1
|
Anilkumar A, Högler W, Bursell J, Nadar R, Ryan F, Randell T, Shaw NJ, Uday S. Successful treatment approaches for tumoral calcinosis in children and young people: A condition of diverse pathogenesis. Bone 2024; 182:117049. [PMID: 38364881 DOI: 10.1016/j.bone.2024.117049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/27/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Ectopic calcification is inappropriate biomineralization of soft tissues occurring due to genetic or acquired causes of hyperphosphataemia and rarely in normophosphataemic individuals. Tumoral Calcinosis (TC) is a rare metabolic bone disorder commonly presenting in childhood and adolescence with periarticular extra-capsular calcinosis. Three subtypes of TC have been recognised: primary hyperphosphataemic familial TC (HFTC), primary normophosphataemic familial TC and secondary TC most commonly seen in chronic renal failure. In the absence of established treatment, management is challenging due to variable success rates with medical therapies and recurrence following surgery. AIM We outline the successful treatment approaches in four children with TC (2 normophosphatemic TC, 2 HFTC) aged 2.5-10 years at initial presentation. CASES Patient 1 (P1) presented at 10 years with a painless lump behind the right knee, P2 with swelling of the right knee anteriorly at 9 years, P3 and P4 with pain and swelling over the right elbow at 5 and 2.5 years respectively. All patients were of Black African-Caribbean origin and were previously reported to be fit and well with no family history of TC. RESULTS P1, P2 had normophosphataemic TC and P3, P4 had HFTC with genetically confirmed GALNT3 mutation. All four patients had initial surgical resection with TC confirmed on histology. P1 had complete surgical resection with no recurrence at 27 months post-operatively. P2 had significant overgrowth of the tumour following surgery and was subsequently successfully managed with 25 % topical sodium metabisulphite (total duration of 8 months with a 4 month gap during which there was recurrence). P3 had post-surgical recurrence of TC on the right elbow and a new lesion on left elbow which resolved with oral acetazolamide monotherapy (15-20 mg/kg/day). P4 had recurrence of right elbow lesion following surgery and developed an extensive new hip lesion on sevelamer therapy which resolved completely with additional acetazolamide therapy (18-33 mg/kg/day). Acetazolamide was well tolerated with normal growth for 5 years in P3 and 6.5 years in P4 and no recurrence of lesions. CONCLUSION The frequent post-surgical recurrence in TC and successful medical therapy on the other hand indicates that medical management as first line therapy should be adopted. Monotherapies with topical 25 % sodium metabisulphite in normophosphataemic and oral acetazolamide in HFTC are effective treatment strategies which are well tolerated.
Collapse
Affiliation(s)
- A Anilkumar
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - W Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - J Bursell
- Department of Paediatrics, Milton Keynes University Hospital, Milton Keynes, UK
| | - R Nadar
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - F Ryan
- Department of Paediatric Endocrinology, Oxford Children's Hospital, Oxford, UK
| | - T Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham, UK
| | - N J Shaw
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Uday
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK.
| |
Collapse
|
2
|
Jung YS, Radhakrishnan K, Hammad S, Müller S, Müller J, Noh JR, Kim J, Lee IK, Cho SJ, Kim DK, Kim YH, Lee CH, Dooley S, Choi HS. ERRγ-inducible FGF23 promotes alcoholic liver injury through enhancing CYP2E1 mediated hepatic oxidative stress. Redox Biol 2024; 71:103107. [PMID: 38479224 PMCID: PMC10950689 DOI: 10.1016/j.redox.2024.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
Fibroblast growth factor 23 (FGF23) is a member of endocrine FGF family, along with FGF15/19 and FGF21. Recent reports showed that under pathological conditions, liver produces FGF23, although the role of hepatic FGF23 remains nebulous. Here, we investigated the role of hepatic FGF23 in alcoholic liver disease (ALD) and delineated the underlying molecular mechanism. FGF23 expression was compared in livers from alcoholic hepatitis patients and healthy controls. The role of FGF23 was examined in hepatocyte-specific knock-out (LKO) mice of cannabinoid receptor type 1 (CB1R), estrogen related receptor γ (ERRγ), or FGF23. Animals were fed with an alcohol-containing liquid diet alone or in combination with ERRγ inverse agonist. FGF23 is mainly expressed in hepatocytes in the human liver, and it is upregulated in ALD patients. In mice, chronic alcohol feeding leads to liver damage and induced FGF23 in liver, but not in other organs. FGF23 is transcriptionally regulated by ERRγ in response to alcohol-mediated activation of the CB1R. Alcohol induced upregulation of hepatic FGF23 and plasma FGF23 levels is lost in ERRγ-LKO mice, and an inverse agonist mediated inhibition of ERRγ transactivation significantly improved alcoholic liver damage. Moreover, hepatic CYP2E1 induction in response to alcohol is FGF23 dependent. In line, FGF23-LKO mice display decreased hepatic CYP2E1 expression and improved ALD through reduced hepatocyte apoptosis and oxidative stress. We recognized CBIR-ERRγ-FGF23 axis in facilitating ALD pathology through hepatic CYP2E1 induction. Thus, we propose FGF23 as a potential therapeutic target to treat ALD.
Collapse
Affiliation(s)
- Yoon Seok Jung
- Host-derived Antiviral Research Center, School of Biological Sciences and Technology, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Kamalakannan Radhakrishnan
- Host-derived Antiviral Research Center, School of Biological Sciences and Technology, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Seddik Hammad
- Molecular Hepatology Section, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3 (H42, Floor 4), 68167, Mannheim, Germany; Department of Forensic Medicine and Veterinary Toxicology, Faculty of Veterinary Medicine, South Valley University, 83523 Qena, Egypt
| | - Sebastian Müller
- Center for Alcohol Research (CAR), University of Heidelberg, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Johannes Müller
- Center for Alcohol Research (CAR), University of Heidelberg, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - Jung-Ran Noh
- Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - Jina Kim
- New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Republic of Korea
| | - In-Kyu Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; Research Institute of Aging and Metabolism, Kyungpook National University, Daegu 41940, Republic of Korea
| | - Sung Jin Cho
- Center for Brain Disorders, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - Don-Kyu Kim
- Host-derived Antiviral Research Center, Department of Integrative Food, Bioscience and Biotechnology, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Yong-Hoon Kim
- Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea; Laboratory Animal Resource Center, Korea Research Institute of Bioscience and Biotechnology, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
| | - Chul-Ho Lee
- Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea; Laboratory Animal Resource Center, Korea Research Institute of Bioscience and Biotechnology, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
| | - Steven Dooley
- Molecular Hepatology Section, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3 (H42, Floor 4), 68167, Mannheim, Germany.
| | - Hueng-Sik Choi
- Host-derived Antiviral Research Center, School of Biological Sciences and Technology, Chonnam National University, Gwangju 61186, Republic of Korea.
| |
Collapse
|
3
|
de Tienda M, Bonnet-Lebrun A, Mannes I, Nguyen-Khac V, Ouchrif Y, Assi A, Massaad A, Linglart A, Adamsbaum C, Skalli W, Wicart P. MRI quantitative muscle characterization in children with X-linked hypophosphatemia. Orthop Traumatol Surg Res 2024; 110:103713. [PMID: 37863188 DOI: 10.1016/j.otsr.2023.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Children with X Linked Hypophosphatemia (XLH) suffer from carential ricket, bone deformities and lameness. No previous study demonstrated a morphological distinction in muscles in these patients. The aim of this prospective study was to characterize, using Magnetic Resonance Imaging (MRI), the muscle morphology of pelvis, thigh and leg in children with XLH and to compare it with typically developed (TD) children. HYPOTHESIS We hypothesized that lower limbs muscles in children with XLH are different from TD children and could explain limp walking. MATERIAL AND METHODS Three-dimensional reconstructions of the muscles were performed in 11 patients with XLH and 15 TD children. Muscle lengths, sections and volumes were calculated and normalized with height and weight. Mean age was 10. RESULTS Lengths were all smaller in children with XLH except for the Medius/minimus gluteus muscles (p=0.64). The difference seemed higher in muscles with a long tendinous part as semitendinosus (0.139 vs 0,164; p<0.01). All volumes were significantly inferior in children with XLH. This preliminary study showed significant differences in muscle structures between patients with XLH and TD children. DISCUSSION Medius/minimus gluteus seemed to be particularly developed in children with XLH. Nevertheless it is not possible to conclude if it is related to XLH or a consequence of bone deformities. LEVEL OF PROOF IV.
Collapse
Affiliation(s)
- Marine de Tienda
- Department of Pediatric Orthopaedic Surgery, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Aurore Bonnet-Lebrun
- Arts et Métiers ParisTech, CNRS, Laboratoire de Biomécanique (LBM), 151, boulevard de l'Hôpital, 75013 Paris, France.
| | - Inès Mannes
- Department of Pediatric Radiology, Hôpital Universitaire Kremlin Bicêtre, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Virginie Nguyen-Khac
- Department of Pediatric Orthopaedic Surgery, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Younès Ouchrif
- Department of Pediatric Orthopaedic Surgery, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
| | - Agnès Linglart
- Department of Pediatric Radiology, Hôpital Universitaire Kremlin Bicêtre, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Catherine Adamsbaum
- Department of Pediatric Radiology, Hôpital Universitaire Kremlin Bicêtre, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Wafa Skalli
- Arts et Métiers ParisTech, CNRS, Laboratoire de Biomécanique (LBM), 151, boulevard de l'Hôpital, 75013 Paris, France.
| | - Philippe Wicart
- Department of Pediatric Orthopaedic Surgery, Hôpital Universitaire Necker Enfants Malades, 149, rue de Sèvres, 75015 Paris, France.
| |
Collapse
|
4
|
Bi J, Zheng M, Li K, Sun S, Zhang Z, Yan N, Li X. Relationships of serum FGF23 and α-klotho with atherosclerosis in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2024; 23:128. [PMID: 38622690 PMCID: PMC11020347 DOI: 10.1186/s12933-024-02205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Compelling evidence suggests that calcium/phosphorus homeostasis-related parameters may be linked to diabetes mellitus and cardiovascular events. However, few studies have investigated the association of fibroblast growth factor 23 (FGF23), α-klotho and FGF23/α-klotho ratio with atherosclerosis in patients with type 2 diabetes mellitus (T2DM). OBJECTIVE This study was designed to evaluate whether FGF23, α-klotho and FGF23/α-klotho ratio are associated with T2DM and further to explore the relationships between these three factors and atherosclerosis in Chinese patients with T2DM. METHODS Serum FGF23 and α-klotho levels were measured via an enzyme-linked immunosorbent assay (ELISA) kit, and the carotid intima-media thickness (CIMT) was assessed via high-resolution color Doppler ultrasonography. The associations of serum FGF23, α-klotho and FGF23/α-klotho ratio with atherosclerosis in T2DM patients were evaluated using multivariable logistic regression models. RESULTS This cross-sectional study involved 403 subjects (207 with T2DM and 196 without T2DM), 41.7% of the patients had atherosclerosis, and 67.2% of the carotid intima were thickened to a thickness greater than 0.9 mm. Compared with those in the lowest tertile, higher tertiles of FGF23 levels and FGF23/α-klotho ratio were positively associated with T2DM after adjusting for covariates, and serum α-klotho concentration was inversely correlated with T2DM (all P values < 0.01). Moreover, elevated serum FGF23 levels and FGF23/α-klotho ratio were positively associated with CIMT and carotid atherosclerosis in T2DM patients (all P values < 0.01). Further spline analysis similarly revealed linear dose‒response relationship (all P values < 0.01). And there was still significant differences in CIMT and carotid atherosclerosis between the highest group of α-klotho and the reference group in T2DM patients (P values = 0.05). CONCLUSIONS T2DM was positively linearly related to serum FGF23 concentration and FGF23/α-klotho ratio, and negatively correlated with serum α-klotho concentration. Furthermore, both FGF23 and FGF23/α-klotho ratio were positively correlated with CIMT and atherosclerosis in T2DM patients, while α-klotho was inversely correlated with both CIMT and atherosclerosis, although the associations were not completely significant. Prospective exploration and potential mechanisms underlying these associations remain to be further elucidated.
Collapse
Affiliation(s)
- Jiao Bi
- Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases, Translational and Research Centre for Prevention and Therapy of Chronic Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, 710021, PR China
| | - Mei Zheng
- The First Affiliated Hospital of Xi'an Medical College, Xi'an Medical University, Xi'an, 710021, China
| | - Ke Li
- Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases, Translational and Research Centre for Prevention and Therapy of Chronic Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, 710021, PR China
| | - Siwei Sun
- Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases, Translational and Research Centre for Prevention and Therapy of Chronic Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, 710021, PR China
| | - Zihang Zhang
- Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases, Translational and Research Centre for Prevention and Therapy of Chronic Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, 710021, PR China
| | - Nana Yan
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Xueping Li
- Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases, Translational and Research Centre for Prevention and Therapy of Chronic Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, 710021, PR China.
| |
Collapse
|
5
|
Jin X, Jin W, Li G, Zheng J, Xu X. Erythropoietin alleviates lung ischemia-reperfusion injury by activating the FGF23/FGFR4/ERK signaling pathway. PeerJ 2024; 12:e17123. [PMID: 38560469 PMCID: PMC10981413 DOI: 10.7717/peerj.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background The purpose of the present study was to investigate the effect of erythropoietin (EPO) on lung ischemia-reperfusion injury (LIRI). Methods Sprague Dawley rats and BEAS-2B cells were employed to construct an ischemia-reperfusion (I/R)-induced model in vivo and in vitro, respectively. Afterward, I/R rats and tert-butyl hydroperoxide (TBHP)-induced cells were treated with different concentrations of EPO. Furthermore, 40 patients with LIRI and healthy controls were enrolled in the study. Results It was observed that lung tissue damage, cell apoptosis and the expression of BAX and caspase-3 were higher in the LIRI model in vivo and in vitro than in the control group, nevertheless, the Bcl-2, FGF23 and FGFR4 expression level was lower than in the control group. EPO administration significantly reduced lung tissue damage and cell apoptosis while also up-regulating the expression of FGF23 and FGFR4. Rescue experiments indicated that EPO exerted a protective role associated with the FGF23/FGFR4/p-ERK1/2 signal pathway. Notably, the expression of serum EPO, FGF23, FGFR4 and Bcl-2 was decreased in patients with LIRI, while the expression of caspase-3 and BAX was higher. Conclusion EPO could effectively improve LIRI, which might be related to the activation of the FGF23/FGFR4/p-ERK1/2 signaling pathway.
Collapse
Affiliation(s)
- Xiaosheng Jin
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Weijing Jin
- Department of Neonatology, Hangzhou Children’s Hospital, Hangzhou, China
| | - Guoping Li
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jisheng Zheng
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xianrong Xu
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| |
Collapse
|
6
|
Hoong CWS, Sfeir J, Algeciras-Schimnich A, Clarke BL. A retrospective cohort of tumor-induced osteomalacia and case series of malignant disease. J Clin Endocrinol Metab 2024:dgae183. [PMID: 38506445 DOI: 10.1210/clinem/dgae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/21/2024] [Accepted: 03/18/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE We aimed to describe the clinical characteristics of a large cohort of patients diagnosed with tumor-induced osteomalacia (TIO), with a focus on patients with non-localizing and malignant TIO. METHODS This is a retrospective cohort of TIO patients in an academic medical center, diagnosed between January 1998 to May 2023. We described their demographics, biochemistries, tumor features, localization, treatment and complications. RESULTS Of 68 patients diagnosed with TIO, 49 (72%) were localizing and 5 (7.4%) were malignant. Of 50 patients who attempted localizing procedures, 29 (58%) achieved cure. 20 (40%) had persistent disease due to wrong tumor targeted, or refractory or recurrent tumors, despite up to 6 procedural attempts. There was no difference in demographics, phosphorus or baseline fibroblast growth factor-23 (FGF23) levels between localizing versus non-localizing groups, and malignant versus non-malignant groups. Lower extremity was the commonest site of localization (37%), with 47% in bone and 53% in soft tissue. 60% of malignant cases were located in the trunk. Tumor size correlated with peak FGF23 (R=0.566, p<0.001) but was not associated with malignancy risk (p=0.479). A cut-off FGF23 of >20 times upper limit of normal in the presence of normal renal function (p=0.025), and recurrence after initial cure (p=0.013) were factors significantly associated with malignancy. The non-localizing group had lower survival than localizing group (p=0.0097). CONCLUSIONS TIO is a condition with significant morbidity. Very high FGF23 level and disease recurrence are associated with malignant disease. Reasons behind the observation of higher mortality in non-localizing TIO should be further explored.
Collapse
Affiliation(s)
- Caroline Wei Shan Hoong
- Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester, USA
- Division of Endocrinology, Woodlands Health, National Healthcare Group, Singapore
| | - Jad Sfeir
- Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester, USA
- Robert and Arlene Kogod Center on Aging, Mayo Clinic Rochester, USA
| | | | - Bart Lyman Clarke
- Division of Endocrinology and Metabolism, Department of Medicine, Mayo Clinic Rochester, USA
| |
Collapse
|
7
|
唐 帅, 杨 扬, 李 湘, 别 炳, 张 建. [Clinical study on growth impairment induced by oral glucocorticoids based on FGF23/Klotho homeostasis observations]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:269-274. [PMID: 38557379 PMCID: PMC10986375 DOI: 10.7499/j.issn.1008-8830.2309160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To observe the correlation between growth impairment induced by long-term oral glucocorticoids (GC) therapy and the ratio of FGF23/Klotho in children with primary nephrotic syndrome (PNS). METHODS A prospective study was conducted on 56 children with GC-sensitive PNS who had discontinued GC therapy for more than 3 months and revisited the Department of Pediatrics of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine between June 2022 and December 2022. After monitoring qualitative and quantitative urine protein levels upon admission, the children with proteinuria relapse were treated with GC (GC group; n=29), while those without relapse did not receive GC treatment (non-GC group; n=27). In addition, 29 healthy children aged 3 to prepuberty were selected as the control group. Height, bone age, growth rate, and the FGF23/Klotho ratio were compared among the groups. The correlations of the FGF23/Klotho ratio with height, bone age, and growth rate were analyzed. RESULTS The FGF23/Klotho ratio in the GC group was significantly higher than that in the non-GC group after 1 month of GC therapy (P<0.05), and the height and bone age growth rates within 6 months were lower than those in the non-GC group (P<0.05). Correlation analysis showed significant negative correlations between the FGF23/Klotho ratio after 1 month of treatment and the growth rates of height and bone age within 6 months in children with PNS (r=-0.356 and -0.436, respectively; P<0.05). CONCLUSIONS The disturbance in FGF23/Klotho homeostasis is one of the mechanisms underlying the growth impairment caused by long-term oral GC therapy.
Collapse
Affiliation(s)
| | | | | | | | - 建 张
- 河南中医药大学第一附属医院儿科医院,河南郑州450000
| |
Collapse
|
8
|
Dwabe S, Chow W. Phosphaturic mesenchymal tumor with de novo liver metastases: a case report and literature review. Ther Adv Med Oncol 2024; 16:17588359241232092. [PMID: 38455709 PMCID: PMC10919134 DOI: 10.1177/17588359241232092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
Phosphaturic mesenchymal tumors (PMTs) are rare tumors that can cause tumor-induced osteomalacia (TIO) through overproduction of FGF23, a peptide hormone that causes renal phosphate wasting and reduced osteoblastic activity. The diagnosis of PMTs can be difficult to make as the presenting symptoms are non-specific. Although PMT is a rare entity, most cases are benign in nature, not requiring further intervention after surgery, as resection is typically curative. Here, we present a unique case of malignant PMT with de novo liver metastasis in a female patient who presented with TIO and underwent surgical resection of her primary lesion with subsequent regression of her liver metastasis. Moreover, we analyze a review of literature and discuss the importance of a timely diagnosis of this rare phenomenon. It is encouraged that providers strongly consider a diagnosis of PMT in patients with otherwise unexplained bone pain, fatigue, weakness, especially if accompanied with hypophosphatemia. Further studies are also warranted to identify prognostic factors that predict a PMT's malignant potential as they may help identify possible therapeutic targets.
Collapse
Affiliation(s)
- Sami Dwabe
- Division of Hematology/Oncology, University of California Irvine, 101 The City Dr., Orange, CA 92868, USA
| | - Warren Chow
- Division of Hematology/Oncology, University of California Irvine, Orange, CA, USA
| |
Collapse
|
9
|
Michon-Colin A, Bouderlique E, Prié D, Maruani G, Nevoux J, Briot K, Courbebaisse M. Successful Burosumab Treatment in an Adult Patient with X-Linked Hypophosphatemia and Chronic Kidney Disease Stage 3b. Calcif Tissue Int 2024; 114:310-314. [PMID: 38195892 DOI: 10.1007/s00223-023-01169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/19/2023] [Indexed: 01/11/2024]
Abstract
X-linked hypophosphatemic rickets (XLH) is a genetic cause of renal hypophosphatemia due to inactivation of the PHEX gene, with an inappropriate concentration of fibroblast growth factor 23 (FGF23). Burosumab, an anti-FGF23 monoclonal antibody, is a validated treatment for XLH, but its use in patients with chronic kidney disease (CKD) has not been validated. A 61-year-old man with XLH developed CKD during follow-up. Conventional treatment (phosphate salts and active vitamin D analogs) was poorly tolerated. Treatment with burosumab was decided at a multi-professional meeting. Before burosumab initiation, his measured glomerular filtration rate was 44 mL/min/1.73 m2 defining CKD stage 3b and intact FGF23 concentration was very high (4496.0 ng/mL, N: 22.7-93.1) due to both XLH and CKD. Severe hypophosphatemia was observed after the two first injections of burosumab at usual doses (1 mg/kg monthly) and concomitant discontinuation of the conventional treatment. After increasing the dose and reducing the interval between doses (1.3 mg/kg every three weeks) from the third injection, serum phosphate concentration normalized and remained around the lower limit of the normal range. A local cutaneous reaction was observed just after the second injection, but did not recur. We report for the first time the efficacy and good short-term tolerance of burosumab in a patient with XLH and CKD, subject to a higher dosage aimed at achieving a phosphatemia at the lower limit of the normal range.
Collapse
Affiliation(s)
- Arthur Michon-Colin
- Service de Physiologie, Unité d'Explorations Fonctionnelles Métaboliques et Rénales, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
- Université Paris Cité (UPC), Paris, France.
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), 75015, Paris, France.
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, 75015, Paris, France.
| | - Elise Bouderlique
- Service de Physiologie, Unité d'Explorations Fonctionnelles Métaboliques et Rénales, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité (UPC), Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), 75015, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, 75015, Paris, France
| | - Dominique Prié
- Université Paris Cité (UPC), Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
- Service de Physiologie, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, 75015, Paris, France
| | - Gérard Maruani
- Service de Physiologie, Unité d'Explorations Fonctionnelles Métaboliques et Rénales, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), 75015, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, 75015, Paris, France
| | - Jérôme Nevoux
- Université Paris-Saclay, Paris, France
- Institut de l'Audition, Paris, France
- Service ORL et implants auditifs, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris Le Kremlin-Bicêtre, Paris, France
| | - Karine Briot
- Université Paris Cité (UPC), Paris, France
- Service de Rhumatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Service de Physiologie, Unité d'Explorations Fonctionnelles Métaboliques et Rénales, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité (UPC), Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), 75015, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, 75015, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
| |
Collapse
|
10
|
Bosman A, Appelman-Dijkstra NM, Boot AM, de Borst MH, van de Ven AC, de Jongh RT, Bökenkamp A, van den Bergh JP, van der Eerden BCJ, Zillikens MC. Disease Manifestations and Complications in Dutch X-Linked Hypophosphatemia Patients. Calcif Tissue Int 2024; 114:255-266. [PMID: 38226986 PMCID: PMC10901935 DOI: 10.1007/s00223-023-01172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Abstract
X-linked hypophosphatemia (XLH) is the most common monogenetic cause of chronic hypophosphatemia, characterized by rickets and osteomalacia. Disease manifestations and treatment of XLH patients in the Netherlands are currently unknown. Characteristics of XLH patients participating in the Dutch observational registry for genetic hypophosphatemia and acquired renal phosphate wasting were analyzed. Eighty XLH patients, including 29 children, were included. Genetic testing, performed in 78.8% of patients, showed a PHEX mutation in 96.8%. Median (range) Z-score for height was - 2.5 (- 5.5; 1.0) in adults and - 1.4 (- 3.7; 1.0) in children. Many patients were overweight or obese: 64.3% of adults and 37.0% of children. All children received XLH-related medication e.g., active vitamin D, phosphate supplementation or burosumab, while 8 adults used no medication. Lower age at start of XLH-related treatment was associated with higher height at inclusion. Hearing loss was reported in 6.9% of children and 31.4% of adults. Knee deformities were observed in 75.0% of all patients and osteoarthritis in 51.0% of adult patients. Nephrocalcinosis was observed in 62.1% of children and 33.3% of adults. Earlier start of XLH-related treatment was associated with higher risk of nephrocalcinosis and detection at younger age. Hyperparathyroidism longer than six months was reported in 37.9% of children and 35.3% of adults. This nationwide study confirms the high prevalence of adiposity, hearing loss, bone deformities, osteoarthritis, nephrocalcinosis and hyperparathyroidism in Dutch XLH patients. Early start of XLH-related treatment appears to be beneficial for longitudinal growth but may increase development of nephrocalcinosis.
Collapse
Affiliation(s)
- A Bosman
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - N M Appelman-Dijkstra
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Boot
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M H de Borst
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - A C van de Ven
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R T de Jongh
- Department of Internal Medicine, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - A Bökenkamp
- Department of Pediatric Nephrology, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - B C J van der Eerden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| |
Collapse
|
11
|
Hu SL, Thadevoos LA, Ho TL, Lin YY, Chen HT, Huang CC, Su CM, Tang CH. FGF23 facilitates IL-1β synthesis in rheumatoid arthritis through activating PI3K, Akt, and NF-κB pathways. Environ Toxicol 2024. [PMID: 38380842 DOI: 10.1002/tox.24180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Rheumatoid arthritis (RA) is a well-known autoimmune disorder related with joint pain, joint swelling, cartilage and bone degradation as well as deformity. Fibroblast growth factor 23 (FGF23) is an endocrine factor of the FGF family primarily produced by osteocytes and osteoblasts, involves an essential effect in pathogenesis of RA. IL-1β is a vital proinflammatory factor in the development of RA. However, the role of FGF23 on IL-1β synthesis in RA has not been fully explored. Our analysis of database revealed higher levels of FGF23 and IL-1β in RA samples compared with healthy controls. High-throughput screening demonstrated that IL-1β is a potential candidate factor after FGF23 treatment in RA synovial fibroblasts (RASFs). FGF23 concentration dependently promotes IL-1β synthesis in RASFs. FGF23 enhances IL-1β expression by activating the PI3K, Akt, and NF-κB pathways. Our findings support the notion that FGF23 is a promising target in the remedy of RA.
Collapse
Affiliation(s)
- Sung-Lin Hu
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Louis Anoop Thadevoos
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Trung-Loc Ho
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yen-You Lin
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Ming Su
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Tang
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
12
|
Abate V, Vergatti A, De Filippo G, Damiano V, Menale C, D'Elia L, Rendina D. Clinical Characteristics of Malignant Phosphaturic Mesenchymal Tumor Causing Tumor-Induced Osteomalacia. J Clin Endocrinol Metab 2024; 109:e1006-e1011. [PMID: 38006315 DOI: 10.1210/clinem/dgad690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
CONTEXT Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by oversecretion of fibroblast growth factor 23 (FGF23) from a phosphaturic mesenchymal tumor (PMT). PMTs are usually benign neoplasms but some of them show malignant characteristics. OBJECTIVE The aim of this study was to compare the clinical characteristics of benign and malignant PMTs inducing TIO. METHODS On March 31, 2023, we performed a systematic review of individual patient data analysis in Medline, Google Scholar, Google book, and Cochrane Library using the terms "tumor induced osteomalacia," "oncogenic osteomalacia," "hypophosphatemia," with no language restrictions and according to Preferred Reporting Items for Systematic reviews and Meta-Analyses criteria. RESULTS Overall, we collected data from 837 patients with TIO in which the diagnosis of benign and malignant PMT was specified. Of them, 89 were affected by malignant PMT and 748 by benign PMT. Patients with malignant PMTs were younger and presented bone pain, functional impairment, and bone deformities more frequently. Malignant PMTs showed higher values of intact FGF23 and a higher mortality rate. CONCLUSION The study results identify the clinical characteristics of patients with malignant TIO, permitting the early identification of patients with PMT at increased risk of malignancy. This may significantly improve the diagnostic approach to disease. Further experimental studies are mandatory to clarify the role of FGF23 in the pathogenesis of malignancy in PMTs.
Collapse
Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Anita Vergatti
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Gianpaolo De Filippo
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Service d'Endocrinologie-Diabétologie, 75019 Paris, France
| | - Vincenzo Damiano
- Clinical Department of Oncology and Hematology, University of Naples "Federico II", 80131 Naples, Italy
| | - Ciro Menale
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| |
Collapse
|
13
|
Chiuariu T, Șalaru D, Ureche C, Vasiliu L, Lupu A, Lupu VV, Șerban AM, Zăvoi A, Benchea LC, Clement A, Tudurachi BS, Sascău RA, Stătescu C. Cardiac and Renal Fibrosis, the Silent Killer in the Cardiovascular Continuum: An Up-to-Date. J Cardiovasc Dev Dis 2024; 11:62. [PMID: 38392276 PMCID: PMC10889423 DOI: 10.3390/jcdd11020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular disease (CVD) and chronic kidney disease (CKD) often coexist and have a major impact on patient prognosis. Organ fibrosis plays a significant role in the pathogenesis of cardio-renal syndrome (CRS), explaining the high incidence of heart failure and sudden cardiac death in these patients. Various mediators and mechanisms have been proposed as contributors to the alteration of fibroblasts and collagen turnover, varying from hemodynamic changes to the activation of the renin-angiotensin system, involvement of FGF 23, and Klotho protein or collagen deposition. A better understanding of all the mechanisms involved has prompted the search for alternative therapeutic targets, such as novel inhibitors of the renin-angiotensin-aldosterone system (RAAS), serelaxin, and neutralizing interleukin-11 (IL-11) antibodies. This review focuses on the molecular mechanisms of cardiac and renal fibrosis in the CKD and heart failure (HF) population and highlights the therapeutic alternatives designed to target the responsible pathways.
Collapse
Affiliation(s)
- Traian Chiuariu
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Delia Șalaru
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Carina Ureche
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Laura Vasiliu
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Ancuta Lupu
- Department of Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Department of Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adela Mihaela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Alexandra Zăvoi
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Laura Catalina Benchea
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Alexandra Clement
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Bogdan-Sorin Tudurachi
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Radu Andy Sascău
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| | - Cristian Stătescu
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 University Street, 700115 Iasi, Romania
- Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Carol I Boulevard, No. 50, 700503 Iasi, Romania
| |
Collapse
|
14
|
Al-Hassi HO, Ali NM, Cooke H, De Silva S, Brini AT, Babu P, Sumathi V, Morris MR, Niada S. FGF23 Expression Is a Promising Immunohistochemical Diagnostic Marker for Undifferentiated Pleomorphic Sarcoma of Bone (UPSb). Genes (Basel) 2024; 15:242. [PMID: 38397231 PMCID: PMC10887495 DOI: 10.3390/genes15020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Undifferentiated pleomorphic sarcoma of bone (UPSb) is a rare primary bone sarcoma that lacks a specific line of differentiation. Distinguishing between UPSb and other malignant bone sarcomas, including dedifferentiated chondrosarcoma and osteosarcoma, is challenging due to their overlapping features. We have previously identified that UPSb tumours have elevated mRNA levels of Fibroblast Growth Factor 23 (FGF23) transcripts compared to other sarcomas including osteosarcoma. In the present study, we evaluated the specificity and practicality of FGF23 immunoreactivity as a specific diagnostic tool to differentiate UPSb tumours from osteosarcomas and dedifferentiated chondrosarcomas. Methods: A total of 10 UPSb, 10 osteosarcoma, and 10 dedifferentiated chondrosarcoma cases (all high-grade), were retrieved and immunohistochemistry for FGF23 was performed. Results: FGF23 protein was expressed at high levels in 80-90% of undifferentiated pleomorphic sarcoma of the bone cases, whereas it was expressed at significantly lower levels in dedifferentiated chondrosarcoma and osteosarcoma cases. A semiquantitative analysis, considering the intensity of immunoreactivity, confirmed significantly elevated FGF23 expression levels in UPSb tissues compared to those observed in osteosarcoma and dedifferentiated chondrosarcoma tissues. Conclusions: The results we present here suggest that FGF23 immunohistochemistry may be a useful tool to aid in differentiating UPSb from morphologically similar malignant bone sarcomas, especially in situations where sampling is restricted and there is limited clinical information available.
Collapse
Affiliation(s)
- Hafid O. Al-Hassi
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Naser M. Ali
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- Department of Medical Laboratories, General Ahmadi Hospital (KOC Hospital), Ahmadi 61008, Kuwait
| | - Hannah Cooke
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Shamini De Silva
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Anna T. Brini
- Laboratory of Biotechnological Applications, IRCCS Orthopedic Institute Galeazzi, 20157 Milan, Italy;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
| | - Pavithra Babu
- Acute Medicine, Birmingham Heartlands Hospital, University Hospital Birmingham, Birmingham B9 5SS, UK;
| | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, University Hospital of Birmingham, Birmingham B15 2TT, UK;
| | - Mark R. Morris
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Stefania Niada
- Laboratory of Biotechnological Applications, IRCCS Orthopedic Institute Galeazzi, 20157 Milan, Italy;
| |
Collapse
|
15
|
Vaisbich MH, de Cillo ACP, Silva BCC, DÁlva CB, de Carvalho ÉH, de Almeida JMCM, Marques LLM, Ribeiro M, da Silva MBM, de Medeiros PFV, Mendes PH. Real-world data of Brazilian adults with X-linked hypophosphatemia (XLH) treated with burosumab and comparison with other worldwide cohorts. Mol Genet Genomic Med 2024; 12:e2387. [PMID: 38337160 PMCID: PMC10858313 DOI: 10.1002/mgg3.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Disease-related variants in PHEX cause XLH by an increase of fibroblast growth factor 23 (FGF23) circulating levels, resulting in hypophosphatemia and 1,25(OH)2 vitamin D deficiency. XLH manifests in early life with rickets and persists in adulthood with osseous and extraosseous manifestations. Conventional therapy (oral phosphate and calcitriol) improves some symptoms, but evidence show that it is not completely effective, and it can lead to nephrocalcinosis (NC) and hyperparathyroidism (HPT). Burosumab (anti-FGF23 antibody) has shown to be effective and safety in the clinical trials. METHODS The current real-world collaborative study evaluated genetic, clinical and laboratory data of XLH Brazilian adult patients treated with burosumab. RESULTS Nineteen unrelated patients were studied. Patients reported pain, limb deformities and claudication, before burosumab initiation. 78% of them were previously treated with conventional therapy. The severity of the disease was moderate to severe (15 patients with score >5). At the baseline, 3 patients presented NC (16.7%) and 12 HPT (63%). After 16 ± 8.4 months under burosumab, we observed a significant: increase in stature (p = 0.02), in serum phosphate from 1.90 ± 0.43 to 2.67 ± 0.52 mg/dL (p = 0.02); in TmP/GFR from 1.30 ± 0.46 to 2.27 ± 0.64 mg/dL (p = 0.0001), in 1,25 (OH)2 D from 50.5 ± 23.3 to 71.1 ± 19.1 pg/mL (p = 0.03), and a decrease in iPTH from 86.8 ± 37.4 pg/mL to 66.5 ± 31.1 (p = 0.002). Nineteen variants were found (10 novel). HPT tended to develop in patients with truncated PHEX variants (p = 0.06). CONCLUSIONS This study confirms the efficacy and safety of burosumab on XLH adult patients observed in clinical trials. Additionally, we observed a decrease in iPTH levels in patients with moderate to severe HPT at the baseline.
Collapse
Affiliation(s)
| | | | - Bárbara Campolina C. Silva
- Hospital Felício Rocho, Osteometabolism Unit of Santa Casa de Belo HorizonteProfessor of Medicine at University Center of Belo Horizonte – UNIBHBelo HorizonteBrazil
| | | | - Érico Higino de Carvalho
- Instituto de Medicina Integrada Professor Fernado Figueira, recifeFederal University of PernambucoRecifeBrazil
| | | | | | - Marcia Ribeiro
- Genetic Unit of Federal University of Rio de JaneiroRio de JaneiroBrazil
| | | | | | | |
Collapse
|
16
|
Ye S, Grill V, Luo J, Nguyen HH. Concurrent Denosumab and Parenteral Iron Therapy Precipitating Severe Hypocalcemia and Hypophosphatemia. JCEM Case Rep 2024; 2:luae005. [PMID: 38304007 PMCID: PMC10833138 DOI: 10.1210/jcemcr/luae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Indexed: 02/03/2024]
Abstract
Denosumab-induced hypocalcemia and iron infusion-related hypophosphatemia are both well described. We describe a case of severe hypocalcemia and hypophosphatemia following sequential denosumab and parenteral iron administration. This resulted in respiratory failure due to muscle weakness and cardiac arrhythmia, requiring noninvasive ventilation and urgent intravenous electrolyte replacement. This case highlights the severe dysregulation in calcium and phosphate homeostasis that can occur with denosumab and iron infusions when administered in quick succession. Given that these drugs are among the most common therapies prescribed across a range of specialties, we hope to alert clinicians to this potential serious drug-drug interaction and suggest strategies for monitoring and management of the electrolyte derangement.
Collapse
Affiliation(s)
- Sylvia Ye
- Endocrinology and Diabetes Unit, Western Health, Melbourne, VIC 3021, Australia
| | - Vivian Grill
- Endocrinology and Diabetes Unit, Western Health, Melbourne, VIC 3021, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3021, Australia
| | - Jinghang Luo
- Endocrinology and Diabetes Unit, Western Health, Melbourne, VIC 3021, Australia
| | - Hanh H Nguyen
- Endocrinology and Diabetes Unit, Western Health, Melbourne, VIC 3021, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3021, Australia
| |
Collapse
|
17
|
Machado I, Zhang Y, Hameed M, Hwang S, Sharma AE, Bilsky MH, Linos K. GRM1-Rearranged Chondromyxoid Fibroma With FGF23 Expression: A Potential Pitfall in Small Biopsies. Int J Surg Pathol 2024:10668969241229345. [PMID: 38303543 DOI: 10.1177/10668969241229345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The clinical, radiological, and histopathological features of chondromyxoid fibroma can sometimes resemble those of other benign or malignant tumors. Recently, recurrent GRM1 rearrangements have been identified in chondromyxoid fibroma, and GRM1 positivity by immunohistochemistry has emerged as a dependable surrogate marker for this molecular alteration. Phosphaturic mesenchymal tumor is a rare tumor that often exhibits overexpression of fibroblastic growth factor 23 (FGF23) through various mechanisms. In this report, we present a case of GRM1-rearranged chondromyxoid fibroma that also exhibited FGF23 expression via in situ hybridization, posing significant diagnostic challenges during workup of the initial core biopsy. We hope that this case can serve as an educational resource, shedding light on a rare diagnostic pitfall.
Collapse
Affiliation(s)
- Isidro Machado
- Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
- Department of Pathology, Patologika Laboratory, Hospital Quiron-Salud, Valencia, Spain
- Pathology Department, University of Valencia and CIBERON Cancer, Madrid, Spain
| | - Yanming Zhang
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera Hameed
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aarti E Sharma
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Konstantinos Linos
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
18
|
Das O, Mohin M, Dey S, Kar A, Singhania P, Adhikari S, Chowdhury S, Chatterjee U. Cytological findings of phosphaturic mesenchymal tumor: Report of a case with summary of prior published cases. Diagn Cytopathol 2024; 52:E44-E47. [PMID: 37897246 DOI: 10.1002/dc.25245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm causing tumor-induced osteomalacia (TIO) and is characterized by secretion of FGF23, renal phosphate wasting and hypophosphataemia. It can be completely cured by resection and therefore its diagnosis is of utmost importance. Although the histology is well described, there is sparse literature on cytology of PMT and only three cases have been described so far. A 45-year-old lady presented with a non-tender mass in hard palate for 2 years from which fine-needle aspiration was done. The smears were paucicellular and showed bland spindle cells embedded in osteoid-like stromal matrix in a hemorrhagic background. Here we take the opportunity to describe the cytological findings of PMT along with its cytological differentials and a summary of prior published cases.
Collapse
Affiliation(s)
- Oindrila Das
- Department of Pathology, IPGME&R, Kolkata, India
| | - Md Mohin
- Department of Pathology, IPGME&R, Kolkata, India
| | - Soumya Dey
- Department of Pathology, IPGME&R, Kolkata, India
| | - Anish Kar
- Department of Endocrinology, IPGME&R, Kolkata, India
| | | | | | | | | |
Collapse
|
19
|
Oris C, Lautrette A, Dougé A, Bouraima F, Kahouadji S, Pickering ME, Garrouste C, Gagnière J, Guièze R, D'Ostrevy N, Futier E, Grobost V, Buisson A, Batisse M, Bouillon-Minois JB, Pereira B, Durif J, Sapin V, Bouvier D. Prevalence of FGF23 elevation in patients with hypophosphatemia. Clin Chim Acta 2024; 554:117782. [PMID: 38224930 DOI: 10.1016/j.cca.2024.117782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND AIMS To investigate the contribution of FGF23 in explaining the cases of hypophosphatemia observed in clinical practice, we aimed to determine for the first time the prevalence of FGF23 elevation in patients with hypophosphatemia and to describe the different mechanisms of FGF23-related hypophosphatemic disorders. MATERIALS AND METHODS We performed a prospective, observational, multicenter, cohort study of 260 patients with hypophosphatemia. Blood measurements (PTH, 1,25-dihydroxyvitamin D, bone alkaline phosphatase, 25-hydroxyvitamin D, and FGF23) were performed on a Liaison XL® (DiaSorin) analyzer. RESULTS Primary elevation of FGF23 (>95.4 pg/mL) was reported in 10.4% (95CI: 7.0-14.7) of patients (n = 27) with hypophosphatemia, suggesting that at least 1 in 10 cases of hypophosphatemia was erroneously attributed to an etiology other than FGF23 elevation. Patients with elevated blood FGF23 were grouped according to the etiology of the FGF23 elevation. Thus, 10 patients had a renal pathology, chronic kidney disease or post-renal transplantation condition. The remaining patients (n = 17) had the following etiologies: malignancies (n = 9), benign pancreatic tumor (n = 1), post-cardiac surgery (n = 4), cirrhosis (n = 2), and chronic obstructive pulmonary disease (n = 1). CONCLUSION In order to improve patient management, it seems essential to better integrate plasma FGF23 measurement into the routine evaluation of hypophosphatemia.
Collapse
Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Clermont Auvergne University, CNRS, INSERM, iGReD, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Department of Intensive Care Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurore Dougé
- Department of Oncology, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Farouk Bouraima
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Samy Kahouadji
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Clermont Auvergne University, CNRS, INSERM, iGReD, Clermont-Ferrand, France
| | - Marie-Eva Pickering
- Rheumatology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Cyril Garrouste
- Department of Nephrology, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Romain Guièze
- Department of Clinical Hematology, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Department of Cardiac Surgery, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, Anesthesia & Critical Care, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Vincent Grobost
- Department of Internal Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Batisse
- Department of Oncology, Centre Jean Perrin, 63000 Clermont-Ferrand, France
| | | | - Bruno Pereira
- Biostatistics Unit (DRCI) Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Clermont Auvergne University, CNRS, INSERM, iGReD, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Clermont Auvergne University, CNRS, INSERM, iGReD, Clermont-Ferrand, France.
| |
Collapse
|
20
|
Jurina A, Kasumović D, Delimar V, Filipec Kanižaj T, Japjec M, Dujmović T, Vučić Lovrenčić M, Starešinić M. Fibroblast growth factor 23 and its role in bone diseases. Growth Factors 2024; 42:1-12. [PMID: 37906060 DOI: 10.1080/08977194.2023.2274579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
Fibroblast growth factor 23 (FGF23) has been casually linked to numerous hypophosphatemic bone diseases, however connection with bone loss or fragility fractures is still a matter of debate. The purpose of this review is to explore and summarise the known actions of FGF23 in various pathological bone conditions. Besides implication in bone mineralisation, elevated FGF23 showed a pathological effecton bone remodelling, primarily by inhibiting osteoblast function. Unlike the weak association with bone mineral density, high values of FGF23 have been connected with fragility fracture prevalence. This review shows that its effects on bone are concomitantly present on multiple levels, affecting both qualitative and quantitative part of bone strength, eventually leading to impaired bone strength and increased tendency of fractures. Recognising FGF23 as a risk factor for the development of bone diseases and correcting its levels could lead to the reduction of morbidity and mortality in specific groups of patients.
Collapse
Affiliation(s)
- Andrija Jurina
- Department of Surgery, Division of General and Sport Traumatology and Orthopaedics, Merkur University Hospital, Zagreb, Croatia
| | - Dino Kasumović
- Department of Internal Medicine, Division of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Valentina Delimar
- Special Hospital for Medical Rehabilitation KrapinskeToplice, KrapinskeToplice, Croatia
| | - Tajana Filipec Kanižaj
- Department of Internal Medicine, Division of Gastroenterology, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mladen Japjec
- Department of Surgery, Division of General and Sport Traumatology and Orthopaedics, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Dujmović
- Department of Surgery, Division of General and Sport Traumatology and Orthopaedics, Merkur University Hospital, Zagreb, Croatia
| | - Marijana Vučić Lovrenčić
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Mario Starešinić
- Department of Surgery, Division of General and Sport Traumatology and Orthopaedics, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
21
|
Li J, Nie J, Zhou Z, Guo M, Yang Q, Yuan D, Huang J, Li R, Li Q. Changes of FGF23 and hearing in chronic renal failure and their correlation analysis. Cytokine 2024; 174:156478. [PMID: 38134554 DOI: 10.1016/j.cyto.2023.156478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND To explore the association between fibroblast growth factor 23 (FGF23) and hearing in chronic renal failure (CRF). METHODS Pure tone audiometry was used to detect the hearing of patients with CRF; the level of serum FGF23, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), and mean binaural hearing threshold were compared to the control group (people without kidney disease). The rat model of renal failure was established by 5/6 nephrectomy, and the auditory brainstem response (ABR) of rats after modeling was detected by the Tucker Davis Technologies (TDT) system; the expression level of FGF23 in the peripheral blood, renal and cochlear tissue was also detected. RESULTS The incidence of hearing loss (HL) and serum FGF23 were higher in CRF patients than the control group; the sFGF23 was positively correlated with the mean binaural hearing threshold. Animal studies showed that the ABR threshold, creatinine, FGF23, BUN, and PTH increased after modeling; although, an increase in FGF23 was observed earlier than other indicators. The HL of rats with renal failure was significantly correlated with BUN, phosphate, PTH, sFGF23, kFGF23/β-actin, eFGF23/β-actin, weight, and modeling cycle. CONCLUSIONS Both CRF patients and rat models showed high-frequency HL. FGF23 was highly expressed in the serum of HL renal failure patients and rats, as well as in the renal tissue and cochlea of renal failure rats. Therefore, FGF23 may be involved in the occurrence and development of HL caused by CRF.
Collapse
Affiliation(s)
- Jiaqing Li
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingwen Nie
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhu Zhou
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Guo
- Department of Otolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Yang
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dunlu Yuan
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingjing Huang
- Department of Medical Record, The Third People's Hospital of Kunming, Kunming, China
| | - Ruomei Li
- Department of Otolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Li
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
| |
Collapse
|
22
|
Biasucci G, Donini V, Cannalire G. Rickets Types and Treatment with Vitamin D and Analogues. Nutrients 2024; 16:416. [PMID: 38337700 PMCID: PMC10857029 DOI: 10.3390/nu16030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The definition of "Vitamin D" encompasses a group of fat-soluble steroid compounds of different origins with similar chemical structures and the same biological effects. Vitamin D deficiency and/or a defect in the process of its synthesis or transport predispose individuals to several types of rickets. In addition to cholecalciferol, ergocalciferol, and vitamins D3 and D2, there are also active metabolites for the treatment of this condition which are commercially available. Calcitriol and aphacalcidiol are active metabolites that do not require the renal activation step, which is required with calcifediol, or hepatic activation. The purpose of this review is to summarize current approaches to the treatment of rickets for generalist physicians, focusing on the best vitamin D form to be used in each type, or, in the case of X-linked hypophosphatemic rickets (XLH), on both conventional and innovative monoclonal antibody treatments.
Collapse
Affiliation(s)
- Giacomo Biasucci
- Pediatrics and Neonatology Unit, University of Parma, Gugliemo da Saliceto Hospital, 29121 Piacenza, Italy;
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Valentina Donini
- Unit of Pediatrics, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Giuseppe Cannalire
- Pediatrics and Neonatology Unit, University of Parma, Gugliemo da Saliceto Hospital, 29121 Piacenza, Italy;
| |
Collapse
|
23
|
Schmidt FN, Delsmann J, Yazigi B, Beil FT, Amling M, Oheim R. Approaching virtual osteoid volume estimation and in-depth tissue characterization in patients with tumor-induced Osteomalacia. J Bone Miner Res 2024:zjae008. [PMID: 38477742 DOI: 10.1093/jbmr/zjae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Tumor-induced osteomalacia (TIO) poses a significant diagnostic challenge, leading to increased disease duration and patient burden also by missing clinical suspicion. Today, diagnosis of osteomalacia relies on invasive iliac crest biopsy, if needed. Therefore, a noninvasive, method would be beneficial for patients with severe osteomalacia, such as TIO, and inform their clinical management to address specific needs, like estimating the regeneration capacity at high osteoid-volumes or the potential of a hungry bone syndrome after tumor-removal. Further, given the lack of comprehensive histological characterization of TIO, there is a need for additional tissue characterization. MATERIAL & METHODS Our assessment encompassed iliac crest biopsies that were examined using quantitative electron backscattered microscopy (qBEI), Raman spectroscopy, micro-CT and histology to analyze the biopsy tissue. Our clinical assessment encompassed dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (HR-pQCT) alongside with biochemical analyses and clinical evaluations. Combining imaging and clinical data, we established a model to predict the osteoid volume. RESULTS We compared 9 TIO patients with 10 osteoporosis (OPO) patients and 10 healthy controls. Histological analyses confirmed a pronounced osteoid volume in TIO patients (OPO: 1.20% ± 1.23% vs. TIO: 23.55% ± 12.23%, p < 0.0005), spectroscopy revealed lower phosphate levels in TIO biopsies. By combining HR-pQCT and laboratory diagnostics, we developed a linear regression model to noninvasively predict the osteoid volume revealing significantly higher modeled OV/BVmodel values of 24.46% ± 14.22% for TIO compared to the control group (5.952% ± 3.44%, p ≤ 0.001). CONCLUSION By combining laboratory diagnostics, namely, ALP and Tt.BMDRadius measured by HR-pQCT, we achieved the calculation of the virtual osteoid volume to bone volume ratio (OV/BVmodel) with a significant correlation to histology as well as reliable identification of TIO patients compared to OPO and control. This novel approach is potentially helpful for predicting osteoid volume by noninvasive techniques in diagnostic procedures and improving the clinical management of TIO.
Collapse
Affiliation(s)
- Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bashar Yazigi
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
24
|
Sikaneta T, Ho N, Bellasi A, Mahdavi S, Taskapan H, Svendrovski A, Makanjee B, Roberts J, Wu G, Nathoo B, Tam P. QTc Interval Prolongation Is Independently Associated with FGF23 and Predicts Mortality in Predialysis Chronic Kidney Disease. Cardiorenal Med 2024; 14:45-57. [PMID: 37963445 DOI: 10.1159/000535133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION QTc interval prolongation is increasingly frequent as chronic kidney disease (CKD) advances and predicts death in dialysis. However, predictors and mortality risk in predialysis CKD are understudied. FGF23 induces left ventricular hypertrophy (LVH) which is associated with QTc interval prolongation and death, suggesting a possible pathway from FGF23 to death that entails LVH and QTc prolongation. We looked for links between FGF23 and prolonged QTc intervals mediated by LVH and for deaths associated with QTc prolongation in a prospective observational cohort of patients with predialysis CKD. METHODS Participants underwent protocolized baseline and semiannual FGF23 testing, baseline and study end echocardiograms, and baseline and annual electrocardiograms over 3 years. RESULTS A total of 2,254 participants (34.1% female; mean age: 68.7 years; mean glomerular filtration: rate 41.4 mL/min/m2) enrolled in the study. Baseline LVH (left ventricular mass index >131 g/m2 [>100 g/m2 if female]) was present in 10.8% and prolonged QTc intervals (≥500 ms) in 1.5% of participants. One hundred thirty-eight (6.1%) participants died during the study. In generalized mixed-effects regression, each unit increase in the natural log of FGF23 - but not LVH - predicted an odds ratio of 1.76 (1.15, 2.70, p = 0.009) for prolonged QTc intervals independently of 15 other covariates. Mediation analysis showed that only 13% of FGF23's total effect on prolonged QTc intervals was mediated by LVH. Patients with prolonged QTc intervals had higher unadjusted (log rank p < 0.001) and adjusted (hazard ratio: 2.06 [1.08, 3.92, p = 0.028]) mortality rates than those with QTc intervals <500 ms. DISCUSSION QTc interval prolongation ≥500 ms was prospectively associated with FGF23 independently of LVH and with increased mortality risk in patients with predialysis CKD.
Collapse
Affiliation(s)
- Tabo Sikaneta
- Department of Nephrology, The Scarborough Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Kidney Life Sciences Institute, Toronto, Ontario, Canada
| | - Natalie Ho
- Department of Cardiology, The Scarborough Health Network, Toronto, Ontario, Canada
| | - Antonio Bellasi
- Division of Nephrology, Department of Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Sara Mahdavi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hulya Taskapan
- Kidney Life Sciences Institute, Toronto, Ontario, Canada
| | | | | | - Jason Roberts
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - George Wu
- Credit Valley Hospital, Mississauga, Ontario, Canada
| | | | - Paul Tam
- Department of Nephrology, The Scarborough Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Castillo RF, Pérez RG, González AL. Beneficial effects of physical exercise on the osteo-renal Klotho-FGF-23 axis in Chronic Kidney Disease: A systematic review with meta-analysis. Int J Med Sci 2024; 21:332-340. [PMID: 38169578 PMCID: PMC10758140 DOI: 10.7150/ijms.90195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
The aim of this study was to investigate the efficacy of physical exercise in chronic kidney disease, describing its impact on the Klotho-FGF23 axis. PubMed, Web of Science and Scopus databases, updated to January 2023, were searched. The present study employed mean difference and a 95% confidence interval (CI) to examine the efficacy of the intervention. Heterogeneity was assessed through inconsistency statistics (I2). Out of the 299 studies identified, a total of 4 randomized controlled trials (RCTs), comprising 272 participants, met the eligibility criteria. Compared with the control group, physical exercise significantly decreased the concentrations of FGF23 (MD: -102.07 Pg/mL, 95% CI: -176.23.47, -27.91 I2= 97%, p = 0.001), and a significantly increased the concentrations of Klotho protein: (MD: 158.82 Pg/mL, 95% CI: 123.33, -194.31, I2 = 0%, p = 0.001). The results of our study indicated that the exercise has a direct relationship with Klotho-FGF23 axis. We can conclude that physical exercise in patients with CKD produces beneficial effects on the pathophysiological components related to this disease, including cardiorespiratory fitness and vascular functions. As observed, both endurance and aerobic physical exercise increase Klotho production and decrease FGF23 levels. Evidence indicates that exercise attenuates the progression of CKD, improves uremic parameters and down-regulates inflammation-related markers.
Collapse
Affiliation(s)
- Rafael Fernandez Castillo
- Instituto de Investigación Biosanitaria ibs.Granada; Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Raquel García Pérez
- University of Granada. Faculty of Health Sciences, Parque Tecnológico de Ciencias de la Salud. Avd de la Ilustración 60 CP18016 Granada/Spain
| | - Antonio Liñán González
- University of Granada. Faculty of Health Sciences, Parque Tecnológico de Ciencias de la Salud. Avd de la Ilustración 60 CP18016 Granada/Spain
| |
Collapse
|
26
|
Radvanyi Z, Yoo EJ, Kandasamy P, Salas-Bastos A, Monnerat S, Refardt J, Christ-Crain M, Hayashi H, Kondo Y, Jantsch J, Rubio-Aliaga I, Sommer L, Wagner CA, Hediger MA, Kwon HM, Loffing J, Pathare G. Extracellular sodium regulates fibroblast growth factor 23 ( FGF23) formation. J Biol Chem 2024; 300:105480. [PMID: 37992803 PMCID: PMC10770535 DOI: 10.1016/j.jbc.2023.105480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
The bone-derived hormone fibroblast growth factor-23 (FGF23) has recently received much attention due to its association with chronic kidney disease and cardiovascular disease progression. Extracellular sodium concentration ([Na+]) plays a significant role in bone metabolism. Hyponatremia (lower serum [Na+]) has recently been shown to be independently associated with FGF23 levels in patients with chronic systolic heart failure. However, nothing is known about the direct impact of [Na+] on FGF23 production. Here, we show that an elevated [Na+] (+20 mM) suppressed FGF23 formation, whereas low [Na+] (-20 mM) increased FGF23 synthesis in the osteoblast-like cell lines UMR-106 and MC3T3-E1. Similar bidirectional changes in FGF23 abundance were observed when osmolality was altered by mannitol but not by urea, suggesting a role of tonicity in FGF23 formation. Moreover, these changes in FGF23 were inversely proportional to the expression of NFAT5 (nuclear factor of activated T cells-5), a transcription factor responsible for tonicity-mediated cellular adaptations. Furthermore, arginine vasopressin, which is often responsible for hyponatremia, did not affect FGF23 production. Next, we performed a comprehensive and unbiased RNA-seq analysis of UMR-106 cells exposed to low versus high [Na+], which revealed several novel genes involved in cellular adaptation to altered tonicity. Additional analysis of cells with Crisp-Cas9-mediated NFAT5 deletion indicated that NFAT5 controls numerous genes associated with FGF23 synthesis, thereby confirming its role in [Na+]-mediated FGF23 regulation. In line with these in vitro observations, we found that hyponatremia patients have higher FGF23 levels. Our results suggest that [Na+] is a critical regulator of FGF23 synthesis.
Collapse
Affiliation(s)
- Zsuzsa Radvanyi
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland
| | - Eun Jin Yoo
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Palanivel Kandasamy
- Membrane Transport Discovery Lab, Department of Nephrology and Hypertension and Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | | | - Sophie Monnerat
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Himeka Hayashi
- Department of Animal Sciences, Teikyo University of Science, Yamanashi, Japan
| | - Yasuhiko Kondo
- Department of Animal Sciences, Teikyo University of Science, Yamanashi, Japan
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg and University of Regensburg, Regensburg, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Isabel Rubio-Aliaga
- Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Lukas Sommer
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Carsten A Wagner
- Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland; Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Matthias A Hediger
- Membrane Transport Discovery Lab, Department of Nephrology and Hypertension and Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Hyug Moo Kwon
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Johannes Loffing
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland
| | - Ganesh Pathare
- Institute of Anatomy, University of Zurich, Zurich, Switzerland; Swiss National Centre of Competence in Research "Kidney Control of Homeostasis", Zurich, Switzerland.
| |
Collapse
|
27
|
Rodríguez D, Gurevich E, Mohammadi Jouabadi S, Pastor Arroyo EM, Ritter A, Estoppey Younes S, Wagner CA, Imenez Silva PH, Seeger H, Mohebbi N. Serum sclerostin is associated with recurrent kidney stone formation independent of hypercalciuria. Clin Kidney J 2024; 17:sfad256. [PMID: 38186870 PMCID: PMC10768761 DOI: 10.1093/ckj/sfad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background Kidney stones are frequent in industrialized countries with a lifetime risk of 10 to 15%. A high percentage of individuals experience recurrence. Calcium-containing stones account for more than 80% of kidney stones. Diet, environmental factors, behavior, and genetic variants contribute to the development of kidney stones. Osteocytes excrete the 21 kDa glycoprotein sclerostin, which inhibits bone formation by osteoblasts. Animal data suggests that sclerostin might directly or indirectly regulate calcium excretion via the kidney. As hypercalciuria is one of the most relevant risk factors for kidney stones, sclerostin might possess pathogenic relevance in nephrolithiasis. Methods We performed a prospective cross-sectional observational controlled study in 150 recurrent kidney stone formers (rKSF) to analyse the association of sclerostin with known stone risk factors and important modulators of calcium-phosphate metabolism. Serum sclerostin levels were determined at the first visit. As controls, we used 388 non-stone formers from a large Swiss epidemiological cohort. Results Sclerostin was mildly increased in rKSF in comparison to controls. This finding was more pronounced in women compared to men. Logistic regression indicated an association of serum sclerostin with rKSF status. In hypercalciuric individuals, sclerostin levels were not different from normocalciuric patients. In Spearman correlation analysis we found a positive correlation between sclerostin, age, and BMI and a negative correlation with eGFR. There was a weak correlation with iPTH and intact FGF 23. In contrast, serum sclerostin levels were not associated with 25-OH Vitamin D3, 1,25-dihydroxy-Vitamin D3, urinary calcium and phosphate or other urinary lithogenic risk factors. Conclusion This is the first prospective controlled study investigating serum sclerostin in rKSF. Sclerostin levels were increased in rKSF independent of hypercalciuria and significantly associated with the status as rKSF. It appears that mechanisms other than hypercalciuria may be involved and thus further studies are required to elucidate underlying pathways.
Collapse
Affiliation(s)
- Daniel Rodríguez
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Soroush Mohammadi Jouabadi
- Department of Internal Medicine , Division of Vascular Medicine and Pharmacology, Erasmus Medical Center, University Medical Center Rotterdam, the Netherlands
| | | | - Alexander Ritter
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Pedro Henrique Imenez Silva
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, the Netherlands
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Nilufar Mohebbi
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
28
|
Wolf L, Vogt J, Alber J, Franjic D, Feger M, Föller M. PKC regulates αKlotho gene expression in MDCK and NRK-52E cells. Pflugers Arch 2024; 476:75-86. [PMID: 37773536 PMCID: PMC10758369 DOI: 10.1007/s00424-023-02863-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
Particularly expressed in the kidney, αKlotho is a transmembrane protein that acts together with bone hormone fibroblast growth factor 23 (FGF23) to regulate renal phosphate and vitamin D homeostasis. Soluble Klotho (sKL) is released from the transmembrane form and controls various cellular functions as a paracrine and endocrine factor. αKlotho deficiency accelerates aging, whereas its overexpression favors longevity. Higher αKlotho abundance confers a better prognosis in cardiovascular and renal disease owing to anti-inflammatory, antifibrotic, or antioxidant effects and tumor suppression. Serine/threonine protein kinase C (PKC) is ubiquitously expressed, affects several cellular responses, and is also implicated in heart or kidney disease as well as cancer. We explored whether PKC is a regulator of αKlotho. Experiments were performed in renal MDCK or NRK-52E cells and PKC isoform and αKlotho expression determined by qRT-PCR and Western Blotting. In both cell lines, PKC activation with phorbol ester phorbol-12-myristate-13-acetate (PMA) downregulated, while PKC inhibitor staurosporine enhanced αKlotho mRNA abundance. Further experiments with PKC inhibitor Gö6976 and RNA interference suggested that PKCγ is the major isoform for the regulation of αKlotho gene expression in the two cell lines. In conclusion, PKC is a negative regulator of αKlotho gene expression, an effect which may be relevant for the unfavorable effect of PKC on heart or kidney disease and tumorigenesis.
Collapse
Affiliation(s)
- Lisa Wolf
- Department of Physiology, University of Hohenheim, Garbenstraße 30, 70599, Stuttgart, Germany
| | - Julia Vogt
- Department of Physiology, University of Hohenheim, Garbenstraße 30, 70599, Stuttgart, Germany
| | - Jana Alber
- Department of Physiology, University of Hohenheim, Garbenstraße 30, 70599, Stuttgart, Germany
| | - Domenic Franjic
- Core Facility Hohenheim, Data and Statistical Consulting, University of Hohenheim, 70599, Stuttgart, Germany
| | - Martina Feger
- Department of Physiology, University of Hohenheim, Garbenstraße 30, 70599, Stuttgart, Germany
| | - Michael Föller
- Department of Physiology, University of Hohenheim, Garbenstraße 30, 70599, Stuttgart, Germany.
| |
Collapse
|
29
|
Fuchs MA, Burke EJ, Latic N, Murray S, Li H, Sparks M, Abraham D, Zhang H, Rosenberg P, Hänzelmann S, Hausmann F, Huber T, Erben R, Fisher-Wellman K, Bursac N, Wolf M, Grabner A. Fibroblast Growth Factor (FGF) 23 and FGF Receptor 4 promote cardiac metabolic remodeling in chronic kidney disease. Res Sq 2023:rs.3.rs-3705543. [PMID: 38196615 PMCID: PMC10775858 DOI: 10.21203/rs.3.rs-3705543/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Chronic kidney disease (CKD) is a global health epidemic that significantly increases mortality due to cardiovascular disease. Left ventricular hypertrophy (LVH) is an important mechanism of cardiac injury in CKD. High serum levels of fibroblast growth factor (FGF) 23 in patients with CKD may contribute mechanistically to the pathogenesis of LVH by activating FGF receptor (FGFR) 4 signaling in cardiac myocytes. Mitochondrial dysfunction and cardiac metabolic remodeling are early features of cardiac injury that predate development of hypertrophy, but these mechanisms of disease have been insufficiently studied in models of CKD. Wild-type mice with CKD induced by adenine diet developed LVH that was preceded by morphological changes in mitochondrial structure and evidence of cardiac mitochondrial and metabolic dysfunction. In bioengineered cardio-bundles and neonatal rat ventricular myocytes grown in vitro, FGF23-mediated activation of FGFR4 caused a mitochondrial pathology, characterized by increased bioenergetic stress and increased glycolysis, that preceded the development of cellular hypertrophy. The cardiac metabolic changes and associated mitochondrial alterations in mice with CKD were prevented by global or cardiac-specific deletion of FGFR4. These findings indicate that metabolic remodeling and eventually mitochondrial dysfunction are early cardiac complications of CKD that precede structural remodeling of the heart. Mechanistically, FGF23-mediated activation of FGFR4 causes mitochondrial dysfunction, suggesting that early pharmacologic inhibition of FGFR4 might serve as novel therapeutic intervention to prevent development of LVH and heart failure in patients with CKD.
Collapse
Affiliation(s)
- Michaela A. Fuchs
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Emily J. Burke
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nejla Latic
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Susan Murray
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hanjun Li
- Department of Biomedical Engineering, Duke University, Durham, USA
| | - Matthew Sparks
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dennis Abraham
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hengtao Zhang
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul Rosenberg
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sonja Hänzelmann
- Division of Nephrology, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Hausmann
- Division of Nephrology, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Huber
- Division of Nephrology, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhold Erben
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital, Vienna, Austria
| | - Kelsey Fisher-Wellman
- East Carolina Diabetes and Obesity Institute, Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, USA
- Duke Regeneration Center, Duke University, Durham, North Carolina, USA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Alexander Grabner
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Nephrology, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Duke Regeneration Center, Duke University, Durham, North Carolina, USA
| |
Collapse
|
30
|
Vermeulen S, Scheffer-Rath MEA, Besouw MTP, van der Vaart A, de Borst MH, Boot AM. Fibroblast growth factor 23 and calcium-phosphate metabolism in relation to cardiovascular risk factors in patients with type 1 diabetes. J Diabetes 2023. [PMID: 38124483 DOI: 10.1111/1753-0407.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/10/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the major cause of mortality in type 1 diabetes (T1D). The objective of this study is to evaluate fibroblast growth factor 23 (FGF23) and calcium-phosphate metabolism in relation to cardiovascular risk factors in adults with and without T1D. METHODS A case-control study was conducted using data from patients with T1D and age- and sex matched controls without T1D from the Lifelines Cohort Study. RESULTS We included 302 adults in the T1D group and 302 adults in the control group. Median age was 42 years. Median glycosylated hemoglobin (HbA1c) in the T1D group was 7.8%. FGF23 of all patients with T1D was not significantly different from controls. Females with T1D had significantly higher FGF23 than males with T1D (83.3 vs 69.3 U/mL, p = 0.002), this was not observed in controls. Serum phosphate, calcium, and alkaline phosphatase were higher and parathyroid hormone was lower in patients with T1D, compared to controls (all p < .001), all within normal range. In the T1D group, FGF23 was positively correlated with serum phosphate (p < .001), alkaline phosphatase (p = .01), and calcium (p = .030), these correlations were not observed in controls. Median FGF23 was significantly higher in current smokers than in nonsmokers with T1D (84.9 vs 73.5 U/mL, p < .05). CONCLUSIONS Serum calcium, phosphate, and alkaline phosphatase were higher in patients with T1D than in controls and were positively correlated to FGF23 in patients with T1D. Current smokers with T1D had higher FGF23 than nonsmokers with T1D. These findings may contribute to the increased risk of CVD in patients with T1D.
Collapse
Affiliation(s)
- Stephanie Vermeulen
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Diabeter Center for Pediatric and Adolescent Diabetes Care and Research, Groningen, the Netherlands
| | | | - Martine T P Besouw
- Department of Pediatric Nephrology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Amarens van der Vaart
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annemieke M Boot
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Diabeter Center for Pediatric and Adolescent Diabetes Care and Research, Groningen, the Netherlands
| |
Collapse
|
31
|
Chen X, Cai C, Lun S, Ye Q, Pan W, Chen Y, Wu Y, Feng T, Su F, Ma C, Luo J, Liu M, Ma G. The contribution of a novel PHEX gene mutation to X-linked hypophosphatemic rickets: a case report and an analysis of the gene mutation dosage effect in a rat model. Front Endocrinol (Lausanne) 2023; 14:1251718. [PMID: 38116308 PMCID: PMC10728720 DOI: 10.3389/fendo.2023.1251718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
A Chinese family was identified to have two patients with rickets, an adult female and a male child (proband), both exhibiting signs related to X-linked hypophosphatemic rickets (XLH). Gene sequencing analysis revealed a deletion of adenine at position 1985 (c.1985delA) in the PHEX-encoding gene. To investigate the relationship between this mutation and the pathogenicity of XLH, as well as analyze the effects of different dosages of PHEX gene mutations on clinical phenotypes, we developed a rat model carrying the PHEX deletion mutation. The CRISPR/Cas9 gene editing technology was employed to construct the rat model with the PHEX gene mutation (c.1985delA). Through reproductive procedures, five genotypes of rats were obtained: female wild type (X/X), female heterozygous (-/X), female homozygous wild type (-/-), male wild type (X/Y), and male hemizygous (-/Y). The rats with different genotypes underwent analysis of growth, serum biochemical parameters, and bone microstructure. The results demonstrated the successful generation of a stable rat model inheriting the PHEX gene mutation. Compared to the wild-type rats, the mutant rats displayed delayed growth, shorter femurs, and significantly reduced bone mass. Among the female rats, the homozygous individuals exhibited the smallest body size, decreased bone mass, shortest femur length, and severe deformities. Moreover, the mutant rats showed significantly lower blood phosphorus concentration, elevated levels of FGF23 and alkaline phosphatase, and increased expression of phosphorus regulators. In conclusion, the XLH rat model with the PHEX gene mutation dosage demonstrated its impact on growth and development, serum biochemical parameters, and femoral morphology.
Collapse
Affiliation(s)
- Xiaoming Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China
| | - Cijing Cai
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Maternal and Children’s Health Research Institute, Shunde Women and Children’s Hospital, Guangdong Medical University, Foshan, China
| | - Shaocong Lun
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qiuli Ye
- Department of Traditional Chinese Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Weiyuan Pan
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yushi Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuexuan Wu
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Taoshan Feng
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Faming Su
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Choudi Ma
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiaxin Luo
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Meilian Liu
- Department of Pulmonary Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guoda Ma
- Maternal and Children’s Health Research Institute, Shunde Women and Children’s Hospital, Guangdong Medical University, Foshan, China
- Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan, China
| |
Collapse
|
32
|
van der Vaart A, Bakker SJL, Laverman GD, van Dijk PR, de Borst MH. NT-proBNP Mediates the Association Between FGF23 and All-Cause Mortality in Individuals With Type 2 Diabetes. J Am Heart Assoc 2023; 12:e031873. [PMID: 38014662 PMCID: PMC10727346 DOI: 10.1161/jaha.123.031873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND FGF23 (fibroblast growth factor 23) is associated with a higher mortality risk in type 2 diabetes, but the mechanism is unclear. We aimed to study whether NT-proBNP (N-terminal pro-brain natriuretic peptide) mediates the association between FGF23 and mortality. METHODS AND RESULTS We analyzed C-terminal FGF23 and NT-proBNP levels in 399 patients with type 2 diabetes. Cox regression analyses were performed, followed by mediation analyses using Structural Equation Modeling. During follow-up of 9.2 [7.6-11.3] years, 117 individuals died. FGF23 was associated with all-cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR], 2.32 [95% CI, 1.21-4.43], P=0.01). The association was lost upon further adjustment for NT-proBNP (HR, 1.84; 95% CI, 0.91-3.73). NT-proBNP accounted for 26% of the mediation effect between FGF23 and all-cause mortality. CONCLUSIONS These findings suggest that a higher FGF23 level is associated with increased mortality in individuals with type 2 diabetes through an effect on volume homeostasis.
Collapse
Affiliation(s)
- Amarens van der Vaart
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Gozewijn D. Laverman
- Division of Nephrology, Department of Internal MedicineZiekenhuisgroep TwenteHengeloThe Netherlands
| | - Peter R. van Dijk
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| |
Collapse
|
33
|
Feger M, Alber J, Strotmann J, Grund A, Leifheit-Nestler M, Haffner D, Föller M. Short-term fasting of mice elevates circulating fibroblast growth factor 23 ( FGF23). Acta Physiol (Oxf) 2023; 239:e14049. [PMID: 37746883 DOI: 10.1111/apha.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
AIMS Phosphate and vitamin D homeostasis are controlled by fibroblast growth factor 23 (FGF23) from bone suppressing renal phosphate transport and enhancing 24-hydroxylase (Cyp24a1), thereby inactivating 1,25(OH)2 D3 . Serum FGF23 is correlated with outcomes in several diseases. Fasting stimulates the production of ketone bodies. We hypothesized that fasting can induce FGF23 synthesis through the production of ketone bodies. METHODS UMR106 cells and isolated neonatal rat ventricular myocytes (NRVM) were treated with ketone body β-hydroxybutyrate. Mice were fasted overnight, fed ad libitum, or treated with β-hydroxybutyrate. Proteins and further blood parameters were determined by enzyme-linked immunoassay (ELISA), western blotting, immunohistochemistry, fluorometric or colorimetric methods, and gene expression by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS β-Hydroxybutyrate stimulated FGF23 production in UMR106 cells in a nuclear factor kappa-light-chain enhancer of activated B-cells (NFκB)-dependent manner, and in NRVMs. Compared to fed animals, fasted mice exhibited higher β-hydroxybutyrate and FGF23 serum levels (based on assays either detecting C-terminal or intact, biologically active FGF23 only), cardiac, pancreatic, and thymic Fgf23 and renal Cyp24a1 expression, and lower 1,25(OH)2 D3 serum concentration as well as renal Slc34a1 and αKlotho (Kl) expression. In contrast, Fgf23 expression in bone and serum phosphate, calcium, plasma parathyroid hormone (PTH) concentration, and renal Cyp27b1 expression were not significantly affected by fasting. CONCLUSION Short-term fasting increased FGF23 production, as did administration of β-hydroxybutyrate, effects possibly of clinical relevance in view of the increasing use of FGF23 as a surrogate parameter in clinical monitoring of diseases. The fasting state of patients might therefore affect FGF23 tests.
Collapse
Affiliation(s)
- Martina Feger
- Department of Physiology, University of Hohenheim, Stuttgart, Germany
| | - Jana Alber
- Department of Physiology, University of Hohenheim, Stuttgart, Germany
| | - Jörg Strotmann
- Department of Physiology, University of Hohenheim, Stuttgart, Germany
| | - Andrea Grund
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Michael Föller
- Department of Physiology, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
34
|
Zheng L, Han Z, Luo D, Li J, Pang N, Ding M, Ye H, Zhu K, Yao Y. IL-6, IL-1β and TNF-α regulation of the chondrocyte phenotype: a possible mechanism of haemophilic cartilage destruction. Hematology 2023; 28:2179867. [PMID: 36799502 DOI: 10.1080/16078454.2023.2179867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Proinflammatory cytokines are considered to be one of the key causes of haemophilic cartilage destruction by inducing chondrocyte apoptosis and extracellular matrix degradation. However, few studies have focused on how proinflammatory cytokines regulate the phenotypic changes of chondrocytes, which may be an important factor in haemophilic cartilage degradation pathogenesis. More understanding is needed about the effect of proinflammatory cytokines on phenotypic changes of the chondrocyte. The objective of this study was to examine how IL-6, TNF-α and IL-1β regulate the chondrocyte phenotype, which may be an important factor in haemophilic cartilage degradation pathogenesis. METHODS HUM-iCell-s018 chondrocytes were treated with increasing concentrations of TNF-α, IL-6 or IL-1β (0, 1, 5, 10 ng/ml) for 24 h, then FGF23 and SOX9 expression was determined by qRT-PCR and WB, respectively. RESULTS We found that TNF-α, IL-6 and IL-1β induced FGF23 and suppressed SOX9 expression in chondrocytes in a dose-dependent manner. IL-1β had a stronger regulatory effect on FGF23, while TNF-α and IL-6 had stronger regulatory effects on SOX9. CONCLUSIONS These findings suggest that IL-6, IL-1β and TNF-α may be involved in haemophilic cartilage destruction pathogenesis by altering the chondrocyte phenotype through modulation of FGF23 and SOX9 gene expression.
Collapse
Affiliation(s)
- Liujie Zheng
- Department of Orthopaedic Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhiwei Han
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Dasheng Luo
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jiale Li
- Department of Orthopaedic Surgery, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Nanyu Pang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Mingyang Ding
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Houlong Ye
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Keyan Zhu
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yunfeng Yao
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| |
Collapse
|
35
|
Liu SH, Xiao Z, Smith JC, Quarles LD. Structural asymmetry in FGF23 signaling. Trends Pharmacol Sci 2023; 44:862-864. [PMID: 37778940 DOI: 10.1016/j.tips.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Chen et al. have derived cryogenic electron microscopy (cryo-EM) structures of signaling complexes of the endocrine hormone fibroblast growth factor 23 (FGF23) with fibroblast growth factor receptor (FGFR), α-Klotho, and heparin sulfate. These structures are asymmetric, leading to questions concerning in vivo function, and will facilitate structure-based drug design to modulate FGF23 signaling.
Collapse
Affiliation(s)
- Shih-Hsien Liu
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA; Department of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Knoxville, TN 37996, USA
| | - Zhousheng Xiao
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jeremy C Smith
- UT/ORNL Center for Molecular Biophysics, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA; Department of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Knoxville, TN 37996, USA
| | - L Darryl Quarles
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| |
Collapse
|
36
|
Gauffenic A, Ratsimbazafy V, Ostertag A, Linglart A, Bourrat E, Leroy C, Lioté F, Latourte A, Richette P, Ea HK, Guigonis V. Effectiveness of topical sodium thiosulfate for ectopic calcifications and ossifications. Results of the CATSS-O study. Semin Arthritis Rheum 2023; 63:152306. [PMID: 37976811 DOI: 10.1016/j.semarthrit.2023.152306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Ectopic calcifications (ECs) and heterotopic ossifications (HOs) form in non-mineralized tissues, most often in subcutaneous and muscular areas. Local and systemic complications can cause severe disability. Systemic administration of sodium thiosulfate (STS) gives promising results but is difficult to use in clinical practice. OBJECTIVE Evaluation of the efficacy and safety of topical STS in ECs and HOs. METHODS Retrospective analysis of the CATSS-O registry that included patients receiving topical STS 25 % prepared by the pharmacy of Limoges hospital during 2014-2020. The efficacy of STS was assessed by imaging (radiography or CT) after at least 6 months' treatment. RESULTS Among 126 patients who received STS 25 %, 35 had complete clinical and radiographic data for analysis (28 with ECs and 7 with HOs; 18 children [mean age 8.9 years, range 1.5-16], 17 adults [mean age 52.4 years, range 24-90]). Calcifications or ossifications were due to dermatomyositis (8 children, 6 adults), systemic scleroderma (6 adults) or pseudo-hypoparathyroidism 1A (7 children). They were single (37.1 %) or multiple (62.9 %). Treated regions were in the lower limbs (31.4 %), upper limbs (37.1 %) or both (28.6 %) and the axial region (2.9 %). Topical STS was clinically effective in 9/28 (32.1 %) patients with ECs and 2/7 (28.6 %) children with HOs. Three patients experienced complete disappearance of their calcifications. Response for ECs was better in children than adults (54.5% vs 17.6 %, p = 0.035). Topical STS was well tolerated. CONCLUSION Local STS seems effective for ossifications, particularly pediatric calcifications or ossifications. Randomized and experimental studies are needed to confirm this observation and to identify the underlying mechanisms.
Collapse
Affiliation(s)
- Alan Gauffenic
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Voa Ratsimbazafy
- University of Limoges, EpiMaCT Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; IRD, U270, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; CHU Limoges, Department of Pharmacy, Limoges, France
| | - Agnès Ostertag
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France; APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and 'Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France; APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - Charles Leroy
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Frédéric Lioté
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Augustin Latourte
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Pascal Richette
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Hang Korng Ea
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France.
| | - Vincent Guigonis
- Service de Pédiatrie, CHU de Limoges, Limoges, France; CIC 1435, CHU de Limoges, Limoges, France; UMR CNRS 7276, Limoges, France
| |
Collapse
|
37
|
Zheng L, Yao Y, Luo D, Han Z, Zhang X, Pang N, Ding M, Ye H, Zhu K, Yi W. Iron regulates chondrocyte phenotype in haemophilic cartilage through the PTEN/PI3 K/AKT/FOXO1 pathway. Hematology 2023; 28:2240585. [PMID: 37493406 DOI: 10.1080/16078454.2023.2240585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Our previous study demonstrated that iron overload could lead to haemophilic cartilage destruction by changing chondrocyte phenotype. This change was caused by iron's effect on chondrocyte expression of FGF23 and SOX9, in addition to iron-induced chondrocyte apoptosis and cartilage extracellular matrix degradation. However, the underlying mechanisms remain unclear. This study aimed to determine the mechanism by which iron influences chondrocyte phenotype in the pathogenesis of haemophilic cartilage destruction. METHODS The expression of the PTEN/PI3K/AKT/FOXO1 signal pathway in the articular cartilage of patients with haemophilic arthritis (HA) or osteoarthritis (OA) was determined using western blot (WB). Additionally, we quantified the expression of iron-induced PTEN, PI3K, p-PI3K, AKT, p-AKT, FOXO1, and p-FOXO1 in primary human normal chondrocyte cells (HUM-iCell-s018) using WB. RESULTS We found that compared to that in patients with OA, the expression of PTEN, PI3K, AKT, and FOXO1 in the articular cartilage of patients with HA was up-regulated, while the expression of p-PI3K, p-AKT, and p-FOXO1 was down-regulated. Additionally, iron increased the expression of PTEN, PI3K, AKT, and FOXO1 and suppressed that of p-PI3K, p-AKT, and p-FOXO1 in chondrocytes in a dose-dependent manner. CONCLUSIONS Our findings demonstrated that iron was involved in the pathogenesis of haemophilic cartilage destruction by affecting chondrocyte phenotype through the inhibition of the PTEN/PI3K/AKT/FOXO1 pathway.
Collapse
Affiliation(s)
- Liujie Zheng
- Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan, Wuhan, People's Republic of China
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yunfeng Yao
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Dasheng Luo
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhiwei Han
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Xin Zhang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Nanyu Pang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Mingyang Ding
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Houlong Ye
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Keyan Zhu
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wenkai Yi
- Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan, Wuhan, People's Republic of China
| |
Collapse
|
38
|
Zhu Y, Hu Z, Liu Y, Qin C, Chen X, Shi Y, Wang L. Association of serum 25-hydroxyvitamin D3, fibroblast growth factor-23, and C1q/tumor necrosis factor-related protein-3 with coronary artery calcification in nondialysis chronic kidney disease patients. Ren Fail 2023; 45:2220412. [PMID: 37293793 DOI: 10.1080/0886022x.2023.2220412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To assess serum 25-hydroxyvitamin D3 (25(OH)D3), fibroblast growth factor 23 (FGF23), and C1q/tumor necrosis factor-related protein-3 (CTRP3) levels in nondialysis chronic kidney disease (CKD) patients and their relationship with coronary artery calcification (CAC). METHODS One hundred and twenty-eight patients diagnosed with CKD were selected and all underwent cardiac computed tomography. CAC was assessed using the Agatston score, and coronary artery calcification score (CACs) >10 was identified as CAC. The differences in serum 25(OH)D3, FGF23, and CTRP3 levels between the CAC and non-CAC groups were analyzed. Their correlation with CACs was assessed by Spearman's analysis, and logistic regression analysis was used to find risk factors for CAC. RESULTS Compared to the non-CAC group, the CAC group was older (64.21 ± 9.68 years), with a higher percentage of hypertension (93.10%) and diabetes (63.80%) and higher levels of serum CTRP3 [1079.20 (644.4-1567.2) ng/mL]. However, there was no significant difference in serum 25(OH)D3 and FGF23 between these two groups. The high level CTRP3 group had a higher prevalence of CAC (61.5%). Logistic regression results showed that age, diabetes, decreased 25(OH)D3 (odds ratio (OR) = 0.95, p = .030) and high levels of CTRP3 (OR = 3.19, p = .022) were risk factors for CAC in nondialysis CKD patients. CONCLUSIONS Serum CTRP3 levels progressively increased with the progression of kidney disease, while 25(OH)D3 levels progressively decreased. Decreased 25(OH)D3 and high levels of CTRP3 are associated with CAC in patients with nondialysis CKD.
Collapse
Affiliation(s)
- Yuanjie Zhu
- Graduate School, North China University of Science, Tangshan, China
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
| | - Zhijuan Hu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
| | - Yu Liu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
- Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Congcong Qin
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
- Graduate School, Hebei North University, Zhangjiakou, China
| | - Xing Chen
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
| | - Yanan Shi
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
| | - Lijun Wang
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, China
| |
Collapse
|
39
|
Yadav PS, Kobelski MM, Martins JS, Tao T, Liu ES, Demay MB. Impaired Growth Plate Maturation in XLH Is due to Both Excess FGF23 and Decreased 1,25-Dihydroxyvitamin D Signaling. Endocrinology 2023; 165:bqad186. [PMID: 38066669 PMCID: PMC10732678 DOI: 10.1210/endocr/bqad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 12/22/2023]
Abstract
X-linked hypophosphatemia (XLH) is the most common form of hereditary hypophosphatemic rickets. The genetic basis for XLH is loss of function mutations in the phosphate-regulating endopeptidase X-linked (PHEX), which leads to increased circulating fibroblast growth factor 23 (FGF23). This increase in FGF23 impairs activation of vitamin D and attenuates renal phosphate reabsorption, leading to rickets. Previous studies have demonstrated that ablating FGF23 in the Hyp mouse model of XLH leads to hyperphosphatemia, high levels of 1,25-dihydroxyvitamin D, and is not associated with the development of rickets. Studies were undertaken to define a role for the increase in 1,25-dihydroxyvitamin D levels in the prevention of rickets in Hyp mice lacking FGF23. These mice were mated to mice lacking Cyp27b1, the enzyme responsible for activating vitamin D metabolites, to generate Hyp mice lacking both FGF23 and 1,25-dihydroxyvitamin D (FCH mice). Mice were fed a special diet to maintain normal mineral ion homeostasis. Despite normal mineral ions, Hyp mice lacking both FGF23 and Cyp27b1 developed rickets, characterized by an interrupted, expanded hypertrophic chondrocyte layer and impaired hypertrophic chondrocyte apoptosis. This phenotype was prevented when mice were treated with 1,25-dihydroxyvitamin D from day 2 until sacrifice on day 30. Interestingly, mice lacking FGF23 and Cyp27b1 without the PHEX mutation did not exhibit rickets. These findings define an essential PHEX-dependent, FGF23-independent role for 1,25-dihydroxyvitamin D in XLH and have important therapeutic implications for the treatment of this genetic disorder.
Collapse
Affiliation(s)
- Prem Swaroop Yadav
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | | | - Janaina S Martins
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Tao Tao
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Eva S Liu
- Harvard Medical School, Boston, MA 02115, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Marie B Demay
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
40
|
Lucea S, Chopo-Escuin G, Guillén N, Sosa C, Sorribas V. Intestinal and Renal Adaptations to Changes of Dietary Phosphate Concentrations in Rat. Function (Oxf) 2023; 5:zqad063. [PMID: 38033458 PMCID: PMC10686248 DOI: 10.1093/function/zqad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
We have studied the role of the intestine, kidney, and several hormones when adapting to changes in dietary P concentration. Normal and parathyroidectomized (PTX) rats were fed pH-matched diets containing 0.1%, 0.6%, and 1.2% P concentrations. 32Pi uptake was determined in the jejunum and kidney cortex brush border membrane vesicles. Several hormone and ion concentrations were determined in the blood and urine of rats. Both jejunum and kidney cortex Pi transport was regulated with 5 d of chronic feeding of P diets in normal rats. Acute adaptation was determined by switching foods on day 6, which was only clearly observed in the kidney cortex of normal rats, with more statistical variability in the jejunum. However, no paradoxical increase of Pi uptake in the jejunum was reproduced after the acute switch to the 1.2% P diet. Pi uptake in the jejunum was parathyroid hormone (PTH)-independent, but in the kidney, the chronic adaptation was reduced, and no acute dietary adaptations were observed. The NaPi2a protein was more abundant in the PTX than the sham kidneys, but contrary to the modest or absent changes in Pi uptake adaptation, the transporter was similarly regulated by dietary P, as in the sham rats. PTH and fibroblast growth factor 23 (FGF23) were the only hormones regulated by all diet changes, even in fasting animals, which exhibited regulated Pi transport despite similar phosphatemia. Evidence of Pi appetite effects was also observed. In brief, our results show new characteristics of Pi adaptations, including a lack of correlation between Pi transport, NaPi2a expression, and PTH/FGF23 concentrations.
Collapse
Affiliation(s)
- Susana Lucea
- Laboratory of Molecular Toxicology, Department of Biochemistry and Cell and Molecular Biology, University of Zaragoza, E50013 Zaragoza, Spain
| | - Gema Chopo-Escuin
- Laboratory of Molecular Toxicology, Department of Biochemistry and Cell and Molecular Biology, University of Zaragoza, E50013 Zaragoza, Spain
| | - Natalia Guillén
- Laboratory of Molecular Toxicology, Department of Biochemistry and Cell and Molecular Biology, University of Zaragoza, E50013 Zaragoza, Spain
| | - Cecilia Sosa
- Laboratory of Molecular Toxicology, Department of Biochemistry and Cell and Molecular Biology, University of Zaragoza, E50013 Zaragoza, Spain
| | - Víctor Sorribas
- Laboratory of Molecular Toxicology, Department of Biochemistry and Cell and Molecular Biology, University of Zaragoza, E50013 Zaragoza, Spain
| |
Collapse
|
41
|
Hocher CF, Chen X, Zuo J, Horvathova K, Hocher B, Krämer BK, Chu C. Fibroblast growth factor 23 is associated with the development of gestational diabetes mellitus. Diabetes Metab Res Rev 2023; 39:e3704. [PMID: 37553983 DOI: 10.1002/dmrr.3704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Besides its established impact on bone and mineral metabolism, it was suggested that fibroblast growth factor 23 (FGF23) might play an important role in the pathogenesis of type 2 diabetes. The impact of FGF23 on gestational diabetes mellitus (GDM), however, is not well understood. iFGF23 ELISAs measure the intact FGF23 molecule, whereas cFGF23 assays measure intact FGF23 as well as degradation products of FGF23. OBJECTIVES The aim of this study is to compare the association of maternal and foetal cFGF23 and iFGF23 with GDM in a German birth cohort. METHODS cFGF23 and iFGF23 were analysed in 826 random mother/child pairs from the Berlin Birth Cohort. RESULTS Mothers who developed GDM had higher concentrations of iFGF-23 compared to mothers who did not suffer from GDM (19.73 vs. 13.23 pg/mL, p < 0.0001), but not higher concentrations of cFGF-23. Multivariant regression analyses showed that gestational diabetes is associated with iFGF23 independently of confounding factors such as age, BMI, ethnic background, family history of diabetes, smoking during pregnancy, and recurrent pregnancy loss. This, however, was only seen when using an iFGF23 ELISA measuring just the full length FGF23 and not in addition FGF23 fragments. No differences in both iFGF23 and cFGF23 concentrations between the GDM and non-GDM groups were detected in cord blood samples of the offspring. CONCLUSIONS This study of a representative German birth cohort showed that maternal but not foetal iFGF23 is independently associated with GDM.
Collapse
Affiliation(s)
- Carl-Friedrich Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Xin Chen
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiao Zuo
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Medical Diagnostics, IMD Berlin-Potsdam, Berlin, Germany
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Bernhard K Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- European Center for Angioscience ECAS, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
- Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chang Chu
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/ Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
42
|
Liu Y, Cheng Y, Sun M, Hao X, Li M. Analysis of serum insulin-like growth factor-1, fibroblast growth factor 23, and Klotho levels in girls with rapidly progressive central precocious puberty. Eur J Pediatr 2023; 182:5007-5013. [PMID: 37644169 PMCID: PMC10640509 DOI: 10.1007/s00431-023-05174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
To study the levels of serum insulin-like growth factor 1 (IGF-1), fibroblast growth factor 23 (FGF23), and Klotho, and to study their relationship with girls with rapidly progressive central precocious puberty (RP-CPP). This is a cross-sectional study on the progression rate of central precocious puberty in girls, who complained of breast development before the age of 8 years and were followed between June 2021 and June 2022. At the same time, 28 healthy girls less than 8 years old who had not started puberty were recruited as the control group. The physical examination and laboratory evaluation of each group was completed. Only patients with CPP received pelvic ultrasound examination and bone age test. Bone age index (BAI), basal LH levels (BLH), basal LH levels/basal FSH levels (BFSH), peak LH (PLH)/peak FSH (PFSH), IGF-1, Klotho, FGF23, and ovarian volume in the RP-CPP group were higher than those in slowly progressive CPP (SP-CPP) group. In the RP-CPP group, IGF-1 was correlated with Klotho, FGF23, and BLH; Klotho was correlated with FGF23 and BLH; FGF23 was correlated with BLH. CONCLUSION The BLH, FGF23, Klotho, and IGF-1 have a certain correlation with RP-CPP, which may play an important role in the speed of girls' sexual development. WHAT IS KNOWN • The association between IGF-1 and RP-CPP. WHAT IS NEW • We found the association between FGF23, Klotho and RP-CPP.
Collapse
Affiliation(s)
- Yuping Liu
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Yaying Cheng
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China.
| | - Meng Sun
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Xiaojing Hao
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| | - Mengmeng Li
- Department of Pediatrics, Hebei General Hospital, 348 Heping West Road, Xinhua District, Shijiazhuang, Hebei, China
| |
Collapse
|
43
|
Tsai WC, Hsu SP, Chiu YL, Wu HY, Luan CC, Yang JY, Pai MF, Lin CJ, Lin WY, Sun WH, Peng YS. Short-Term Effects of a Therapeutic Diet on Biochemical Parameters in Hemodialysis Patients: A Randomized Crossover Trial. J Ren Nutr 2023; 33:731-739. [PMID: 37120127 DOI: 10.1053/j.jrn.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/12/2023] [Accepted: 04/09/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE Although unhealthy diets exacerbate nutritional and metabolic derangements in patients with end-stage kidney disease (ESKD), how therapeutic diets that possess a variety of different dietary strategies acutely modify diverse biochemical parameters related to cardiovascular disease remains underexplored. METHODS Thirty-three adults with end-stage kidney disease undergoing thrice-weekly hemodialysis participated in a randomized crossover trial comparing a therapeutic diet with their usual diets for 7 days, separated by a 4-week washout period. The therapeutic diet was characterized by adequate calorie and protein amounts, natural food ingredients with a low phosphorus-to-protein ratio, higher portions of plant-based food, and high fiber content. The primary outcome measure was the mean difference in the change-from-baseline intact fibroblast growth factor 23 (FGF23) level between the 2 diets. The other outcomes of interest included changes in mineral parameters, uremic toxins, and high-sensitivity C-reactive protein (hs-CRP) levels. RESULTS Compared with the usual diet, the therapeutic diet lowered intact FGF23 levels (P = .001), decreased serum phosphate levels (P < .001), reduced intact parathyroid hormone (PTH) levels (P = .003), lowered C-terminal FGF23 levels (P = .03), increased serum calcium levels (P = .01), and tended to lower total indoxyl sulfate levels (P = .07) but had no significant effect on hs-CRP levels. Among these changes, reduction in serum phosphate level achieved in 2 days, modifications of intact PTH and calcium levels in 5 days, and reductions in intact and C-terminal FGF23 levels in 7 days of therapeutic diet intervention. CONCLUSION Within the 1-week intervention period, the dialysis-specific therapeutic diet rapidly reversed mineral abnormalities and tended to decrease total indoxyl sulfate levels in patients undergoing hemodialysis but had no effect on inflammation. Future studies to assess the long-term effects of such therapeutic diets are recommended.
Collapse
Affiliation(s)
- Wan-Chuan Tsai
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan
| | - Shih-Ping Hsu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Life Science, National Taiwan Normal University, Taipei City, Taiwan
| | - Yen-Ling Chiu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan City, Taiwan
| | - Hon-Yen Wu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chia-Chin Luan
- Dietary Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ju-Yeh Yang
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan
| | - Mei-Fen Pai
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei City, Taiwan; Department of Medicine, Mackay Medical College, Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
| | - Wan-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Wen-Huei Sun
- Dietary Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Yu-Sen Peng
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Applied Cosmetology, Lee-Ming Institute of Technology, New Taipei City, Taiwan; Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan.
| |
Collapse
|
44
|
Bouraima F, Sapin V, Kahouadji S, Pickering ME, Pereira B, Bouvier D, Oris C. Tumor-Induced Osteomalacia in Patients With Malignancy: A Meta-analysis and Systematic Review of Case Reports. J Clin Endocrinol Metab 2023; 108:3031-3040. [PMID: 37235783 DOI: 10.1210/clinem/dgad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT Tumor-induced osteomalacia (TIO) due to fibroblast growth factor 23 (FGF23) overexpression is becoming recognized in patients with malignancy. The condition may be underdiagnosed, with a scarce medical literature. OBJECTIVE To perform a meta-analysis of case reports to allow a better understanding of malignant TIO and its clinical implications. METHODS Full texts were selected according to strict inclusion criteria. All case reports were included where patients had hypophosphatemia, malignant TIO, and FGF23 blood levels. Thirty-two of 275 eligible studies (n = 34 patients) met inclusion criteria. A list of desired data was extracted and graded for methodological quality. RESULTS Prostate adenocarcinoma (n = 9) were the most tumors reported. Twenty-five of 34 patients had a metastatic disease and a poor clinical outcome was reported for 15 of 28 patients. The median levels of blood phosphate and C-terminal FGF23 (cFGF23) were 0.40 mmol/L and 788.5 RU/mL, respectively. For most of patients, blood PTH was elevated or within range, and calcitriol levels were inappropriately low or normal. Alkaline phosphatase concentrations were increased for 20 of 22 patients. The cFGF23 values were significantly higher for patients with a poor clinical outcome when compared to other patients (1685 vs 357.5 RU/mL). In case of prostate cancer, cFGF23 levels were significantly lower (429.4 RU/mL) than for other malignancies (1007.5 RU/mL). CONCLUSION We report for the first time a detailed description of the clinical and biological characteristics of malignant TIO. In this context, FGF23 blood measurement would be of value for the diagnostic workup, prognostication, and follow-up of patients.
Collapse
Affiliation(s)
- Farouk Bouraima
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, INSERM, iGReD, 63000 Clermont-Ferrand, France
| | - Samy Kahouadji
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, INSERM, iGReD, 63000 Clermont-Ferrand, France
| | - Marie-Eva Pickering
- Rheumatology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics unit (DRCI) Department, University Hospital, 63000 Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, INSERM, iGReD, 63000 Clermont-Ferrand, France
| | - Charlotte Oris
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, INSERM, iGReD, 63000 Clermont-Ferrand, France
| |
Collapse
|
45
|
Imel EA, Glorieux FH, Whyte MP, Portale AA, Munns CF, Nilsson O, Simmons JH, Padidela R, Namba N, Cheong HI, Pitukcheewanont P, Sochett E, Högler W, Muroya K, Tanaka H, Gottesman GS, Biggin A, Perwad F, Chen A, Roberts MS, Ward LM. Burosumab vs Phosphate/Active Vitamin D in Pediatric X-Linked Hypophosphatemia: A Subgroup Analysis by Dose Level. J Clin Endocrinol Metab 2023; 108:2990-2998. [PMID: 37084401 PMCID: PMC10583998 DOI: 10.1210/clinem/dgad230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT In an open-label, randomized, controlled, phase 3 trial in 61 children aged 1 to 12 years with X-linked hypophosphatemia (XLH), burosumab improved rickets vs continuing conventional therapy with active vitamin D and phosphate. OBJECTIVE We conducted an analysis to determine whether skeletal responses differed when switching to burosumab vs continuing higher or lower doses of conventional therapy. METHODS Conventional therapy dose groups were defined as higher-dose phosphate [greater than 40 mg/kg] (HPi), lower-dose phosphate [40 mg/kg or less] (LPi), higher-dose alfacalcidol [greater than 60 ng/kg] or calcitriol [greater than 30 ng/kg] (HD), and lower-dose alfacalcidol [60 ng/kg or less] or calcitriol [30 ng/kg or less] (LD). RESULTS At week 64, the Radiographic Global Impression of Change (RGI-C) for rickets was higher (better) in children randomly assigned to burosumab vs conventional therapy for all prebaseline dose groups: HPi (+1.72 vs +0.67), LPi (+2.14 vs +1.08), HD (+1.90 vs +0.94), LD (+2.11 vs +1.06). At week 64, the RGI-C for rickets was also higher in children randomly assigned to burosumab (+2.06) vs conventional therapy for all on-study dose groups: HPi (+1.03), LPi (+1.05), HD (+1.45), LD (+0.72). Serum alkaline phosphatase (ALP) also decreased in the burosumab-treated patients more than in the conventional therapy group, regardless of on-study phosphate and active vitamin D doses. CONCLUSION Prior phosphate or active vitamin D doses did not influence treatment response after switching to burosumab among children with XLH and active radiographic rickets. Switching from conventional therapy to burosumab improved rickets and serum ALP more than continuing either higher or lower doses of phosphate or active vitamin D.
Collapse
Affiliation(s)
- Erik A Imel
- Departments of Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Francis H Glorieux
- Emeritus Director of Research, Shriners Hospitals for Children–Canada, Montreal, QC H4A 0A9, Canada
| | - Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children–St. Louis, St Louis, MO 63110, USA
| | - Anthony A Portale
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Craig F Munns
- The University of Queensland, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
| | - Ola Nilsson
- Division of Pediatric Endocrinology and Center for Molecular Medicine, Department of Women’s and Children’s Health, Karolinska Institutet and University Hospital, Stockholm 171 64, Sweden
- School of Medical Sciences and Department of Pediatrics, Örebro University and University Hospital, Örebro 701 85, Sweden
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Raja Padidela
- Paediatric Endocrinology, Royal Manchester Children’s Hospital and Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Noriyuki Namba
- Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization, Osaka 553-0003, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
| | - Hae Il Cheong
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, South Korea
| | - Pisit Pitukcheewanont
- Children's Hospital Los Angeles, Los Angeles, CA and Keck School of Medicine of USC, Los Angeles, CA 90027, USA
| | - Etienne Sochett
- Department of Endocrinology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz 4040, Austria
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Koji Muroya
- Kanagawa Children’s Medical Center, Yokohama 232-0066, Japan
| | | | - Gary S Gottesman
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children–St. Louis, St Louis, MO 63110, USA
- Washington University School of Medicine, St Louis, MO 63110, USA
| | - Andrew Biggin
- Children’s Hospital Westmead, Westmead 2145, Australia
| | - Farzana Perwad
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Angel Chen
- Ultragenyx Pharmaceutical Inc, Novato, CA 94949, USA
| | | | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada
| |
Collapse
|
46
|
Tokarzewicz A, Ołdak Ł, Młynarczyk G, Klekotka U, Gorodkiewicz E. A New Approach to the Quantification of Fibroblast Growth Factor 23-An Array Surface Plasmon Resonance Imaging Biosensor. Int J Mol Sci 2023; 24:15327. [PMID: 37895007 PMCID: PMC10607372 DOI: 10.3390/ijms242015327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
A new biosensor based on the "surface plasmon resonance imaging (SPRi)" detection technique for the quantification of "fibroblast growth factor 23 (FGF23)" has been developed. FGF23 is mainly produced in bone tissues as a phosphaturic hormone that forms a trimeric complex with "fibroblast growth factor receptor 1 (FGFR1)" and αKlotho upon secretion. FGF23 stimulates phosphate excretion and inhibits the formation of active vitamin D in the kidneys. FGF23 has been shown to play a role in bone carcinogenesis and metastasis. The newly developed method, based on the array SPRi biosensor, was validated-the precision, accuracy, and selectivity were acceptable, and yielded less than ±10% recovery. The rectilinear response of the biosensor ranges from 1 to 75 pg/mL. The limit of detection was 0.033 pg/mL, and the limit of quantification was 0.107 pg/mL. The biosensor was used to determine FGF23 concentrations in the blood plasma of healthy subjects and patients with "clear cell" renal cell carcinoma (ccRCC). The obtained results were compared with those measured through an "enzyme-linked immunosorbent assay (ELISA)". The determined Pearson correlation coefficients were 0.994 and 0.989, demonstrating that the newly developed biosensor can be used as a competitive method for the ELISA.
Collapse
Affiliation(s)
- Anna Tokarzewicz
- Department of Medical Biochemistry, Medical University of Bialystok, A. Mickiewicza 2C St., 15-089 Bialystok, Poland
| | - Łukasz Ołdak
- Bioanalysis Laboratory, Faculty of Chemistry, University of Bialystok, Ciolkowskiego 1K St., 15-245 Bialystok, Poland; (Ł.O.); (E.G.)
| | - Grzegorz Młynarczyk
- Department of Urology, Medical University of Bialystok, M. Sklodowskiej-Curie 24A St., 15-276 Bialystok, Poland;
| | - Urszula Klekotka
- Department of Physical Chemistry, Faculty of Chemistry, University of Bialystok, Ciolkowskiego 1K St., 15-245 Bialystok, Poland;
| | - Ewa Gorodkiewicz
- Bioanalysis Laboratory, Faculty of Chemistry, University of Bialystok, Ciolkowskiego 1K St., 15-245 Bialystok, Poland; (Ł.O.); (E.G.)
| |
Collapse
|
47
|
Poorhemati H, Ghaly M, Sadvakassova G, Komarova SV. FGF23 level in poultry chicken, a systematic review and meta-analysis. Front Physiol 2023; 14:1279204. [PMID: 37908340 PMCID: PMC10614003 DOI: 10.3389/fphys.2023.1279204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction: In vertebrates fibroblast growth factor 23 (FGF23) is a phosphate regulating hormone closely linked to calcium regulation by vitamin D and parathyroid hormone (PTH). Although phosphorus, calcium and vitamin D are important for poultry well-being, relatively little is known about their levels of FGF23. Our objective was to quantitatively estimate the blood FGF23 level in birds, and to examine its relationship to diet and blood levels of other components of phosphate and calcium homeostasis. Methods: A systematic search of Agricola, Embase and Medline identified 86 studies focused on FGF23 in birds, from which 12 manuscripts reporting data for 60 independent groups of chickens were included in the analysis. Results: FGF23 levels were 256 pg/ml (Confidence interval (CI): 215, 297) in broilers (39 datasets containing 435 birds), and 256 pg/ml (CI: 178, 339) in egg-laying hens (21 datasets containing 208 birds). FGF23 levels did not correlate with dietary phosphorus, calcium or vitamin D, or with plasma calcium or PTH. FGF23 levels demonstrated a trend to positively correlate with plasma phosphate and a strongly and positive correlation with plasma vitamin D. Discussion: This study provides normative estimates of FGF23 levels in poultry birds and new insights into the regulation of calcium and phosphate homeostasis.
Collapse
Affiliation(s)
- Hossein Poorhemati
- Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
- Shriners Hospitals for Children–Canada, Montreal, QC, Canada
| | - Melody Ghaly
- Shriners Hospitals for Children–Canada, Montreal, QC, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Gulzhakhan Sadvakassova
- Shriners Hospitals for Children–Canada, Montreal, QC, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Svetlana V. Komarova
- Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
- Shriners Hospitals for Children–Canada, Montreal, QC, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| |
Collapse
|
48
|
Horinouchi Y, Shiota S, Kaimori R, Yoshimura K, Utsunomiya-Nishimizu R, Yamamoto K, Miyazaki E. A Case of Tumor-Induced Osteomalacia Detected by Venous Sampling. Int Med Case Rep J 2023; 16:659-665. [PMID: 37840970 PMCID: PMC10576504 DOI: 10.2147/imcrj.s425599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Tumor-induced osteomalacia (TIO) can cause osteomalacia due to excessive production of fibroblast growth factor 23 (FGF23) by the tumor. Since TIO is a very rare disease, it is often misdiagnosed as intervertebral disc herniation, spondyloarthritis, or osteoporosis. We report a 65-year-old man who developed generalized arthralgia and difficulty walking two years ago and was diagnosed with multiple fractures throughout his body. He was initially diagnosed with osteoporosis and was treated with calcitriol. However, he was referred to our hospital since his symptoms did not improve. We diagnosed tumor-induced osteomalacia based on low serum phosphorus, high bone-type alkaline phosphatase, high FGF23 levels, and the presence of two tumors. The responsible tumor was identified using FGF23 levels in venous sampling. As the location of the tumor made surgical resection difficult, we selected treatment with burosumab, a human monoclonal antibody against FGF23, leading to improvement in the hypophosphatemia and pain, such that he was able to walk with a cane. In cases of osteoporosis with hypophosphatemia, general physicians should keep TIO in mind, and attempt to identify the responsible tumor lesion.
Collapse
Affiliation(s)
- Yasuo Horinouchi
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Seiji Shiota
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryo Kaimori
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Katsuhiko Yoshimura
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Rie Utsunomiya-Nishimizu
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Kyoko Yamamoto
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Eishi Miyazaki
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| |
Collapse
|
49
|
Jia Z, Liu Q, Xie Y, Wei J, Sun X, Meng F, Zhao B, Yu Z, Zhao L, Xing Z. Klotho/ FGF23 Axis Regulates Cardiomyocyte Apoptosis and Cytokine Release through ERK/MAPK Pathway. Cardiovasc Toxicol 2023; 23:317-328. [PMID: 37704925 DOI: 10.1007/s12012-023-09805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
Coronary artery disease (CAD) as a major cardiovascular disease is the leading global cause of mortality, Klotho/FGF23 axis involved in development of cardiovascular disease, while the function and underlying mechanism of Klotho/FGF23 axis in CAD is unclear. Blood samples from 67 CAD patients with coronary artery bypass graft (CABG) surgery were collected, and the level of Klotho and FGF23 of those patients was measured by using an ELISA kit. Cardiomyocyte was isolated from 0 to 3 days Sprague Dawley (SD) rats. Expression of Klotho, FGF23 and the cardiomyocyte marker α-sarcomeric actin (α-SA), myosin heavy chain (MHC) and cardiac troponin I (cTnI) was assessed by immunofluorescence staining. Expression of Klotho and FGF23 mRNA was detected by qRT-PCR. Apoptosis and cell cycle were measured by flow cytometry. Cell viability was detected by using CCK-8. The protein expression of ERK/MAPK pathway related protein and cytokines production was measured by western blotting. The levels of Klotho in CAD patients increased after CABG surgery, while FGF23 decreased. Isolated cardiomyocyte morphology and structure were completed, and with stabilized beating within culture for 15 days, besides, α-SA, MHC, and cTnI proved positive. After transfected Lenti-Klotho and Lenti-FGF23 into isolated cardiomyocyte, fluorescence staining showed that the transfection was successful, and qRT-PCR results showed that the expression levels of Klotho and FGF23 mRNA significant increased compared with NEG (empty vector) group. Immunofluorescence staining results showed that compared with NEG group, there was a higher Klotho positive rate and lower FGF23 positive rate in Klotho overexpression (Klotho) group, while, there was a higher FGF23 positive rate and lower Klotho positive rate in FGF23 overexpression (FGF23) group. In addition, the expression of p-ERK1/2 and p-P38 increased in Klotho group but decreased in FGF23 group. Furthermore, overexpression of Klotho inhibited cardiomyocyte apoptosis, increased S phase fraction, promoted proliferation and elevated expression of transforming growth factor β1 (TGF-β1), nuclear factor-kappa B (NF-κB), angiotensin-II (AT-II), and activator protein-1 (AP-1), overexpression of FGF23 showed the opposite effect, however, ERK agonist (TPA) and inhibitor (U0126) reversed the effect caused by overexpression of Klotho and FGF23 separately. Klotho/FGF23 axis play a critical role in CAD progression through regulating ERK/MAPK pathway in Cardiomyocyte.
Collapse
Affiliation(s)
- Zheng Jia
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Qian Liu
- Department of Geriatric Cardiovascular, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Ying Xie
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Jie Wei
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Xiaolin Sun
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Fandi Meng
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Bin Zhao
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Zhenkun Yu
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China
| | - Li Zhao
- Department of Cardiovascular Ultrasound, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China.
| | - Zhengjiang Xing
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, NO. 245 Renmin East Road, Panlong District, Kunming, 650051, Yunnan, China.
| |
Collapse
|
50
|
Egli-Spichtig D, Hamid AK, Arroyo EMP, Ketteler M, Wiecek A, Rosenkranz AR, Pasch A, Lorenz H, Hellmann B, Karus M, Ammer R, Rubio-Aliaga I, Wagner CA. Intact FGF23 predicts serum phosphate improvement after combined nicotinamide and phosphate binder treatment in hemodialysis patients. Clin Kidney J 2023; 16:1622-1633. [PMID: 37779856 PMCID: PMC10539220 DOI: 10.1093/ckj/sfad040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 10/03/2023] Open
Abstract
Background Hyperphosphatemia is associated with increased mortality and cardiovascular morbidity of end-stage kidney failure (ESKF) patients. Managing serum phosphate in ESKF patients is challenging and mostly based on limiting intestinal phosphate absorption with low phosphate diets and phosphate binders (PB). In a multi-centric, double-blinded, placebo-controlled study cohort of maintenance hemodialysis patients with hyperphosphatemia, we demonstrated the efficacy of nicotinamide modified release (NAMR) formulation treatment in addition to standard PB therapy in decreasing serum phosphate. Here we aimed to assess the relationship between phosphate, FGF23, inflammation and iron metabolism in this cohort. Methods We measured the plasma concentrations of intact fibroblast growth factor 23 (iFGF23) and selected proinflammatory cytokines at baseline and Week 12 after initiating treatment. Results We observed a strong correlation between iFGF23 and cFGF23 (C-terminal fragment plus iFGF23). We identified iFGF23 as a better predictor of changes in serum phosphate induced by NAMR and PB treatment compared with cFGF23. Recursive partitioning revealed at baseline and Week 12, that iFGF23 and cFGF23 together with T50 propensity were the most important predictors of serum phosphate, whereas intact parathyroid hormone (iPTH) played a minor role in this model. Furthermore, we found serum phosphate and iPTH as the best predictors of iFGF23 and cFGF23. Sex, age, body mass index, and markers of inflammation and iron metabolism had only a minor impact in predicting FGF23. Conclusion Lowering serum phosphate in ESKF patients may depend highly on iFGF23 which is correlated to cFGF23 levels. Serum phosphate was the most important predictor of plasma FGF23 in this ESKF cohort.
Collapse
Affiliation(s)
- Daniela Egli-Spichtig
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH
| | - Ahmad Kamal Hamid
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH
| | - Eva Maria Pastor Arroyo
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH
| | - Markus Ketteler
- Robert Bosch Hospital, Department of General Internal Medicine and Nephrology, Stuttgart, Germany
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Pasch
- Calciscon AG, 2503 Biel, Switzerland
- Department of Nephrology, Lindenhofspital, 3012 Bern, Switzerland
- Department of Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria
| | - Horst Lorenz
- Buero fuer Biometrie und Statistik, Neuberg, Germany
| | | | - Michael Karus
- MEDICE Arzneimittel Pütter GmbH & Co KG, Iserlohn, Germany
| | - Richard Ammer
- MEDICE Arzneimittel Pütter GmbH & Co KG, Iserlohn, Germany
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Isabel Rubio-Aliaga
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH
| |
Collapse
|