29/12/2025
ECM Remodelling in the Metastatic Cascadeπ
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Intravasation and survival in circulation
At the primary tumour site, intense angiogenesis and high matrix metalloproteinase (MMP) activity disrupt normal vascular architecture. This leaky and disorganized vasculature allows tumour cells to intravasate and enter the bloodstream.
Once in circulation, tumour cells become circulating tumour cells (CTCs). Some CTCs secrete or associate with extracellular matrix (ECM) components, which can shield them from immune recognition and enhance their survival under shear stress.
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Interactions with neutrophils and NETs
CTCs do not travel alone in the circulation. They can form matrix-like interactions with neutrophil extracellular traps (NETs) and NETotic neutrophils.
These interactions are mediated by integrins expressed on both CTCs and neutrophils. NETβCTC binding promotes CTC survival, clustering, and arrest within the vasculature, increasing the likelihood of metastatic seeding.
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Endothelial ECM remodelling and extravasation
At distant organs, endothelial cells actively participate in ECM remodelling. They deposit and assemble fibrillar fibronectin on the endothelial surface, which promotes adhesion of CTCs to the vessel wall.
Elevated MMP activity further increases vascular permeability. This leaky vasculature facilitates CTC extravasation into the surrounding tissue, marking a critical step in metastatic colonization.
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Formation of the pre-metastatic niche
Primary tumours release a wide range of factors into the circulation, including growth factors, MMPs, lysyl oxidase (LOX), ECM proteins such as fibronectin, and tumour-derived exosomes.
These signals act at distant organs to establish a pre-metastatic niche. This niche primes the local tissue environment to become permissive for incoming tumour cells even before their arrival.
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Stromal activation and ECM deposition
Within the pre-metastatic niche, stromal cells respond to tumour-derived factors and become activated.