S. Gilg

Circulating Fibroblast Growth Factor 19 in Portal and Systemic Blood

Background Bile acid homeostasis is essential and imbalance may lead to liver damage and liver failure. The bile acid induced intestinal factor fibroblast growth factor 19 (FGF19) has been identified as a key protein for mediating negative feedback inhibition of bile acid synthesis. The aim of the study was to define FGF19 and bile acid concentrations in portal and systemic blood in the fasted and postprandial state. We also addressed the question if physiological portal levels of FGF19 can be extrapolated from the concentration in systemic blood. Methods Portal and systemic blood was collected from 75 fasted patients undergoing liver surgery and from three organ donors before and after enteral nutrition. Serum concentration of FGF19 was determined with ELISA and bile acid concentration with gas chromatography-mass spectrometry. Results Concentration of bile acids was twice as high in portal compared to systemic blood in the fasted group and 3-5 times higher in the postprandial group. FGF19 increased after enteral nutrition but did not differ between portal and systemic blood, in either group. In addition, a strong, positive correlation between bile acids and FGF19 was found. Conclusion Our results confirm that bile acids drive the postprandial increase of circulating FGF19 but a hepatic clearance of FGF19 is unlikely. We conclude that systemic concentrations of FGF19 reflect portal concentrations of FGF19.

Pancreatic Carcinoma: Therapeutic Future Prospects

In pancreatic cancer management progress has been made in the understanding of the disease on a molecular biological level and modalities for early diagnosis of pancreatic cancer have improved as well as the medical and surgical treatment strategies with curative, adjuvant and palliative aims. Realistic expectations for an earlier and more accurate diagnosis of pancreatic cancer – and thereby better treatment results – are constituted by the development of new blood tests and functional imaging. Adjuvants and neoadjuvants are presumed to be more effective and tolerable already in the near future, making the extended surgery more meaningful. On the same time, minimally invasive local treatments and laparoscopic resections are under development, eventually combined with localized growth factor treatment. One of the most important issue for improved clinical and oncological results is the centralization of complex resective procedures to few surgical centers, not due to the need of surgical skills but for an experienced team treatment approach during the operative and postoperative course. Finally, adjuvant treatment with pancreatic stem cells after curatively intended surgical resections is already on its way.