Opportunity for Pharmaceutical Intervention in Lung Cancer: Selective Inhibition of JAK1/2 to Eliminate EMT-Derived Mesenchymal Cells

Abstract

EMT-Mediated Metastasis After EMT has transpired, the newly formed mesenchymal cells enter the bloodstream through the process of intravasation (invasion of cancer cells through the basement membrane) and disseminate throughout the body, eventually invading a distant organ site, through the process of extravasation (cancer cells exit the capillaries and invade an organ; Fig 1). At this distant organ site, the cancer cells undergo a Mesenchymal-Epithelial Transition (MET), the reverse process of EMT, in order to colonize and form a secondary epithelial tumor. By reverting to their original epithelial phenotype, the cells regain the ability to proliferate rapidly and form cellcell junctions, two characteristics that are necessary for successful colonization. These characteristics were lost during the original EMT, when the cells acquired the ability to metastasize (Kalluri & Weinberg, 2009). After MET has occurred and a second epithelial tumor is established, the process of metastasis is complete. Thus, EMT is considered an important process during the early stages of metastasis, while MET is considered an important process during the later stages of metastasis (Brabletz, 2012). EMT induction primarily occurs through the activation of phosphorylation cascades by various cytokines and growth factors present within the tumor microenvironment, including TransINTRODUCTION Lung cancer is currently the most prevalent form of cancer in the United States, causing over 158,000 deaths each year (American Lung Association, 2016). More than 90% of these deaths and other cancer-associated mortality can be attributed to metastasis (Ray & Jablons, 2009). An immense clinical need exists for novel treatments either targeting or preventing metastasis, especially in early stage cancer patients. In order for distant metastasis to occur, primary tumor cells must disseminate through the blood vessels and invade a distant organ site (Brabletz, 2012). A biological phenomenon known as the Epithelial-Mesenchymal Transition (EMT) is a key facilitator of this process. EMT involves a series of changes which allow a cancer cell to transition from a stationary epithelial phenotype to a migratory, drug resistant mesenchymal phenotype. This process includes the disassembly of epithelial cell-junctions and a loss of epithelial polarity in exchange for mesenchymal characteristics, such as a fibroblast-like morOpportunity for Pharmaceutical Intervention in Lung Cancer: Selective Inhibition of JAK1/2 to Eliminate EMT-Derived Mesenchymal Cells