Iron can also enter cells via CD44 in complexes bound to hyaluronic acid during epithelial–mesenchymal transition (EMT). In this process, epithelial cells transform into mesenchymal cells with detachment from the basement membrane, to which they’re normally anchored, paving the way for the newly differentiated motile mesenchymal cells to begin migration away from the epithelial layer.
While EMT plays a crucial role in physiological processes like implantation, where it enables the embryo to invade the endometrium to facilitate placental attachment, its dysregulation can also fuel the malignant spread of tumors empowering them to invade surrounding tissues and establish distant colonies (metastasis).
Malignant cells often exhibit a heightened demand for iron, fueling their transition towards a more invasive mesenchymal state. This iron is necessary for the expression of mesenchymal genes, like those encoding transforming growth factor beta (TGF-β), crucial for EMT. Notably, iron’s unique ability to catalyze protein and DNA demethylation plays a vital role in this gene expression process.
Conventional iron uptake pathways, such as those using the transferrin receptor 1 (TfR1), often prove insufficient to meet these elevated iron demands in cancer cells. As a result, various cytokines and growth factors trigger the upregulation of CD44, a surface molecule capable of internalizing iron bound to the hyaluronan complex. This alternative pathway, relying on CD44-mediated endocytosis, becomes the dominant iron uptake mechanism compared to the traditional TfR1-dependent route.