FGF23 and its role in X-linked hypophosphatemia-related morbidity

Orphanet Journal of Rare Diseases

Signe Sparre Beck-Nielsen¹  Outi Mäkitie²  Dieter Haffner³  Carmen de Lucas Collantes⁴  Gema Ariceta⁵  Ola Nilsson⁶  Elena Levtchenko⁷  Ravi Jandhyala⁸  Zulf Mughal⁹  Dirk Schnabel^1,10 

[1] Centre for Rare Diseases, Aarhus University Hospital;Children’s Hospital, University of Helsinki and Helsinki University Hospital;Hannover Medical School;Hospital Niño Jesús;Hospital Universitario Materno-Infantil Vall d’Hebron, Universitat Autonoma de Barcelona;Karolinska Institutet, Stockholm, Sweden and Örebro University;Katholieke Universiteit Leuven;Medialis Ltd;Royal Manchester Children’s Hospital;University Children’s Hospital of Berlin;

关键词: X-linked hypophosphatemia (XLH);    fibroblast growth factor 23 (FGF23);    phosphate regulating endopeptidase homolog, X-linked (PHEX);    hypophosphatemia;    vitamin D deficiency;    rickets;   

DOI  :  10.1186/s13023-019-1014-8

来源: DOAJ

【 摘 要 】

Abstract Background X-linked hypophosphatemia (XLH) is an inherited disease of phosphate metabolism in which inactivating mutations of the Phosphate Regulating Endopeptidase Homolog, X-Linked (PHEX) gene lead to local and systemic effects including impaired growth, rickets, osteomalacia, bone abnormalities, bone pain, spontaneous dental abscesses, hearing difficulties, enthesopathy, osteoarthritis, and muscular dysfunction. Patients with XLH present with elevated levels of fibroblast growth factor 23 (FGF23), which is thought to mediate many of the aforementioned manifestations of the disease. Elevated FGF23 has also been observed in many other diseases of hypophosphatemia, and a range of animal models have been developed to study these diseases, yet the role of FGF23 in the pathophysiology of XLH is incompletely understood. Methods The role of FGF23 in the pathophysiology of XLH is here reviewed by describing what is known about phenotypes associated with various PHEX mutations, animal models of XLH, and non-nutritional diseases of hypophosphatemia, and by presenting molecular pathways that have been proposed to contribute to manifestations of XLH. Results The pathophysiology of XLH is complex, involving a range of molecular pathways that variously contribute to different manifestations of the disease. Hypophosphatemia due to elevated FGF23 is the most obvious contributor, however localised fluctuations in tissue non-specific alkaline phosphatase (TNAP), pyrophosphate, calcitriol and direct effects of FGF23 have been observed to be associated with certain manifestations. Conclusions By describing what is known about these pathways, this review highlights key areas for future research that would contribute to the understanding and clinical treatment of non-nutritional diseases of hypophosphatemia, particularly XLH.

【 授权许可】

Unknown