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Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease.

Publication ,  Journal Article
Wolf, M; White, KE
Published in: Curr Opin Nephrol Hypertens
July 2014

PURPOSE OF REVIEW: High levels of fibroblast growth factor 23 (FGF23) cause the rare disorders of hypophosphatemic rickets and are a risk factor for cardiovascular disease and death in patients with chronic kidney disease (CKD). Despite major advances in understanding FGF23 biology, fundamental aspects of FGF23 regulation in health and in CKD remain mostly unknown. RECENT FINDINGS: Autosomal dominant hypophosphatemic rickets (ADHR) is caused by gain-of-function mutations in FGF23 that prevent its proteolytic cleavage, but affected individuals experience a waxing and waning course of phosphate wasting. This led to the discovery that iron deficiency is an environmental trigger that stimulates FGF23 expression and hypophosphatemia in ADHR. Unlike osteocytes in ADHR, normal osteocytes couple increased FGF23 production with commensurately increased FGF23 cleavage to ensure that normal phosphate homeostasis is maintained in the event of iron deficiency. Simultaneous measurement of FGF23 by intact and C-terminal assays supported these breakthroughs by providing minimally invasive insight into FGF23 production and cleavage in bone. These findings also suggest a novel mechanism of FGF23 elevation in patients with CKD, who are often iron deficient and demonstrate increased FGF23 production and decreased FGF23 cleavage, consistent with an acquired state that mimics the molecular pathophysiology of ADHR. SUMMARY: Iron deficiency stimulates FGF23 production, but normal osteocytes couple increased FGF23 production with increased cleavage to maintain normal circulating levels of biologically active hormone. These findings uncover a second level of FGF23 regulation within osteocytes, failure of which culminates in elevated levels of biologically active FGF23 in ADHR and perhaps CKD.

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Published In

Curr Opin Nephrol Hypertens

DOI

EISSN

1473-6543

Publication Date

July 2014

Volume

23

Issue

4

Start / End Page

411 / 419

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Rickets
  • Renal Insufficiency, Chronic
  • Phosphates
  • Osteocytes
  • Iron Deficiencies
  • Humans
  • Homeostasis
  • Gene Expression Regulation
  • Fibroblast Growth Factors
 

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Wolf, M., & White, K. E. (2014). Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease. Curr Opin Nephrol Hypertens, 23(4), 411–419. https://doi.org/10.1097/01.mnh.0000447020.74593.6f
Wolf, Myles, and Kenneth E. White. “Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease.Curr Opin Nephrol Hypertens 23, no. 4 (July 2014): 411–19. https://doi.org/10.1097/01.mnh.0000447020.74593.6f.
Wolf, Myles, and Kenneth E. White. “Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease.Curr Opin Nephrol Hypertens, vol. 23, no. 4, July 2014, pp. 411–19. Pubmed, doi:10.1097/01.mnh.0000447020.74593.6f.
Wolf M, White KE. Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease. Curr Opin Nephrol Hypertens. 2014 Jul;23(4):411–419.

Published In

Curr Opin Nephrol Hypertens

DOI

EISSN

1473-6543

Publication Date

July 2014

Volume

23

Issue

4

Start / End Page

411 / 419

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Rickets
  • Renal Insufficiency, Chronic
  • Phosphates
  • Osteocytes
  • Iron Deficiencies
  • Humans
  • Homeostasis
  • Gene Expression Regulation
  • Fibroblast Growth Factors