[5][6] Basic helix-loop-helix (bHLH) transcription factors have been implicated in cell lineage determination and differentiation.

Moreover, Twist plays an important role in some physiological processes involved in metastasis, like angiogenesis, invadopodia, extravasation, and chromosomal instability.

[17] Here and in epithelial ovarian cancer, Twist1 has been shown to be involved in evading apoptosis, making the tumour cells resistant against platinum-based chemotherapeutic drugs like cisplatin.

[16][18] Moreover, Twist1 has been shown to be expressed under conditions of hypoxia, corresponding to the observation that hypoxic cells respond less to chemotherapeutic drugs.

The underlying mechanism is not completely understood, but it has been implicated in the upregulation of matrix metalloproteinases[19] and inhibition of TIMP.