In fact, in addition to two key transcription factors, Snail and Twist, various signaling pathways could also be responsible factors such as Notch, tumor necrosis factor-alpha (TNFα), transforming growth factor beta (TGF-β), and hypoxia-inducible factor-1 alpha (HIF1α), which are involved in the induction of EMT in pancreatic cancer cells [65]. Here, TWIST1 is linked to familial pancreatic carcinoma.