IL-1⁺ macrophages fuel pathogenic inflammation in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with high resistance to therapies1. Inflammatory and immunomodulatory signals co-exist in the pancreatic tumour microenvironment, leading to dysregulated repair and cytotoxic responses. Tumour-associated macrophages (TAMs) have key roles in PDAC(2), but their diversity has prevented therapeutic exploitation. Here we combined single-cell and spatial genomics with functional experiments to unravel macrophage functions in pancreatic cancer. We uncovered an inflammatory loop between tumour cells and interleukin-1 beta (IL-1 beta )-expressing TAMs, a subset of macrophages elicited by a local synergy between prostaglandin E-2 (PGE(2)) and tumour necrosis factor (TNF). Physical proximity with IL-1 beta+ TAMs was associated with inflammatory reprogramming and acquisition of pathogenic properties by a subset of PDAC cells. This occurrence was an early event in pancreatic tumorigenesis and led to persistent transcriptional changes associated with disease progression and poor outcomes for patients. Blocking PGE(2) or IL-1 beta activity elicited TAM reprogramming and antagonized tumour cell-intrinsic and-extrinsic inflammation, leading to PDAC control in vivo. Targeting the PGE(2)-IL-1 beta axis may enable preventive or therapeutic strategies for reprogramming of immune dynamics in pancreatic cancer.