Abstract Multiphoton microscopy of live animals (IVI) has revolutionized our understanding of cancer metastasis. IVI demonstrates that TMEM, the intravasation doorway, composed of a three cell complex: Mena-Hi tumor cell, endothelial cell and Tie2-Hi/VEGF-Hi macrophage, is the only site in breast tumors where tumor cell intravasation occurs1. During tumor progression, macrophage progenitor cells undergo unidirectional transition from migratory to TMEM-associated macrophages2. During and after this macrophage programming, tumor cells migrate with macrophages and chemotax with high persistence to blood vessels under the control of HGF gradients3 arriving at TMEM1. The TMEM structure itself, as well as the signaling pathways unique to tumor cells interacting with TMEM, have been validated as prognostic markers for predicting metastasis in breast cancer patients4-6. These were the first markers of metastasis in clinical use derived from multiphoton intravital imaging. TMEM are found in both primary and metastatic tumor sites of breast cancer7 and in primary and metastatic sites of pancreatic ductal and neuro-endocrine tumors. Clinical trials of TMEM inhibitors, targeting TMEM in both primary and secondary sites8,9, are now underway in breast cancer patients (clinical trials study number NCT02824575). As tumor cells interact with TMEM, MenaINV. expression in the tumor cells occurs in response to macrophage-induced NOTCH signaling10, which drives invadopod assembly/ function, and metastatic seeding11,12. MenaINV expression is necessary for invadopod-mediated transendothelial migration during intravasation at TMEM13 and assures the efficient dissemination of seeding competent and non-dividing tumor cells which, after a delay, contribute to metastatic recurrence at multiple systemic sites. These findings support TMEM as a critical therapeutic target for inhibiting breast cancer metastasis. 1.Harney, A.S. et al. (2015) PMC4560669 2.Arwert, E.N. et al. (2018) PMC5946803 3.Leung, E. et al. (2017) PMC5426963 4.Karagiannis, G.S. et al (2016) PMC4893654 5.Rohan, T.E. et al. (2014) PMC4133559 6.Sparano, J.A. et al. (2017)PMC5678158 7.Entenberg, D. et al. (2018)PMC5755704 8.Harney, A.S. et al. (2017)PMC5669998 9.Karagiannis, G.S. et al. (2017) PMC5592784 10.Pignatelli, J. et al. (2016) PMC5129016 11.Eddy, R.J. et al (2017) PMC5524604 12.Linde, N. et al. (2018) PMC5750231 13.Pignatelli, J. et al.(2014) PMC4266931 Citation Format: Condeelis J. High resolution intravital imaging of the mechanism of how breast cancer initiates and sustains systemic dissemination [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr BS1-1.
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