However, it is still unclear whether ADM and PanINs primarily arise by expansion of ductal cells and secondary replacement of acinar cells or by direct reprogramming of acinar cells into cells with ductal morphology.
This sentence defines the central question of the study. Although pancreatic ductal adenocarcinoma has ductal morphology, it remains unclear whether precursor lesions arise from true ductal cells or from acinar cells that undergo reprogramming. The authors test whether oncogenic KRAS expands existing ductal cells or instead drives acinar cells to adopt a duct-like state through factors such as Sox9. Defining this distinction is essential for identifying the true cell of origin in PDA.