The genetic basis of pancreatic ductal adenocarcinoma, which constitutes the most common type of pancreatic malignancy, involves the sequential activation of oncogenes and inactivation of tumor suppressor genes. Among the pivotal genetic alterations are Ki-RAS oncogene activation and p53 tumor suppressor gene inactivation. We explain that the combination of these genetic events facilitates pancreatic carcinogenesis as revealed in novel three-dimensional cell (spheroid cyst) culture and in vivo subcutaneous and orthotopic xenotransplantation models. N-cadherin, a member of the classic cadherins important in the regulation of cell-cell adhesion, is induced in the presence of Ki-RAS mutation but subsequently downregulated with the acquisition of p53 mutation as revealed by gene microarrays and corroborated by reverse transcription-PCR and Western blotting. N-cadherin modulates the capacity of pancreatic ductal cells to migrate and invade, in part via complex formation with keratinocyte growth factor receptor and neural cell adhesion molecule and in part via interaction with p120-catenin. However, modulation of these complexes by Ki-RAS and p53 leads to enhanced cell migration and invasion. This preferentially induces the downstream effector AKT over mitogenactivated protein kinase to execute changes in cellular behavior. Thus, we are able to define molecules that in part are directly affected by Ki-RAS and p53 during pancreatic ductal carcinogenesis, and this provides a platform for potential new molecularly based therapeutic interventions.There are nearly 30,000 new cases of pancreatic ductal adenocarcinoma each year. As such, there are about an equivalent number of pancreatic cancer-related deaths annually (11). Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related deaths and carries with it a dismal prognosis with median survival of 6 months and 5-year survival of less than 5% (55). A subset of patients who have surgically resectable disease harbor 5-year survival rates of 15 to 20% (55). Overall, the poor prognosis is the result of anatomic considerations, nonspecific clinical manifestations, and presentation of patients at late stages when therapeutic modalities are palliative in nature. However, some progress is occurring with the development of adjuvant chemotherapy for locally advanced disease and with the potential employment of experimental therapeutic strategies involving immunotherapy.While there is a complex interplay of genetic and environmental events that cooperate to facilitate initiation and promotion of pancreatic cancer, certain well-accepted genetic alterations are known to be of paramount importance. Point mutations in codon 12 of the Ki-RAS oncogene are the most frequent genetic alterations found in premalignant and advanced stages of pancreatic ductal adenocarcinoma (5, 46).
Cooperating events with HER2/NEU overexpression, CDKN2A/ p16INK4A inactivation, p53 mutations, SMAD4 mutations, and BRCA2 mutations are recognized to be necessary for progression from pancreatic ...