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Fibroblast drug scavenging increases intratumoural gemcitabine accumulation in murine pancreas cancer
  1. E Hessmann1,
  2. M S Patzak1,
  3. L Klein1,
  4. N Chen1,
  5. V Kari2,
  6. I Ramu1,
  7. T E Bapiro3,4,
  8. K K Frese5,
  9. A Gopinathan3,
  10. F M Richards3,
  11. D I Jodrell3,6,
  12. C Verbeke7,8,
  13. X Li9,
  14. R Heuchel9,
  15. J M Löhr9,
  16. S A Johnsen2,
  17. T M Gress10,
  18. V Ellenrieder1,
  19. A Neesse1
  1. 1Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Goettingen, Germany
  2. 2Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
  3. 3Cancer Research UK Cambridge Institute, The University of Cambridge, Li Ka Shing Centre, Cambridge, UK
  4. 4Oncology iMED DMPK AstraZeneca UK Ltd, HODGKIN C/o B310 Cambridge Science Park, Cambridge, UK
  5. 5The University of Manchester, Cancer Research UK Manchester Institute, Manchester, UK
  6. 6Department of Oncology, University of Cambridge, Cambridge, UK
  7. 7Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
  8. 8Department of Pathology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  9. 9Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
  10. 10Department of Gastroenterology, Endocrinology and Metabolism, Philipps University Marburg, Marburg, Germany
  1. Correspondence to Dr Albrecht Neesse, Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen, Robert-Koch-Str. 40, Goettingen 37075, Germany; albrecht.neesse{at}


Objective Desmoplasia and hypovascularity are thought to impede drug delivery in pancreatic ductal adenocarcinoma (PDAC). However, stromal depletion approaches have failed to show clinical responses in patients. Here, we aimed to revisit the role of the tumour microenvironment as a physical barrier for gemcitabine delivery.

Design Gemcitabine metabolites were analysed in LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx-1-Cre (KPC) murine tumours and matched liver metastases, primary tumour cell lines, cancer-associated fibroblasts (CAFs) and pancreatic stellate cells (PSCs) by liquid chromatography-mass spectrometry/mass spectrometry. Functional and preclinical experiments, as well as expression analysis of stromal markers and gemcitabine metabolism pathways were performed in murine and human specimen to investigate the preclinical implications and the mechanism of gemcitabine accumulation.

Results Gemcitabine accumulation was significantly enhanced in fibroblast-rich tumours compared with liver metastases and normal liver. In vitro, significantly increased concentrations of activated 2′,2′-difluorodeoxycytidine-5′-triphosphate (dFdCTP) and greatly reduced amounts of the inactive gemcitabine metabolite 2′,2′-difluorodeoxyuridine were detected in PSCs and CAFs. Mechanistically, key metabolic enzymes involved in gemcitabine inactivation such as hydrolytic cytosolic 5′-nucleotidases (Nt5c1A, Nt5c3) were expressed at low levels in CAFs in vitro and in vivo, and recombinant expression of Nt5c1A resulted in decreased intracellular dFdCTP concentrations in vitro. Moreover, gemcitabine treatment in KPC mice reduced the number of liver metastases by >50%.

Conclusions Our findings suggest that fibroblast drug scavenging may contribute to the clinical failure of gemcitabine in desmoplastic PDAC. Metabolic targeting of CAFs may thus be a promising strategy to enhance the antiproliferative effects of gemcitabine.


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  • EH and MSP are co-first authors.

  • Contributors AN, EH, MSP and TMG conceived and designed the experiments. AN, MSP, IR, KKF and AG performed animal experiments. EH, VK, IR, MSP and SAJ performed cell culture experiments. MSP, LK, IR, NC, CV, XL, RH and JML performed histology stainings. TEB, FMR and DIJ designed and analysed pharmacokinetic liquid chromatography-mass spectrometry/mass spectrometry experiments. AN, TMG and VE wrote the manuscript. All authors reviewed the manuscript.

  • Funding This work was supported by the Deutsche Krebshilfe, Max Eder Research Group (110972) to AN. TEB, FMR, AG and DIJ were supported by Cancer Research UK (C14303/A17197) and the University of Cambridge. The Cancer Research UK CRUK Cambridge Institute also acknowledges its support from Hutchison Whampoa.

  • Competing interests None declared.

  • Ethics approval Karolinska Institutional Review Board (EPN D-No. 2014/2147-31/1). Regional Committee for Medical and Health Research Ethics for Southern Norway (REK nr. S-05081).

  • Provenance and peer review Not commissioned; externally peer reviewed.