Rationale: Pancreatic ductal adenocarcinoma (PDAC) tumors are notorious for their extensive non-malignant stroma in which the most abundant cells are cancer-associated fibroblasts (CAFs). CAFs are comprised of distinct subtypes with seemingly diverse roles within the PDAC tumor microenvironment (TME) and have been shown to influence disease progression and therapy response. However, most insights into PDAC CAF heterogeneity have been based on KPC (KrasLSL-G12D/+; Trp53LSL-R172H/+; Pdx1-Cre) mouse models, which recapitulate the pathophysiology of human PDAC but not its genetic complexity, representing only ~5% of patient tumor mutation profiles. We hypothesized that further understanding of CAF heterogeneity in PDAC tumors with commonly occurring mutations is essential for improving patient stratification and treatment strategies, and consequently, survival of this disease. To start exploring this, we developed and analyzed new PDAC models with deletion of Smad4, which is inactivated in ~30% of PDAC cases, in the context of Kras and Trp53 mutations. Methods: Smad4 deletion was performed using CRISPR-Cas9 technology in pancreatic cancer organoids derived from KPC tumors to generate matched KPC Smad4 knockout organoids. To assess whether this mutation profile modulates the PDAC TME, we cultured pancreatic stellate cells (PSCs), a precursor of CAFs, in media conditioned from KPC and KPC Smad4 knockout organoids and assessed the activation of inflammatory CAF (iCAF) and myofibroblastic CAF (myCAF) markers by RT-qPCR. We also established co-cultures of PSCs and organoids and performed bulk RNA-sequencing on flow-sorted CAFs and cancer cells. Finally, orthotopically-grafted organoid (OGO) transplantation mouse models were generated and pancreatic tumors were evaluated by ultrasound-based imaging, single-cell RNA-sequencing, immunohistochemistry, and flow cytometry. Results: We found that Smad4 deletion in PDAC cells, in the context of Kras and Trp53 mutations, promotes PDAC progression, as expected, and alters the PDAC TME. In particular, Smad4 deletion leads to a decrease in matrix-producing myCAFs, CD105-positive CAFs and antigen-presenting apCAFs, while increasing potentially immunosuppressive iCAFs. Additionally, pancreatic tumors with Smad4 deletion are depleted for macrophages, while enriched for neutrophils. Conclusions and Significance: This study demonstrates how distinct cancer genetics differentially shape the PDAC TME and establishes a workflow for ongoing investigation of additional relevant mutation profiles. This approach could lead to better PDAC patient stratification based on the profile of both cancer and stromal cells for more effective and targeted therapies.

Citation Format: Eloise G. Lloyd, Gianluca Mucciolo, Muntadher Jihad, Judhell Sandoval Manansala, Sara Pinto Teles, Giulia Biffi. Smad4 deletion alters the composition of the tumor microenvironment in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C063.