As it was first characterized in 1997, the ADAMTS (A Disintegrin and Metalloprotease with ThromboSpondin motifs) metalloprotease family has been associated with many physiological and pathological conditions. Of the 19 proteases belonging to this family, considerable attention has been devoted to the role of its first member ADAMTS1 in cancer. Elevated ADAMTS1 promotes pro-tumorigenic changes such as increased tumor cell proliferation, inhibited apoptosis and altered vascularization. Importantly, it facilitates significant peritumoral remodeling of the extracellular matrix environment to promote tumor progression and metastasis. However, discrepancy exists, as several studies also depict ADAMTS1 as a tumor suppressor. This article reviews the current understanding of ADAMTS1 regulation and the consequence of its dysregulation in primary cancer and ADAMTS1-mediated pathways of cancer progression and metastasis.In cancer, the remodeling of the host tissue environment is fundamental for the dismantling of normal tissue structural constraints, establishment of vascular supply and invasion of metastatic cells. For this aberrant remodeling to occur, cancers cells rely on the proteolytic activity of extracellular matrix (ECM) proteases to facilitate the degradation of structural proteins that make up the ECM. 1,2 Metalloproteases belonging to the ADAMTS family have been widely implicated in tissue remodeling events manifested in cancer development, growth and progression. [3][4][5][6][7][8][9][10][11][12][13][14] There are 19 ADAMTS proteases identified in humans. They share homology in the catalytic ADAM-metalloprotease and disintegrin domains, but differ in the variable numbers of thrombospondin-like motifs and other carboxyl-terminal domains associated with ECM interaction. 15,16 Unlike the transmembrane ADAM family, ADAMTS proteases are secreted and bind to the ECM through their C-terminal regions. 17 33 Among them, the modulated expression of ADAMTS1 has been the most characterized in cancer and is the focus of this review.ADAMTS1 was initially described as a mediator of inflammation 34 but its activity has since become appreciated in organogenesis, [35][36][37][38] blood/lymph vessel formation, [39][40][41][42][43][44][45] ovarian folliculogenesis 39 and ovulation. 23,46 In these physiological events, ADAMTS1 remodels the ECM through the proteolytic degradation of key substrates such as chondroitin sulfated proteoglycans [47][48][49][50] and collagen. 51-53 ADAMTS1 also acts as an inhibitor of angiogenesis by sequestering proangioigenic stimuli, vascular epithelial growth factor (VEGF) and preventing its interaction with its receptor. 41,45 The dysregulation of ADAMTS1 often leads to pathological manifestations of altered ECM 54-56 and/or vascular density 57-60 and many studies have highlighted its functional activity during tumorigenic transformation. 14,[61][62][63][64][65][66][67] ADAMTS1 dysregulation is linked to four of the most commonly diagnosed cancers. But, conflicting reports currently surround its exp...