EditorialPancreatic Ductal Adenocarcinoma (PDAC) is one of the most aggressive and lethal tumors, representing the fourth most common cause of cancer death in the Western world, with an estimated incidence of more than 40,000 cases per year in the United States. Despite continuous progress in imaging, surgical techniques, intensive care, and chemotherapeutic approaches, the current overall 5-year survival is less than 6%.
1,2In carcinoma progression, including PDAC, cancer cells acquire their metastatic phenotype undergoing a complex step-wise process defined as Epithelial-To-Mesenchymal Transition (EMT), leading to a "phenotypic switch" of epithelial cells to mesenchymal cells.
3The epithelial phenotype is characterized by distinct, well demarcated intercellular adhesive structures, and apical-basal polarity, all mediated by the expression of E-cadherin on the plasma membrane of the cell. The EMT-related phenotype of carcinoma cells is characterized by the loss of epithelial features, including loss of cell adhesion and polarity, down-regulation of E-cadherin, cytoskeleton reorganization by expressing vimentin and α-Smooth Muscle Actin (αSMA). Moreover, the acquisition of motile properties and secretion of Matrix Metalloproteinases (MMPs) leads to the disruption of basement membranes.
3The key event of EMT is considered the loss of E-cadherin, a transmembrane glycoprotein with its intracellular domain linked to β-catenin to form the E-cadherin/β-catenin complex, mediating cell-cell adhesion and playing a major role in the control of epithelial cell architecture, differentiation and phenotype.Interestingly, the EMT process can exhibit different characteristics in different carcinoma cells, therefore sometimes is difficult to recognize the typical EMT-related phenotype and the events responsible of carcinoma progression. This is evident in PDAC, since it was shown that 6 out of 7 PDAC cell lines maintain E-cadherin expression on the cell membrane, and that the expression of some EMT markers in PDAC are similar than in benign pancreatic ducts. 4 The point is: how is it possible that PDAC cells exhibiting highly invasive and malignant behavior retain a differentiated epithelial phenotype? Do these cells undergo EMT? Moreover, what is the role of E-cadherin in these cells?To understand this apparent inconsistency, we have to consider that some invasive and metastatic carcinoma cells possess morphological and molecular characteristics typical of welldifferentiated epithelia, including high levels of E-cadherin and the presence of cell junctions and cell polarity, possibly due to an incomplete EMT.5 Carcinoma cells exhibiting an epithelial morphology were described also in prostate 6 and breast cancer.
7,8Moreover, EMT is not an "all or nothing" event, but rather a multistep process that manifests in a broad range of phenotypic changes, not occurring consecutively and not all necessarily present in a given sample. 6 According to this suggestion, epithelial-related phenotype and mesenchymal markers can be concomitantly...