Circulating αKlotho influences phosphate handling by controlling FGF23 production

• Published in: The Journal of clinical investigation 2012-12, Vol.122 (12), p.4710
• Main Authors: Smith, Rosamund C, O'Bryan, Linda M, Farrow, Emily G, Summers, Lelia J, Clinkenbeard, Erica L, Roberts, Jessica L, Cass, Taryn A, Saha, Joy, Broderick, Carol, Ma, Y. Linda, Zeng, Qing Qiang, Kharitonenkov, Alexei, Wilson, Jonathan M, Guo, Qianxu, Sun, Haijun, Allen, Matthew R, Burr, David B, Breyer, Matthew D, White, Kenneth E
• Format: Article
• Language: English
• Subjects: Bone cells; Gene expression; Genetic aspects; Genetic regulation; Growth; Phosphates; Physiological aspects
• ISSN: 0021-9738; 1558-8238
• DOI: 10.1172/JCI64986.

The FGF23 coreceptor αKlotho (αKL) is expressed as a membrane-bound protein (mKL) that forms hetero-meric complexes with FGF receptors (FGFRs) to initiate intracellular signaling. It also circulates as an endo-proteolytic cleavage product of mKL (cKL). Previously, a patient with increased plasma cKL as the result of a translocation [t(9;13)] in the _KLOTHO (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.