title: Pancreatic stellate cells and pancreas cancer: current perspectives and future strategies.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant disease with a very poor prognosis. To date patient outcomes have not improved principally due to the limited number of patients suitable for surgical resections and the radiation and chemotherapy resistance of these tumours. In the last decade, a failure of conventional therapies has forced researchers to re-examine the environment of PDAC. The tumour environment has been demonstrated to consist of an abundance of stroma containing many cells but predominantly pancreatic stellate cells (PSCs). Recent research has focused on understanding the interaction between PSCs and PDAC cells in vitro and in vivo. It is believed that the interaction between these cells is responsible for supporting tumour growth, invasion and metastasis and creating the barrier to delivery of chemotherapeutics. Novel approaches which focus on the interactions between PDAC and PSCs which sustain the tumour microenvironment may achieve significant patient benefits. This manuscript reviews the current evidence regarding PSCs, their interaction with PDAC cells and the potential implication this may have for future therapies.
  
  
  METHODS
  A PubMed search was carried out for the terms 'pancreas cancer' OR 'pancreatic cancer', AND 'pancreatic stellate cells', NOT 'hepatic stellate cells'. All studies were screened and assessed for their eligibility and manuscripts exploring the relationship between PSCs and PDAC were included. The studies were subdivided into in vitro and in vivo groups.
  
  
  RESULTS
  One hundred and sixty-six manuscripts were identified and reduced to seventy-three in vitro and in vivo studies for review. The manuscripts showed that PDAC cells and PSCs interact with each other to enhance proliferation, reduce apoptosis and increase migration and invasion of cancer cells. The pathways through which they facilitate these actions provide potential targets for future novel therapies.
  
  
  CONCLUSIONS
  There is accumulating evidence supporting the multiple roles of PSCs in establishing the tumour microenvironment and supporting the survival of PDAC. To further validate these findings there is a need for greater use of physiologically relevant models of pancreatic cancer in vitro such as three dimensional co-cultures and the use of orthotopic and genetically engineered murine (GEM) models in vivo.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom. Electronic address: jh250@le.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Haqq
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Howells
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Metcalfe
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom.
authors.forename: Will P
authors.initials: WP
authors.lastname: Steward
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery & Cancer Studies and Molecular Medicine Group, University Hospitals of Leicester & University of Leicester, Leicester LE5 4PW, United Kingdom.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D017209:Apoptosis; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002450:Cell Communication; D002465:Cell Movement; D049109:Cell Proliferation; D006801:Humans; D010190:Pancreatic Neoplasms / Q000473:pathology*; D058954:Pancreatic Stellate Cells / Q000473:pathology*; D059016:Tumor Microenvironment
keywords: Desmoplastic/stromal reaction; Pancreatic cancer; Pancreatic stellate cells; Stellate cells; Stroma–tumour interactions