Cited by 229Cancer Cells and MetastasisColorectal Cancer Treatments and StudiesEpigenetics and DNA Methylation

Progressive plasticity during colorectal cancer metastasis

Open access
Moorman, Andrew, Benitez, Elizabeth K., Cambuli, Francesco, Jiang, Qingwen, Mahmoud, Ahmed, Lumish, Melissa, Hartner, Saskia, Balkaran, Sasha +31 more·2025·Nature

Published version of a preprint

Abstract

As cancers progress, they become increasingly aggressive—metastatic tumours are less responsive to first-line therapies than primary tumours, they acquire resistance to successive therapies and eventually cause death1,2. Mutations are largely conserved between primary and metastatic tumours from the same patients, suggesting that non-genetic phenotypic plasticity has a major role in cancer progression and therapy resistance3–5. However, we lack an understanding of metastatic cell states and the mechanisms by which they transition. Here, in a cohort of biospecimen trios from same-patient normal colon, primary and metastatic colorectal cancer, we show that, although primary tumours largely adopt LGR5+ intestinal stem-like states, metastases display progressive plasticity. Cancer cells lose intestinal cell identities and reprogram into a highly conserved fetal progenitor state before undergoing non-canonical differentiation into divergent squamous and neuroendocrine-like states, a process that is exacerbated in metastasis and by chemotherapy and is associated with poor patient survival. Using matched patient-derived organoids, we demonstrate that metastatic cells exhibit greater cell-autonomous multilineage differentiation potential in response to microenvironment cues compared with their intestinal lineage-restricted primary tumour counterparts. We identify PROX1 as a repressor of non-intestinal lineage in the fetal progenitor state, and show that downregulation of PROX1 licenses non-canonical reprogramming. Colorectal cancer metastasis involves dramatic plasticity and loss of PROX1-mediated repression of non-intestinal lineages.

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  • CRC cells exhibit remarkable cellular plasticity to survive treatment, transitioning into alternative cell states under therapeutic pressure.

    “Recent studies suggest that CRC cells also exhibit remarkable cellular plasticity to survive treatment, transitioning into alternative cell states under therapeutic pressure.”
  • In colorectal cancer, PROX1 has been described as suppressing lineage plasticity by repressing nonintestinal genes.

    “Interestingly, in the context of colorectal cancer, PROX1 has been recently described as suppressing lineage plasticity by repressing nonintestinal genes64, supporting the notion that it can prevent cell fate plasticity and cancer.”
  • In advanced colorectal cancer stages, the tumour niche (primary versus different sites of metastasis) and host-specific factors are important factors in establishing an immunosuppressive CMS4-like colorectal cancer.

    “Therefore, in advanced CRC stages, the tumour niche (primary vs different sites of metastasis) and host specific factors are important factors in establishing an immunosuppressive CMS4-like CRC.125”

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Authors
Moorman, A., Benitez, E. K., Cambuli, F., Jiang, Q., Mahmoud, A., Lumish, M., Hartner, S., Balkaran, S., Bermeo, J., Asawa, S., Firat, C., Saxena, A., Wu, F., Luthra, A., Burdziak, C., Xie, Y., Sgambati, V., Luckett, K., Li, Y., Yi, Z., Masilionis, I., Soares, K., Pappou, E., Yaeger, R., Kingham, T. P., Jarnagin, W., Paty, P. B., Weiser, M. R., Mazutis, L., D’Angelica, M., Shia, J., Garcia-Aguilar, J., Nawy, T., Hollmann, T. J., Chaligné, R., Sanchez-Vega, F., Sharma, R., Pe’er, D., & Ganesh, K.
Affiliations
Memorial Sloan Kettering Cancer Center (US)
Corresponding author
  • Pe’er, Dana
  • Ganesh, Karuna
Venue
Nature
Published
2024-10-30
Volume
637
Issue
8047
Pages
947-954
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W4403921034
Cited by
229
References
114
Citations by year
2026: 125 · 2025: 83 · 2024: 17 · 2023: 3 · 2022: 1
FWCI
38.19
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion, cc-by-nc-nd)
  • bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Science Foundation
  • Damon Runyon Cancer Research Foundation
  • Memorial Sloan-Kettering Cancer Center (P30 CA008748)
  • Pershing Square Sohn Cancer Research Alliance
  • National Institutes of Health
  • Stand Up To Cancer (Convergence 3.1416, 3.1416)
  • National Cancer Institute (U2CCA233284, U54CA209975, K08CA230213, P30CA008748, R37CA266185, U54CA274492)
  • National Institute of General Medical Sciences (T32GM007739, T32GM152349)
  • National Institute of Biomedical Imaging and Bioengineering (R01EB027498)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
Keywords
colorectal cancer metastasis, phenotypic plasticity, Prox1, Lgr5, squamous differentiation, neuroendocrine differentiation, multilineage differentiation, patient-derived organoids, chemoresistance, tumor microenvironment, patient survival

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