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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Curr+Opin+Nephrol+Hypertens
2014 ; 23
(4
): 411-9
Nephropedia Template TP
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Coupling fibroblast growth factor 23 production and cleavage: iron deficiency,
rickets, and kidney disease
#MMPMID24867675
Wolf M
; White KE
Curr Opin Nephrol Hypertens
2014[Jul]; 23
(4
): 411-9
PMID24867675
show ga
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.