The role of fibroblast growth factor 23 in renal disease

FGF23 is elevated in multiple myeloma and increases heparanase expression by tumor cells

Multiply myeloma (MM) grows in and destroys bone, where osteocytes secrete FGF23, a hormone which affects phosphate homeostasis and aging. We report that multiple myeloma (MM) cells express receptors for and respond to FGF23. FGF23 increased mRNA for EGR1 and its target heparanase, a pro-osteolytic factor in MM. FGF23 signals through a complex of klotho and a classical FGF receptor (FGFR); both were expressed by MM cell lines and patient samples. Bone marrow plasma cells from 42 MM patients stained positively for klotho, while plasma cells from 8 patients with monoclonal gammopathy of undetermined significance (MGUS) and 6 controls were negative. Intact, active FGF23 was increased 2.9X in sera of MM patients compared to controls. FGF23 was not expressed by human MM cells, but co-culture with mouse bone increased its mRNA. The FGFR inhibitor NVP-BGJ398 blocked the heparanase response to FGF23. NVP-BGJ398 did not inhibit 8226 growth in vitro but significantly suppressed growth in bone and induction of the osteoclast regulator RANK ligand, while decreasing heparanase mRNA. The bone microenvironment provides resistance to some anti-tumor drugs but increased the activity of NVP-BGJ398 against 8226 cells. The FGF23/klotho/heparanase signaling axis may offer targets for treatment of MM in bone.

The extracellular matrix in the kidney: a source of novel non-invasive biomarkers of kidney fibrosis?

Interstitial fibrosis is the common endpoint of end-stage chronic kidney disease (CKD) leading to kidney failure. The clinical course of many renal diseases, and thereby of CKD, is highly variable. One of the major challenges in deciding which treatment approach is best suited for a patient but also in the development of new treatments is the lack of markers able to identify and stratify patients with stable versus progressive disease. At the moment renal biopsy is the only means of diagnosing renal interstitial fibrosis. Novel biomarkers should improve diagnosis of a disease, estimate its prognosis and assess the response to treatment, all in a non-invasive manner. Existing markers of CKD do not fully and specifically address these requirements and in particular do not specifically reflect renal fibrosis. The aim of this review is to give an insight of the involvement of the extracellular matrix (ECM) proteins in kidney diseases and as a source of potential novel biomarkers of renal fibrosis. In particular the use of the protein fingerprint technology, that identifies neo-epitopes of ECM proteins generated by proteolytic cleavage by proteases or other post-translational modifications, might identify such novel biomarkers of renal fibrosis.

Fibroblast growth factor-23: what we know, what we don't know, and what we need to know

Traditional risk factors of cardiovascular morbidity and mortality such as hypertension, hypercholesterolemia and obesity are paradoxically associated with better outcomes in dialysis patients, and the few trials of interventions targeting modifiable traditional risk factors have yielded disappointing results in this patient population. Non-traditional risk factors such as inflammation, anemia and abnormalities in bone and mineral metabolism have been proposed as potential explanations for the excess mortality seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), but without clear understanding of what the most important pathophysiologic mechanisms of these risk factors are, which ones might be ideal treatment targets and which therapeutic interventions may be effective and safe in targeting them. Among the novel risk factors, fibroblast growth factor-23 (FGF23) has recently emerged as one of the most powerful predictors of adverse outcomes in patients with CKD and ESRD. FGF23 is a hormone produced by osteoblasts/osteocytes in bone that acts on the kidney to regulate phosphate and vitamin D metabolism through activation of FGF receptor/α-Klotho co-receptor complexes. It is possible that elevated FGF23 may exert its negative impact through distinct mechanisms of action independent from its role as a regulator of phosphorus homeostasis. Elevated circulating FGF23 concentrations have been associated with left ventricular hypertrophy (LVH), and it has been suggested that FGF23 exerts a direct effect on the myocardium. While it is possible that 'off target' effects of FGF23 present in very high concentrations could induce LVH, this possibility is controversial, since α-klotho is not expressed in the myocardium. Another possibility is that FGF23's effect on the heart is mediated indirectly, via 'on target' activation of other humoral pathways. We will review the physiology and pathophysiology of FGF23, the outcomes associated with elevated FGF23 levels, and describe putative mechanisms of action responsible for its negative effects and potential therapeutic strategies to treat these.

E-Pharmacophore mapping and docking studies on Vitamin D receptor (VDR)

Small structured chemical molecules are importance in the field of molecular medicine since their pharmacokinetic and pharmacodynamic properties are predictable and because of its ability to bind with target molecules and execute biological function. In this study, we engaged computer-aided methodology in combination with molecular docking and pharmacophore filtering to identify chemical compounds that can increase the synthesis of vitamin D receptor (VDR) since its lower expression leads to calcium phosphate metabolic disorders in Chronic Kidney Disease. Energy-optimized pharmacophore was mapped using available agonists for VDR. Based on the e-pharmacophore, we propose the pharmacophore features that should present in VDR agonists. The resulting pharmacophore model contains one hydrogen bond acceptor (A), one hydrogen bond donor (D) and two hydrophobic regions (H). Using these features pharmacophore had been made and screened against large public library of compounds (Asinex, TOSLab, Binding and Zinc database) to find potential lead compounds. The compounds which yield fitness score of more than 1.0 were further subjected to Glide HTVS, SP and XP. Glide docking results revealed five hits (BD_230, BD_12938, BD_18601, BD_19517 and BD_19584) were identified as potential lead molecules against calcium phosphate metabolic disorders.

Special AT-rich sequence-binding protein 2 and its related genes play key roles in the differentiation of MC3T3-E1 osteoblast like cells

Special AT-rich sequence-binding protein (SATB) plays a critical role in bone generation and osteoblast differentiation. In the present study, the differentially expressed genes by SATB2 overexpression were analyzed in MC3T3-E1 osteoblast-like cells using Alizarin red S staining, wound healing assay and Agilent's Human Oligo Microarray. Calcium mineralization and motility were significantly enhanced in SATB2-overexpressed cells compared with untreated control. In addition, using the GeneSpringGX 7.3 program to compare the identified genes expressed in SATB2-overexpresed cells with untreated control, we found several unique genes closely associated with osteoblast differentiation, including SOX2, MBP2, WNT11 and MEN1 (up-regulated genes), and ILK, FGF23, FGFR2, and SNAI1 (down-regulated genes). Consistent with microarray data, real-time RT-PCR confirmed the significant up- and down-regulation of these genes at mRNA level in SATB2-overexpressed MC3T3-E1 cells. Overall, our findings suggest that the molecular regulation of SATB2 can be an attractive approach to develop a novel therapeutic strategy for bone-related diseases.

Serum fibroblast growth factor-23 levels in chronic haemodialysis patients

BACKGROUND

Fibroblast growth factor-23 (FGF23) is a circulating factor that regulates renal reabsorption of inorganic phosphate. Serum FGF23 level is increased in chronic kidney disease (CKD) patients as a compensatory mechanism to hyperphosphataemia. FGF23 directly signals in the parathyroid glands and can be used to predict future secondary hyperparathyroidism in dialysis patients. We examined the relationship between FGF23 and serum calcium, phosphate, 1,25(OH)(2)D(3), and PTH levels in haemodialysis patients.

METHODS

FGF23 and the above mentioned characteristics were measured in 50 chronic haemodialysis patients. We analysed the correlation between FGF23 and the other characteristics by using the Pearson correlation coefficient and multiple regression analysis.

RESULTS

FGF23 was significantly increased in haemodialysis patients compared with healthy controls (1525 +/- 373 vs. 37 +/- 9 pg/ml, P < 0.0001). There was a significant negative correlation between log FGF23 and 1,25(OH)(2)D(3) (R = -0.375, P = 0.009) and a significant positive correlation between log FGF23 and log PTH values (R = 0.287, P = 0.041). In multiple regression analysis log PTH and 1,25(OH)(2)D(3) values were independent predictors of log FGF23 (P = 0.037 and 0.009, respectively).

CONCLUSIONS

Our results revealed a marked increase in FGF23 levels in haemodialysis patients. PTH and vitamin D3 were independent predictors of FGF23 in the study group. Serum phosphate did not correlate with or predict FGF23 level despite the high prevalence of hyperphosphataemia in the study group.

Post-renal transplantation hypophosphatemia: a review and novel insights

PURPOSE OF REVIEW

This review intends to elucidate the pathophysiologic mechanism of renal phosphorus loss in the post-renal transplantation population. This review will provide new insight in to the pathophysiologic mechanism(s) responsible for the development of this phenomenon and will also explore the pathogenetic role of persistent phosphorus wasting in the development of post-renal transplantation osteodystrophy.

RECENT FINDINGS

Recently, the phosphaturic hormone, fibroblast growth factor-23, has been ascertain to be increased in the sera of patients with chronic kidney and end-stage renal disease. There is new evidence that a non-PTH humoral factor is persistently present in post-renal transplantation patients that is likely responsible for the observed persistent renal phosphorus loss. We offer that fibroblast growth factor-23 (and/or other phosphatonins) is the culprit factor responsible for the phenomenon of persistent hypophosphatemia in post-renal transplantation patients. Moreover, we believe that the phenomenon of persistent renal phosphorus wasting is an important but overlooked cause of osteodystrophy and increased fracture risk in this patient population.

SUMMARY

The pathophysiology of post-renal transplantation phosphorus wasting is complex and to date is still not fully recognized. Further studies of the regulatory mechanism of fibroblast growth factor-23 and its metabolism may offer additional insights into phosphorus homeostasis and its clinical application in the post-renal transplantation population.