AbstractHyaluronan, one of the major components of the extracellular matrix (ECM), surrounds and protects neighboring cells from diverse stresses. Hyaluronan promotes epithelial-to-mesenchymal transition (EMT) and metastasis in various epithelial cancers. However, the mechanism by which the hyaluronan network built up by cancer cells regulates cancer progression and metastasis in the tumor microenvironment has not been elucidated in detail. In this study, ITIH2, a hyaluronan-binding protein that participates in building a hyaluronan network, was confirmed to be secreted from mesenchymal-like lung cancer cells when co-cultured with cancer-associated fibroblasts. ITIH2 was transcriptionally upregulated by ZEB1, an EMT-inducing transcription factor. Hyaluronic acid synthase-2 (HAS2) was also up-regulated by ZEB1, and the expression of HAS2 and ZEB1 showed a positive correlation in the TCGA database. In addition, ZEB1 controlled alternative splicing and isoform expression of CD44, a hyaluronan receptor. Interestingly, ITIH2 knockdown and 4-methylumbelliferone (4-MU), a HAS inhibitor, reduced the formation of hyaluronan cables and inhibited the migration and invasion of lung cancer cells. Likewise, when lung cancer cells were treated with “Compound S,” an ITIH2 inhibitor predicted by a deep learning-based drug-target interaction algorithm, the formation of hyaluronan cables and cell migration were suppressed. In addition, the ITIH2 inhibitor prevented the growth of metastatic tumors in an orthotopic lung cancer mouse model. Collectively, the EMT signal controlled by ZEB1 establishes the pro-metastatic hyaluronan network in the tumor microenvironment, suggesting a novel strategy for targeting the hyaluronan network to suppress lung cancer progression and metastasis.Citation Format: Sieun Lee, Jihye Park, Eun Ju Kim, Sungsoo Park, Jonathan M. Kurie, Young-Ho Ahn. ZEB1-driven reconstruction of the hyaluronan network establishes a pro-metastatic microenvironment in lung adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5860.