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Reply:

We read with great interest the Letter to the Editor sent by Coriat et al. as well as their article published in PLoS One.1 In this article, they showed a significant reduction of 54% in portal venous flow 1 month after sorafenib treatment and they concluded that it was consistent with a decrease in portal pressure. However, they did not measure the hepatic venous pressure gradient, which is the most appropriate way to assess portal pressure. Because portal pressure depends not only on splanchnic blood flow, but also on intrahepatic vascular resistance, it is difficult to state that portal pressure decreased in the study by Coriat et al.

The reason why we suggest that anti-PLGF (placental growth factor) is probably safer than sorafenib is that PLGF is not necessary for normal physiological angiogenesis and is only involved in pathological angiogenesis.2 Targeting PLGF may, therefore, lead to less collateral damage and side effects.

We completely agree that further clinical studies with anti-PLGF and sorafenib should be conducted to evaluate the hemodynamic effects and safety in patients with cirrhosis.

References

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  • 1
    Coriat R, Gouya H, Mir O, Ropert S, Vignaux O, Chaussade S, et al. Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib. PLoS One 2011; 6: e16978.
  • 2
    Van Steenkiste C, Ribera J, Geerts A, Pauta M, Tugues S, Casteleyn C, et al. Inhibition of placental growth factor activity reduces the severity of fibrosis, inflammation, and portal hypertension in cirrhotic mice. Hepatology 2011; 53: 1629-1640.

Isabelle Colle M.D., Ph.D.*, Christophe Van Steenkiste M.D., Ph.D.*, * Department of Hepatology and Gastroenterology Ghent University Hospital Medical School Ghent, Belgium.