PDAC: advances in tumour microenvironment, microbiome and AI

Pancreatic cancer remains one of the most challenging malignancies, with a very poor prognosis. Current research is focused on elucidating the role of the tumour microenvironment and the microbiome in the development and progression of the disease, as well as on the promising potential of artificial intelligence for early diagnosis and outcome prediction.

Key advances

• Findings by Mucciolo et al.⁶ indicate that the cancer-associated fibroblast (CAF) population in the tumour microenvironment of pancreatic ductal adenocarcinoma (PDAC) is even more complex than previously recognized, as evidenced by the fact that even within a certain population of CAFs, such as myofibroblastic CAFs, there exists functional heterogeneity in response to known activating factors such as transforming growth factor-β.

• Porphyromonas gingivalis, a known component of the oral microbiome, can translocate to Kras-mutation-bearing pancreatic acinar cells to induce acinar-to-ductal metaplasia and progression of pancratic intraepithelial neoplasms⁷.

• A precision medicine platform called Molecular Twin, developed by Osipov et al.⁹, has used advanced machine-learning models to analyse more than 6,000 clinical and multi-omic molecular features of resected human PDAC specimens to accurately predict disease survival.