Javier Donate-Correa1, Mercedes Muros de Fuentes2, Carmen Mora-Fernández1, Juan F Navarro-González3. 1. Research Unit, GEENDIAB and REDINREN (Sociedad Española de Nefrología e Instituto de Salud Carlos III, RD12/0021/0019), Madrid, Spain. 2. Clinical Analysis Service, and GEENDIAB and REDINREN (Sociedad Española de Nefrología e Instituto de Salud Carlos III, RD12/0021/0019), Madrid, Spain. 3. Research Unit, Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; GEENDIAB and REDINREN (Sociedad Española de Nefrología e Instituto de Salud Carlos III, RD12/0021/0019), Madrid, Spain. jnavgon@gobiernodecanarias.org.
Abstract
BACKGROUND: Fibroblast growth factor-23 (FGF-23) and Klotho constitute the main regulatory system of phosphorus homeostasis. Beyond this physiological role, there is growing evidence suggesting that this system has relevant pathophysiological implications in different clinical processes. CONTENT: In this review we discuss the pathophysiological implications of the FGF-23/Klotho system and the potential utility that measurements of its components may have as clinical biomarkers in different clinical settings, such as progression of chronic kidney disease, acute renal failure, and secondary hyperparathyroidism, as well as vascular dysfunction, atherosclerosis, and cardiovascular morbidity and mortality. We outline and discuss the current commercially available assays for determination of FGF-23 and Klotho and the assay limitations that must be overcome to translate these biomarkers into reliable indicators in clinical practice. SUMMARY: In addition to its physiological role, the FGF-23/Klotho system appears to provide important information regarding the pathophysiology of several clinical conditions. Although there has been increasing study of the components of this new biological system and their potential use as clinical biomarkers, the ultimate value of this system in clinical practice will not be known until remaining assay limitations can be overcome and adequately designed studies have been conducted to demonstrate its clinical utility.
BACKGROUND:Fibroblast growth factor-23 (FGF-23) and Klotho constitute the main regulatory system of phosphorus homeostasis. Beyond this physiological role, there is growing evidence suggesting that this system has relevant pathophysiological implications in different clinical processes. CONTENT: In this review we discuss the pathophysiological implications of the FGF-23/Klotho system and the potential utility that measurements of its components may have as clinical biomarkers in different clinical settings, such as progression of chronic kidney disease, acute renal failure, and secondary hyperparathyroidism, as well as vascular dysfunction, atherosclerosis, and cardiovascular morbidity and mortality. We outline and discuss the current commercially available assays for determination of FGF-23 and Klotho and the assay limitations that must be overcome to translate these biomarkers into reliable indicators in clinical practice. SUMMARY: In addition to its physiological role, the FGF-23/Klotho system appears to provide important information regarding the pathophysiology of several clinical conditions. Although there has been increasing study of the components of this new biological system and their potential use as clinical biomarkers, the ultimate value of this system in clinical practice will not be known until remaining assay limitations can be overcome and adequately designed studies have been conducted to demonstrate its clinical utility.
Authors: Andrea Trombetti; Nasser Al-Daghri; Maria Luisa Brandi; Jorge B Cannata-Andía; Etienne Cavalier; Manju Chandran; Catherine Chaussain; Lucia Cipullo; Cyrus Cooper; Dieter Haffner; Pol Harvengt; Nicholas C Harvey; Muhammad Kassim Javaid; Famida Jiwa; John A Kanis; Andrea Laslop; Michaël R Laurent; Agnès Linglart; Andréa Marques; Gabriel T Mindler; Salvatore Minisola; María Concepción Prieto Yerro; Mario Miguel Rosa; Lothar Seefried; Mila Vlaskovska; María Belén Zanchetta; René Rizzoli Journal: Nat Rev Endocrinol Date: 2022-04-28 Impact factor: 43.330