The Portal-Drained Viscera Release Fibroblast Growth Factor 19 in Humans.

Fibroblast growth factor 19 (FGF19) is an ileum-derived endrocrine factor that is produced in response to transepithelial bile salt flux. FGF19 represses bile salt synthesis in the liver. Despite the general assumption that FGF19 signals to the liver via portal blood, no human data are available to support this notion. The aim was to study portal FGF19 levels, and determined bile salt and FGF19 fluxes across visceral organs in humans. Bile salt and FGF19 levels were assessed in arterial, portal, and hepatic venous blood collected from fasted patients who underwent partial liver resection for colorectal liver metastases (n=30). Fluxes across the portal-drained viscera (PDV), liver, and splanchnic area were calculated. Portal bile salt levels (7.8 [5.0-12.4] mol/L) were higher than levels in arterial (2.7 [1.7-5.5] mol/L, P<0.0001) and hepatic venous blood (3.4 [2.5-6.5] mol/L, P<0.0001). Bile salts released by the PDV (+1.2 [+0.7-+2.0] mmolkg(-1)h(-1), P<0.0001) were largely taken up by the liver (-1.0 [-1.8 to -0.4] mmolkg(-1)h(-1), P<0.0001). Portal levels of FGF19 (161 +/- 78pg/mL) were higher than arterial levels (135 +/- 65pg/mL, P=0.046). A net release of FGF19 by the PDV (+4.0 [+2.1 to +9.9] ngkg(-1)h(-1), P<0.0001) was calculated. There was no significant flux of FGF19 across the liver (-0.2 [-3.7 to +7.4]ngkg(-1)h(-1), P=0.93). In conclusion, FGF19 levels in human portal blood are higher than in arterial blood. FGF19 is released by the portal-drained viscera under fasted steady state conditions.