Partial liver resection alters the bile salt-FGF19 axis in patients with perihilar cholangiocarcinoma: Implications for liver regeneration.

BACKGROUND: Extended liver resection is the only treatment option for perihilar cholangiocarcinoma (pCCA). Bile salts and the gut hormone FGF19, both promoters of liver regeneration (LR), have not been investigated in patients undergoing resection for pCCA. We aimed to evaluate the bile salt-FGF19 axis perioperatively in pCCA and study its effects on LR. METHODS: Plasma bile salts, FGF19, and C4 (bile salt synthesis marker) were assessed in patients with pCCA and controls (colorectal liver metastases), before and after resection on postoperative days (PODs) 1, 3, and 7. Hepatic bile salts were determined in intraoperative liver biopsies. RESULTS: Partial liver resection in pCCA elicited a sharp decline in bile salt and FGF19 plasma levels on POD 1 and remained low thereafter, unlike in controls, where bile salts rose gradually. Preoperatively, suppressed C4 in pCCA normalized postoperatively to levels similar to those in the controls. The remnant liver volume and postoperative bilirubin levels were negatively associated with postoperative C4 levels. Furthermore, patients who developed postoperative liver failure had nearly undetectable C4 levels on POD 7. Hepatic bile salts strongly predicted hyperbilirubinemia on POD 7 in both groups. Finally, postoperative bile salt levels on day 7 were an independent predictor of LR. CONCLUSIONS: Partial liver resection alters the bile salt-FGF19 axis, but its derailment is unrelated to LR in pCCA. Postoperative monitoring of circulating bile salts and their production may be useful for monitoring LR.

Microarray-based detection of specific IgE against recombinant ω-5-gliadin in suspected wheat-dependent exercise-induced anaphylaxis.

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare IgE-mediated food allergy. Component-resolved measurement of specific IgE (sIgE) against ω-5-gliadin by fluorescence enzyme immunoassay (FEIA) has been postulated as a good predictive decision criterion in the diagnosis of WDEIA. More recently, microarray technology has been introduced into component-resolved diagnostics. The aim of this study was to evaluate the performance of an allergen microarray in the detection of sIgE against ω-5-gliadin in 10 patients with suspected WDEIA and high levels of sIgE against ω-5-gliadin (mean: 9.31±7.53 kU/L, range: 4.24-25.8) as measured by FEIA. Using an old version of the microarray assay (ImmunoCAP ISAC™, Phadia), sIgE against ω-5-gliadin was detected in only 3 of the first 6 patients. The same samples and those of another 4 patients were then analysed with an improved version of the microarray system, yielding elevated levels of sIgE against ω-5-gliadin in all patients. In conclusion, the old version of the microarray was not reliable for the detection of sIgE against ω-5-gliadin in the examined individuals with suspected WDEIA. In contrast, the improved version of the microarray seems to be as adequate as FEIA in the detection of sIgE against ω-5-gliadin. However, further large-scale studies are warranted to confirm these results.