Fibroblast growth factor 23 (FGF- 23) is a member of the FGF family, within a subfamily that also includes FGF- 19 and FGF- 21. FGF proteins contain a 120 amino acid (aa) core FGF domain that exhibits a beta-trefoil structure. β-Klotho has been identified as
co-factor required for FGF-19, 21, 23 signaling. It can obviously increase ligand-receptor affinity. Klotho has a restricted distribution that limits FGF- 23 activity. FGF- 23 is produced by osteocytes and osteoblasts in response to high circulating phosphate levels, elevated parathyroid hormone, and circulatory volume loading. It functions as an endocrine phosphatonin by suppressing circulating phosphate levels. FGF- 23 interaction with renal proximal tubular epithelium decreases the renal resorption of phosphate by down-regulating phosphate transporters and by suppressing vitamin D production. It also decreases the intestinal absorption of phosphate.
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