Suppression of stromal-derived Dickkopf-3 (DKK3) inhibits tumor progression and prolongs survival in pancreatic ductal adenocarcinoma

Sci Transl Med. 2018 Oct 24;10(464):eaat3487. doi: 10.1126/scitranslmed.aat3487.


Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, and it is unclear whether its stromal infiltrate contributes to its aggressiveness. Here, we demonstrate that Dickkopf-3 (DKK3) is produced by pancreatic stellate cells and is present in most human PDAC. DKK3 stimulates PDAC growth, metastasis, and resistance to chemotherapy with both paracrine and autocrine mechanisms through NF-κB activation. Genetic ablation of DKK3 in an autochthonous model of PDAC inhibited tumor growth, induced a peritumoral infiltration of CD8+ T cells, and more than doubled survival. Treatment with a DKK3-blocking monoclonal antibody inhibited PDAC progression and chemoresistance and prolonged survival. The combination of DKK3 inhibition with immune checkpoint inhibition was more effective in reducing tumor growth than either treatment alone and resulted in a durable improvement in survival, suggesting that DKK3 neutralization may be effective as a single targeted agent or in combination with chemotherapy or immunotherapy for PDAC.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing
  • Animals
  • Antibodies, Neutralizing / pharmacology
  • Antibodies, Neutralizing / therapeutic use
  • Autocrine Communication / drug effects
  • Carcinoma, Pancreatic Ductal / drug therapy
  • Carcinoma, Pancreatic Ductal / pathology*
  • Cell Line, Tumor
  • Chemokines
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / pharmacology
  • Deoxycytidine / therapeutic use
  • Disease Models, Animal
  • Disease Progression*
  • Drug Resistance, Neoplasm / drug effects
  • Gene Silencing
  • Humans
  • Immunotherapy
  • Intercellular Signaling Peptides and Proteins / metabolism*
  • Mice, Inbred C57BL
  • Mice, Nude
  • NF-kappa B / metabolism
  • Neutralization Tests
  • Pancreatic Neoplasms / drug therapy
  • Pancreatic Neoplasms / pathology
  • Pancreatic Stellate Cells / drug effects
  • Pancreatic Stellate Cells / metabolism
  • Pancreatic Stellate Cells / pathology
  • Paracrine Communication / drug effects
  • Survival Analysis


  • Adaptor Proteins, Signal Transducing
  • Antibodies, Neutralizing
  • Chemokines
  • DKK3 protein, human
  • Intercellular Signaling Peptides and Proteins
  • NF-kappa B
  • Deoxycytidine
  • gemcitabine

Supplementary concepts

  • Pancreatic Carcinoma