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Sci Transl Med. 2020 Jan 8;12(525). pii: eaay5186. doi: 10.1126/scitranslmed.aay5186.

Pancreatitis is an FGF21-deficient state that is corrected by replacement therapy.

Author information

1
Department of Pharmacology, UT Southwestern Medical Center, Dallas, TX 75390, USA.
2
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA.
3
Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
4
Department of Pediatrics, Stanford University, Palo Alto, CA 94305, USA.
5
Department of Pharmacology, UT Southwestern Medical Center, Dallas, TX 75390, USA. steven.kliewer@utsouthwestern.edu davo.mango@utsouthwestern.edu.
6
Department of Molecular Biology, UT Southwestern Medical Center, Dallas, TX 75390, USA.
7
Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, TX 75390, USA.

Abstract

The exocrine pancreas expresses the highest concentrations of fibroblast growth factor 21 (FGF21) in the body, where it maintains acinar cell proteostasis. Here, we showed in both mice and humans that acute and chronic pancreatitis is associated with a loss of FGF21 expression due to activation of the integrated stress response (ISR) pathway. Mechanistically, we found that activation of the ISR in cultured acinar cells and mouse pancreata induced the expression of ATF3, a transcriptional repressor that directly bound to specific sites on the Fgf21 promoter and resulted in loss of FGF21 expression. These ATF3 binding sites are conserved in the human FGF21 promoter. Consistent with the mouse studies, we also observed the reciprocal expression of ATF3 and FGF21 in the pancreata of human patients with pancreatitis. Using three different mouse models of pancreatitis, we showed that pharmacologic replacement of FGF21 mitigated the ISR and resolved pancreatitis. Likewise, inhibition of the ISR with an inhibitor of the PKR-like endoplasmic reticulum kinase (PERK) also restored FGF21 expression and alleviated pancreatitis. These findings highlight the importance of FGF21 in preserving exocrine pancreas function and suggest its therapeutic use for prevention and treatment of pancreatitis.

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