NODAL and familial pancreatic carcinoma: Unsurprisingly, CSCs also secret Actin and Nodal that interact with Alk4/7 receptors to form pancreatic cancer cell sphere; however, through reduction of Akl4/7 expression and inhibition of interplay with CSCs, pancreatic cancer cells are more sensitive to gemcitabine treatment and lead to a long overall survival (174).