Research Article For reprint orders, please contact: reprints@futuremedicine.com Expression pattern of ALDH1, E-cadherin, Vimentin and Twist in early and late onset sporadic colorectal cancer Litika Vermani 1 , Rajeev Kumar* ,2 , Rengaswamy R Kannan 2 , Monoj K Deka 3 , Anuradha Talukdar 2 & Nachimuthu S Kumar 1 1 Mizoram University, Biotechnology, Aizawl, Mizoram 796004, India 2 Cachar Cancer Hospital & Research Centre, Research Silchar, 788015, India 3 Silchar Medical College & Hospital, 788015, India *Author for correspondence: Tel.: +91 700 246 8599; rajeev.kvhfc@gmail.com Aim: To evaluate the expression pattern of ALDH1 (aldehyde dehydrogenase 1), E-cadherin, Vimentin and Twist in early and late onset sporadic colorectal cancer (CRC) and to study association of their expres- sion with the occurrence of CRC at a young age. Materials & methods: Immunohistochemistry of ALDH1, E-cadherin, Vimentin and Twist was performed on 103 pretreated CRC biopsy samples. Results: ALDH1 ex- pression was found to have strong correlation with early onset CRC (p < 0.0001). Conclusion: High ALDH1 expression correlates with the early onset of CRC. ALDH1 over-expression correlates with poor overall survival in colon cancer. First draft submitted: 10 April 2020; Accepted for publication: 30 July 2020; Published online: 16 October 2020 Keywords: ALDH1 • cancer stem cell • E-cadherin • epithelial mesenchymal transition • twist • Vimentin • young colorectal cancer Colorectal cancer (CRC) remains the third most common cancer with 1,849,518 new cases reported and it is the second highest leading cause of cancer-related deaths (880,792) worldwide in 2018, despite new advancements in its screening, diagnosis and medicine [1,2]. The same report describes the highest incidence of CRC in Asian countries (51.8%) followed by Europe (27%), North America (9.7%), Latin America and Caribbean (6.9%), Africa (3.3%) and Oceania (1.2%) countries. The highest incidence of CRC is seen in countries with a very high human development index (HDI), like the USA where CRC cancer is the third most common cancer [3]. An increase in the prosperity of a developing nation like India and eastern European countries, with the rise in their HDI, has witnessed an increase in the incidence of CRC in their countries, while developed countries including western European countries, USA and Australia have very high HDI and reported a decline or plateau in the incidence and mortality of CRC in patients who are older than 50 years of age, which may be due to the large population-based screening intervention and availability of better cancer care treatment facilities. Although, incidence and mortality rates in CRC patients who are less than 50 years of age appears to be on rising trend [4–6]. In Europe, CRC incidence increased with 7.9, 4.9 and 1.6% per year among subjects aged 20–29, 30–30 and 40–49 years, respectively from 2004 to 2016 [7]. Globally, the similar trend suggests there is a rising incidence of CRC in patients who are less than 50 years of age in the USA, Australia, Canada, the UK, Brazil, Japan, China and India for reasons that are not yet clear [8,9]. Clinical behavior of a young patient with CRC shows aggressive tumor biology and quite often they present with an advanced stage (stage III or IV) node positive or metastasis [10]. Considering the global surge in the incidence at a young age, CRC cases that often come with aggressive tumor biology, and due to the lack of supporting data that could have explained the reason behind this trend, it is imperative to investigate the key pathways like epithelial-to-mesenchymal transition (EMT) and cancer stem cells (CSC) that are reported to enhance the spread of tumor cells and subsequently promote metastatic potential in the current context. The epithelial-to-mesenchymal transition is a biological process where epithelial cells acquire the mesenchymal properties that help them in the migration from one site to another within the body [11]. EMT induction in Biomark. Med. (Epub ahead of print) ISSN 1752-0363 10.2217/bmm-2020-0206 C  2020 Future Medicine Ltd