Published online Apr 21, 2019. doi: 10.3748/wjg.v25.i15.1797
Peer-review started: February 6, 2019
First decision: March 5, 2019
Revised: March 20, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: April 21, 2019
Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with no efficacious treatment options. PDAC incidence is projected to increase, which may be caused at least partially by the obesity epidemic. Significantly enhanced efforts to prevent or intercept this cancer are clearly warranted. Oncogenic KRAS mutations are recognized initiating events in PDAC development, however, they are not entirely sufficient for the development of fully invasive PDAC. Additional genetic alterations and/or environmental, nutritional, and metabolic signals, as present in obesity, type-2 diabetes mellitus, and inflammation, are required for full PDAC formation. We hypothesize that oncogenic KRAS increases the intensity and duration of the growth-promoting signaling network. Recent exciting studies from different laboratories indicate that the activity of the transcriptional co-activators Yes-associated protein (YAP) and WW-domain-containing transcriptional co-activator with PDZ-binding motif (TAZ) play a critical role in the promotion and maintenance of PDAC operating as key downstream target of KRAS signaling. While initially thought to be primarily an effector of the tumor-suppressive Hippo pathway, more recent studies revealed that YAP/TAZ subcellular localization and co-transcriptional activity is regulated by multiple upstream signals. Overall, YAP has emerged as a central node of transcriptional convergence in growth-promoting signaling in PDAC cells. Indeed, YAP expression is an independent unfavorable prognostic marker for overall survival of PDAC. In what follows, we will review studies implicating YAP/TAZ in pancreatic cancer development and consider different approaches to target these transcriptional regulators.
Core tip: The identification of signaling networks that underlie risk factor promoted pancreatic cancer development and progression is of paramount importance to prevent or intercept this lethal disease. Accumulating evidence suggests that several core signaling pathways downstream of oncogenic Kras, augmented by environmental conditions, e.g., obesity, converge on Yes-associated protein (YAP) and WW-domain-containing transcriptional co-activator with PDZ-binding motif (TAZ), transcriptional co-activators in the Hippo pathway. Statins and metformin, widely used Food and Drug Administration-approved drugs, show great promise to intercept this disease by disrupting or inhibiting this amplifying network at multiple points converging onto YAP/TAZ.