Circulating αKlotho influences phosphate handling by controlling FGF23 production

J Clin Invest. 2012 Dec;122(12):4710-5. doi: 10.1172/JCI64986. Epub 2012 Nov 26.

Abstract

The FGF23 coreceptor αKlotho (αKL) is expressed as a membrane-bound protein (mKL) that forms heteromeric complexes with FGF receptors (FGFRs) to initiate intracellular signaling. It also circulates as an endoproteolytic cleavage product of mKL (cKL). Previously, a patient with increased plasma cKL as the result of a translocation [t(9;13)] in the αKLOTHO (KL) gene presented with rickets and a complex endocrine profile, including paradoxically elevated plasma FGF23, despite hypophosphatemia. The goal of this study was to test whether cKL regulates phosphate handling through control of FGF23 expression. To increase cKL levels, mice were treated with an adeno-associated virus producing cKL. The treated groups exhibited dose-dependent hypophosphatemia and hypocalcemia, with markedly elevated FGF23 (38 to 456 fold). The animals also manifested fractures, reduced bone mineral content, expanded growth plates, and severe osteomalacia, with highly increased bone Fgf23 mRNA (>150 fold). cKL activity in vitro was specific for interactions with FGF23 and was FGFR dependent. These results demonstrate that cKL potently stimulates FGF23 production in vivo, which phenocopies the KL translocation patient and metabolic bone syndromes associated with elevated FGF23. These findings have important implications for the regulation of αKL and FGF23 in disorders of phosphate handling and biomineralization.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Bone Density
  • Bone and Bones / metabolism
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / genetics
  • Fibroblast Growth Factors / metabolism*
  • Gene Expression
  • Glucuronidase
  • Kidney / metabolism
  • Klotho Proteins
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / physiology
  • Mice
  • Mice, Inbred C57BL
  • NIH 3T3 Cells
  • Organ Specificity
  • Phenotype
  • Phosphates / blood*
  • Radiography
  • Receptors, Cell Surface / blood*
  • Receptors, Cell Surface / genetics

Substances

  • Fgf23 protein, mouse
  • Phosphates
  • Receptors, Cell Surface
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • Glucuronidase
  • Klotho Proteins