Tumor necrosis factor stimulates fibroblast growth factor 23 levels in chronic kidney disease and non-renal inflammation

Daniela Egli-Spichtig, Pedro Henrique Imenez Silva, Bob Glaudemans, Nicole Gehring, Carla Bettoni, Martin Y H Zhang, Eva M Pastor-Arroyo, Désirée Schönenberger, Michal Rajski, David Hoogewijs, Felix Knauf, Benjamin Misselwitz, Isabelle Frey-Wagner, Gerhard Rogler, Daniel Ackermann, Belen Ponte, Menno Pruijm, Alexander Leichtle, Georg-Martin Fiedler, Murielle Bochud, Virginia Ballotta, Sandra Hofmann, Farzana Perwad, Michael Föller, Florian Lang, Roland H Wenger, Ian Frew, Carsten A Wagner

Published: October 2019

Fibroblast growth factor 23 (FGF23) regulates phosphate homeostasis, and its early rise in patients with chronic kidney disease is independently associated with all-cause mortality. Since inflammation is characteristic of chronic kidney disease and associates with increased plasma FGF23 we examined whether inflammation directly stimulates FGF23. In a population-based cohort, plasma tumor necrosis factor (TNF) was the only inflammatory cytokine that independently and positively correlated with plasma FGF23. Mouse models of chronic kidney disease showed signs of renal inflammation, renal FGF23 expression and elevated systemic FGF23 levels. Renal FGF23 expression coincided with expression of the orphan nuclear receptor Nurr1 regulating FGF23 in other organs. Antibody-mediated neutralization of TNF normalized plasma FGF23 and suppressed ectopic renal Fgf23 expression. Conversely, TNF administration to control mice increased plasma FGF23 without altering plasma phosphate. Moreover, in Il10-deficient mice with inflammatory bowel disease and normal kidney function, plasma FGF23 was elevated and normalized upon TNF neutralization. Thus, the inflammatory cytokine TNF contributes to elevated systemic FGF23 levels and also triggers ectopic renal Fgf23 expression in animal models of chronic kidney disease.

Full Access Link: Kidney International