DNA released from neutrophil extracellular traps (NETs) activates pancreatic stellate cells and enhances pancreatic tumor growth

Jennifer L. Miller-Ocuin, Xiaoyan Liang, Brian A. Boone, W. Reed Doerfler, Aatur D. Singhi, Daolin Tang, Rui Kang, Michael T. Lotze, Herbert J. Zeh

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Neutrophil extracellular trap (NET) formation results in the expulsion of granulocyte proteins and DNA into the extracellular space. This process is mediated by the enzyme peptidyl arginine deiminase 4 (PADI4) and translocation of elastase to the nucleus. NET formation, marked by increased levels of extracellular DNA, promotes pancreatic cancer proliferation and metastasis. Mice deficient in Padi4 demonstrate decreased pancreatic tumor growth, associated with a reduction in circulating extracellular DNA levels, diminished pancreatic stromal activation and improved survival in murine orthotopic pancreatic adenocarcinoma. Transplantation of Padi4−/− bone marrow into genetically engineered mice with Kras driven pancreatic adenocarcinoma (Pdx1-Cre:KrasG12D/+, KC mice) limits the frequency of invasive cancers when compared with syngeneic controls. DNA from neutrophils activates pancreatic stellate cells that form dense, fibrous stroma which can promote and enable tumor proliferation. DNase treatment diminishes murine tumor growth and stromal activation to reverse the effect of NETs within the tumor microenvironment. Furthermore, deletion of the receptor for advanced glycation end products (RAGE) in pancreatic stellate cells abrogates the effects of DNA in promoting stellate cell proliferation and decreases tumor growth. Circulating neutrophil-derived DNA correlates with the stage in patients with pancreatic ductal adenocarcinoma, confirming the role of NETs in human pancreatic cancer. These findings support further investigation into targeting of NETs, PADI4 and extracellular DNA as a potential treatment strategy in patients with pancreatic cancer. Trial Registration: This study reports correlative data from a clinical trial registered with clinicaltrials.gov, NCT01978184 (November 7, 2013).

Original languageEnglish (US)
Article numbere1605822
Issue number9
StatePublished - Sep 2 2019


  • DNase
  • Desmoplastic stroma
  • Padi4
  • damage associated molecular pattern molecules (DAMPs)
  • neutrophil extracellular traps (NETs)
  • pancreatic adenocarcinoma
  • receptor for advanced glycation end products (RAGE)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology


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