Abstract
FGF23 is a hormone secreted mainly by osteocytes and osteoblasts in bone. Its pivotal role concerns the maintenance of mineral ion homeostasis. It has been confirmed that phosphate and vitamin D metabolisms are related to the effect of FGF23 and its excess or deficiency leads to various hereditary diseases. Multiple studies have shown that FGF23 level increases in the very early stages of chronic kidney disease (CKD), and its concentration may also be highly associated with cardiac complications. The present review is limited to some of the most important aspects of calcium and phosphate metabolism. It discusses the role of FGF23, which is considered an early and sensitive marker for CKD-related bone disease but also as a novel and potent cardiovascular risk factor. Furthermore, this review gives particular attention to the reliability of FGF23 measurement and various confounding factors that may impact on the clinical utility of FGF23. Finally, this review elaborates on the clinical usefulness of FGF23 and evaluates whether FGF23 may be considered a therapeutic target.
Highlights
Fibroblast growth factors (FGF) are polypeptide growth factors with diverse biological activities [1]
These results indicate that the second generation Immutopics assay is the most reliable and appropriate for Fibroblast growth factor 23 (FGF23) measurement
FGF23 plays a crucial role in calcium-phosphate metabolism regulation and interorgan signaling
Summary
Fibroblast growth factors (FGF) are polypeptide growth factors with diverse biological activities [1]. FGF23 is a 32 kDa polypeptide with an N-terminal and a Cterminal region with 251 amino acids [1] It is a phosphaturic hormone secreted mainly by osteocytes and osteoblasts in bone and expressed by salivary glands, stomach, and, in much lower concentrations, by other tissues, including skeletal muscles, brain, mammary gland, liver, and heart [3, 4]. A newly discovered FGF23 has become a part of the bone-kidney axis that influences vitamin D metabolism; it is considered a phosphate regulating hormone. This review will focus on the role of FGF23, which is considered an early marker of CKD and a potent CV risk factor. It will elaborate on the reliability of FGF23 measurement and the potential use of FGF23 as a target for therapy
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