Martinez, Alicia K. Fleming

Abstract Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal human malignancies due to its silent clinical onset, rapid progression, and limited responsiveness to current treatment options. These features underscore the urgent need for early detection strategies and for new molecular targets that can be exploited therapeutically. Epithelial Cell Transforming Sequence 2 (ECT2) is a Rho family guanine nucleotide exchange factor that was originally identified as an oncoprotein and later shown to regulate cytokinesis. In this study, we examined the clinical relevance of ECT2 expression in PDAC and determined its functional contribution to transformed growth and tumorigenicity. Our analyses revealed that ECT2 expression increases at the earliest stages of PDAC development, remains persistently elevated during disease progression, and associates with reduced overall patient survival. Furthermore, a substantial fraction of ECT2 is aberrantly localized to the cytoplasm of PDAC cells. Functional studies demonstrated that depletion of ECT2 suppresses three-dimensional growth, invasive behavior, and tumor formation in vivo, while having little impact on PDAC cell cytokinesis. Mechanistically, we found that ECT2 is required for activation of Rac1 and RhoA and downstream MEK/ERK and ROCK signaling, respectively. Consistent with these results, analyses of PDAC patient datasets revealed a strong positive association between ECT2 expression and Rho GTPase as well as MEK/ERK and ROCK pathway signatures. Together, our data identify ECT2 as an early driver of PDAC transformation and highlight it as a promising therapeutic target. Citation Format: Dania Al-Qasrawi, Nayya N. Murray, Ryan A. Argo, Alicia K. Fleming Martinez, Prita Pandya, Anaya Y. Clarke, Kayla C. Winter, Murli Krishna, Peter Storz, Nicole R. Murray, Verline Justilien, . The Rho-GEF ECT2 links Rho GTPases to MEK/ERK pathway activation in pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5993.

Abstract Mitochondrially-generated reactive oxygen species (mROS) have been shown to induce acinar-to-ductal metaplasia (ADM). ADM, in presence of an oncogenic KRAS mutation, is an initiating step for progression to pancreatic intraepithelial neoplasia (PanIN) and eventually pancreatic ductal adenocarcinoma (PDA). Here, we utilize primary murine cells as well as the p48Cre;LSL-KrasG12D (KC) mouse model to explore the use of the mitochondria-targeted mimetic of manganese superoxide dismutase MitoQ for targeting PDA initiation and progression. Previously published data by our laboratory has shown that treatment with MitoQ decreases the abundance of pancreatic low-grade lesions in KC mice. However, we here demonstrate that superoxide depletion by MitoQ at the same time increases formation of DCLK1+ cancer stem cells in such lesions. We here evaluate if the detoxification of mitochondrial superoxide results in a build-up of hydrogen peroxide, which is a major driver of the DCLK1+ cell type. We determine how altered expression of ROS detoxifying enzymes in different cell types contribute to PDA stem cell formation and PDA development. Eventually we test if the increase in DCLK1+ cancer stem cells can contribute to changes in the microenvironment and accelerated progression of abnormal tissue. Citation Format: Jeffrey Mario Perera, Alicia K. Fleming Martinez, Peter Storz. MnSOD mimetic mitoquinone mesylate (MitoQ) increases DCLK1+pancreatic cancer stem cells. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4779.

Abstract Recent studies demonstrate that mitochondrially-generated reactive oxygen species (ROS) downstream of oncogenic KRAS drive acinar-to-ductal metaplasia (ADM), a key first step in the pancreatic ductal adenocarcinoma (PDA) progression model. MnSOD/SOD2 is a mitochondrial enzyme that converts superoxide into hydrogen peroxide. Previous studies have shown that SOD2 is biologically relevant to the study of pancreatic cancer. Some patients with a SOD2 polymorphism resulting in less active MnSOD at the mitochondrial matrix are at increased risk of developing pancreatic cancer. Additionally, MnSOD is lost in high-grade human PanIN, further suggesting a role in tumor development. To elucidate the role of MnSOD in pancreatic cancer initiation and progression, we crossed Sod2lox/lox mice into the p48Cre;LSL-KrasG12D (KC) mouse model. We found increased ROS, abundantly more abnormal tissue development and presence of flat lesions indicating accelerated early progression. However, Kaplan Meyer survival analysis of KC and KC;Sod2−/− mice did not indicate faster progression to cancer, suggesting that for later steps additional signaling is needed. In summary, we identify MnSOD as a key antioxidant molecule preventing initiation of PDA. Citation Format: Alicia K. Fleming Martinez, Brandy H. Edenfield, Irene Esposito, Peter Storz. Knockout of Sod2 accelerates KrasG12D-driven formation of pancreatic cancerous lesions. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4775.

Abstract Manganese superoxide dismutase (MnSOD) is an important reactive oxygen species (ROS) scavenger which has largely been studied in pancreatic cancer cell lines, where it contributes to invasion but also decreases proliferation. In pancreatic cancer, it is unknown whether MnSOD contributes to or prevents lesion development. Therefore, we utilize a transgenic mouse model to study precancerous lesion development and progression. We here show that knockout of Sod2 in a p48Cre;LSL-KrasG12D (KC) mouse model accelerates formation of abnormal tissue area, increases abundance of DCLK1+ cancer stem cells (CSCs) and oxidative damage, and promotes formation of atypical flat lesions (AFLs) which are a direct precursor to pancreatic ductal adenocarcinoma (PDA). We further characterize AFLs as having fewer senescent cells and less oxidative damage than low grade PanIN lesions. Thus, MnSOD has a protective effect in early pancreatic lesion development and its deletion drives tumor development. Citation Format: Alicia K. Fleming Martinez, Brandy H. Edenfield, Irene Esposito, Peter Storz. Knockout of Sod2 accelerates formation of pancreatic atypical flat lesions which are a direct precursor to pancreatic ductal adenocarcinoma (PDA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 922.

The development of pancreatic cancer requires recruitment and activation of different macrophage populations. However, little is known about how macrophages are attracted to the pancreas after injury or an oncogenic event, and how they crosstalk with lesion cells or other cells of the lesion microenvironment. Here, we delineate the importance of CXCL10/CXCR3 signaling during the early phase of murine pancreatic cancer. We show that CXCL10 is produced by pancreatic precancerous lesion cells in response to IFNγ signaling and that inflammatory macrophages are recipients for this chemokine. CXCL10/CXCR3 signaling in macrophages mediates their chemoattraction to the pancreas, enhances their proliferation, and maintains their inflammatory identity. Blocking of CXCL10/CXCR3 signaling in vivo shifts macrophage populations to a tumor-promoting (Ym1 + , Fizz + , Arg1 + ) phenotype, increases fibrosis, and mediates progression of lesions, highlighting the importance of this pathway in PDA development. This is reversed when CXCL10 is overexpressed in PanIN cells.

Abstract During development of pancreatic cancer, alternatively activated macrophages contribute to fibrogenesis, pancreatic intraepithelial neoplasia (PanIN) lesion growth, and generation of an immunosuppressive environment. Here, we show that the immunomodulatory agent pomalidomide depletes pancreatic lesion areas of alternatively activated macrophage populations. Pomalidomide treatment resulted in downregulation of interferon regulatory factor 4, a transcription factor for M2 macrophage polarization. Pomalidomide-induced absence of alternatively activated macrophages led to a decrease in fibrosis at PanIN lesions and in syngeneic tumors; this was due to generation of an inflammatory, immune-responsive environment with increased expression of IL1α and presence of activated (IFNγ-positive) CD4+ and CD8+ T-cell populations. Our results indicate that pomalidomide could be used to decrease fibrogenesis in pancreatic cancer and may be ideal as a combination treatment with chemotherapeutic drugs or other immunotherapies. Significance: These findings reveal new insights into how macrophage populations within the pancreatic cancer microenvironment can be modulated, providing the means to turn the microenvironment from immunosuppressive to immune-responsive.

Pancreatitis is an inflammatory disease of the pancreas characterized by dysregulated activity of digestive enzymes, necrosis, immune infiltration, and pain. Repeated incidence of pancreatitis is an important risk factor for pancreatic cancer. Legumain, a lysosomal cysteine protease, has been linked to inflammatory diseases such as atherosclerosis, stroke, and cancer. Until now, legumain activation has not been studied during pancreatitis. We used a fluorescently quenched activity-based probe to assess legumain activation during caerulein-induced pancreatitis in mice. We detected activated legumain by ex vivo imaging, confocal microscopy, and gel electrophoresis. Compared with healthy controls, legumain activity in the pancreas of caerulein-treated mice was increased in a time-dependent manner. Legumain was localized to CD68+ macrophages and was not active in pancreatic acinar cells. Using a small-molecule inhibitor of legumain, we found that this protease is not essential for the initiation of pancreatitis. However, it may serve as a biomarker of disease, since patients with chronic pancreatitis show strongly increased legumain expression in macrophages. Moreover, the occurrence of legumain-expressing macrophages in regions of acinar-to-ductal metaplasia suggests that this protease may influence reprogramming events that lead to inflammation-induced pancreatic cancer.