Published online May 15, 2016. doi: 10.4291/wjgp.v7.i2.199
Peer-review started: July 30, 2015
First decision: September 28, 2015
Revised: October 21, 2015
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 15, 2016
Core tip: The Hedgehog (Hh) pathway is a ligand-dependent and evolutionary conserved cellular signaling mechanism with various physiologic (development) and pathogenetic functions (especially carcinogenesis). Concerted Hh signaling is essential for human pancreatic development and homeostasis of the gastrointestinal tract. Aberrant expression within the Hh signaling pathway results in malformations like annular pancreas. The Janus aspect of Hh in pancreatitis is reflected by the protective role of Hh in acute pancreatitis vs the disease-progressive function of Hh in chronic pancreatitis (CP), whereby CP is linked to pancreatic cancerogenesis via pancreatic intraepithelial neoplasia (PanIn). Starting with PanIn and ending up at metastatic disease, Hh pathway is expressed in ductal pancreatic cancer thereby influencing and being paracrine influenced by the tumor microenvironment.