Recent studies from Kliewer's laboratory have identified FGF15 as a bile acid/FXR induced intestinal hormone that inhibits Cyp7A1 gene transcription in the liver (
17). FGF15 also stimulates gallbladder refilling in mice, thus serving as a feed forward signal for biliary bile acid excretion and storage (
25). These investigators suggest that FGF15 in the intestine is secreted into circulation, transported to the liver to activate the FGFR4 signaling pathway and inhibit CYP7A1. This endocrine regulation of hepatic CYP7A1 by intestinal FGF15 is based on the fact that FGF15 is exclusively expressed in mouse jejunum and ileum but not in liver, while FGF15-specific receptor FGFR4 is highly expressed in mouse liver (
17,
18). However, these investigators have not been able to detect FGF15 in mouse sera and livers (
17,
26). A recent study of conditional liver- and intestine-FXR knockout mice has clearly demonstrated that knockout of the liver FXR did not affect GW4064 inhibition of CYP7A1, whereas knockout of the intestine FXR abrogated GW4064 inhibition of CYP7A1 (
27). This study provides the first direct and compelling evidence that intestinal FXR, but not liver FXR is required for bile acid feedback inhibition of CYP7A1 and bile acid synthesis in the liver. The bile acid-induced FGF15 appears to be the “intestine factor” we proposed in 1995 (
6).
It has been shown that FGF19 inhibits CYP7A1 in primary human hepatocytes and HepG2 cells (
15), and FGF19 is detected in human patient sera (
28). Interestingly the serum FGF19 levels show diurnal variation similar to serum 7α-hydroxy-4-cholesten-3-one, a product of CYP7A1 and a marker of the rate of bile acid synthesis and CYP7A1 activity in humans. These investigators suggest that serum FGF19 is derived from the intestine and is transported via blood circulation to hepatocytes to inhibit CYP7A1 in human liver. Here we show that FGF19 mRNA and protein are expressed at very low levels in human hepatocytes. An endogenous FXR ligand, CDCA and a specific FXR agonist, GW4064 strongly induced FGF19 mRNA and protein expression by more than one hundred-fold to inhibit CYP7A1 mRNA expression in primary human hepatocytes. Moreover, neutralizing FGF19 by a FGF19 antibody or siRNA knockdown of FGFR4 abrogated FGF19 inhibition of CYP7A1. FGF19 is readily detectable after CDCA treatment in human hepatocytes indicating that the human liver may contribute significant amounts of circulating FGF19 in humans. Our results also suggest that FGF19 produced in the liver may be a paracrine factor that inhibits CYP7A1 expression in hepatocytes by activating FGFR4 signaling in surrounding hepatocytes or an autocrine factor that directly activates intracellular signaling pathways in hepatocytes to inhibit CYP7A1 and bile acid synthesis in human livers. Thus bile acid-activated FXR may induce the production and secretion of FGF19 in both intestine and liver in humans. This is in contrast to the mouse that only the intestine produces and secretes FGF15. We also show that cholic acid, a weaker FXR ligand is less effective in inducing FGF19 and inhibiting CYP7A1. It should be mentioned that the bile acid pool in mice is highly hydrophilic consisting mostly cholic acid and muricholic acids, which are synthesized in mouse liver and are poor FXR ligands. This may explain lack of induction of FGF15 in the mouse liver by bile acids. In humans, the bile acid pool is highly hydrophobic consisting mostly cholic acid, chenodeoxycholic acid and deoxycholic acid, which are potent FXR ligands in human livers. Our current findings suggest that the liver-produced FGF19 may be a feed forward signal for biliary secretion and refilling of bile acids in the gallbladder, and a feedback signal for bile acid inhibition of bile acid synthesis. Like bile acid induction of inflammatory cytokines, bile acid activation of FGF19 signaling may be an rapid response to cholestatic liver injury to protect the liver against bile acid toxicity (
29).
Despite a plethora of studies of the nuclear receptor regulation of CYP7A1 in recent years, the molecular mechanism of bile acid feedback inhibition of CYP7A1 gene transcription remains unclear. It is generally recognized that the FXR/SHP cascade mechanism mediates bile acid feedback inhibition of CYP7A1 in the liver (
7,
8). SHP is a negative factor that interacts with many nuclear receptors including LRH-1. SHP inhibits the trans-activating activity of LRH-1, which binds to the CYP7A1 gene. It has been proposed that LRH-1 is required for CYP7A1 expression and is a competence factor of the liver orphan receptor α (LXRα) that binds to and stimulates CYP7A1 gene in mice (
8). However, the human CYP7A1 gene does not bind LXRα (
30) and LRH-1 may compete with HNF4α for binding to the overlapping sequence and inhibits the human CYP7A1 gene (
31,
32). A recent study of conditional liver LRH-1 knockout mice revealed that mRNA expression of sterol 12α-hydroxylase (CYP8B1) involved in cholic acid synthesis was markedly suppressed, but surprisingly CYP7A1 mRNA expression remained unchanged (
33,
34). These investigators suggest that LRH-1 plays a key role in regulating CYP8B1 and bile acid composition but is not required for bile acid inhibition of CYP7A1 gene transcription (
33,
34). Since LRH-1 is the major target gene of SHP, the physiological significance of the cascade FXR/SHP/LRH-1 pathway mediating bile acid feedback inhibition of CYP7A1 needs to be re-evaluated.
It has been suggested that FGF19/FGFR4 signaling activates JNK/c-Jun, which cooperates with SHP to inhibit CYP7A1 mRNA expression (
15). However, study of human FGFR4 transgenic mice reveals that SHP mRNA expression levels are markedly decreased in FGFR4 transgenic mouse livers, but not increased in FGFR4 null mice. These investigators suggested that bile acid inhibition of bile acid synthesis and FGFR4 activation of c-Jun/JNK pathway are independent of each other, and JNK- and SHP-independent pathways for bile acid feedback inhibition may exist (
22). It should be emphasized that induction of SHP mRNA expression by CDCA or GW4064 is rapid and transient, in contrast to a sustained induction of FGF19 and inhibition of CYP7A1 by CDCA and GW4064. This may be because CDCA activates several signaling pathways in addition to activation of FXR (
35). Our current study reveals that FGF19 does not induce SHP expression in primary human hepatocytes. Furthermore, FGF19 strongly inhibits CYP7A1 expression even when expression of SHP was knock-downed. These results suggest that SHP may not be required for FGF19 to inhibit CYP7A1 at least in human hepatocytes.
Several recent studies have confirmed that FGFR4 activity requires a co-receptor β-Klotho, which is highly expressed in hepatocytes (
24,
36,
37). β-Klotho induces ERK1/2 phosphorylation in response to FGF19 and is required for FGF19 binding to FGFR4 and inhibition of CYP7A1 (
24,
36,
37). Thus our results on kinase inhibition and activation assays are consistent with the ERK1/2 pathway being a major MAP kinase involved in mediating FGF19 inhibition of CYP7A1. This is also consistent to a recent report that activation of FXR by CDCA or GW4064 increases ERK1/2 phosphorylation and knockout of the
Fxr gene in mice reduced ERK1/2 phosphorylation (
38). It appears that the FXR is required for ERK1/2 phosphorylation and FGF19 probably is the major factor mediating FXR activation of the ERK1/2/MAPK pathway. The major downstream targets of ERK1/2 signaling are c-Fos and early growth responsive-1 (EGR-1), the latter is highly induced by FGF19 in the liver (
37). In summary, our present study provides the direct evidence that in addition to inducing FGF19 in the intestine, bile acids in hepatocytes may activate the liver FGF19/FGFR4 signaling pathway to inhibit bile acid synthesis and prevent accumulation of toxic bile acid in human livers.