{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:51:21Z","timestamp":1792788681955,"version":"4.5.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","funder":[{"name":"National Institute of Diabetes and Digestive and Kidney Diseases","award":["F31DK131914"],"award-info":[{"award-number":["F31DK131914"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of Diabetes and Digestive and Kidney Diseases","award":["K23DK100533"],"award-info":[{"award-number":["K23DK100533"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of Diabetes and Digestive and Kidney Diseases","award":["R01DK125794"],"award-info":[{"award-number":["R01DK125794"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of Diabetes and Digestive and Kidney Diseases","award":["R01DK125459"],"award-info":[{"award-number":["R01DK125459"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NHLBI","award":["R01HL145528"],"award-info":[{"award-number":["R01HL145528"]}],"id":[{"id":"https:\/\/ror.org\/012pb6c26","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIH","award":["U54OD030167"],"award-info":[{"award-number":["U54OD030167"]}]},{"name":"American Heart Association","award":["24PRE1242192"],"award-info":[{"award-number":["24PRE1242192"]}],"id":[{"id":"https:\/\/ror.org\/013kjyp64","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Our study identified skeletal muscle as a novel source of fibroblast growth factor 23 (FGF23) in scenarios of hyperphosphatemia, including high dietary phosphate intake and CKD.<\/jats:p>\n <\/jats:list-item>\n \n Skeletal muscle\u2013derived FGF23 had endocrine actions lowering serum phosphate levels, which may protect from hyperphosphatemia-induced tissue damages.<\/jats:p>\n <\/jats:list-item>\n \n Skeletal muscle\u2013derived FGF23 might also have paracrine effects counteracting atrophy.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Fibroblast growth factor 23 (FGF23) is a hormone that reduces the renal reabsorption of phosphate in response to systemic phosphate elevations. In CKD, serum levels of phosphate and FGF23 reach levels that can harm various tissues. While the bone acts as the main production site for FGF23, bone-specific gene deletion studies in mice suggest the existence of other FGF23 sources. Here, we determine if skeletal muscle produces FGF23 in response to phosphate elevations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We studied four mouse models with phosphate elevations, two with CKD (global\n Col4a3<\/jats:italic>\n deletion and adenine-rich diet) and two without CKD (genetic\n klotho<\/jats:italic>\n deficiency and high-phosphate diet). Furthermore, we generated a new mouse line with skeletal muscle\u2013specific\n Fgf23<\/jats:italic>\n deletion (KO), which received an adenine-rich or a high-phosphate diet. We measured skeletal muscle FGF23 by quantitative real-time PCR, ELISA, and immunohistochemistry, as well as serum levels of phosphate, FGF23, and parathyroid hormone (PTH). We determined FGF23 mRNA levels in muscle biopsies from patients with CKD, and we studied the effects of phosphate and PTH elevations on FGF23 expression in cultured myotubes isolated from mice and patients with CKD. Finally, we studied the effects of acute phosphate loading on urine phosphate levels in\n Fgf23<\/jats:italic>\n KO mice.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n All four mouse models with phosphate and PTH elevations showed FGF23 expression in skeletal muscle tissue on mRNA and protein level. Phosphate, but not PTH, induced FGF23 expression in cultured myotubes. Furthermore, patients with CKD with higher serum phosphate levels expressed more FGF23 in skeletal muscle.\n Fgf23<\/jats:italic>\n KO mice had elevated serum phosphate levels when administered a high-phosphate diet and decreased urine phosphate levels after acute phosphate loading.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Phosphate elevations induced FGF23 expression in skeletal muscle, independent of the absence or presence of CKD. Skeletal muscle\u2013derived FGF23 reduced renal phosphate reabsorption.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.0000000963","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T17:00:35Z","timestamp":1767114035000},"page":"1160-1173","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Systemic Phosphate Elevations Induce Fibroblast Growth Factor 23 Production in Skeletal Muscle to Reduce Renal Phosphate Reabsorption in Mice"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5345-2727","authenticated-orcid":false,"given":"Kylie","family":"Heitman","sequence":"first","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-7915","authenticated-orcid":false,"given":"Qing","family":"Li","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-5697","authenticated-orcid":false,"given":"Abul","family":"Fajol","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Denniff","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, United Kingdom"},{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom"},{"name":"Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7815-2755","authenticated-orcid":false,"given":"Dungeng","family":"Peng","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3327-0528","authenticated-orcid":false,"given":"S. Madison","family":"Thomas","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7888-2432","authenticated-orcid":false,"given":"Brian","family":"Czaya","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yanucil","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Wasiuddin","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8195-9605","authenticated-orcid":false,"given":"Glenn C.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Disease, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-847X","authenticated-orcid":false,"given":"Abolfazl","family":"Zarjou","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6593-3571","authenticated-orcid":false,"given":"Orlando M.","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4204-7670","authenticated-orcid":false,"given":"Jorge L.","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma L.","family":"Watson","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, United Kingdom"},{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-5171","authenticated-orcid":false,"given":"Matthew S.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Division of Neurology, Department of Pediatrics, The University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama"},{"name":"Department of Genetics, The University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Civitan International Research Center, The University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Neurodegeneration and Experimental Therapeutics, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-0977","authenticated-orcid":false,"given":"Christian","family":"Faul","sequence":"additional","affiliation":[{"name":"Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"issue":"8","key":"B1-20261014","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1038\/s41581-019-0159-y","article-title":"Mechanisms of phosphate transport","volume":"15","author":"Levi","year":"2019","journal-title":"Nat Rev Nephrol."},{"key":"B2-20261014","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/0030-4220(63)90081-1","article-title":"The homeostatic function of bone as a mineral 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