EMT, epithelial-mesenchymal transition

EMT,上皮 - 间质转化
  • 文章类型: Journal Article
    驱动蛋白家族成员20A(KIF20A)是驱动蛋白家族的成员。它在有丝分裂期间运输染色体,在细胞分裂中起着关键作用。最近,研究证明KIF20A在癌症中高表达。KIF20A的高表达与低总生存期(OS)相关。在这次审查中,我们总结了所有高表达KIF20A的癌症,描述了KIF20A在癌症中的作用。我们还组织了KIF20A肽疫苗的I期和II期临床试验。所有结果表明KIF20A是多种癌症的有希望的治疗靶标。
    Kinesin family member 20A (KIF20A) is a member of the kinesin family. It transports chromosomes during mitosis, plays a key role in cell division. Recently, studies proved that KIF20A was highly expressed in cancer. High expression of KIF20A was correlated with poor overall survival (OS). In this review, we summarized all the cancer that highly expressed KIF20A, described the role of KIF20A in cancer. We also organized phase I and phase II clinical trials of KIF20A peptides vaccine. All results indicated that KIF20A was a promising therapeutic target for multiple cancer.
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  • 文章类型: Journal Article
    头颈部鳞状细胞癌(HNSC)是全球最常见的恶性肿瘤之一,死亡率高。重要的是,HNSC的分子异质性使临床诊断和治疗复杂化,导致整体生存结果不佳。为了剖析复杂的异质性,最近的研究报道了多个分子亚型系统。例如,HNSC可以细分为四种不同的分子亚型:非典型,基底,古典,和间充质,其中间充质亚型的特征是上皮-间充质转化(EMT)上调,并与较差的生存结局相关。尽管对复杂的分子异质性进行了大量研究,这种侵袭性亚型特有的调节机制仍不清楚.在这里,我们开发了一个基于网络的生物信息学框架,该框架整合了lncRNA和mRNA表达谱,以阐明亚型特异性调控机制.将框架应用于HNSC,我们确定了临床相关的lncRNALNCOG作为介导间充质亚型基础EMT的关键主调节因子.5个具有强预后价值的基因,即ANXA5,ITGA5,CCBE1,P4HA2和EPHX3被预测为LNCOG的假定目标,随后在其他独立数据集中进行了验证。通过对miRNA表达谱的综合分析,我们发现LNCOG可能作为ceRNA来海绵miR-148a-3p,从而上调ITGA5以促进HNSC进展.此外,我们的药物敏感性分析表明,LNCOG的5个推定目标也可预测多种FDA批准药物的敏感性.总之,我们的生物信息学框架促进了癌症亚型特异性lncRNA调控机制的解剖,为HNSC的更优化治疗提供潜在的新型生物标志物。
    Head and neck squamous cell carcinoma (HNSC) is one of most common malignancies with high mortality worldwide. Importantly, the molecular heterogeneity of HNSC complicates the clinical diagnosis and treatment, leading to poor overall survival outcomes. To dissect the complex heterogeneity, recent studies have reported multiple molecular subtyping systems. For instance, HNSC can be subdivided to four distinct molecular subtypes: atypical, basal, classical, and mesenchymal, of which the mesenchymal subtype is characterized by upregulated epithelial-mesenchymal transition (EMT) and associated with poorer survival outcomes. Despite a wealth of studies into the complex molecular heterogeneity, the regulatory mechanism specific to this aggressive subtype remain largely unclear. Herein, we developed a network-based bioinformatics framework that integrates lncRNA and mRNA expression profiles to elucidate the subtype-specific regulatory mechanisms. Applying the framework to HNSC, we identified a clinically relevant lncRNA LNCOG as a key master regulator mediating EMT underlying the mesenchymal subtype. Five genes with strong prognostic values, namely ANXA5, ITGA5, CCBE1, P4HA2, and EPHX3, were predicted to be the putative targets of LNCOG and subsequently validated in other independent datasets. By integrative analysis of the miRNA expression profiles, we found that LNCOG may act as a ceRNA to sponge miR-148a-3p thereby upregulating ITGA5 to promote HNSC progression. Furthermore, our drug sensitivity analysis demonstrated that the five putative targets of LNCOG were also predictive of the sensitivities of multiple FDA-approved drugs. In summary, our bioinformatics framework facilitates the dissection of cancer subtype-specific lncRNA regulatory mechanisms, providing potential novel biomarkers for more optimized treatment of HNSC.
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  • 文章类型: Journal Article
    放射治疗广泛用于癌症治疗,但矛盾的是,据报道,存活的癌细胞可以获得耐药性,导致复发或转移。需要努力降低抗辐射性以增加放射疗法的有效性。miRNA作为治疗剂是有利的,因为它可以同时抑制几种靶mRNA的表达。因此,本研究发现了调节辐射抗性的miRNA,并阐明了其信号传导机制。我们先前的研究证实miR-5088-5p与乳腺癌的恶性和转移有关。作为一项阐明辐射与miR-5088-5p被鉴定为onco-miRNA之间关系的研究,已证实辐射诱导miR-5088-5p启动子的低甲基化及其表达增加。另一方面,miR-5088-5p抑制剂被证实可以减少辐射诱导的上皮间质转化,stemness,通过减少Slug进行转移。因此,这项研究显示miR-5088-5p抑制剂作为治疗药物抑制放射抗性的潜力.
    Radiotherapy is widely used for cancer treatment, but paradoxically, it has been reported that surviving cancer cells can acquire resistance, leading to recurrence or metastasis. Efforts to reduce radioresistance are required to increase the effectiveness of radiotherapy. miRNAs are advantageous as therapeutic agents because it can simultaneously inhibit the expression of several target mRNAs. Therefore, this study discovered miRNA that regulated radioresistance and elucidated its signaling mechanism. Our previous study confirmed that miR-5088-5p was associated with malignancy and metastasis in breast cancer. As a study to clarify the relationship between radiation and miR-5088-5p identified as onco-miRNA, it was confirmed that radiation induced hypomethylation of the promoter of miR-5088-5p and its expression increased. On the other hand, miR-5088-5p inhibitors were confirmed to reduce radiation-induced epithelial-mesenchymal transition, stemness, and metastasis by reducing Slug. Therefore, this study showed the potential of miR-5088-5p inhibitors as therapeutic agents to suppress radioresistance.
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  • 文章类型: Journal Article
    流行病学研究表明,吸烟可以增加一个人患几种癌症的风险,包括肺癌.肺癌起源于肿瘤干细胞(CSC),它们构成了肿瘤中的次要细胞群,并导致耐药性和复发。加热烟草制品(HTPs)产生含有尼古丁和有毒化学物质的气溶胶。目前的证据,然而,不足以准确确定HTPs是否比燃烧的香烟危害小。这项研究研究了HTPs的香烟烟雾提取物(CSE)对肺癌细胞系中肺CSC的影响。我们发现CSE诱导了肺CSC的增殖并增加了干细胞标志物的表达水平。此外,CSE诱导上皮-间质转化(EMT)表达和细胞因子产生。这些结果表明HTPs可以在体外诱导肺CSC。
    Epidemiological studies have suggested that cigarette smoking can increase a person\'s risk of developing several types of cancer, including lung cancer. Lung cancer originates from cancer stem cells (CSCs), which constitute a minor cell population in tumors, and contribute to drug resistance and recurrence. Heated tobacco products (HTPs) produce aerosols that contain nicotine and toxic chemicals. Current evidence, however, is insufficient to accurately determine if HTPs are less harmful than burned cigarettes. This study has investigated the effects of cigarette smoke extract (CSE) from HTPs on lung CSCs in lung cancer cell lines. We found that CSEs induced the proliferation of lung CSCs and increased the expression levels of stem cell markers. In addition, CSE induced epithelial-mesenchymal transition (EMT) expression and cytokine production. These results suggest that HTPs can induce lung CSCs in vitro.
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  • 文章类型: Journal Article
    中心体和纺锤体极相关蛋白(CSP1)是一种中心体和微管结合蛋白,在细胞周期依赖性细胞骨架组织和纤毛形成中起作用。以前的研究表明,CSP1在肿瘤发生中起作用;然而,尚未进行泛癌症分析.本研究系统地调查了CSP1的表达及其与诊断相关的潜在临床结果。预后,和治疗。CSP1广泛存在于组织和细胞中,其异常表达可作为癌症的诊断生物标志物。CSP1失调是由涉及遗传改变的多维机制驱动的,DNA甲基化,和miRNA。CSP1在特定位点的磷酸化可能在肿瘤发生中起作用。此外,CSP1与多种癌症的临床特征和结果相关。以预后不良的脑低级别胶质瘤(LGG)为例,功能富集分析表明CSP1可能在铁凋亡和肿瘤微环境(TME)中发挥作用,包括调节上皮-间质转化,基质反应,和免疫反应。进一步的分析证实,CSP1在LGG和其他癌症中失调铁凋亡,使得基于铁凋亡的药物有可能用于治疗这些癌症。重要的是,CSP1相关肿瘤在不同的TME中浸润,使免疫检查点阻断治疗对这些癌症患者有益。我们的研究首次证明CSP1是与铁凋亡和TME相关的潜在诊断和预后生物标志物。为特定癌症的药物治疗和免疫治疗提供了新的靶点。
    Centrosome and spindle pole-associated protein (CSPP1) is a centrosome and microtubule-binding protein that plays a role in cell cycle-dependent cytoskeleton organization and cilia formation. Previous studies have suggested that CSPP1 plays a role in tumorigenesis; however, no pan-cancer analysis has been performed. This study systematically investigates the expression of CSPP1 and its potential clinical outcomes associated with diagnosis, prognosis, and therapy. CSPP1 is widely present in tissues and cells and its aberrant expression serves as a diagnostic biomarker for cancer. CSPP1 dysregulation is driven by multi-dimensional mechanisms involving genetic alterations, DNA methylation, and miRNAs. Phosphorylation of CSPP1 at specific sites may play a role in tumorigenesis. In addition, CSPP1 correlates with clinical features and outcomes in multiple cancers. Take brain low-grade gliomas (LGG) with a poor prognosis as an example, functional enrichment analysis implies that CSPP1 may play a role in ferroptosis and tumor microenvironment (TME), including regulating epithelial-mesenchymal transition, stromal response, and immune response. Further analysis confirms that CSPP1 dysregulates ferroptosis in LGG and other cancers, making it possible for ferroptosis-based drugs to be used in the treatment of these cancers. Importantly, CSPP1-associated tumors are infiltrated in different TMEs, rendering immune checkpoint blockade therapy beneficial for these cancer patients. Our study is the first to demonstrate that CSPP1 is a potential diagnostic and prognostic biomarker associated with ferroptosis and TME, providing a new target for drug therapy and immunotherapy in specific cancers.
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  • 文章类型: Journal Article
    宫颈癌(CC)伴淋巴结转移(LNM)患者的预后极差。脂滴(LDs)在促进肿瘤转移中具有重要作用。在CC中调制的LD和LNM之间的串扰机制仍然很大程度上未知。
    本研究旨在构建CC患者的miRNA依赖性预后模型,并研究miR-532-5p是否通过调节LDs积累对LNM具有生物学影响。
    应用LASSO-Cox回归建立预后预测模型。miR-532-5p在RNA表达(P<0.001)和预后预测(P<0.0001)中具有最低的P值,并被选择用于进一步研究。研究了预后miR-532-5p相关的竞争性内源性RNA(ceRNA)网络的功能作用,以阐明LD和LNM之间的串扰。使用定点诱变确定了潜在的机制,双荧光素酶报告分析,RNA免疫沉淀试验,和救援实验。建立异种移植LNM模型以评估miR-532-5p和奥利司他组合疗法对肿瘤生长和LNM的影响。
    构建了新的5-miRNA预后特征以更好地预测CC患者的预后。进一步的研究表明miR-532-5p通过调节LDs的积累抑制上皮间质转化和淋巴管生成。有趣的是,我们还发现LDs的积累促进了体外细胞转移。机械上,我们展示了一个miR-532-5p相关的ceRNA网络,其中LINC01410直接与miR-532-5p结合,并作为miR-532-5p海绵有效发挥功能,去抑制其靶基因-脂肪酸合酶(FASN).miR-532-5p和FASN抑制剂-奥利司他的联合治疗在体内进一步抑制肿瘤生长和LNM。
    我们的发现强调了miR-532-5p调节的LNM的LD积累依赖性机制,并支持使用miR-532-5p/orlistat作为治疗CC中LNM患者的新策略。
    The prognosis for cervical cancer (CC) patients with lymph node metastasis (LNM) is extremely poor. Lipid droplets (LDs) have a pivotal role in promoting tumor metastasis. The crosstalk mechanism between LDs and LNM modulated in CC remains largely unknown.
    This study aimed to construct a miRNA-dependent progonostic model for CC patients and investigate whether miR-532-5p has a biological impact on LNM by regualting LDs accumulation.
    LASSO-Cox regression was applied to establish a prognostic prediction model. miR-532-5p had the lowest P-value in RNA expression (P < 0.001) and prognostic prediction (P < 0.0001) and was selected for further study. The functional role of the prognostic miR-532-5p-correlated competing endogenous RNA (ceRNA) network was investigated to clarify the crosstalk between LDs and LNM. The underlying mechanism was determined using site-directed mutagenesis, dual luciferase reporter assays, RNA immunoprecipitation assays, and rescue experiments. A xenograft LNM model was established to evaluate the effect of miR-532-5p and orlistat combination therapy on tumor growth and LNM.
    A novel 5-miRNAs prognostic signature was constructed to better predict the prognosis of CC patient. Further study demonstrated that miR-532-5p inhibited epithelial-mesenchymal transition and lymphangiogenesis by regulating LDs accumulation. Interestingly, we also found that LDs accumulation promoted cell metastasis in vitro. Mechanistically, we demonstrated a miR-532-5p-correlated ceRNA network in which LINC01410 was bound directly to miR-532-5p and effectively functioned as miR-532-5p sponge to disinhibit its target gene-fatty acid synthase (FASN). Combined therapy with miR-532-5p and FASN inhibitor-orlistat further inhibited tumor growth and LNM in vivo.
    Our findings highlight a LD accumulation-dependent mechanism of miR-532-5p-modulated LNM and support treatment with miR-532-5p/orlistat as novel strategy for treating patients with LNM in CC.
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  • 文章类型: Journal Article
    SMYD3在几种人类癌症中的过表达强调了其在致癌作用中的关键作用。尽管如此,SMYD3在癌症发展和进展中的特异性活性目前正在争论中。利用稀有三肽库,我们首先测试了它们对SMYD3的体外结合亲和力,然后用作计算机探针,我们最近发现了BRCA2ATM,和CHK2作为直接SMYD3交互体。为了深入了解新的SMYD3癌症相关角色,在这里,我们进行了全面的计算机分析,通过筛选人类蛋白质组来鉴定所有潜在的SMYD3相互作用蛋白,以筛选先前测试的三肽,基于他们参与癌症的标志。值得注意的是,我们确定了mTOR,BLM,MET,AMPK,和p130作为新的SMYD3相互作用者参与癌症过程。需要进一步的研究来表征这些相互作用的功能机制。尽管如此,这些发现可能有助于设计基于联合抑制SMYD3及其新鉴定的分子伴侣的新型治疗策略.值得注意的是,我们的计算机模拟方法可能有助于搜索其他感兴趣的蛋白质的未识别的相互作用物。
    SMYD3 overexpression in several human cancers highlights its crucial role in carcinogenesis. Nonetheless, SMYD3 specific activity in cancer development and progression is currently under debate. Taking advantage of a library of rare tripeptides, which we first tested for their in vitro binding affinity to SMYD3 and then used as in silico probes, we recently identified BRCA2, ATM, and CHK2 as direct SMYD3 interactors. To gain insight into novel SMYD3 cancer-related roles, here we performed a comprehensive in silico analysis to cluster all potential SMYD3-interacting proteins identified by screening the human proteome for the previously tested tripeptides, based on their involvement in cancer hallmarks. Remarkably, we identified mTOR, BLM, MET, AMPK, and p130 as new SMYD3 interactors implicated in cancer processes. Further studies are needed to characterize the functional mechanisms underlying these interactions. Still, these findings could be useful to devise novel therapeutic strategies based on the combined inhibition of SMYD3 and its newly identified molecular partners. Of note, our in silico methodology may be useful to search for unidentified interactors of other proteins of interest.
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  • 文章类型: Journal Article
    肿瘤干性与肿瘤进展和治疗抵抗有关。测序的最新进展,基因组学,和计算技术促进了对肿瘤干细胞样特征的研究。我们通过对其转录组学谱的聚类分析,基于12种干细胞特征的富集评分,鉴定了块状肿瘤或单细胞中肺腺癌(LUAD)的亚型。确定了LUAD的三种干性亚型:St-H,St-M,还有St-L,有高,中等,和低干性签名,分别,在六个不同的数据集中一致。在这三种亚型中,St-H在上皮-间质转化中最丰富,入侵,和转移信号,基因组不稳定,对免疫疗法和靶向疗法没有反应,因此预后最差。我们观察到高干性肿瘤的瘤内异质性明显高于低干性块状肿瘤,但在高干性中明显低于低干性单个癌细胞。此外,高干细胞的肿瘤免疫力强于低干细胞的肿瘤免疫力,但高干性比低干性块状肿瘤要弱。大量肿瘤和单个癌细胞之间的这些差异可以归因于大量肿瘤中的非肿瘤细胞,这混淆了相关性分析的结果。此外,假时间分析表明,许多St-H细胞处于细胞进化轨迹的初期,与晚期或晚期的大多数St-L细胞相比,表明许多低干细胞起源于高干细胞。基于干性的LUAD分类可能为肿瘤生物学以及该疾病的精确临床管理提供新的见解。
    Tumor stemness is associated with tumor progression and therapy resistance. The recent advances in sequencing, genomics, and computational technologies have facilitated investigation into the tumor stemness cell-like characteristics. We identified subtypes of lung adenocarcinoma (LUAD) in bulk tumors or single cells based on the enrichment scores of 12 stemness signatures by clustering analysis of their transcriptomic profiles. Three stemness subtypes of LUAD were identified: St-H, St-M, and St-L, having high, medium, and low stemness signatures, respectively, consistently in six different datasets. Among the three subtypes, St-H was the most enriched in epithelial-mesenchymal transition, invasion, and metastasis signaling, genomically instable, irresponsive to immunotherapies and targeted therapies, and hence had the worst prognosis. We observed that intratumor heterogeneity was significantly higher in high-stemness than in low-stemness bulk tumors, but significantly lower in high-stemness than in low-stemness single cancer cells. Moreover, tumor immunity was stronger in high-stemness than in low-stemness cancer cells, but weaker in high-stemness than in low-stemness bulk tumors. These differences between bulk tumors and single cancer cells could be attributed to the non-tumor cells in bulk tumors that confounded the results of correlation analysis. Furthermore, pseudotime analysis showed that many St-H cells were at the beginning of the cell evolution trajectory, compared to most St-L cells in the terminal or later phase, suggesting that many low-stemness cells are originated from high-stemness cells. The stemness-based classification of LUAD may provide novel insights into the tumor biology as well as precise clinical management of this disease.
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  • 文章类型: Journal Article
    背景:骨浸润是口腔鳞状细胞癌的重要预后因素,导致较低的生存率和积极治疗方法的使用。上皮-间质转化(EMT)可能参与了这一过程,因为它通常与细胞运动和侵袭机制有关。这项研究检查了在患有骨侵袭的口腔鳞状细胞癌中是否存在一组上皮-间质标志物,以及这些蛋白质是否与患者的临床病理参数和预后因素有任何关系。
    方法:E-cadherin的免疫组织化学分析,twist,波形蛋白,在62例口腔鳞状细胞癌的石蜡包埋样品中进行TGFβ1和骨膜蛋白。
    结果:分析显示,大多数病例(66%)在骨组织中表现出主要的肿瘤浸润模式,与较低的生存率相关,与具有显性侵蚀性侵袭模式的病例相比(P=0.048)。27例(43%)在肿瘤-骨界面表达了与全部或部分EMT相容的标志物。全部或部分EMT的证据与其他人口统计学或预后特征之间没有关联。E-cadherin阳性病例与吸烟有关(P=0.022);波形蛋白阳性病例与4cm以下肿瘤有关(P=0.043)。在具有显性浸润模式的肿瘤中观察到Twist表达(P=0.041),并且与缺乏骨膜素有关(P=0.031)。
    结论:我们观察到口腔鳞状细胞癌骨浸润中存在完全或部分EMT的证据。转录因子扭曲似乎与骨侵袭和疾病进展有关。
    BACKGROUND: Bone invasion is an important prognostic factor in oral squamous cell carcinoma, leading to a lower survival rate and the use of aggressive treatment approaches. Epithelial-mesenchymal transition (EMT) is possibly involved in this process, because it is often related to mechanisms of cell motility and invasiveness. This study examined whether a panel of epithelial-mesenchymal markers are present in cases of oral squamous cell carcinoma with bone invasion and whether these proteins have any relationship with patients\' clinical-pathological parameters and prognostic factors.
    METHODS: Immunohistochemical analysis of E-cadherin, twist, vimentin, TGFβ1, and periostin was performed in paraffin-embedded samples of 62 oral squamous cell carcinoma cases.
    RESULTS: The analysis revealed that most cases (66%) presented with a dominant tumor infiltrative pattern in bone tissue, associated with lower survival rates, when compared with cases with a dominant erosive invasion pattern (P = 0.048). Twenty-seven cases (43%) expressed markers that were compatible with total or partial EMT at the tumor-bone interface. There was no association between evidence of total or partial EMT and other demographic or prognostic features. E-cadherin-positive cases were associated with tobacco smoking (P = 0.022); vimentin-positive cases correlated with tumors under 4 cm (P = 0.043). Twistexpression was observed in tumors with a dominant infiltrative pattern (P = 0.041) and was associated with the absence of periostin (P = 0.031).
    CONCLUSIONS: We observed evidence of total or partial EMT in oral squamous cell carcinoma bone invasion. The transcription factor twist appears to be involved in bone invasion and disease progression.
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  • 文章类型: Journal Article
    背景:对ECM的功能多功能性和动态特性的更深入了解提高了对癌症生物学的理解。翻译意义:这项工作提供了ECM的重要性,以开发更多的模拟乳腺癌模型的深入视图,旨在重建肿瘤微环境的组成部分和架构。特别关注来自组织和细胞培养的脱细胞基质,在采购和应用中,因为他们在癌症研究和制药领域取得了巨大的成功。摘要:细胞外基质(ECM)越来越被认为是细胞行为和对乳腺癌(BC)治疗反应的主要调节因子。在BC进展期间,乳腺ECM在组成和组织上被重塑和改变。积累的证据表明,ECM的组成和力学的变化,由肿瘤-基质相互作用以及ECM重塑酶协调,积极参与BC的进展和转移。了解特定的ECM成分如何调节致瘤过程已导致对开发基于生物材料的仿生ECM模型以概括关键肿瘤特征的兴趣增加。脱细胞ECMs(dECMs)已成为有前途的体外3D肿瘤模型,其在加工和应用方面的最新进展可能成为BC研究和制药业卓越的生物材料。这篇综述详细介绍了ECM在BC进展中的贡献,并强调了基于dECM的生物材料作为有前途的个性化肿瘤模型的应用,可以更准确地模拟BC的致瘤机制和对治疗的反应。这将允许设计适合每个肿瘤的特定特征的靶向治疗方法,这将对应用于BC患者的精准医学产生重大影响。
    BACKGROUND: A deeper knowledge of the functional versatility and dynamic nature of the ECM has improved the understanding of cancer biology. Translational Significance: This work provides an in-depth view of the importance of the ECM to develop more mimetic breast cancer models, which aim to recreate the components and architecture of tumor microenvironment. Special focus is placed on decellularized matrices derived from tissue and cell culture, both in procurement and applications, as they have achieved great success in cancer research and pharmaceutical sector. Abstract: The extracellular matrix (ECM) is increasingly recognized as a master regulator of cell behavior and response to breast cancer (BC) treatment. During BC progression, the mammary gland ECM is remodeled and altered in the composition and organization. Accumulated evidence suggests that changes in the composition and mechanics of ECM, orchestrated by tumor-stromal interactions along with ECM remodeling enzymes, are actively involved in BC progression and metastasis. Understanding how specific ECM components modulate the tumorigenic process has led to an increased interest in the development of biomaterial-based biomimetic ECM models to recapitulate key tumor characteristics. The decellularized ECMs (dECMs) have emerged as a promising in vitro 3D tumor model, whose recent advances in the processing and application could become the biomaterial by excellence for BC research and the pharmaceutical industry. This review offers a detailed view of the contribution of ECM in BC progression, and highlights the application of dECM-based biomaterials as promising personalized tumor models that more accurately mimic the tumorigenic mechanisms of BC and the response to treatment. This will allow the design of targeted therapeutic approaches adapted to the specific characteristics of each tumor that will have a great impact on the precision medicine applied to BC patients.
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