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Gastroenterology. 2019 Jul 25. pii: S0016-5085(19)41127-X. doi: 10.1053/j.gastro.2019.07.030. [Epub ahead of print]

Oncogenic KRAS Reduces Expression of FGF21 in Acinar Cells to Promote Pancreatic Tumorigenesis in Mice on a High-Fat Diet.

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School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Medicine. Electronic address:
Department of Gastrointestinal Medical Oncology.
Department of Medicine.
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
Department of Cancer Biology.
Department of Experimental Therapeutics, University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, 11724, USA.
Departments of Pediatrics, Oncology, and Physiology and Pharmacology, Schulich School of Medicine, University of Western Ontario Children's Health Research Institute, London, ON, Canana N5C 2V5.
Department of Medical and Molecular Genetics, Indiana University School of Medicine. Indianapolis, IN, USA.
Department of Pathology, Stony Brook University, Stony Brook, NY, 11794, USA.
Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA.
Department of Gastroenterology, Changhai Hospital, Shanghai, China.
Department of Gastrointestinal Medical Oncology; Department of Cancer Biology.
Department of Gastrointestinal Medical Oncology; Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, 27710, USA.
Department of Medicine; Department of Gastrointestinal Medical Oncology. Electronic address:



Obesity is a risk factor for pancreatic cancer. In mice, a high-fat diet (HFD) and expression of oncogenic KRAS lead to development of invasive pancreatic ductal adenocarcinoma (PDAC) by unknown mechanisms. We investigated how oncogenic KRAS regulates the expression of fibroblast growth factor 21 (FGF21), a metabolic regulator that prevents obesity, and the effects of recombinant human FGF21 (rhFGF21) on pancreatic tumorigenesis.


We performed immunohistochemical analyses of FGF21 levels in human pancreatic tissue arrays, comprising 59 PDAC specimens and 45 non-tumor tissues. We also studied mice with tamoxifen-inducible expression of oncogenic KRAS in acinar cells (KrasG12D/+ mice) and fElasCreERT mice (controls). KrasG12D/+ mice were placed on a HFD or regular chow diet (control) and given injections of rhFGF21 or vehicle; pancreata were collected and analyzed by histology, immunoblots, quantitative PCR, and immunohistochemistry. We measured markers of inflammation in the pancreas, liver, and adipose tissue. Activity of RAS was measured based on the amount of bound GTP.


Pancreatic tissues of mice expressed high levels of FGF21 compared with liver. FGF21 and its receptor proteins were expressed by acinar cells. Acinar cells that expressed KrasG12D/+ had significantly lower expression of Fgf21 mRNA, compared with acinar cells from control mice, partly due to downregulation of PPARG expression-a transcription factor that activates Fgf21 transcription. Pancreata from KrasG12D/+ mice on a control diet and given injections of rhFGF21 had reduced pancreatic inflammation, infiltration by immune cells, and acinar-to-ductal metaplasia compared with mice given injections of vehicle. HFD-fed KrasG12D/+ mice given injections of vehicle accumulated abdominal fat, developed extensive inflammation, pancreatic cysts, and high-grade pancreatic intraepithelial neoplasias (PanINs); half the mice developed PDAC with liver metastases. HFD-fed KrasG12D/+ mice given injections of rhFGF21 had reduced accumulation of abdominal fat and pancreatic triglycerides, fewer pancreatic cysts, reduced systemic and pancreatic markers of inflammation, fewer PanINs, and longer survival-only about 12% of mice developed PDACs and none of the mice had metastases. Pancreata from HFD-fed KrasG12D/+ mice given injections of rhFGF21 had lower levels of active RAS than from mice given vehicle.


Normal acinar cells from mice and humans express high levels of FGF21. In mice, acinar expression of oncogenic KRAS significantly reduces FGF21 expression. When these mice are placed on a HFD, they develop extensive inflammation, pancreatic cysts, PanINs, and PDACs, which are reduced by injection of FGF21. FGF21 also reduces the GTP binding capacity of RAS. FGF21 might be used in prevention or treatment of pancreatic cancer.


FGFR1; KLB; gene regulation; signaling

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