Pancreatic cancer variant analysis of the All of Us cohort

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PROJECT SUMMARY Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease that is refractory to current treatment strategies due in part to adaptive mechanisms of chemoresistance. Racial health disparities also confound the treatment and care of these patients. Blacks have significantly higher incidence rates of PDAC and decreased survival times compared to Whites and Latino/Hispanics (L/H) even after socioeconomic status and tumor stages are controlled. Therefore, it is likely different racial groups exhibit unique molecular characteristics in PDAC tumors that contribute to these health disparities. The molecular characteristics that distinguish PDAC tumors between racial groups have the potential to identify novel therapeutic targets required to overcome the disparities. Indeed, delineating the underlying molecular basis for health disparities in lung, breast and prostate cancers has led to therapeutic advancements and improved patient outcomes. Similar breakthroughs for PDAC are possible and needed for this deadly disease, but this field of research has not yet been adequately explored. We identified 4 distinct subtypes of PDAC (Metabolic, Progenitor-like, Proliferative, and Inflammatory) that can be distinguished using multivariate analysis of quantitative mass spectrometry data. These PDAC subtypes are predictive of therapeutic response, but this has not yet been analyzed in a racially diverse population. We have examined the proteomes of primary PDAC tumors using quantitative mass spectrometry and identified unique protein signatures for Blacks, L/H, and Whites. In PDAC tumors from Black patients, we observed features consistent with the Inflammatory subtype of PDAC, which is characterized by an inflammatory microenvironment and resistance to chemotherapy. Therefore, it is possible that race influences subtype and Blacks could preferentially develop the more aggressive and treatment refractory Inflammatory subtype. However, the underlying genetic variants associated with PDAC subtype specification have not been examined. Toward this goal, our project will utilize the All of Us database to identify variants in a diverse cohort pancreatic cancer patients and evaluate specific gene sets associated with PDAC tumorigenesis, including alcohol responsive genes, and differentially expressed proteins in PDACs originating in Blacks. In addition, we will perform a discovery GWAS analysis to identify variants associated with PDAC development in the All of Us cohort and examine their predicted functional consequences in selected PDAC subtype specification genes. The successful completion of these aims outlined in this proposal has the potential to improve our understanding of the drivers of PDAC subtype specification, which could be developed to improve overall patient survival by optimizing treatment strategies.