Epithelial mesenchymal transition and cancer stem cells in esophageal adenocarcinoma originating from barrett's esophagus

Carcinomas comprise cohesive epithelial cells linked to one another by E-cadherin-based cell-cell junctions. Epithelial mesenchymal transition (EMT) enables carcinoma cells to migrate from the original tissue and invade into stromal components. The E-cadherin promoter is frequently repressed by specific transcriptional repressors including Snail, Slug and Twist. CD133 is known to be a marker of tumor-initiating cells in human cancers. This is the first study to characterize the transcriptional factors for E-cadherin and the representative cancer stem cell marker in specimens of early esophageal adenocarcinoma (EAC) originating from Barrett's esophagus. Ten surgically treated patients were analyzed in the present study. Immunohistochemistry was performed to determine the expression of Snail, Slug, Twist and CD133, and the results were scored. Unlike previous studies of advanced stage esophageal cancers showing the overexpression of each specific transcriptional protein, the invading edges of the tumor were found to abundantly express Snail, Slug, Twist and CD133 in our cohort. Therefore, results of this study suggest that early stage cancers predominantly comprise cells with metastatic potential and this evidence adds legitimacy to the complete removal of early EAC.