The role of tumor microenvironment has been demonstrated for a long time during tumor progression. Tumor stroma develops and evolves as a result of multiple interactions between carcinoma and mesenchymal cells, involving a reactive extracellular-matrix mediating a complex signalization. The timing of disease progression is critical in predicting clinical outcome and treatment response.
During carcinoma progression, cancer-associated fibroblasts (CAF) promote cancer invasion, angiogenesis, metastasis and resistance to chemotherapy. Other cell types participate to these interactions including mesenchymal, inflammatory and endothelial cells. Some of them may be derived from the tumor itself, along a process called epithelial mesenchymal transition (EMT). During this process, partially dedifferentiated carcinoma epithelial cells loosen cell–cell adhesion structures. They modulate their polarity, cytoskeleton organization and typically express vimentin filaments and downregulate cytokeratins. They become motile, resistant to anoikis and, depending on the tumor type, may become difficult to distinguish from bona fide mesenchymal cells. EMT was originally defined in the context of developmental stages, including heart morphogenesis, mesoderm and neural crest formation. The relevance of the EMT concept in carcinoma environment is supported by in vitro and in vivo models using transformed epithelial cells. It is also reinforced by the raising interest in circulating tumor cells, typically resulting from an EMT process. Transduction pathways typical of embryogenic EMT in vivo were also found to be activated during cancer progression. They converge on the activation of several families of transcription factors including Snail, Twist and Zeb families. More recently, it has been found that these pathways determine an increased phenotypic plasticity linked to cellular stemness and tumor initiating potential. They are also linked to apoptosis resistance, following chemotherapy or radiotherapy. Finally, direct connection has been observed between EMT transcription factors and tumor recurrence.

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Hair Therapy and Transplantation

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