influencing this KER
The investigation of EMT-CSC relations is important to understand the relationship between EMT and cancer malignancy. Non-CSCs in cancer can spontaneously undergo EMT and dedifferentiate into new CSC, subsequently induce the regeneration of tumorigenic potential (Marjanovic, Weinberg, & Chaffer, 2013; Shibue & Weinberg, 2017).
The plastic CSC theory demonstrates the bidirectional conversions between non-CSCs and CSCs, which may contribute to the acquisition of cancer malignancy in EMT-activated cells (Marjanovic et al., 2013).
Domain of Applicability
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Shibue, T., & Weinberg, R. A. (2017). EMT, CSCs, and drug resistance: the mechanistic link and clinical implications. Nat Rev Clin Oncol, 14(10), 611-629. doi:10.1038/nrclinonc.2017.44
Smith, B. N., & Bhowmick, N. A. (2016). Role of EMT in Metastasis and Therapy Resistance. J Clin Med, 5(2). doi:10.3390/jcm5020017
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