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Pancreatic ductal adenocarcinoma is a devastating disease, and patient outcomes have not improved in decades. Treatments that target tumor cells have largely failed. This could be because research has focused on cancer cells and the influence of the stroma on tumor progression has been largely ignored. The focus of pancreatic cancer research began to change with the identification of pancreatic stellate cells, which produce the pancreatic tumor stroma. There is compelling in vitro and in vivo evidence for the influence of pancreatic stellate cells on pancreatic cancer development; several recent preclinical studies have reported encouraging results with approaches designed to target pancreatic stellate cells and the stroma. We review the background and recent advances in these areas, along with important areas of future research that could improve therapy.

Inflammation and cell death are critical to pathogenesis of acute pancreatitis. Here we show that transcription factor nuclear factor-κB (NF-κB), which regulates these processes, is activated and plays a role in rat cerulein pancreatitis. NF-κB was strongly activated in the pancreas within 30 min of cerulein infusion; a second phase of NF-κB activation was prominent at 3–6 h. This biphasic kinetics could result from observed transient degradation of the inhibitory protein IκBα and slower but sustained degradation of IκBβ. The hormone also caused NF-κB translocation and IκB degradation in vitro in dispersed pancreatic acini. Both p65/p50 and p50/p50, but not c-Rel, NF-κB complexes were manifest in pancreatitis and in isolated acini. Coinfusion of CCK JMV-180, which abolishes pancreatitis, prevented cerulein-induced NF-κB activation. The second but not early phase of NF-κB activation was inhibited by a neutralizing tumor necrosis factor-α antibody. Antioxidant N-acetylcysteine (NAC) blocked NF-κB activation and significantly improved parameters of pancreatitis. In particular, NAC inhibited intrapancreatic trypsin activation and mRNA expression of cytokines interleukin-6 and KC, which were dramatically induced by cerulein. The results suggest that NF-κB activation is an important early event that may contribute to inflammatory and cell death responses in acute pancreatitis.

The aim of this study was to determine whether tumor necrosis factor-␣ (TNF ␣ )

Diabetes mellitus is a group of diseases defined by persistent hyperglycaemia. Type 2 diabetes, the most prevalent form, is characterised initially by impaired insulin sensitivity and subsequently by an inadequate compensatory insulin response. Diabetes can also develop as a direct consequence of other diseases, including diseases of the exocrine pancreas. Historically, diabetes due to diseases of the exocrine pancreas was described as pancreatogenic or pancreatogenous diabetes mellitus, but recent literature refers to it as type 3c diabetes. It is important to note that type 3c diabetes is not a single entity; it occurs because of a variety of exocrine pancreatic diseases with varying mechanisms of hyperglycaemia. The most commonly identified causes of type 3c diabetes are chronic pancreatitis, pancreatic ductal adenocarcinoma, haemochromatosis, cystic fibrosis, and previous pancreatic surgery. In this Review, we discuss the epidemiology, pathogenesis, and clinical relevance of type 3c diabetes secondary to chronic pancreatitis and pancreatic ductal adenocarcinoma, and highlight several important knowledge gaps.

One reason why pancreatic cancer is so aggressive and unresponsive to treatments is its resistance to apoptosis. We report here that reactive oxygen species (ROS) are a prosurvival, antiapoptotic factor in pancreatic cancer cells. Human pancreatic adenocarcinoma MIA PaCa-2 and PANC-1 cells generated ROS, which was stimulated by growth factors (serum, insulin-like growth factor I, or fibroblast growth factor-2). Growth factors also stimulated membrane NAD(P)H oxidase activity in these cells. Both intracellular ROS and NAD(P)H oxidase activity were inhibited by antioxidants tiron and N-acetylcysteine and the inhibitor of flavoprotein-dependent oxidases, diphenylene iodo- Pancreatic adenocarcinoma is an aggressive malignancy resistant to chemotherapy and radiotherapy (1). One mechanism mediating pancreatic cancer aggressiveness and unresponsiveness to treatment is its resistance to apoptosis. Constitutive activation of antiapoptotic proteins such as transcription factors NF-B (2) and signal transducers and activators of transcription (3), heat shock proteins (4), or phosphatidylinositide 3-kinase (5) is thought to contribute to pancreatic cancer resistance to apoptosis. We hypothesized that a key factor mediating this resistance is ROS 1 generated in pancreatic cancer cells. Although ROS have long been thought to promote cell death (6 -8), recent data (9 -12) suggest that they may also play a prosurvival role. ROS can activate the above mentioned antiapoptotic signaling pathways. In this regard, we recently showed (13) (12, 19 -21). Furthermore, functional components of the phagocytic NAD(P)H oxidase have been found to mediate superoxide production in some nonphagocytic cells (22,23). Other ROS-generating enzymes are xanthine oxidase, nitric-oxide synthase (NOS), phospholipase A 2 (PLA 2 ), and lipoxygenases (14). A growing body of evidence indicates that ROS play signaling roles in physiologic and pathophysiologic processes, including proliferation (24), adhesion (25), and hypertension (17, 26). In particular, growth factors are known to stimulate ROS in a variety of cell types through receptor-transducing pathways,

Pancreatic ductal adenocarcinoma (PDAC) is most frequently detected at an advanced stage. This limits treatment options and contributes to a dismal 5-year survival rate of 3 to 15%. PDAC is relatively uncommon and with current modalities, screening of the asymptomatic adult population is not feasible or recommended. However, screening of individuals in highrisk groups is undertaken. Here we review high-risk groups for PDAC, including individuals with inherited predisposition and patients with pancreatic cystic lesions. We discuss new studies aimed at finding ways of identifying PDAC in high-risk groups, such as individuals with new-onset diabetes mellitus and those attending primary and secondary care practices with suggestive symptoms. We review early detection biomarkers, explore the potential of exploiting social media for PDAC detection, appraise prediction models developed using electronic health records and research data, and examine the application of artificial intelligence to imaging for the purposes of early PDAC detection.