- Todoric, Jelena;
- Antonucci, Laura;
- Di, Giuseppe;
- Li, Ning;
- Wu, Xuefeng;
- Lytle, Nikki K;
- Dhar, Debanjan;
- Banerjee, Sourav;
- Fagman, Johan B;
- Browne, Cecille D;
- Umemura, Atsushi;
- Valasek, Mark A;
- Kessler, Hannes;
- Tarin, David;
- Goggins, Michael;
- Reya, Tannishtha;
- Diaz-Meco, Maria;
- Moscat, Jorge;
- Karin, Michael
Despite expression of oncogenic KRAS, premalignant pancreatic intraepithelial neoplasia 1 (PanIN1) lesions rarely become fully malignant pancreatic ductal adenocarcinoma (PDAC). The molecular mechanisms through which established risk factors, such as chronic pancreatitis, acinar cell damage, and/or defective autophagy increase the likelihood of PDAC development are poorly understood. We show that accumulation of the autophagy substrate p62/SQSTM1 in stressed KrasG12D acinar cells is associated with PDAC development and maintenance of malignancy in human cells and mice. p62 accumulation promotes neoplastic progression by controlling the NRF2-mediated induction of MDM2, which acts through p53-dependent and -independent mechanisms to abrogate checkpoints that prevent conversion of differentiated acinar cells to proliferative ductal progenitors. MDM2 targeting may be useful for preventing PDAC development in high-risk individuals.