Bile acid-farnesoid X receptor-fibroblast growth factor 19 axis in patients with short bowel syndrome: The randomized, glepaglutide phase 2 trial

Mark Krogh Hvistendahl*, Rahim Mohammad Naimi, Svend Høime Hansen, Jens Frederik Rehfeld, Hannelouise Kissow, Jens Pedersen, Lars Ove Dragsted, David Peick Sonne, Filip Krag Knop, Palle Bekker Jeppesen

*Corresponding author for this work

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Abstract

Background: The gut-liver axis and enterohepatic circulation have gained increasing attention lately. Patients with short bowel syndrome (SBS) are, in fact, human knock-out models that may assist in the understanding of bile acid synthesis and regulation. We evaluated effect of glepaglutide (a long-acting glucagon-like peptide-2 analog) on bile acid synthesis (the enterohepatic circulation of bile acids and liver biochemistry in patients with SBS.

Method: In a single-center, double-blinded, dose-finding, crossover phase 2 trial, 18 patients with SBS were randomly assigned to 2 of 3 treatment arms (0.1, 1 and 10 mg) with daily subcutaneous injections of glepaglutide for 3 weeks. The washout period between the 2 treatment periods was 4-8 weeks. Measurements were performed at baseline and at the end of each treatment period and included postprandial plasma samples for fibroblast growth factor 19 (FGF19), 7α-hydroxy-4-cholesten-3-one (C4), total excretion of fecal bile acids, gene expression of farnesoid X receptor (FXR) in intestinal mucosal biopsies, total plasma bile acids, and liver biochemistry.

Results: Compared to baseline, the median (interquartile range) postprandial response (area under the curve 0-2h) of FGF19 increased by 150 h × ng/L (41, 195; P = 0.001) and C4 decreased by 82 h × μg/L (-169, -28; P = 0.010) in the 10-mg dose. FXR gene expression did not change in any of the groups. Alkaline phosphatase significantly decreased.

Conclusions: Glepaglutide may stimulate the bile acid/FXR/FGF19 axis, leading to increased plasma concentrations of FGF19. Thereby, glepaglutide may ameliorate the accelerated de novo bile acid synthesis and play a role in the prevention and/or treatment of intestinal failure-associated liver disease.

Original languageEnglish
JournalJournal of Parenteral and Enteral Nutrition
Volume46
Issue number4
Pages (from-to)923-935
Number of pages13
ISSN0148-6071
DOIs
Publication statusPublished - 2022

Keywords

  • Faculty of Science
  • Short bowel syndrome
  • Glucagon-like peptide-2 (GLP-2)
  • Fibroblast growth factor 19
  • 7αhydroxy-4-cholesten-3-one

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