Pancreatic Adenocarcinoma Research Articles

PRIM2 promotes proliferation and metastasis of pancreatic ductal adenocarcinoma through interactions with FAM111B

PRIM2 promotes proliferation and metastasis of pancreatic ductal adenocarcinoma through interactions with FAM111B

Abstract C043: Alprazolam abrogates the secretion of proinflammatory cytokines in PDAC CAFs

Abstract The present study sets out to determine how commonly prescribed triazolobenzodiazepines (triazoloBZDs) modulate the tumor microenvironment in pancreatic ductal adenocarcinoma (PDAC), and how this can be leveraged therapeutically to improve patient outcomes. PDAC is one of the most lethal cancer subtypes with a 5-year survival rate of ∼13%. The poor prognosis of this disease is, in part, attributable to the dense, fibrotic tumor microenvironment (TME), and lack of durable responses to standard-of-care treatment options. A recent study from our lab reported that over 40% of PDAC patients at Roswell Park are prescribed benzodiazepines (BZDs) to manage anxiety, nausea, and other disease-related side effects. Importantly, survival outcomes in these patients varied in a compound-specific manner, as the usage of the n-unsubstituted BZD lorazepam was associated with poorer outcomes, while usage of the n-substituted triazoloBZD alprazolam was associated with improved progression-free survival. In vitro and in vivo data from the aforementioned study suggested that these findings may be a result of BZD-specific regulation of interleukin-6 (IL6), a proinflammatory cytokine with a known role in PDAC pathogenesis. More specifically, alprazolam-treated cancer-associated fibroblasts (CAFs) exhibited a potent reduction in IL6 transcription and secretion, while lorazepam treatment increased IL6 production. Based on these data, we hypothesized that triazoloBZDs may uniquely reduce intratumoral inflammation to alleviate immunosuppression in PDAC. We now find that triazoloBZDs such as alprazolam suppress the secretion of several proinflammatory cytokines (IL6, CCL2, CXCL12, IL8) by CAFs, the stromal components of the PDAC TME responsible for fibrosis and exclusion of immune infiltrates. Furthermore, we have observed that this phenotype is likely a result of triazoloBZD-mediated inhibition of the platelet- activating factor (PTAFR) signaling cascade. Investigations are currently underway to determine the impact of triazoloBZDs on regulating the immune landscape of the PDAC TME in vivo. Altogether, these findings provide a basis to inform clinical selection of BZDs for symptom management and present a novel therapeutic opportunity to repurpose FDA-approved compounds for treatment of PDAC. Citation Format: Hunter D. Reavis, Arwen A. Tisdale, Kathryn E. Maraszek, Michael E. Feigin. Alprazolam abrogates the secretion of proinflammatory cytokines in PDAC CAFs [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C043.

Abstract PR015: Sepsis-induced inflammation alters natural killer cell-mediated surveillance of liver metastasis

Abstract A majority of pancreatic ductal adenocarcinoma (PDAC) patients who undergo surgery for primary tumor resection will develop lethal metastases, despite having no evidence of metastasis at the time of their initial diagnosis. Liver metastases constitute nearly half of recurrences detected within the first six months following PDAC resection. Several clinical and experimental studies provide evidence that perioperative inflammation, including infectious complications like sepsis, positively correlates with liver metastasis across several malignancies. Despite these observations, it is still unknown whether there is a causal link between perioperative inflammation and PDAC liver metastasis. To gain mechanistic insight into the regulation of PDAC liver metastasis in the context of perioperative inflammation, we established mouse models that combine experimental PDAC liver metastasis with either the cecal ligation and puncture (CLP) model of polymicrobial sepsis or the lipopolysaccharide (LPS) model of acute sterile endotoxemia. Mice challenged with CLP prior to seeding PDAC cells in the liver had increased metastatic burden at endpoint compared to sham laparotomy controls. In contrast, mice challenged with LPS prior to PDAC cell seeding had reduced metastatic burden at endpoint compared to PBS-injected controls. We hypothesized that these opposing pro- and anti-metastatic effects of CLP and LPS, respectively, were due to qualitatively distinct inflammatory responses elicited in the liver. Our profiling of the host response to either CLP or LPS revealed shared systemic changes, including activation of the acute-phase protein response. However, LPS-associated inflammation uniquely upregulated a distinct set of interferon-regulated genes in the liver important for modifying immune cell activity (i.e., Ccl2, Ccl5, Cxcl9, Cxcl10). Accordingly, immunostaining and flow cytometry of the liver revealed that LPS uniquely increased the abundance of activated natural killer (NK) cells and MPO+ myeloid cells. We utilized Tlr4 -/- mice, which lack the primary receptor for LPS, to determine that the anti-metastatic effect of LPS required a host-facilitated response downstream of TLR4-mediated signaling. Through a series of genetic models and short-term depletion experiments, we determined that NK cells restrict PDAC cell seeding and outgrowth in our experimental liver metastasis model, and that this protective effect is further enhanced by activation of type-I interferon signaling in the host. Our findings confirm prior work identifying NK cell-mediated surveillance of disseminated cancer cells as an important mechanism in protecting against liver metastasis and show sterile endotoxemia and its associated inflammation establish a protective ‘anti-metastatic niche’ marked by enhanced NK cell activity. Further insights into the establishment of this niche may reveal potential therapeutic strategies to reduce the incidence of liver metastasis among resected PDAC patients. Citation Format: Nicole Sivetz, Patrick J. Cunniff, Christopher R. Vakoc, Semir Beyaz, Mikala Egeblad. Sepsis-induced inflammation alters natural killer cell-mediated surveillance of liver metastasis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR015.

Abstract A006: Investigating the effects of fibroblasts derived from the primary versus the metastatic organ on 3D biomimetic models of pancreatic cancer

Abstract Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer death in the United States with a 5-year survival rate of only 13%. Early diagnosis is very difficult and thus 53% of patients are diagnosed after metastasis has already occurred, with the liver being the most frequently affected site. Both primary tumors and metastases have dense desmoplastic stroma due to a high percentage of fibroblasts within the tumor microenvironment (TME). Previously, we developed a tunable 3D biomimetic model of the liver metastatic niche (LMN) to investigate how local fibroblasts affect tumor growth and chemoresistance in PDAC liver metastasis. This study aims to investigate the contributions of fibroblasts at the primary versus metastatic sites. We used matched primary PDAC and liver metastatic (LM) organoids derived from the Kras+/LSL-G12D; Trp53+/LSL-R172H; Pdx1-Cre (“KPC”) genetically engineered mouse model. This allows us to compare the effects of primary PDAC cancer associated fibroblasts (CAFs) and liver metastasis associated fibroblasts (MAFs) on tumor cell growth and chemoresistance. Rheometry analyses were conducted to study the impact of local fibroblasts on the extracellular matrix (ECM) stiffness. Our results showed that both storage and loss moduli were enhanced only when PDAC CAFs were present in the co-cultured gels compared to gels with MAFs. Additionally, the 3D biomimetic model showed fibroblasts increased tumor growth and chemoresistance to gemcitabine, only when they were derived from the same site as the tumor cells. This highlighted the importance of studying the organ-specific microenvironment to develop better treatment options for patients with metastatic PDAC. To delve deeper into the molecular basis of these observations, we conducted RNA-sequencing to identify and compare the gene expression profiles in primary and metastatic tumor organoids exposed to conditioned media from CAFs and MAFs using a transwell membrane co-culture model. Our results showed significant differences in gene expression based on the type of fibroblasts co-cultured with the organoids. Moreover, we investigated the role of MAF-derived exosomes on LM growth and chemoresistance using exosome depletion and direct exosome addition to LM organoids. Lastly, we performed exosomes size and distribution characterizations using dynamic light scattering (DLS) analysis. Taken together, these findings highlight the critical role of the organ-specific microenvironment in tumor progression and the necessity of targeted therapies to improve patient outcomes in metastatic PDAC. Our results underscore the importance of developing a tunable 3D biomimetic model of the LMN, as it enables the testing of novel therapeutic strategies designed to disrupt interactions between MAFs and tumor cells, and potentially advancing treatments for metastatic PDAC. Citation Format: Mahsa Pahlavanneshan, Weikun Xiao, Eileen Fung, Vaidhyanathan Mahaganapathy, Chae Young Eun, Chang-Il Hwang, Shannon Mumenthaler, Reginald Hill. Investigating the effects of fibroblasts derived from the primary versus the metastatic organ on 3D biomimetic models of pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A006.

Abstract B041: Investigating the impact of extracellular matrix stiffness on macrophage function and organoid growth in pancreatic ductal adenocarcinoma

Abstract Pancreatic ductal adenocarcinoma (PDAC) has a 5-year survival rate of only 11%. Current treatments mostly target the cancer cells themselves and have not been able to significantly improve survival rates, meaning there is an urgent need for novel therapies. PDAC is unique among solid tumors because it exhibits extensive desmoplasia that is characterized by an abundance of extracellular matrix (ECM) components. In recent years, an increasing body of work has shown that cancer tissue is stiffer than normal tissue by a factor of 3 or more. This increase in ECM stiffness has been shown to play an important role in affecting cell-to-cell communication as well as cancer progression and chemoresistance . However, how ECM stiffness affects tumor-associated macrophages, an important component of the pancreatic tumor microenvironment (TME), is still understudied. Previous studies have demonstrated that macrophages are highly responsive to mechanical cues, with the mechanical environment influencing macrophage polarization and function in a context- and disease-dependent manner. Elucidating these potential changes in PDAC can provide us with insights on how stiffness affects therapeutic outcome. Healthy pancreatic tissue typically exhibits a storage modulus of approximately 0.5-1 kPa, whereas PDAC tissue can range from 4-10 kPa. To study macrophage responses to varying stiffness, we cultured RAW264.7 mouse macrophage cell lines on 2D substrates with stiffness levels of 0.2, 2, and 8 kPa. We observed that macrophages cultured on stiffer matrices exhibited a trend toward a pro-inflammatory phenotype, with increased expression of M1 markers such as iNOS, IL-1β, and IL-6, compared to those cultured on softer matrices. However, conditioned media from macrophages cultured on both soft and stiff substrates similarly reduced the size of PDAC organoids, indicating a lack of functional difference between these groups. These findings suggest the need for more sophisticated models that better replicate the PDAC TME to fully capture the complex cell-to-cell interactions that are not evident in 2D cultures. To address this limitation, we developed a 3D tri-culture tunable biomimetic mouse model comprising PDAC organoids, host-matched cancer-associated fibroblasts (CAFs), and macrophages. This novel model allows us to modulate the stiffness of the 3D co-culture system through the addition of collagen I and CAFs. Rheometry data confirmed that the stiff tri-culture model had a significantly higher storage modulus than the soft tri-culture model. Using qPCR, we investigated the role of mechanosensitive ion channels, specifically Transient Receptor Potential Vanilloid-type 4 (TRPV4) and Piezo1, in mediating macrophage mechanosensing in response to varying levels of matrix stiffness. This study highlights the importance of 3D models that can recapitulate biophysical cues of cancer and will allow us to better understand how macrophages respond to stiffness, which may give rise to new therapeutic targets and development of new treatments in the future. Citation Format: Bayan Mahgoub, Weikun Xiao, Eileen Fung, Shannon Mumenthaler, Reginald Hill. Investigating the impact of extracellular matrix stiffness on macrophage function and organoid growth in pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr B041.

Abstract C004: Glucocorticoids establish a metastatic-promoting tumor microenvironment in a PDAC mouse model

Abstract Disseminated cancer cells (DCCs) arriving to a new organ may either proliferate and form metastasis, get eliminated by immune cells, or enter a quiescent stage. The factors that determine the DCCs’ fate, including getting quiescent DCCs to re-initiate proliferation and successfully evade the immune system, remain poorly understood, in part due to the lack of robust mouse models. We established a pancreatic ductal adenocarcinoma (PDAC) mouse model of dormant DCCs in the liver. An “immunization protocol” was used to mimic PDAC resection in patients: KPC1199 PDAC cells were injected to establish primary tumors and allow an adaptive immune response to develop against the cancer cells; the tumors were surgically resected; and new KPC1199 cells were intrasplenically injected to establish experimental liver metastases. The overwhelming majority of the KPC1199 cells were eliminated. No metastases spontaneously formed during 20 months of observation, but about 3-8 sporadic, single DCCs were found per liver cross section, and 94% of these DCCs were negative for proliferation markers. Although the model is based on entraining an adaptive immune response, T cell depletion resulted in only 25-30% of mice developing just 1-3 metastases each. This suggests that T cell depletion results in metastasis from the small percentage of DCCs that were proliferating. The DCC-hosting mice therefore represents of model to identify factors that can trigger further DCC proliferation and metastatic recurrence. Patients with PDAC often experience significant stress, leading to excess of endogenous glucocorticoids (GCs). Additionally, synthetic GCs are used during e.g., chemotherapy to manage side effects. To mimic elevated GC levels in patients, we treated DCC-hosting mice with synthetic GCs resulting in an increased percentage of proliferating DCCs (increasing from <6% of the examined cells in control mice to about 36%). Yet, no metastases formed. GC treatment also decreased T cell and increased neutrophil liver infiltration. Neutrophils can form protease-containing neutrophil extracellular traps (NETs), which we previously showed trigger DCC proliferation by proteolytic remodeling of the extracellular matrix protein laminin. We found that neutrophils from GC-treated mice spontaneously formed more NETs, and additionally, NET-generated laminin remodeling was observed in the liver metastasis. Together, the data suggest, that GC treatment drive quiescent DCCs to proliferate via neutrophils but alone this is insufficient to cause metastases. Consistent with this interpretation, T cell depletion combined with GC treatment resulted in multiple metastases in all mice examined. Of note, deleting the GC receptor in the DCCs did not reduce metastases, supporting that GCs act on the host and not the cancer cells. In conclusion, our data suggest that for quiescent DCCs to form metastases, they need signals that trigger proliferation and simultaneously, they must overcome immune surveillance. Elevated GC levels or GC treatment in immune suppressed individuals represents such a scenario. Citation Format: Xiao Han, Xueyan He, Yuan Gao, Sicheng Pan, Mikala Egeblad. Glucocorticoids establish a metastatic-promoting tumor microenvironment in a PDAC mouse model [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C004.

Abstract C022: Exercise reduces pancreatic tumor in a gut microbiome dependent manner

Abstract Preclinical studies suggest that aerobic exercise influences the tumor microenvironment by normalizing vasculature and reducing immunosuppression in Pancreatic Ductal Adenocarcinoma (PDAC). Gut microbes can influence PDAC progression by modulating metabolic and immune pathways. However, a knowledge gap remains regarding the role of the gut microbiome in the anti-tumor effects of exercise. We hypothesized that the exercise-induced anti-tumor effect in PDAC is regulated by gut microbiome. We compared the effect of treadmill running on growth of orthotopic PDAC in C57BL/6 mice from Taconic Biosciences (Tac) and Jackson Laboratories (Jax), which have different microbiomes. Tumor-bearing mice performed treadmill exercise (ex, 12 meters/minute (m/min) for 45 minutes (min) daily) or were non-exercised controls (no-ex). Exercise reduced tumor weight compared to no-ex controls in Jax (no-ex, 0.72±0.05 grams (g); ex, 0.54±0.04g; p=0.04) but not in Tac mice (no-ex, 0.72±0.05g; ex, 0.78±0.05g; p=0.47). Interestingly, in Tac mice treated with antibiotics (ATBx) ad libitum, treadmill exercise reduced tumor growth (no-ex, 0.74±0.04 g; ex, 0.53±0.03g; p= 0.006). Taken together, this data indicates that the anti-tumor effect of exercise is affected by gut microbiome. We considered potential mechanisms by which exercise suppresses tumor growth. Tumor infiltrating immune cells were measured by flow cytometry and immunohistochemistry. No significant differences in the tumor infiltrating immune cells were observed between no-ex and ex mice from Tac or Jax, regardless of ATBx, indicating that gut microbiome mediated anti-tumor effect is independent of immune pathways. Previous studies have demonstrated that exercise reduces tumor growth in an intensity dependent manner. Therefore, to determine exercise intensity as percentage of Peak Velocity (VPeak), exercise capacity (ExCap) test was performed. VPeak (m/min), time to exhaustion (min), and distance to exhaustion (m) were used as indicators for treadmill ExCap. Treadmill ExCap was significantly lower in tumor bearing Tac mice (24.86±3.55m/min, 12.56±1.79min, 217.17±31.02m) compared to Jax mice (30.50±3.81m/min; 16.58±2.07min; 320.15±40.02m; p=0.01). However, ATBx treatment did not change the treadmill ExCap in the Tac mice (25.50±3.19m/min; 12.62±1.58min; 209.26±26.16m; p=0.97) despite significantly changing the effect of exercise on tumor growth, indicating that ExCap may not regulate differences observed in the tumor weight. Overall, these results indicate that gut microbiome regulates anti-tumor effects of exercise, that are independent of tumor infiltrating immune cells or exercise intensity. Analysis of serum and tumor metabolites, 16s rRNAseq to evaluate microbial differences, and bulk RNAseq on tumors, is underway with the goal of identifying microbial-derived metabolites which mediate the anti-tumor effect of exercise. Understanding how the gut microbiome mediates the efficacy of exercise to suppress tumor growth will be critical for maximizing the benefits of exercise for patients with PDAC. Citation Format: Sumedha Pareek, Vidhi Chandra, Le Li, Hetal Patel, Truong Lam, Olivereen LeRoux, Haoyue Liu, Jonghae Lee, Florencia McAllister, Keri Schadler. Exercise reduces pancreatic tumor in a gut microbiome dependent manner [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C022.

Abstract PR011: Efferocytic macrophage promotes pancreatic cancer liver metastasis

Abstract Pancreatic ductal adenocarcinoma (PDAC) presents a major therapeutic challenge due to its aggressive metastatic behavior. In the liver metastasis microenvironment of PDAC, macrophages are key drivers of tumor progression. Targeting these pro-tumorigenic macrophages requires a deep understanding of the various macrophage populations and the factors influencing their phenotypes. Our study has revealed a distinct subset of macrophages with a pro-tumorigenic phenotype that emerges early in PDAC liver metastasis. We found that the establishment of hepatic metastases triggers local tissue damage, which, through efferocytosis, reprograms macrophages into an immunosuppressive state, thereby facilitating metastasis. Inhibiting efferocytosis pharmacologically prevented the conversion of macrophages, enhanced CD8+ T cell responses, and reduced liver metastasis. These results highlight the role of macrophages in tissue repair processes that promote liver metastasis in PDAC and suggest potential therapeutic targets to hinder its progression. Citation Format: Yuliana Astuti, Meirion Raymant, Valeria Quaranta, Kim Clarke, Maidinaimu Abudula, Olivia Smith, Gaia Bellomo, Vatshala Chandran-Gorner, Craig Nourse, Christopher Halloran, Paula Ghaneh, Daniel Palmer, Robert Jones, Fiona Campbell, Jeffrey Pollard, Jennifer Morton, Ainhoa Mielgo, Michael Schmid. Efferocytic macrophage promotes pancreatic cancer liver metastasis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR011.

Abstract A024: Tissue biomarkers in the tumor microenvironment predicting the development of cachexia in pancreatic cancer patients

Abstract Pancreatic ductal adenocarcinoma (PDAC) poses significant challenges due to its aggressive nature and the limited efficacy of existing treatments. The complex interactions within the tumor microenvironment (TME) and tumor cell itself remain poorly understood, particularly in relation to cancer cachexia, which is characterized by weight loss, muscle wasting, systemic inflammation, and metabolic disturbances, and has a profound impact on PDAC outcomes. This study investigated the role of the TME in the development of cachexia in PDAC patients, focusing on the potential of cachexia-related proteins as tissue biomarkers in the TME. In this retrospective study, tissue samples from 13 PDAC patients obtained via Endoscopic Ultrasound-Guided Fine Needle Aspiration at the time of diagnosis were analyzed using immunofluorescence staining, supplemented by epidemiological data. The initial classification of cachexia based on epidemiological data, including patients body mass index and three-month weight changes, was further refined through body composition trend analysis during 180 days after the diagnosis with consecutive computed tomography images. These detailed classification criteria allowed for a more realistic classification of cachexia compared to the conventional classification of cachexia based on weight change, resulting in 5 patients being classified as cachexia and 8 as non-cachexia. We selected NAMPT (nicotinamide phosphoribosyl transferase) as a candidate tissue biomarker, a rate-limiting enzyme crucial in the NAD+ salvage pathway, due to its significant role in cellular metabolism, and the regulation of energy depletion and consumption in muscle cells. We hypothesized that NAMPT is closely linked to the mechanisms of cachexia because NAD+ is essential for muscle regeneration. Additionally, PTHLH (Parathyroid Hormone-Like Hormone), selected as another candidate marker, plays a critical role by being secreted from tumor cells, promoting cancer cell growth and metastasis. The overexpression of PTHLH can lead to malignant hypercalcemia, which may trigger severe systemic inflammatory responses in cancer patients, contributing to the development of cachexia. We utilized the coordinated expression of these two proteins as potential tissue biomarkers predicting cachexia at the time of diagnosis of PDAC. In our study, PTHLH expression was significantly elevated in the cachexia group, while NAMPT expression was higher in the non- cachexia group. Although both markers are known to be overexpressed in most metastatic pancreatic cancers, their correlations vary depending on the presence of cachexia. These findings suggest that even in metastatic pancreatic cancer, these markers can serve as precise biomarker signatures that determine the possibility of developing cachexia. To further validate our findings, we are currently testing a larger validation set (cachectic PDAC patients=100, non-cachectic PDAC patients=100) to determine whether the expression of these two markers can be utilized as biomarkers for the early detection of cachexia. Citation Format: Hyun Jung Kee, Jinhee Lee, Ju Young Bae, Hia Jung, Jeehoon Kim, Galam Leem, Hee Seung Lee, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Moon Jae Chung. Tissue biomarkers in the tumor microenvironment predicting the development of cachexia in pancreatic cancer patients [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A024.

Abstract PR012: KRAS mutation-specific effects on the tumor immune microenvironment drive tumor progression in pancreatic cancer

Abstract Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with abysmal survival rates. The highly immunosuppressive microenvironment of PDAC poses a major barrier to effective therapy. KRAS mutations are near-ubiquitous in PDAC, and studies indicate clinical outcomes vary depending on the specific KRAS genotype. Given that tumor genotype can shape the immune cell composition of tumors, we examined the immune cell composition of pancreatic tumors with specific KRAS mutations, focusing on KRASG12D mutations (representing 40% of PDAC cases which have the worst prognosis) and KRASG12R mutations (which make up 20% of PDAC cases and have a better prognosis). Orthotopically implanted Kras G12R/+ ;Trp53 KO mouse pancreatic tumors have a distinct immune profile in comparison to Kras G12D/+ ;Trp53 KO tumors, characterized by an influx of intratumoral CD3+ T cells and mature dendritic cells. Selective depletion of CD4+ T cells induces a rapid progression in KRASG12R, but not KRASG12D mouse tumors. RNA sequencing of KRASG12R tumor cells revealed enrichment of Type I interferon (IFN) pathways accompanied by related chemokines, CXCL9 and CXCL10 in comparison to KRASG12D tumors. Analysis of publicly available and real-world human PDAC datasets and enrichment of dendritic cells and other immune related cell types in KRASG12R tumors. Collectively, these data link the KRASG12R mutation to a unique immunogenic role. Citation Format: Andrew Wenger, Tal Baron, Erika Hissong, Rohit Chandiwani, Lukas Dow, Despina Siolas, Katherine Bacchi, Huanhuan Sun, Erika Hissong, Adrian Vega, Whitney Sisso, and Kawther Abdilleh. KRAS mutation-specific effects on the tumor immune microenvironment drive tumor progression in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR012.

Abstract PR009: FMRP upregulation in cancer: Implicating FMRP-expressing cancer-associated fibroblasts in immune evasion

Abstract Our research has uncovered a novel and significant role for Fragile-X-mental-retardation-protein (FMRP) in cancer biology, extending its well-established functions beyond neuronal development. In a recent Science publication (Zeng et al., 2022), we demonstrated that elevated FMRP levels drive immune evasion in various murine and human tumors by modulating immune cell subsets, particularly through the suppression of effector T-cells. To further elucidate the mechanisms of FMRP-mediated immune evasion, we investigated its influence on the stromal component of the tumor microenvironment. Single-cell RNA sequencing of pancreatic ductal adenocarcinoma (PDAC) tumors revealed cancer-associated fibroblasts (CAFs) as the primary stromal cell subtype expressing FMRP. Given the crucial roles that CAFs play in tumor progression and therapeutic resistance, we explored whether FMRP expression contributes to the immunosuppressive characteristics of CAFs in PDAC and breast tumors. Our findings reveal that FMRP expression is markedly upregulated in CAFs from both breast and PDAC tumors, in contrast to its absence in naïve fibroblasts from healthy tissues. Knockdown of FMRP in CAFs resulted in substantial changes in their myofibroblastic and inflammatory properties, while overexpression of FMRP in naïve fibroblasts was sufficient to induce a CAF-like phenotype. Notably, FMRP overexpression led to significantly elevated inflammatory CAF (iCAF) and myofibroblastic CAF (myCAF) signatures, highlighting its role as a key pan-CAF regulator that influences both extracellular matrix (ECM) modulation and the secretory phenotype of CAFs. We utilized the full-body knockout (KO) mice model of the Fmr1 gene, which encodes FMRP, to further delineate the functional importance of FMRP expression in CAFs in stimulating an immunosuppressive program in vivo. Through bulk RNA sequencing, we developed an FMRP- associated gene signature for CAFs and applied it to human datasets, where we observed a pronounced increase in FMRP signatures in CAFs from human PDAC and breast tumors, highlighting its translational relevance. In conclusion, our research underscores the pivotal role of FMRP in cancer biology, impacting both the immune and stromal components of the tumor microenvironment. Targeting FMRP, particularly within CAFs, emerges as a promising therapeutic strategy to improve cancer treatment outcomes. Citation Format: Simge Yucel, Nadine Fournier, Mireia Blanco Gomez, Douglas Hanahan. FMRP upregulation in cancer: Implicating FMRP-expressing cancer-associated fibroblasts in immune evasion [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR009.

Abstract A022: Disrupting redox homeostasis initiates anti-tumor immune responses in pancreatic cancer

Abstract Although immune therapy has made impressive progress in cancer treatment, pancreatic ductal adenocarcinoma (PDAC) remains an exception, likely due to its immunosuppressive tumor microenvironment that prevents immune responses against the tumor. Our current work aims to reactivate the suppressive immune infiltrate using radiation therapy and oxidative stress to potentiate antitumor immune responses in PDAC. Our lab previously found that PDAC cells are dependent on the antioxidant peroxiredoxin-4 (PRDX4) expression. PRDX4 prevents excessive levels of reactive oxygen species in cells and while high PRDX4 expression is associated with a more aggressive disease, it is dispensable in normal tissue. As such, disrupting redox homeostasis by inhibiting PRDX4 represents a targetable vulnerability in cancer cells. To investigate the radio-sensitizing potential of PRDX4, we knocked-down (KD) PRDX4 in human pancreatic tumor cells as well as in mouse cancer cells obtained from the spontaneous KPC model (driven by the KRas and P53 mutations), in combination with radiation. Presence and quantification of DNA damage were performed by immunofluorescence, and impaired cell survival was analyzed by clonogenic assays. Changes in immune secretion were assessed by RT-qPCR and Elisa and in vitro macrophage phenotyping was performed upon exposure to tumor cell conditioned media. Our data so far show an accumulation of cytosolic DNA upon PRDX4 KD in PDAC cells, with the presence of micronuclei as well as less aggregated DNA. Interestingly, targeting PRDX4 before radiation amplifies the release of radiation-induced cytosolic DNA while significantly decreasing cell growth and survival, compared to radiation alone. Cytosolic DNA has been shown to trigger innate immune signaling in tumor cells. Consistently, PRDX4 loss induces the upregulation of many pro-inflammatory genes, including CCL5, CCL20, and CXCL10, in a STING-dependent manner. Combining PRDX4 KD with radiation leads to a higher gene upregulation of these immune stimulatory chemokines, as well as an increased protein secretion within tumor cell media. These findings support an amplified immunomodulatory effect of radiation when combined with PRDX4 loss in PDAC cells. To assess whether targeting PRDX4 can remodel the tumor microenvironment, we applied tumor conditioned media from cancer cells on isolated naive mouse CD45+/CD11c+/F4/80+ macrophages. Media from cells treated with PRDX4 KD + radiation strongly increased the migration ability of macrophages while modulating the expression of a subset of chemokine-encoding genes in immune cells. Using the spontaneous KPC model depleted for PRDX4, along with syngeneic orthotopic models, we are now aiming to confirm this radio-sensitizing and immune-modulatory potential of PRDX4 in vivo. The aggressiveness of PDAC requires research towards novel treatment strategies and our data strongly support evidence for targeting cancer metabolism, particularly antioxidant systems, in synergy with existing cancer therapies, like radiation and immune therapy. Citation Format: Lucie Malbeteau, Emily Poulton, Vishal Pandya, Marianne Koritzinsky. Disrupting redox homeostasis initiates anti-tumor immune responses in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A022.

Abstract B009: Characterization and CRISPR perturbation of cancer-associated fibroblast heterogeneity in vitro models

Abstract Cancer-associated fibroblasts (CAFs) are attractive therapeutic targets for cancer due to their abundance in the tumor microenvironment (TME) and extensive pro- and antitumorigenic functions. However, formulating CAF-targeting strategies remains challenging due to the complexity of CAF biology. CAFs specialize into phenotypically and functionally distinct subtypes that may respond differently to specific treatments. Thus, designing CAF-targeting therapies necessitates a thorough understanding of CAF heterogeneity and preclinical model systems that can reliably prototype CAF biology observed in tumors. However, CAF heterogeneity is still not well-understood for many solid tumors, including the stroma-rich pancreatic ductal adenocarcinoma (PDAC), and the translatability of stroma models has not been comprehensively evaluated. In this work, we developed in vitro cell lines of tumor-CAF cocultures using primary CAFs derived from PDAC and used single-cell transcriptomics and CRISPR perturbation to investigate CAF heterogeneity and subtype-specific responses. We found that coculturing primary CAFs with the BxPC3 PDAC cell line could capture the tumor-CAF crosstalks underlying CAF activation. We characterized eight subtypes, including myofibroblastic, inflammatory, extracellular matrix (ECM)-like, and interferon CAFs, which could be preserved with immortalization. We also delineated the trajectories of CAF subtype interconvertibility, highlighting inflammatory CAFs as the likely initial diseased state and ECM CAFs as a “reservoir” that seeded the later states. By correlating the in vitro subtypes with clinical data of immunotherapy responses, we established that the in vitro cell lines could model the immuno-modulatory and immunoresistant phenotypes of CAFs. Finally, using an immortalized tumor-CAF coculture line, we performed Perturb-seq single-cell perturbation to perturb several stroma genes of interest, including TGFBR1, SPATS2L, AEBP1, and PTGS1, and evaluated the subtype-specific effects of the perturbations. We found that perturbing TGFBR1 resulted in the expected eradication of myofibroblastic CAFs, while the other perturbations resulted in subtype-specific modulations of metabolic and extracellular matrix related pathways. Overall, our findings underscored that in vitro tumor-CAF coculture models could serve as a translatable system that effectively captured CAF biology and heterogeneity observed in tumors and highlighted some similarities between PDAC CAFs and previously characterized breast cancer CAFs. We also demonstrated that single-cell perturbation could be a useful approach for interrogating the distinct responses of different CAF subtypes to perturbations. Citation Format: Elysia Saputra, Shamsudheen Karuthedath Vellarikkal, Lixia Li, Hong Sun, Suchitra Natarajan, Federica Piccioni, Alex M. Tamburino, Xin Yu, Aleksandra K. Olow. Characterization and CRISPR perturbation of cancer-associated fibroblast heterogeneity in vitro models [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr B009.

Abstract PR007: Pancreatic cancer cachexia is mediated by tumor-derived PTHrP

Abstract Purpose: Our prior work has established that metastasis is initiated by PTHrP-driven mechanisms in pancreatic ductal adenocarcinoma (PDAC). PTHLH (the gene encoding the PTHrP protein) is directly adjacent to and co-amplified along with KRAS, the major oncogenic driver in PDAC patients. The KRAS-PTHLH amplicon is a marker of the highly aggressive squamous/quasi-mesenchymal/basal-like PDAC patient subtypes, is associated with increases in metastasis and cancer cachexia, and correlates with decreased overall patient survival. We have deleted Pthlh in the autochthonous Kras- and Tp53-driven pancreatic cancer mouse model (i.e. KPC mice) and found that the resulting KPC-Pthlh LoxP mice (herein KPC-PthrpcKO) live nearly twice as long as KPC controls. Intriguingly, recent evidence has emerged for PTHrP’s role in cachexia-associated adipose tissue wasting and we posit that the dramatic survival extension in KPC-PthrpcKO mice may be due to reduced cachexia. Results: In PDAC patients, PTHrP is co-amplified along with KRAS and correlates with significantly decreased overall survival. We generated KPC-PthrpcKO mice and showed that they have reduced tumor burden and dramatically increased overall survival relative to KPC controls. In parallel experiments, we treated mice with an anti-PTHrP neutralizing monoclonal antibody, which similarly extended survival. Upon further analysis, we observed that the overall body condition of KPC-PthrpcKO mice (and anti- PTHrP treated KPC mice) was greatly improved, with less loss of adipose and muscle tissue. Mechanistic studies revealed that tumor cell-derived PTHrP signaling to adipocytes in white adipose tissue depots mediates cachexia. Specifically, we found that adipose tissue wasting and lipolysis were greatly reduced upon deletion or pharmacological inhibition of PTHrP. In the same vein, RNA-seq of cachectic adipose tissue revealed that PTHrP mediates adipose wasting by turning off de novo lipogenesis (DNL), a process critical for the generation of fatty acids in adipocytes. PTHrP binds to its cognate receptor, PTH1R, on adipocytes and blocks fatty acid synthesis by turning off the essential DNL transcription factors CHREBP and SREBP, likely through a PTH1R-PKA-CREB1 signaling axis. Thus, the genetic deletion and pharmacological inhibition of PTHrP in vivo led to a profound reduction in cachexia-related adipose tissue wasting and muscle atrophy. Re-introduction of PTHrP into a PDAC cell line with low cachexia-inducing potential (and low baseline PTHrP) dramatically increased the degree of cachexia observed upon orthotopic implantation, leading to a reduction in overall survival. Therefore, PTHrP is both necessary and sufficient to induce cachexia in pancreatic cancer. Conclusions: This work has demonstrated the importance of the previously unappreciated roles of PTHrP signaling in driving pancreatic cancer cachexia and adipose tissue remodeling, and future studies will look to translate anti-PTHrP therapy into clinical trials. Citation Format: Jason Pitarresi. Pancreatic cancer cachexia is mediated by tumor-derived PTHrP [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR007.

Abstract B010: Improving pancreatic cancer image classification with transfer learning: CD45 vs. PANCK

Abstract Pancreatic ductal adenocarcinoma (PDAC) is known for its high aggressiveness and is the fourth most common cause of death of cancer-related death in the United States. It is highly malignant and often goes undiagnosed until advanced stages due to its late-onset symptoms, resulting in poor prognosis. Using quantitative analyses of histological features, such as the expression of prognostic biomarker, can provide valuable insight to guide treatment decisions, monitor disease progression and predict outcomes. Previous researchers have found that CD45 and PANCK play a huge role in characterizing the tumor microenvironment of PDAC. One study using single-cell RNA sequencing compared the microenvironments of healthy pancreata and pancreatic tumors, revealing differences in cellular composition. Tumor samples showed a higher proportion of immune cells, including CD45+ cells, compared to heathy samples and utilized PANCK to differentiate between epithelial and non-epithelial cells. This study aims to enhance the accuracy of classifying pancreatic cancer pathological images based on prognostic markers using transfer learning techniques. We curated and pre-processed a dataset of pancreatic cancer pathological images with different prognostic markers. Using the pre-trained convolutional neural network (CNN) model VGG16, we fine-tuned it with our dataset to better differentiate between two prognostic markers, CD45 and PANCK. The model's performance was evaluated using a similarity matrix to illustrate distinctions among the two prognostic markers. Our results demonstrate that the transfer learning approach significantly improves classification accuracy, achieving confusion matrix validation results of 90% between CD45 and PANCK prognostic markers. SSIM values were relatively low, highlighting the ability of our model to differentiate between the two prognostic markers. The low SSIM value also shows variability within the two prognostic markers, indicating heterogeneity in structural changes due to pancreatic cancer. These findings indicate that transfer learning can be a powerful tool for improving the classification of pathological images and that there is notable variability in the structural features associated with different prognostic markers in pancreatic cancer. Citation Format: Miracle Thomas. Improving pancreatic cancer image classification with transfer learning: CD45 vs. PANCK [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr B010.

Abstract C007: Identifying the role of Interleukin-17 signaling in intestinal stem cells during pancreatic cancer

Abstract Pancreatic ductal adenocarcinoma (PDAC), the most aggressive type of pancreatic cancer, is predicted to become the second leading cause of cancer related deaths by 2030. Interleukin 17 (IL-17) signaling can promote tumor growth. In pancreatic cancer, IL-17 signaling in cancer cells is capable of triggering the formation of neutrophil extracellular traps (NETs) which is detrimental to the anti-tumor effect of immunotherapy. IL-17 signaling has been shown to have critical roles in maintaining gut homeostasis. Intestinal epithelial cells directly interact with the gut microbiome and are actively involved in infection control, injury repair, immune responses, and the production of antimicrobial peptides and cytokines, and need to be constantly replenished by intestinal stem cells (ISCs). Our lab’s study has previously shown that deletion of Interleukin 17 receptor A (IL-17RA) in the entire gut epithelium induces pro-tumorigenic IL-17 signaling due to the disruption of gut homeostasis, suggesting that immune responses induced by gut IL-17/IL-17RA signaling can affect the behavior of distant tumors. However, the mechanism of IL-17 signaling within specific gut epithelial compartments such as ISCs, enterocytes, secretory cells, etc. and their role in maintaining gut homeostasis and cancer risk are not well-studied until now. Thus, we aimed to identify the importance of IL-17 signaling in ISCs during pancreatic cancer. We hypothesized that disruption of IL-17/IL-17RA signaling within ISCs impacts tumor growth. Our preliminary data shows that IL-17 signaling in enterocytes maintains intestinal homeostasis and disruption of this axis triggers systemic increase in B cells that promotes tumor growth by increasing IL-17 levels in circulation. To identify the function of IL-17/IL-17RA signaling in ISCs, we utilized Leucine-rich-repeat-containing G-protein-coupled receptor 5 (Lgr5), a lineage marker for ISCs, to drive Cre enzyme tissue specific expression to specifically knockout Il17ra in gut ISCs - an inducible transgenic mouse model Il17ra fl/fl ;Lgr5- EGFP-CreERT2 (cKO). We used multiplex staining and imaging to validate the cell type specific loss of IL-17RA expression in tamoxifen treated cKO mice. We used implantable pancreatic tumor models and performed immunoprofiling using flow cytometry. We found that the pancreatic tumor growth was altered by the remote signal from gut ISCs in cKO mice. Furthermore, we performed RNAseq in both tumor and gut tissue which identified that the major changes in gene expression were associated with both innate and adaptive immune pathways, especially B cell activation. We conclude that the IL-17/IL-17RA signaling in gut ISCs changes intestinal immune responses locally that can affect distant tumor immunity. Citation Format: Haoyue Liu, Vidhi Chandra, Le Li, Olivereen Le Roux, Virginia Tahan, Florencia McAllister. Identifying the role of Interleukin-17 signaling in intestinal stem cells during pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C007.

Abstract A041: Deciphering the crosstalk between cancer cells and stroma that drives EMT- coupled fibrosis

Abstract In the tumor microenvironment (TME) cancer cells engage dynamically with the stromal component in promoting tumor progression and metastasis formation that are accompanied by intratumor fibrosis. Extensive extracellular matrix (ECM) remodeling and stiffness boost fibrosis which co-occurs with poor immune infiltration. Very little is known about the cross-interactions between tumor cells and stroma. A better understanding of this dynamic relationship may advance the development of new therapies. Transforming growth factor (TGF)-β signaling in both cancer epithelial cells and stroma is crucial for the establishment of intratumor fibrosis that enhances tumor progression. We previously discovered that in cancer cells, TGF-β signaling synergizes with RAS signal to regulate classical EMT transcription factors (Snail, Zeb1) and fibrogenic factors (Il11, Pdgf, Ctgfb, Wisp and others). This synergistic program is required for metastasis formation in pancreatic and lung adenocarcinoma (LUAD) models. However, how this dual program is affecting the stromal population in vivo remains unknown. Additionally, the role of each TGF-β dependent fibrogenic factor in regulating the stroma is still unclear. Using metastasis in vivo assays, we tested the metastatic ability of LUAD cells wild-type in comparison to Knock-Out cells targeting each one of the TGF-β dependent fibrogenic factors. We found that these factors are drivers of metastasis. More interestingly, these fibrogenic factors have a preferential effect depending on the metastatic site, suggesting that survival of the cancer cells in a certain tissue is dependent on the stromal niche within the site, which will act in favor or not of their growth. We also deeply characterize the stroma of micro-metastatic lesions by using high-throughput multiplex immunofluorescence to analyze the whole tissue TME at single cell resolution and found that lack of any of these fibrogenic factors compromise the establishment of a robust ECM at the very beginning of the metastatic colonization, to favor immune infiltration and consequently lead to cancer cell clearance. Together, these findings shed light on the potential role of these specific fibrogenic factors in metastasis, how their absence impacts the TME and how targeting these factors could be beneficial in metastatic disease. Citation Format: Elena Spina, Liangji Li, Junho Lee, Joan Massaguè. Deciphering the crosstalk between cancer cells and stroma that drives EMT- coupled fibrosis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A041.

αvβ6-integrin targeted PET/CT imaging in pancreatic cancer patients using 68Ga-Trivehexin

Purpose68Ga-Trivehexin is a PET tracer targeting αvβ6-integrin, a transmembrane receptor that is frequently expressed by pancreatic cancer cells. This study aimed to determine the biokinetics, image contrast, and acquisition parameters for 68Ga-Trivehexin PET imaging in pancreatic cancers.Methods44 patients with pancreatic cancer underwent Trivehexin PET/CT between June 2021 and November 2022 (EK-242052023). Biokinetics and -distribution were extracted. Previous imaging follow-up imaging, and histological findings were used as reference standards. A one-way ANOVA test, followed by Tukey HSD post-hoc test was conducted. T-tests for subgroups ± chemotherapy prior to PET were performed. Based on dynamic PET data (n = 11) recorded over 45 min, time-activity curves were generated.Results68Ga-Trivehexin PET/CT detected 40 pancreatic cancers, SUVmax 12.6; range [5.1–30.8]; 39 liver metastases, SUVmax 7.9 [2.7–16.3]; 21 lymph node metastases, SUVmax 8.6 [2.5–15.0]; 17 peritoneal metastases, SUVmax 9.5 [4.0–16.9] and 14 other metastases, SUVmax 7.2 [2.9–13.1]. Tukey post-hoc analysis revealed significant differences for SUVmax in pancreatic cancer compared to SUVmax in liver metastases [4.74, 95%-CI (1.74, 7.75)], for SUVmax in pancreatic cancer to SUVmax in lymph node metastasis [4.07, 95%-CI (0.47, 7. 67)], for tumor-to-liver ratio (TLR) of liver metastasis to TLR of pancreatic cancer [1.82, 95%-CI (0.83, 2.80)], for TLR of pancreatic cancer to TLR of peritoneal carcinomatoses [−1.88, 95%-CI (−3.15, −0.61)], and TLR of pancreatic cancer to TLR of pleural carcinomatosis [−2.79, 95%-CI (−5.42, −0.18)]. When comparing subgroups ± chemotherapy prior to PET, TLR of pancreatic cancers and TLR of peritoneal carcinomatoses were significantly different. At 45 min p.i., the highest tumor-to-backround (TBR) was observed.Conclusion68Ga-Trivehexin is suitable for imaging of αvβ6-integrin expression in pancreatic cancer due to its ability to distinguish primary carcinoma and metastases from background tissue.

Global metabolomic profiling of tumor tissue and paired serum samples to identify biomarkers for response to neoadjuvant FOLFIRINOX treatment of human pancreatic cancer.

Neoadjuvant chemotherapy (NAT) is increasingly used for the treatment of non-metastatic pancreatic ductal adenocarcinoma (PDAC) and is established as a standard of care for borderline resectable and locally advanced PDAC. However, full exploitation of its clinical benefits is limited by the lack of biomarkers that assess treatment response. To address this unmet need, global metabolomic profiling was performed on tumor tissue and paired serum samples from patients with treatment-naïve (TN; n = 18) and neoadjuvant leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride and oxaliplatin (FOLFIRINOX)-treated (NAT; n = 17) PDAC using liquid chromatography mass spectrometry. Differentially abundant metabolites (DAMs) in TN versus NAT groups were identified and their correlation with various clinical parameters was assessed. Metabolomics profiling identified 40 tissue and five serum DAMs in TN versus NAT PDAC. In general, DAMs associated with amino acid andnucleotide metabolism were lower in NAT compared to TN. Four DAMs-3-hydroxybutyric acid (BHB), 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), glycochenodeoxycholate and citrulline-were common to both tissue and serum and showed a similar pattern of differential abundance in both groups. A strong positive correlation was observed between serum carbohydrate 19-9 antigen (CA 19-9) and tissue carnitines (C12, C18, C18:2) and N8-acetylspermidine. The reduction in CA 19-9 following NAT correlated negatively with serum deoxycholate levels, and the latter correlated positively with survival. This study revealed neoadjuvant-chemotherapy-induced changes in metabolic pathways in PDAC, mainly amino acid and nucleotide metabolism, and these correlated with reduced CA 19-9 following neoadjuvant FOLFIRINOX treatment.

Lfng-expressing centroacinar cell is a unique cell-of-origin for p53 deficient pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with limited understanding of etiology. Studies in mice showed that both acinar and ductal cells of the pancreas can be targeted by combination of oncogenic Kras and p53 mutations to form PDAC. How the transforming capacities of pancreatic cells are constrained, and whether a subset of cells could serve as a prime target for oncogenic transformation, remain obscure. Here we report that expression of a Notch modulator, Lunatic Fringe (Lfng), is restricted to a limited number of cells with centroacinar location and morphology in the adult pancreas. Lfng-expressing cells are preferentially targeted by oncogenic Kras along with p53 deletion to form PDAC, and deletion of Lfng blocks tumor initiation from these cells. Notch3 is a functional Notch receptor for PDAC initiation and progression in this context. Lfng is upregulated in acinar- and ductal-derived PDAC and its deletion suppresses these tumors. Finally, high LFNG expression is associated with high grade and poor survival in human patients. Taken together, Lfng marks a centroacinar subpopulation that is uniquely susceptible to oncogenic transformation when p53 is lost, and Lfng functions as an oncogene in all three lineages of the exocrine pancreas.