Abstract

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and is associated with high levels of psychological distress. We have shown that beta-adrenergic receptors (β-ARs), which are activated by stress neurotransmitters, regulate PDAC cells via cyclic AMP (cAMP)-dependent signaling in vitro, that social stress promotes PDAC progression in mouse xenografts and that γ-aminobutyric acid (GABA) inhibits these responses in vitro and in vivo. The targeted inhibition of stress-induced regulatory pathways may abolish the potentially negative impact of psychological stress on clinical outcomes. Our current data show that chronic exposure of PDAC cell lines Panc-1 (activating point mutations in K-ras) and BXPC-3 (no mutations in K-ras) in vitro to the stress neurotransmitter epinephrine at the concentration (15 nM) previously measured in the serum of mice exposed to social stress significantly increased proliferation and migration. These responses were inhibited in a concentration-dependent manner by celecoxib. The effects of celecoxib alone and in combination with γ-aminobutyric acid (GABA) on the progression of subcutaneous mouse xenografts from the cell line (BXPC-3) most responsive to epinephrine were then investigated in the presence and absence of social stress. Cancer-stimulating factors (VEGF & prostaglandin E2 [PGE2]) and levels of cAMP were measured by immunoassays in blood and xenograft tissue. Phosphorylation of the signaling proteins ERK, CREB, Src, and AKT was assessed by ELISA assays and Western blotting. Expression of COX-2, 5-lipoxygenase, and p-5-LOX were determined by semi-quantitative Western blotting. Celecoxib alone significantly inhibited xenograft progression and decreased systemic and tumor VEGF, PGE2, and cAMP as well as phosphorylated signaling proteins in stress-exposed and stress-free mice. These responses were significantly enhanced by co-treatment with GABA. The celecoxib-induced downregulation of COX-2 protein and p-5-LOX was also significantly enhanced by GABA under both experimental conditions. Our findings identify the targeted inhibition of stress-induced pathways as a promising area for more effective cancer intervention in pancreatic cancer.

Highlights

  • Cancer is responsible for approximately 13% of deaths worldwide and remains the second-leading cause of death in the United States, accounting for nearly one in every four deaths [1]

  • Our data generated in vitro and in xenograft mouse models suggest, for the first time, that chronic exposure to epinephrine by psychological stress significantly stimulate the progression of Pancreatic ductal adenocarcinoma (PDAC) via mechanisms primarily driven by cyclooxygenase 2 (COX-2) dependent arachidonic acid metabolites

  • Our findings suggest that the selective COX-2 inhibitor celecoxib may have strong inhibiting effects on the stress-induced progression of PDAC and that combination treatment of this agent with the inhibitory neurotransmitter gamma-amino butyric acid (GABA) may significantly improve clinical outcomes in the absence and presence of psychological stress

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Summary

Introduction

Cancer is responsible for approximately 13% of deaths worldwide and remains the second-leading cause of death in the United States, accounting for nearly one in every four deaths [1]. Pancreatic cancer is the fourth-leading cause of cancer-related deaths in developed countries and has a 5-year survival rate below 5% [2,3]. It is one of the most deadly neoplastic diseases, as it is typically asymptomatic until it has reached an advanced stage when effective treatments are unavailing. At the time of diagnosis, most pancreatic cancers are inoperable and have metastasized to distant organs. This malignancy is generally unresponsive to conventional radio-and chemotherapy, resulting in a mortality rate near 100% within 6 months of diagnosis [3]. Novel strategies for the improvement of pancreatic cancer intervention are urgently needed

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