| Cancer stem cells (CSC) constitute a small area of the tumor mass and are characterized by self-renewal, differentiation
and the ability to promote the development of secondary chemo-resistant tumors. Self-renewal of
CSCs is regulated through various signaling pathways including Hedgehog, Notch, and Wnt/β-catenin pathways.
A few surface markers have been identified, which provide a means of targeting CSCs according to tumor type.
Depending on the proximity of CSCs to the tumor hypoxic niche, hypoxia-inducible factors (HIFs) can play a
critical role in modulating several CSC-related characteristics. For instance, the upregulation of HIF-1 and HIF-2
at tumor sites, which correlates with the expansion of CSCs and poor cancer prognosis, has been demonstrated.
In this review, we will discuss the mechanisms by which hypoxia enhances the development of CSCs in the tumor
microenvironment. Targeting HIFs in combination with other common therapeutics is pre-requisite for effective
eradication of CSCs. |