Consequently, the mevalonate pathway, which is responsible for cholesterol and sterol biosynthesis, is upregulated.203,204 Statins can modestly affect cholesterol homeostasis and significantly reduce the synthesis of electron carrier coenzyme Q, leading to severe oxidative stress and apoptosis in pancreatic cancer.205 By using organoid and mouse models, a recent study demonstrated that the loss of sterol O-acyltransferase 1 (SOAT1), a key enzyme catalyzing cholesterol to inert cholesterol esters to sustain mevalonate pathway flux, significantly impairs pancreatic cancer progression. This evidence concerns the gene SOAT1 and familial pancreatic carcinoma.