Abstract C016: Pancreatitis-induced resistance to KRAS targeted therapy: The role of cellular plasticity and underlying mechanisms

Abstract Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease characterized by cell plasticity, particularly the epithelial-to-mesenchymal transition (EMT) phenotype, which significantly contributes to both pancreatic tumorigenesis and therapy resistance. Chronic pancreatitis, a key risk factor for PDAC, induces fibrosis, recruits macrophages, and elevates TGFβ, an EMT master regulator, in the tumor microenvironment (TME). Despite the observed negative correlation between dependence on oncogenic KRAS signaling and the quasi- mesenchymal (QM) subtype, the role of cellular plasticity and the underlying mechanisms of resistance remain unclear. To address this, we employed genetically engineered mouse models that mimic human pancreatitis and PDAC, alongside an in vitro 3-D tumor spheroid culture system. Our study demonstrates that chronic pancreatitis promotes resistance to KRAS- targeted therapy through a canonical TGFβ signaling pathway-dependent mechanism. Nuclear Factor of Activated T Cells 5 (NFAT5) forms a hetero-pentamer with canonical TGFβ factors SMAD3 and SMAD4, inducing EMT and promoting therapy resistance. Analysis of human samples indicates a positive correlation between NFAT5 expression and pancreatic tumorigenesis, with elevated NFAT5 expression correlating with poorer overall survival in the TCGA PDAC dataset. Functional studies reveal that genetic depletion or chemical inhibition of NFAT5 thwarts resistance to KRAS inhibition induced by TGFβ or pancreatitis, impairs the growth of QM-like escaper tumors, and synergizes with KRAS inhibitors to further suppress tumor growth in pre-clinical models. Mechanistically, we identified the chaperone protein and extracellular matrix regulator S100A4 as a key effector transcriptionally activated by the NFAT5- SMAD complex, mediating therapy resistance partially through the activation of key KRAS downstream MAPK and AKT signaling pathways. Furthermore, our investigation reveals that TGFβ stimulates PDAC cells to secrete the chemokine CCL2, which recruits circulating macrophages. In turn, these macrophages support PDAC cells in bypassing KRAS inhibition through paracrine TGFβ and S100A4. Overall, this study establishes a molecular foundation for KRAS-targeted therapy resistance associated with cellular plasticity in PDAC, highlighting pancreatitis as a potential risk factor, and proposes a novel strategy to overcome this resistance through NFAT5 inhibition or S100A4 blockade. Citation Format: Daiyong Deng, Pingping Hou. Pancreatitis-induced resistance to KRAS targeted therapy: The role of cellular plasticity and underlying mechanisms [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr C016.