Pancreatic ductal adenocarcinoma (PDAC) is a highly devastating disease with poor prognosis and rising incidence. Late detection and a particularly aggressive biology are the major challenges which determine therapeutic failure. In this review, we present the current status and the recent advances in PDAC treatment together with the biological and immunological hallmarks of this cancer entity. On this basis, we discuss new concepts combining distinct treatment modalities in order to improve therapeutic efficacy and clinical outcome – with a specific focus on protocols involving radio(chemo)therapeutic approaches.

Decreased bone mass, osteoporosis, and increased fracture rates are common skeletal complications in patients with insulin-dependent diabetes mellitus (IDDM; type I diabetes). IDDM develops from little or no insulin production and is marked by elevated blood glucose levels and weight loss. In this study we use a streptozotocin-induced diabetic mouse model to examine the effect of type I diabetes on bone. Histology and microcomputed tomography demonstrate that adult diabetic mice, exhibiting increased plasma glucose and osmolality, have decreased trabecular bone mineral content compared with controls. Bone resorption could not completely account for this effect, because resorption markers (tartrate-resistant acid phosphatase 5b, urinary deoxypyridinoline excretion, and tartrate-resistant acid phosphatase 5 mRNA) are unchanged or reduced at 2 and/or 4 wk after diabetes induction. However, osteocalcin mRNA (a marker of late-stage osteoblast differentiation) and dynamic parameters of bone formation were decreased in diabetic tibias, whereas osteoblast number and runx2 and alkaline phosphatase mRNA levels did not differ. These findings suggest that the final stages of osteoblast maturation and function are suppressed. We also propose a second mechanism contributing to diabetic bone loss: increased marrow adiposity. This is supported by increased expression of adipocyte markers [peroxisome proliferator-activated receptor gamma2, resistin, and adipocyte fatty acid binding protein (alphaP2)] and the appearance of lipid-dense adipocytes in diabetic tibias. In contrast to bone marrow, adipose stores at other sites are depleted in diabetic mice, as indicated by decreased body, liver, and peripheral adipose tissue weights. These findings suggest that IDDM contributes to bone loss through changes in marrow composition resulting in decreased mature osteoblasts and increased adipose accumulation.

Mechanical loads can lead to matrix damage and chondrocyte death in articular cartilage. This damage has been implicated in the pathogenesis of secondary osteoarthritis. Studies on cartilage explants with the attachment of underlying bone at high rates of loading have documented cell death adjacent to surface lesions. On the other hand, studies involving explants removed from bone at low rates of loading suggest no clear spatial association between cell death and matrix damage. The current study hypothesized that the observed differences in the distribution of cell death in these studies are attributed to the rate of loading. Ninety bovine cartilage explants were cultured for two days. Sixty explants were loaded in unconfined compression to 40 MPa in either a fast rate of loading experiment (-900 MPa/s) or a low rate of loading experiment (40 MPa/s). The remaining 30 explants served as a control population. All explants were cultured for four days after loading. Matrix damage was assessed by measuring the total length and average depth of surface lesions and the release of glycosaminoglycans to the culture media. Explants were sectioned and stained with calcein and ethidium bromide homodimer to document the number of live and dead cells. Greater matrix damage was documented in explants subjected to a high rate of loading, compared to explants exposed to a low rate of loading. The high rate of loading experiments resulted in cell death adjacent to fissures, whereas more dead cells were observed in the low rate of loading experiments and a more diffuse distribution of dead cells was observed away from the fissures. In conclusion, this study indicated that the rate of loading can significantly affect the degree of inatrix damage, the distribution of dead cells, and the amount of cell death in unconfined compression experiments on explants of articular cartilage.