Interstitial fluid flow in cancer: implications for disease progression and treatment

Jennifer M. Munson is a biomedical engineer at the Fralin Biomedical Research Institute at Virginia Tech Carilion, where she directs the Cancer Research Center and runs a laboratory on tumour microenvironment fluid dynamics. Her programme — one of a handful of laboratories worldwide investigating interstitial flow as a tumour-progression variable — concentrates on glioblastoma, the deadliest form of brain cancer, where elevated interstitial fluid pressure and flow alter cell migration, drug delivery, and immune-cell trafficking. Adrian Shieh was a postdoctoral collaborator at the time of the paper.

Published in Cancer Management and Research (an open-access Dove Press journal) in October 2014, the piece is a synthesising review of the cancer-and-interstitial-flow literature. The argument the review consolidates is that the elevated interstitial fluid pressure characteristic of solid tumours is not merely a biophysical curiosity but a driver of disease progression: flow gradients across the tumour invasive edge promote cell migration, elevated pressure limits convective drug delivery, and the interstitial flow itself activates mechanotransduction pathways in stromal and tumour cells that alter the microenvironment in metastasis-favouring ways.

The piece sits as a clinically-oriented secondary review that connects the Wiig-Swartz basic-science synthesis to the oncology-clinical literature. The review is a good entry point for understanding why the interstitium matters therapeutically: tumour interstitial pressure is a measurable variable that correlates with prognosis and treatment response, and modulating it (anti-angiogenic agents, hyaluronidase, pressure-sensitive drug-delivery vehicles) is an active clinical-research direction. Munson's subsequent work has built specifically the 3D tissue- engineered models of glioblastoma microenvironment that the review's framing motivates.

The stake is clinical-translational and scientific. Munson has been funded by NIH and the National Cancer Institute on the interstitial-flow-in-glioblastoma programme; the review is an agenda-setting piece for the subfield she has helped build. None of the work has direct commercial application yet, but the clinical motivation is substantial — glioblastoma's resistance to chemotherapy is partly a drug-delivery problem, and the interstitial-flow account explains why. Read this review for the cancer-flow connection; the Wiig-Swartz review for the foundational physiology.