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ResearchIn-Press PreviewAngiogenesisOncology Open Access | 10.1172/JCI190596

PAX5 modulates vascularization and contributes to neuroendocrine lineage transition during carcinoma progression

Ailing Wu,1 Yujie Hao,1 Xuemiao Yan,1 Junrong Liu,1 Lin Wang,1 Yan Jin,1 Wenxu Liu,1 Xiyue Chen,1 Yuan Jiang,2 Luc Girard,3 Zhiqun Shang,4 Jun Yan,5 Zhenfa Zhang,2 Wenchen Gong,6 Yuanjie Niu,4 Benjamin J. Drapkin,3 John D. Minna,3 Lance S. Terada,7 Zhenyi Ma,1 and Zhe Liu1

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Wu, A. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Hao, Y. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Yan, X. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Liu, J. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Wang, L. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Jin, Y. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Liu, W. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Chen, X. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Jiang, Y. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Girard, L. in: PubMed | Google Scholar |

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Shang, Z. in: PubMed | Google Scholar |

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Yan, J. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Zhang, Z. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Gong, W. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Niu, Y. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Drapkin, B. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Minna, J. in: PubMed | Google Scholar |

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Terada, L. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Ma, Z. in: PubMed | Google Scholar

1Zhejiang Key Laboratory of Medical Epigenetics, Jiande Hospital, Department, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

2Department of Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

3Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, United States of America

4Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin, China

5Department of Pathology, Tianjin First Center Hospital, Tianjin, China

6Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

7Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Liu, Z. in: PubMed | Google Scholar

Published July 23, 2026 - More info

J Clin Invest. https://doi.org/10.1172/JCI190596.
Copyright © 2026, Wu et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published July 23, 2026 - Version history
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Abstract

Human carcinomas often gain aggressive characteristics and escape cell-type specific treatment regimens through cryptic shifts in lineage states. However, the underlying mechanisms that govern lineage plasticity in carcinomas are undefined. Here in this study, we found that PAX5, a neural/lymphatic transcription factor, contributed to neuroendocrine (NE) lineage transition. PAX5 was highly expressed in aggressive human NE carcinoma cells and tissues but not in non-NE cancer cells and tissues. Deletion of Pax5 in Rb1fl/fl;Trp53fl/fl mice caused a reduction of tumor vessels, loss of NE morphologic features and decreased expression of ASCL1, NCAM, and SYP, whereas ectopic expression of PAX5 in CC10-rtTA;TetO-hEGFRex19del/T790M mice adenocarcinomas and in LNCAP prostate cancer xenografts induces an angiogenic microenvironment and NE morphology. Importantly, antiangiogenic drugs reduced NE features of Rb1fl/fl;Trp53fl/fl tumors and blocked PAX5-induced NE transformation. These studies demonstrate an essential role of angiogenic microenvironment in transition/maintenance of NE lineage, suggesting that targeting PAX5 and its downstream signaling may modulate lineage transitions responsible for treatment failure in both SCNCs and adenocarcinomas.

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