For PACA patients, the identified biomarkers comprised MMP28,33 contributing significantly to the tumor microenvironment, CYP3A5,34 serving as a predictor of treatment response, TP53BP1,35 which exhibited inhibitory effects on pancreatic tumor growth, and ROBO2,36 a regulator of TGF-β in the pancreas. Here, MMP28 is linked to permanent neonatal diabetes mellitus-pancreatic and cerebellar agenesis syndrome.