Ca²⁺ Signaling and Its Potential Targeting in Pancreatic Ductal Carcinoma

Pancreatic cancer (PC) is a major cause of cancer-associated mortality in Western countries (and estimated to be the second cause of cancer deaths by 2030). The main form of PC is pancreatic adenocarcinoma, which is the fourth most common cause of cancer-related death, and this situation has remained virtually unchanged for several decades. Pancreatic ductal adenocarcinoma (PDAC) is inherently linked to the unique physiology and microenvironment of the exocrine pancreas, such as pH, mechanical stress, and hypoxia. Of them, calcium (Ca²⁺) signals, being pivotal molecular devices in sensing and integrating signals from the microenvironment, are emerging to be particularly relevant in cancer. Mutations or aberrant expression of key proteins that control Ca²⁺ levels can cause deregulation of Ca²⁺-dependent effectors that control signaling pathways determining the cells' behavior in a way that promotes pathophysiological cancer hallmarks, such as enhanced proliferation, survival and invasion. So far, it is essentially unknown how the cancer-associated Ca²⁺ signaling is regulated within the characteristic landscape of PDAC. This work provides a complete overview of the Ca²⁺ signaling and its main players in PDAC. Special consideration is given to the Ca²⁺ signaling as a potential target in PDAC treatment and its role in drug resistance.