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PALLD mutation in a European family conveys a stromal predisposition for familial pancreatic cancer
Lucia Liotta, … , Maximilian Reichert, Michael Quante
Lucia Liotta, … , Maximilian Reichert, Michael Quante
Published March 25, 2021
Citation Information: JCI Insight. 2021;6(8):e141532. https://doi.org/10.1172/jci.insight.141532.
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Clinical Research and Public Health Gastroenterology Oncology

PALLD mutation in a European family conveys a stromal predisposition for familial pancreatic cancer

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Abstract

BACKGROUND Pancreatic cancer is one of the deadliest cancers, with low long-term survival rates. Despite recent advances in treatment, it is important to identify and screen high-risk individuals for cancer prevention. Familial pancreatic cancer (FPC) accounts for 4%–10% of pancreatic cancers. Several germline mutations are related to an increased risk and might offer screening and therapy options. In this study, we aimed to identity of a susceptibility gene in a family with FPC.METHODS Whole exome sequencing and PCR confirmation was performed on the surgical specimen and peripheral blood of an index patient and her sister in a family with high incidence of pancreatic cancer, to identify somatic and germline mutations associated with familial pancreatic cancer. Compartment-specific gene expression data and immunohistochemistry were also queried.RESULTS The identical germline mutation of the PALLD gene (NM_001166108.1:c.G154A:p.D52N) was detected in the index patient with pancreatic cancer and the tumor tissue of her sister. Whole genome sequencing showed similar somatic mutation patterns between the 2 sisters. Apart from the PALLD mutation, commonly mutated genes that characterize pancreatic ductal adenocarcinoma were found in both tumor samples. However, the 2 patients harbored different somatic KRAS mutations (G12D and G12V). Healthy siblings did not have the PALLD mutation, indicating a disease-specific impact. Compartment-specific gene expression data and IHC showed expression in cancer-associated fibroblasts (CAFs).CONCLUSION We identified a germline mutation of the palladin (PALLD) gene in 2 siblings in Europe, affected by familial pancreatic cancer, with a significant overexpression in CAFs, suggesting that stromal palladin could play a role in the development, maintenance, and/or progression of pancreatic cancer.FUNDING DFG SFB 1321

Authors

Lucia Liotta, Sebastian Lange, H. Carlo Maurer, Kenneth P. Olive, Rickmer Braren, Nicole Pfarr, Sebastian Burger, Alexander Muckenhuber, Moritz Jesinghaus, Katja Steiger, Wilko Weichert, Helmut Friess, Roland Schmid, Hana Algül, Philipp J. Jost, Juliane Ramser, Christine Fischer, Anne S. Quante, Maximilian Reichert, Michael Quante

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Figure 1

Clinical data of the patient.

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Clinical data of the patient.
(A) Axial CT of the index patient prior to...
(A) Axial CT of the index patient prior to therapy, showing a hypodense mass in the head of the pancreas. Note deformity of the superior mesenteric vein (asterisk) indicating vascular wall infiltration. Hazy stranding (arrow), indicating desmoplasia, extends to the superior mesenteric artery. (B) Histopathological view of the surgical specimen of moderately differentiated (G2) pancreatic adenocarcinoma with H&E staining. Original magnification, 20×. There is a very strong induction of a fibroelastic desmoplastic stroma between the tumor and the adjacent inflammatory reaction. (C) IHC for PALLD in pancreatic tissue of the index patient with strong PALLD expression in CAFs, which is more enhanced than among the mesenchymal stroma cells of adjacent pancreatic tissue. Original magnification, 20×. (D and E) Axial CT scan showing a local relapse at the level of the primary tumor (D, arrow), which remains stable in the follow-up exam after 6 cycles of chemotherapy with FOLFIRINOX (E, arrow). (F) Timeline of index patient. Complete pancreatectomy was performed, followed by adjuvant chemotherapy with gemcitabine/capecitabine. Twenty-four months after surgery, the follow-up CT scan showed a local and lymphatic relapse; a systemic chemotherapy with FOLFIRINOX was suggested. The following CT staging showed a stable disease.

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