The top significantly enriched immune modulator in the ME patients was SPP1 (Fig. 5c) which encodes for osteopontin, and is overexpressed in PDAC and known to potentiate tumour cell stemness, M2 macrophage polarisation38, checkpoint expression39 and is associated with poorer survival across multiple cancers including PDAC40. The gene discussed is SPP1; the disease is neoplasm.