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Abstract Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy whose abundant cancer-associated fibroblasts (CAFs) create a hallmark “desmoplasia” that severely limits oxygen and nutrient delivery. Hypoxia inhibits oxygen-dependent metabolic processes. For example, unsaturated lipid biosynthesis relies on oxygen to maintain desaturase enzymatic activities. Here, we investigated the mechanisms by which PDAC cells maintain lipid homeostasis under these conditions. Exogenous unsaturated lipids, rather than de novo synthesis, sustain PDAC cell viability by relieving endoplasmic reticulum (ER) stress under nutrient scarcity. Furthermore, CAFs are less hypoxic than adjacent malignant cells in vivo due to proximal blood vessel accessibility, nominating them as a potential source of these obligatory species. CAF-conditioned medium promoted PDAC cell survival upon nutrient and oxygen deprivation, an effect reversed by delipidation. We determined that lysophosphatidylcholines (LPCs) are particularly enriched in CAF-conditioned medium and preferentially taken up by PDAC cells, where they are converted to phosphatidylcholines (PCs) to sustain membrane integrity. Inhibiting LPC to PC conversion reversed the ability of exogenous unsaturated LPCs to sustain cancer cell survival and restrain ER stress in vitro and in vivo. Collectively, these results reveal a critical lipid cross-feeding mechanism enabling PDAC cell survival and identify an innovative approach to targeting this metabolic dependency. Efforts to target lipid crosstalk between CAFs and PDAC cells will be discussed. Citation Format: Xu Han, Michelle Burrows, Laura C Kim, Jimmy Xu, Will Vostrejs, Tran Ngoc Van Le, Yanqing Jiang, Edna Cukierman, Reiss Binder Kim, Ben Z Stanger, Clementina Mesaros, Brian Keith, Celeste Simon. Cancer-associated fibroblasts maintain critical pancreatic cancer cell lipid homeostasis in the tumor microenvironment abstract. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84 (17 Suppl₂): Abstract nr C038.
Han et al. (Sun,) studied this question.