Abstract 5893: Crosstalk between sensory innervation and pancreatic ductal adenocarcinoma

Abstract In recent years, a growing body of research has illuminated the integral role of the nervous system in the initiation and progression of cancer, giving rise to the establishment of an emergent field known as cancer neuroscience. Pancreatic ductal adenocarcinoma (PDAC), constituting 90% of pancreatic cancers, manifests as a highly malignant solid tumor characterized by insidious onset, strong invasiveness, and a notable propensity for recurrence or metastasis. Consequently, the 5-year survival rate for PDAC remained dismally low at approximately 10% in 2021. Notably, PDAC is distinguished by perineural invasion (PNI), a phenomenon linked to postoperative recurrence and metastasis. A thorough exploration of the interplay between peripheral innervation and PDAC holds promise for identifying novel targets and therapies to enhance outcomes in PDAC. This study unveils a correlation between PDAC patients exhibiting high calcitonin gene-related peptide-positive (CGRP+) sensory innervation in the tumor microenvironment (TME) and diminished overall survival (OS) and disease-free survival (DFS) compared to those with lower CGRP+ nociceptive innervation. Concurrently, heightened CGRP+ sensory innervation corresponds to increased cancer pain, as assessed by Visual Analog Scale (VAS) scores. Further analysis reveals a negative association between CGRP+ nociceptive nerves and lymphatic metastasis, as well as tumor size in PDAC patients. In a murine PDAC model, the genetic or chemical ablation of CGRP+ sensory neurons significantly impedes disease progression. Additionally, sensory neuron ablation attenuates cancer-induced vesical pain and enhances the locomotor function of mice, suggesting an improvement in overall quality of life. Mechanically, within the TME of PDAC, the secretion of neuropeptides substance P (SP) and CGRP from sensory neurons is elevated, with CGRP exhibiting a more pronounced increase. Furthermore, the expression of the CGRP receptor—receptor activity modifying protein 1 (RAMP1)—surpasses that of the SP receptor in the TME. Subsequent blockade of the CGRP pathway using the RAMP1 antagonist Rimegepant significantly suppresses PDAC progression and alleviates cancer pain, accompanied by improved locomotor function. In summary, sensory innervation actively participates in the progression of PDAC through the secretion of CGRP. Consequently, the inhibition of the CGRP pathway emerges as a potential therapeutic strategy for both PDAC and cancer-induced pain. Citation Format: Kaiyuan Wang, Bo Ni, Xiuchao Wang, Jihui Hao. Crosstalk between sensory innervation and pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5893.