Background
Pancreatic ductal adenocarcinoma (PDAC), often simply described as pancreatic cancer, is the most prevalent neoplastic disease of the pancreas [
1]. PDAC has a devastating 5-year survival rate of less than 10% [
2], and is projected to soon become the second- or third-leading cause of cancer mortality in many developed countries [
3,
4]. Like other solid tumors, PDAC adopts fermentative glycolysis as an additional metabolic mechanism to compensate for the impaired oxidative phosphorylation to support cell survival and proliferation [
5,
6]. The elevated glucose consumption—coupled with increased excretion of lactate and protons from glycolytic cells to the poorly perfused extracellular spaces—leads to an acidification of the tumor microenvironment [
7,
8].
Extracellular microenvironmental acidification is a common hallmark of solid tumors [
8,
9]. Although still not fully understood, an acidic microenvironment with an inverted pH gradient of extracellular pH (pH
e) lower than intracellular pH (pH
i) appears to impose selective pressures whereby tumor cells must adapt or die [
10,
11]. It is now assumed that acidic pH
e modulates multiple functions of tumor cells including activation of protective autophagy [
12‐
15], acquisition of anoikis resistance [
15,
16], induction of epithelial to mesenchymal transition (EMT) [
17,
18], promotion of local invasion [
19], and enhancement of chemoresistance [
20]. Hence, a better understanding of the impact of interstitial acidity and how tumor cells coordinate various adaptation mechanisms to cope with the acidified microenvironment is critical to improving therapeutic efficacy against solid cancers especially lethal PDAC.
Many solid tumors grow slowly, with an estimated average TVDT (tumor volume doubling time) of several months to multiple years [
21‐
26]. Given the long latency of tumor development especially for initial primary lesions, the acidification of the extracellular microenvironment is generally considered to be a lengthy and sustained process. However, most literatures to date have examined solid tumor cells exposed to acidic pH
e for a few minutes or hours up to days or weeks [
13‐
18,
27,
28]. In our opinion, these short-term exposure experiments can only provide limited insights toward the early responses of tumor cells to extracellular acidotic stress. Little is known about how solid tumors, such as PDAC originated within the pancreatic duct-acinar system that secretes alkaline fluids, evolve to withstand and adapt to the prolonged acidic microenvironment and then progress into more advanced stages.
Here, we established and characterized PDAC tumor cells exposed to different periods of acidic pHe stress. Unlike previous short-term studies, we show that acidosis-mediated autophagy occurred mainly as an early stress response but not in later adaptation to the prolonged extracellular acidification. Rather, PDAC cells employ a distinct long-term process of reversible adaptive plasticity, centering on the early fast and later slow mitochondrial network dynamics and metabolic reprogramming, for acute responses and chronic adaptations to the acidic pHe microenvironment. A continued advance toward more aggressive phenotypic states in PDAC cells under extended extracellular acidity was observed, with several major gene clusters functionally related to the long-term acidic pHe exposures. Finally, 34 potential target genes were found significantly associated with the overall survival of cancer patients—most of these were previously unable to be identified by short-term analyses of the effects of microenvironmental acidification on solid tumors.
Methods
Materials
List of antibodies was provided in Supplementary Table S
1. Unless otherwise specified, all reagents and chemicals were purchased from either Thermo Fisher Scientific (Carlsbad, CA, USA) or Sigma-Aldrich by Merck (Darmstadt, Germany).
Cell lines and cultures
Human pancreatic ductal adenocarcinoma SUIT-2 and BxPC-3 cell lines were freshly acquired from JCRB (Japanese Collection of Research Bioresources, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan) and BCRC (Bioresource Collection and Research Center, Hsinchu, Taiwan) cell banks, respectively. The STR (short tandem repeat) profiles of both cell lines were validated by FIRDI (Food Industry Research and Development Institute, Hsinchu, Taiwan), and the certificates of authentication can be provided upon request. Cells were cultured as monolayers in RPMI-1640 medium (Cat. #31800-022, Gibco by Thermo Fisher Scientific, Waltham, MA, USA) supplemented with 23.8 mM NaHCO
3 and 10% (v/v) FBS at 37 °C in a humidified atmosphere of 5% CO
2 in air, and were routinely examined for mycoplasma contamination using the EZ-PCR mycoplasma detection kit (Biological Industries, Kibbutz Beit HaEmek, Israel). To assess the impact of acidic pH
e on PDAC cells, the bicarbonated RPMI-1640 medium was further supplemented with 25 mM HEPES/PIPES (bioWORLD by GeneLinx, Dublin, OH, USA) followed by the addition of appropriate amount of 1 N HCl to either pH
e 7.4 for use as the buffer control medium, or to pH
e 6.7 for use as the acidic culture medium as per the guidelines recommended by Michl et al. [
29]. Each cell sample was adapted to the intended pH by adding the corresponding pH-adjusted medium to freshly split cells, followed by intensive daily monitoring (e.g., before and after each experiment or when cultivation took place in the humidified CO
2 incubator) to ensure the desired medium pH level to be accurate within 0.1 units throughout experiments. To achieve statistical power, all cell samples subjected to different periods of acidic exposures were prepared in 3 separate experiments.
Cell viability and proliferation assays
Cell viability was determined by trypan blue (Invitrogen by Thermo Fisher Scientific, Eugene, OR, USA) dye exclusion assay and expressed as the percentage of living cells counted. To measure changes in cellular proliferation, the MTT (thiazolyl blue tetrazolium bromide) assay was performed. The blue formazan crystals were solubilized with DMSO, and the colored solution was read at 570 nm using a SpectraMax 250 microplate reader (Marshall Scientific, Hampton, NH, USA).
The oxygen consumption rate (OCR) and the extracellular acidification rate (ECAR) of test cell samples were assessed using a Seahorse XFe24 Extracellular Flux Analyzer (Agilent, Santa Clara, CA, USA) as per the guideline provided by the manufacture. Briefly, cells were seeded in the XFe24 microplates and cultured in conditioned medium for 16 h (37 °C under 5% CO2 and 95% humidity) to allow attachment and growth. Prior to the start of Seahorse assays, the optimal FCCP (carbonyl cyanide-4(trifluoromethoxy)phenylhydrazone) concentrations were determined by titration studies. For the OCR measurements, cells were washed in pre-warmed medium (2% FBS in RPMI-1640 without NaHCO3, pH adjusted to 7.4) and equilibrated at 37 °C for 1 h before the assay. For the ECAR measurements, cells were washed in pre-warmed glucose-free RPMI-1640 medium (Cat. R1383, Sigma-Aldrich by Merck) supplemented with 2% (v/v) FBS without NaHCO3, pH adjusted to 7.4 and equilibrated at 37 °C for 30 min before the experiments. Data were normalized by cell number, and graphs were calculated and plotted using Agilent Seahorse Wave Desktop software.
Visualization of cellular morphology and mitochondrial cristae ultrastructure
To visualize cellular morphological changes, all cells cultured in their corresponding pH
e medium were collected and plated in 35-mm diameter μ-dishes (Ibidi, Martinsried, Germany). A minimum of 10 randomly chosen microscopic fields (~ 70 cells per field) were imaged using an AF6000 LX microscope (Leica Microsystems, Singapore) equipped with Zyla sCMOS camera (Andor by Oxford Instruments, Belfast, UK) and objective lens (HCX PL Fluotar L 20x/0.40 CORR PH1) with 1.8x digital zoom. To observe mitochondrial morphology and cristae ultrastructure, the TEM (transmission electron microscopy) images of each cell group were taken on an H-7650 electron microscope (Hitachi High-Technologies, Tokyo, Japan) equipped with a CCD (charge-coupled device) camera (Advanced Microscopy Techniques, Danvers, MA, USA). The density of cristae was calculated based on 45 randomly selected mitochondria per cell group with ImageJ software (
https://imagej.nih.gov/ij).
Immunofluorescence analysis
To detect the changes of autophagy, approximately 2 × 104 cells obtained from each sample were incubated with 200 nM LysoTracker Red DND-99 for lysosome visualization, followed by labeling with 1x CYTO-ID Green dye (Enzo Life Sciences, Farmingdale, NY, USA) for tracking autophagic vacuoles, and with 1 μg/mL Hoechst 33342 for nucleus staining. After incubation, the stained cells were subjected to image analysis by a TCS SP5 confocal microscope (Leica Microsystems). For ROS measurement, cells were stained with 5 μM CellROX Green dye for oxidative stress detection and then counterstained with 1 μg/mL Hoechst 33342 for confocal imaging. To determine mitochondrial superoxide production and membrane potential (∆ψ mt), cells were respectively stained with 5 μM MitoSOX Red and 200 nM TMRE (tetramethylrhodamine ethyl ester) as per the manufacturer’s instructions. To observe mitochondrial dynamics, cells were incubated with 200 nM MitoTracker Orange CMTMRos, followed by labeling with 2 drops/mL ActinGreen 488 reagent for tracking F-actin and mounted with ProLong Diamond mounting medium containing DAPI for confocal imaging. The fluorescence intensity profiles were plotted using LAS X software (Leica Microsystems). The super-resolution imaging of mitochondria was carried out using a Nikon N-SIM system equipped with an Apochromat 60×/1.27 numerical aperture water-immersion objective len (Nikon Instruments, Tokyo, Japan). Raw SIM images were obtained and reconstructed using Nikon Elements software. The lengths of mitochondria were analyzed by Imaris 8.0 software (Bitplane, Badenerstrasse, Zurich, Switzerland). For the assessment of filopodia assembly, cells were immunostained with anti-VASP antibody followed by Alexa Fluor 488-conjugated secondary antibody. Actin filaments were revealed by Alexa Fluor 594 phalloidin (Invitrogen) staining. The images were taken with the TCS SP5 confocal microscope, followed by fluorescence signal quantification with MetaMorph software (Molecular Devices, San Jose, CA, USA).
Flow cytometry for cell cycle, mitochondrial ROS, and membrane potential analyses
To characterize cell cycle phase, the collected cells were stained with propidium iodide solution and subjected to a FACSCalibur flow cytometer (BD Biosciences, San Jose, CA, USA). The proportions of cells in different phases of the cell cycle were calculated using CellQuest software (BD Biosciences). The levels of cellular ROS, mitochondrial superoxide, and ∆ψ mt were determined by FACSCalibur and CellQuest using the CellROX Green, MitoSOX Red and TMRE staining, respectively.
Cell migration and invasion assays
Cell migration was assessed using time-lapse microscopy as previously reported [
30] with slight modifications. In brief, approximately 2 × 10
4 cells in each study group were seeded in 6-well plates in their corresponding pH
e medium. On the next day, cells were placed on a Leica AF6000 LX microscope and their movement was recorded for 3 h at 20 min intervals at 37 °C. Individual cells were tracked for motility analysis with Image-Pro Plus software (Media Cybernetics, Rockville, MD, USA). To determine cell invasive capability, cells were stained with 1 μM CellTracker Deep Red dye (Invitrogen), and then seeded in 35-mm glass bottom culture dishes (MatTek, Ashland, MA, USA) precoated with Matrigel Matrix (Corning, Tewksbury, MA, USA) supplemented with 25 μg/mL DQ-collagen IV (Invitrogen). The dishes were left for 16-18 h before nuclear staining with 1 μg/mL Hoechst 33342. Images of live-cell invasion were photographed by the TCS SP5 confocal microscope followed by quantitative analysis using Imaris 8.0 software.
Plasmid construction and RNA interference
To generate HA-tagged constructs, the HA (YPYDVPDYA) epitope-tag was cloned into the pGW1-CMV expression vector (Addgene, Watertown, MA, USA) as a positive control to assess transfection efficiency as previously described [
31]. The construction of two sub-clones, pGW1-HA-Drp1
S637A and pGW1-HA-Drp1
S637D, was engineered as detailed elsewhere [
32]. Cells were transfected with each of the recombinant plasmids using Lipofectamine 3000 (Invitrogen) according to the manufacturer’s guidelines. For gene-silencing studies, non-targeting control siRNA and sequence-specific SMARTpool siRNA against Mfn2 (see Supplementary Table S
2) were purchased from Dharmacon by Horizon Discovery (Cambridge, UK). Transfections were performed using Lipofectamine RNAiMAX transfection reagent (Invitrogen) as per manufacturer’s protocol.
Western blot
For whole-cell protein extraction, cells were harvested and lysed in 1x RIPA lysis buffer (Merck Millipore) containing PhosSTOP phosphatase inhibitors and cOmplete protease inhibitor cocktail (Sigma-Aldrich by Merck). Protein concentrations were determined by the Pierce BCA assay kit (Thermo Fisher Scientific) using BSA as standard. Equal protein quantities of cell lysates (20-50 μg) were electrophoresed on a range of 10-15% (w/v) SDS-PAGE depending on the size of the target proteins, and then processed for Western blotting with corresponding primary antibodies followed by incubation with HRP-conjugated secondary antibodies. Chemiluminescence signals were visualized using an ECL Western Detection System (Merck Millipore) as recommended by the manufacturer. Unless otherwise specified, β-actin served as loading control in all Western blot experiments.
Analysis of OPA1 oligomerization
To investigate changes in OPA1 oligomerization correlated with altered cristae ultrastructure, cells were crosslinked with 1 mM bismaleimidohexane for 20 min at 37 °C. After crosslinking, cells were quenched and washed with PBS supplemented with 0.1% β-mercaptoethanol, and were then lysed in RIPA buffer for gradient gel electrophoresis using EVOgel (GeneDireX, Taoyuan, Taiwan). OPA1 oligomerization was analyzed by Western blotting using an anti-OPA1 antibody.
Microarray and GSEA
Total RNA was extracted using RNeasy mini kit (Qiagen, Hilden, Germany) according to the manufacturer’s guidelines. The quality of RNA was ascertained both by gel electrophoresis and Agilent 2100 Bioanalyzer. Microarray analysis was conducted on the high-resolution Human Transcriptome Array 2.0 platform (Affymetrix, Santa Clara, CA, USA) by the Core Instrument Center at National Health Research Institutes, Taiwan. Raw intensities were normalized using SST-RMA (signal space transformation-robust multi-chip analysis) algorithm. Fold-change values were analyzed by Partek Genomics Suite statistical software (Partek, St. Louis, MO, USA). Gene expression profiles were subjected to GSEA (Gene Set Enrichment Analysis,
https://www.gsea-msigdb.org) and IPA (Ingenuity Pathway Analysis, Qiagen) functional enrichment analysis for a variety of gene sets including the pre-defined gene sets, the hallmark gene sets and the representative MSigDB (Molecular Signatures Database) signatures (see Supplementary Table S
3). The relative gene expressions of leading edge subsets were viewed as heatmaps by MeV software (
https://webmev.tm4.org). The analyzed gene sets were limited to those that contained between 15 and 500 genes. The permutation was conducted 1000 times with random combinations according to default-weighted enrichment statistics, along with the use of a signal-to-noise metric to rank genes based on their differential expression levels across different cell groups.
Survival analysis
Gene expression data and relevant clinical information were obtained from The Cancer Genome Atlas pancreatic cancer dataset (TCGA_PAAD cohort) downloaded from GDC data portal (
https://portal.gdc.cancer.gov). Primary pancreatic tumor samples with available overall survival data (
n = 176) were selected for analysis. The Kaplan-Meier curve was used to estimate the effects of gene on the overall survival of patients. The patients were classified into low and high expression groups based on the median-centered gene expression values. The difference between low or high expression groups was assessed by log-rank test.
Statistical analysis
Data are presented as the means ± SD from at least three individual experiments, unless specified otherwise. Results were analyzed by GraphPad Prism statistical software (GraphPad Software, San Diego, CA, USA) using unpaired Student’s t-test. A p value less than 0.05 was interpreted as statistically significant for all comparisons.
Discussion
Most solid cancers are asymptomatic in their early stages, with a slow TVDT of months to years depending on primary tumor size and location [
25,
26,
51]. Given the long latency of tumor development, the acidification of the extracellular environment is thought to be a lengthy and continuing process. However, most studies to date have only examined the short-term response but not the long-term impact of microenvironmental acidification on solid cancers including PDAC. Even more confusing is that the definition of short term versus long term is not always clear, and can at times be very subjective (e.g., few reports describe an 8-h acidic cell culture as short-term and a 24-h time frame as long-term exposure [
13,
14]). Since the tumor growth rate is a key parameter in assessing the malignant potential and therapeutic response of the disease, here we recommend the use of clinical TVDT as a practical reference for investigating the time effects of acidic pH
e stress on solid tumors. In the current setting, we exposed PDAC cells to different periods of extracellular acidity as illustrated in Fig.
1a. By characterizing these different PDAC cell states under short-, mid-, and long-term acidic stress conditions, we could identify a previously unreported slow-mode of reversible adaptive plasticity of pancreatic tumor cells to the prolonged acidic pH
e microenvironment. More studies on the long-term impact of extracellular acidosis on other types of solid tumors are currently underway, and will be reported in due course.
Some previous short-term studies claimed that the inhibited cell proliferation induced by acute extracellular acidosis could soon be completely restored under the same acidic culture condition [
38]. However, we did not observe any such phenomenon. Rather, we identified a slow but partial recovery of PDAC cell proliferation even after nearly a full year of acidic pH
e exposure (Figs.
1b & S
2a). We showed that the acute extracellular acidotic stress induced a G1 cell cycle arrest that led inhibited cell proliferation. After PDAC cells chronically adapted to the prolonged acidic pH
e pressure, most of the altered expression in G1/S regulators was reversed to normal levels, and the increased percentage of G1-phase cells was gradually reduced to near, but not equal, to those of controls at pH
e 7.4 (Figs.
1d-e, S
2b, & S
2l). The slow mode of reversible recovery in cell cycle progression and proliferation was further underlined by findings showing that PDAC cells rapidly reduced the levels of oxidative phosphorylation and mitochondrial ROS to sustain their survival and minimum growth upon acute acidosis exposure. This continued until they evolved the ability to reinvigorate mitochondrial activity, repair dysfunctional metabolism, and thus generate the energy needed for full proliferation under acidic conditions (Figs.
1j-m,
2j-o, & S
2). Such a multistep process would inevitably require substantial time for cells to evolve and adapt to the hostile acidic microenvironment, thus presenting an interesting paradox of how tumor cells could restore full proliferation in just a few days as described previously under early acute acidotic stress [
38].
Tumor cells have evolved autophagy and EMT as two major mechanisms to respond to external stress stimuli [
52]. Autophagy enables tumor cells to survive environmental stresses by recycling intracellular components to sustain metabolic homoeostasis. EMT gives tumor cells increased motility and propensity to metastasize. As such, autophagy (striving for mere survival) and EMT (escaping from a hostile microenvironment) can be considered two opposite stress responses that are mutually exclusive [
52]. Our observations of the coexistence of autophagy and EMT provoked by acute acidotic stress (see
S.A. in Figs.
1f-g & S
2c-S
2d) clearly do not endorse this assumption. Rather, the results support a recent hypothesis that one of these two stress responses is a necessary requirement for the other, i.e., the EMT-related signaling pathways can either trigger or repress autophagy and that autophagy may provide energy for EMT or suppress EMT-induced metastatic spreading [
52‐
54]. Further work is needed to clarify the molecular control mechanism and the crosstalk between acidic pH
e-mediated autophagy and EMT, and to also determine whether disruption of this crosstalk can lead to dysfunctional responsiveness of tumor cells to the acidic pH
e microenvironment.
Our findings in Fig.
1 indicate that the conventional statement of chronic autophagy induced by extracellular acidosis mainly served as an early stress-responsive survival mechanism, but not for later cellular adaptation to the prolonged acidic pH
e exposure. Instead, solid tumors such as PDAC acquired alternative metabolic strategies to adapt to the constant and prolonged microenvironmental acidification (Figs.
1j-m,
2, & S
2e-S
2j). Therefore, the concept of targeting acidic pH
e-induced autophagy as a therapeutic strategy for anticancer therapy may need to be adjusted [
14,
15]. One would expect little or no autophagy in some, if not all, long-term acid-adapted tumor cells from cancer patients.
Increasing evidence has suggested that environmental stress alteration is associated with rapid adjustments of mitochondrial function often accompanied by aberrant mitochondrial ROS production and fusion/fission activity [
46,
48]. The description is similar to our findings of the early acute effect of extracellular acidosis on PDAC cells causing severe mitochondrial damage coupled with reduced oxidative phosphorylation and ATP production (see
S.A. vs
Ctrl or
Buff, Figs.
1j-k & S
2e-S
2f). These metabolic alterations were attributed to a rapid induction of massive SIMH to counter the microenvironmental stress by preserving damaged mitochondria from mitophagic degradation. However, after PDAC cells become chronically acclimated to the constant stress of extracellular acidity, the damaged mitochondrial network undergoes an unexpectedly slow and progressive ultrastructural transformation from the interconnected reticular SIMH to the disconnected fragmented configuration (see Fig.
2 & Videos S
3, S
4 and S
5).
Although we attempted a thorough and extensive literature search, we could not find any similar report on such gradual and year-long mitochondrial network dynamics starting from global SIMH initiation as an early responsive machinery followed by gradual disintegration as a late adaptative mechanism to acidic stress (Fig.
2). The closest comparison we could find was a recent study of chronic kidney disease showing a slow and gradual change in mitochondrial dynamics from fusion to fission in remnant renal masses from day 2 to day 28 after 5/6 nephrectomy in rats [
55]. Another example of the critical role of shifting the mitochondrial dynamic equilibrium was seen in
S. cerevisiae, in that it employed a delicate balance of fusion and fission to adjust mitochondrial dynamics in a stationary growth phase to resist prolonged dehydration stress [
56]. These examples, together with our observations in human cells, signify the importance of mitochondrial network dynamics in both early stress response and late adaptation to the changing microenvironment. Figure
3a-b shows that successful disruptions of this dynamic mitochondrial network severely hampered the adaptive capability of tumor cells to the microenvironmental acidification, thus suggesting the feasibility of this strategy for future clinical applications.
Apart from fusion and fission, mitochondrial subcellular distribution is also regarded as a pivotal modulator for tumor malignancy even though many fundamental aspects remained unexplored [
49]. We postulate that the accumulated bioenergetically active mitochondria at or near the leading edge of the cell help provide a local source of energy for cell membrane dynamics, migration, and invasion. We present evidence showing the impact of acidic pH
e stress to the increased mitochondrial trafficking and subcellular localization. Upon early exposure to extracellular acidosis, most mitochondria in PDAC cells were fused into interconnected reticular networks (see
S.A. in Fig.
2a-g) and spread throughout the cytoplasm via anchoring to the actin filaments toward cell periphery (see
S.A. in Fig.
4a-b). At this early acidosis-responsive
S.A. state, PDAC cells with substantial mitochondrial trafficking acquired a more aggressive phenotype than the control groups at pH
e 7.4 (see
S.A. vs
Ctrl or
Buff, Fig.
4f-h, m & n). This phenomenon is somewhat unexpected, as tumor cells at this early stress-responsive stage are relatively fragile with a proliferation rate that was severely restrained and that most mitochondria are in hyperfused state associated with ATP insufficiency. However, many mitochondria were fragmented from the filamentous tubular network into spherical active organelles after exposure to acidic stress conditions for a sufficiently long period (see
L.A. in Fig.
2a-g). They remained at the leading edge of the cell to support ATP-consuming activities for tumor cell motility and invasion (see
L.A. in Figs.
1j-k &
4a-n). Quantification of the differential expression levels of a variety of metastasis-related molecules (Fig.
4k-l) confirmed that the acid-adapted PDAC cells progressively evolved into a more malignant state with increased migratory and invasive potential upon stimulation. More extensive studies on these protein molecules and associated pathways are needed to elucidate the molecular mechanism involved in PDAC early responses and late adaptation to extracellular acidification. These can determine whether the alteration of mitochondrial subcellular distributions may prevent accumulation of mitochondria at the cell periphery to subsequently impair PDAC motility and invasiveness under an acidic pH
e microenvironment.
Tumor progression is an evolutionary and ecological process [
11,
17,
57]. At the cellular selection level, only the cell population that is best adjusted to survive in a microenvironmental ecosystem will persist. For a cell population to persist, it must be able to evolve to maintain its fitness and adapt necessary phenotype and metabolic rewiring to be more successful in thriving and progressing within a new or changing microenvironment. However, Noë et al. recently stated that much of today’s discourse on PDAC fails to include an evolutionary perspective [
57]. They suggested that PDAC cells should be viewed as evolving living organisms interacting with their microenvironment [
57]. In this study, PDAC cells exhibited almost totally different responses and adaptations to the acute and chronic acidic microenvironmental pressure (Figs.
1,
2 and
3). In light of evolution, PDAC cells under extracellular acidosis constantly evolved toward a more aggressive phenotypic state in a time-dependent manner (Fig.
4). The identified enrichment of four functional hallmarks (advanced malignancy, EMT, migration & invasion) provides a strong and selective advantage for PDAC cells exposed to extended extracellular acidity; LKB1 and adherens
_junctions
_interactions canonical pathways are primarily involved in the metabolism and growth control of PDAC cells during early acidic pH
e stress (Fig.
5a-b).
Next, comprehensive heatmap analyses uncovered thirteen acid-adaptation up-regulated and six down-regulated genes whose expression levels are respectively negatively and positively correlated with the overall survival of pancreatic cancer patients (Fig.
5c-i). To further classify the molecular targets specifically involved in the long-term adaptation of PDAC cells to the acidic microenvironment, we identified and annotated two distinct gene sets (the chronic_acidosis_adaptation up-regulated signature and the chronic_acidosis_adaptation down-regulated signature; see Tables S
4 & S
5). These expression levels are differentially impacted by prolonged acidic pH
e exposure (Fig.
6). There were fourteen up-regulated genes and one down-regulated gene significantly associated with the overall survival of pancreatic cancer patients (Fig.
6b). Most of these genes were previously unidentified by short-term analyses of the impacts of extracellular acidosis on tumor cells. These fifteen acidic-pHe-related molecules—together with the nineteen genes identified from GSEA analysis in Fig.
5—are potential biomarkers for early diagnosis and therapeutic targets of PDAC. Deeper functional explorations of these acidosis-related genes are necessary to validate their roles in early response or late adaptation of pancreatic tumor cells to extracellular acidification. Finally, our findings fill a relevant knowledge gap in how solid tumor cells such as PDAC cells evolve to withstand, respond, reprogram, and ultimately adapt to the prolonged and persistent acidic pH
e microenvironment.
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