Implications of the hybrid epithelial/mesenchymal phenotype in metastasis

TL;DR

This paper reviews how hybrid epithelial/mesenchymal cancer cell phenotypes influence metastasis, emphasizing their role in collective migration, tumor initiation, and drug resistance, and discusses the underlying regulatory networks controlling these states.

Contribution

It provides a comprehensive analysis of the hybrid E/M phenotype, its regulatory mechanisms, and its advantages in metastasis over complete EMT, highlighting its significance in cancer progression.

Findings

Hybrid E/M cells facilitate collective migration and metastasis.

Hybrid phenotype enhances tumor-initiation and drug resistance.

Regulatory networks act as a three-way switch for cell phenotypes.

Abstract

Understanding cell-fate decisions during tumorigenesis and metastasis is a major challenge in modern cancer biology. One canonical cell-fate decision that cancer cells undergo is Epithelial-to-Mesenchymal Transition (EMT) and its reverse Mesenchymal-to-Epithelial Transition (MET). While transitioning between these two phenotypes - epithelial and mesenchymal - cells can also attain a hybrid epithelial/mesenchymal (i.e. partial or intermediate EMT) phenotype. Cells in this phenotype have mixed epithelial (e.g. adhesion) and mesenchymal (e.g. migration) properties, thereby allowing them to move collectively as clusters of Circulating Tumor Cells (CTCs). If these clusters enter the circulation, they can be more apoptosis-resistant and more capable of initiating metastatic lesions than cancer cells moving individually with wholly mesenchymal phenotypes, having undergo a complete EMT. Here, we review the operating principles of the core regulatory network for EMT/MET that acts as a three-way switch giving rise to three distinct phenotypes - epithelial, mesenchymal and hybrid epithelial/mesenchymal. We further characterize this hybrid E/M phenotype in terms of its capabilities in terms of collective cell migration, tumor-initiation, cell-cell communication, and drug resistance. We elucidate how the highly interconnected coupling between these modules coordinates cell-fate decisions among a population of cancer cells in the dynamic tumor, hence facilitating tumor-stoma interactions, formation of CTC clusters, and consequently cancer metastasis. Finally, we discuss the multiple advantages that the hybrid epithelial/mesenchymal phenotype have as compared to a complete EMT phenotype and argue that these collectively migrating cells are the primary 'bad actors' of metastasis.