Activation of FGF-23 mediated vitamin D degradative pathways by cholecalciferol

Hala Alshayeb, Arif Showkat, Barry Wall, Geeta G. Gyamlani, Valentin David, Leigh Quarles

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Context: The optimal circulating concentration of 25(OH) vitamin D is controversial.

Objective: The aim was to investigate if FGF-23 and 24,25(OH)2D can guide cholecalciferol replacement.

Design: Oral cholecalciferol (10,000 IU weekly) administered to subjects with 25(OH)D levels < 20 ηg/mL and eGFR > 60 mL/min/1.73 m2 (n = 25), chronic kidney disease (CKD) (n = 27), or end stage renal disease (ESRD) (n = 14).

Setting: The study was conducted at the Veterans Affairs clinics.

Main Outcome Measure: Serum FGF-23, PTH, 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, calcium, and phosphorous concentrations, and urinary excretion of calcium and phosphorus at baseline and after 8 weeks of treatment.

Results: Cholecalciferol treatment increased concentrations of serum 25(OH)D by (19.3 ± 8 ηg/mL, P =.001; 12.2 ± 9 ηg/mL, P =.0001) and 24,25(OH)2D (1.14 ± 0.89 ηg/mL, P =.0024; 1.0 ± 0.72 ηg/mL P =.0002), and reduced serum PTH (-11 ±21 pg/mL, P =.0292; -42 ± 68 pg/mL, P =.0494) in normal and CKD subjects, respectively. Cholecalciferol increased serum FGF-23 levels only in normal subjects (44 ± 57 ηg/mL, P =.01). Increments in serum 25(OH)D positively correlated with serum FGF-23 and 24,25(OH)2D and negatively correlated with PTH. In ESRD, cholecalciferol administration increased 25(OH)D by (16.6 ± 6.6 ηg/mLP ≤.05) without changing 24,25(OH)2D, FGF-23 or PTH levels.

Conclusion: Modest elevations of serum 25(OH)D levels after cholecalciferol treatment are sufficient to induce compensatory degradative pathways in patients with sufficient renal reserves, suggesting that optimal circulating 25(OH)D levels are approximately 20 ηg/mL In addition, catabolism of 25(OH)D may also contribute to the low circulating vitamin D levels in CKD, since elevations of FGF-23 in CKD are associated with increased 24,25(OH)2D after cholecalciferol administration.

Original languageEnglish (US)
Pages (from-to)E1830-E1837
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number10
DOIs
StatePublished - Oct 1 2014

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Cholecalciferol
Vitamin D
Chemical activation
Chronic Renal Insufficiency
Serum
Chronic Kidney Failure
Calcium
Veterans
Phosphorus
Therapeutics
Outcome Assessment (Health Care)
Kidney

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Activation of FGF-23 mediated vitamin D degradative pathways by cholecalciferol. / Alshayeb, Hala; Showkat, Arif; Wall, Barry; Gyamlani, Geeta G.; David, Valentin; Quarles, Leigh.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 10, 01.10.2014, p. E1830-E1837.

Research output: Contribution to journalArticle

Alshayeb, Hala ; Showkat, Arif ; Wall, Barry ; Gyamlani, Geeta G. ; David, Valentin ; Quarles, Leigh. / Activation of FGF-23 mediated vitamin D degradative pathways by cholecalciferol. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 10. pp. E1830-E1837.
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abstract = "Context: The optimal circulating concentration of 25(OH) vitamin D is controversial.Objective: The aim was to investigate if FGF-23 and 24,25(OH)2D can guide cholecalciferol replacement.Design: Oral cholecalciferol (10,000 IU weekly) administered to subjects with 25(OH)D levels < 20 ηg/mL and eGFR > 60 mL/min/1.73 m2 (n = 25), chronic kidney disease (CKD) (n = 27), or end stage renal disease (ESRD) (n = 14).Setting: The study was conducted at the Veterans Affairs clinics.Main Outcome Measure: Serum FGF-23, PTH, 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, calcium, and phosphorous concentrations, and urinary excretion of calcium and phosphorus at baseline and after 8 weeks of treatment.Results: Cholecalciferol treatment increased concentrations of serum 25(OH)D by (19.3 ± 8 ηg/mL, P =.001; 12.2 ± 9 ηg/mL, P =.0001) and 24,25(OH)2D (1.14 ± 0.89 ηg/mL, P =.0024; 1.0 ± 0.72 ηg/mL P =.0002), and reduced serum PTH (-11 ±21 pg/mL, P =.0292; -42 ± 68 pg/mL, P =.0494) in normal and CKD subjects, respectively. Cholecalciferol increased serum FGF-23 levels only in normal subjects (44 ± 57 ηg/mL, P =.01). Increments in serum 25(OH)D positively correlated with serum FGF-23 and 24,25(OH)2D and negatively correlated with PTH. In ESRD, cholecalciferol administration increased 25(OH)D by (16.6 ± 6.6 ηg/mLP ≤.05) without changing 24,25(OH)2D, FGF-23 or PTH levels.Conclusion: Modest elevations of serum 25(OH)D levels after cholecalciferol treatment are sufficient to induce compensatory degradative pathways in patients with sufficient renal reserves, suggesting that optimal circulating 25(OH)D levels are approximately 20 ηg/mL In addition, catabolism of 25(OH)D may also contribute to the low circulating vitamin D levels in CKD, since elevations of FGF-23 in CKD are associated with increased 24,25(OH)2D after cholecalciferol administration.",
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AU - Alshayeb, Hala

AU - Showkat, Arif

AU - Wall, Barry

AU - Gyamlani, Geeta G.

AU - David, Valentin

AU - Quarles, Leigh

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N2 - Context: The optimal circulating concentration of 25(OH) vitamin D is controversial.Objective: The aim was to investigate if FGF-23 and 24,25(OH)2D can guide cholecalciferol replacement.Design: Oral cholecalciferol (10,000 IU weekly) administered to subjects with 25(OH)D levels < 20 ηg/mL and eGFR > 60 mL/min/1.73 m2 (n = 25), chronic kidney disease (CKD) (n = 27), or end stage renal disease (ESRD) (n = 14).Setting: The study was conducted at the Veterans Affairs clinics.Main Outcome Measure: Serum FGF-23, PTH, 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, calcium, and phosphorous concentrations, and urinary excretion of calcium and phosphorus at baseline and after 8 weeks of treatment.Results: Cholecalciferol treatment increased concentrations of serum 25(OH)D by (19.3 ± 8 ηg/mL, P =.001; 12.2 ± 9 ηg/mL, P =.0001) and 24,25(OH)2D (1.14 ± 0.89 ηg/mL, P =.0024; 1.0 ± 0.72 ηg/mL P =.0002), and reduced serum PTH (-11 ±21 pg/mL, P =.0292; -42 ± 68 pg/mL, P =.0494) in normal and CKD subjects, respectively. Cholecalciferol increased serum FGF-23 levels only in normal subjects (44 ± 57 ηg/mL, P =.01). Increments in serum 25(OH)D positively correlated with serum FGF-23 and 24,25(OH)2D and negatively correlated with PTH. In ESRD, cholecalciferol administration increased 25(OH)D by (16.6 ± 6.6 ηg/mLP ≤.05) without changing 24,25(OH)2D, FGF-23 or PTH levels.Conclusion: Modest elevations of serum 25(OH)D levels after cholecalciferol treatment are sufficient to induce compensatory degradative pathways in patients with sufficient renal reserves, suggesting that optimal circulating 25(OH)D levels are approximately 20 ηg/mL In addition, catabolism of 25(OH)D may also contribute to the low circulating vitamin D levels in CKD, since elevations of FGF-23 in CKD are associated with increased 24,25(OH)2D after cholecalciferol administration.

AB - Context: The optimal circulating concentration of 25(OH) vitamin D is controversial.Objective: The aim was to investigate if FGF-23 and 24,25(OH)2D can guide cholecalciferol replacement.Design: Oral cholecalciferol (10,000 IU weekly) administered to subjects with 25(OH)D levels < 20 ηg/mL and eGFR > 60 mL/min/1.73 m2 (n = 25), chronic kidney disease (CKD) (n = 27), or end stage renal disease (ESRD) (n = 14).Setting: The study was conducted at the Veterans Affairs clinics.Main Outcome Measure: Serum FGF-23, PTH, 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, calcium, and phosphorous concentrations, and urinary excretion of calcium and phosphorus at baseline and after 8 weeks of treatment.Results: Cholecalciferol treatment increased concentrations of serum 25(OH)D by (19.3 ± 8 ηg/mL, P =.001; 12.2 ± 9 ηg/mL, P =.0001) and 24,25(OH)2D (1.14 ± 0.89 ηg/mL, P =.0024; 1.0 ± 0.72 ηg/mL P =.0002), and reduced serum PTH (-11 ±21 pg/mL, P =.0292; -42 ± 68 pg/mL, P =.0494) in normal and CKD subjects, respectively. Cholecalciferol increased serum FGF-23 levels only in normal subjects (44 ± 57 ηg/mL, P =.01). Increments in serum 25(OH)D positively correlated with serum FGF-23 and 24,25(OH)2D and negatively correlated with PTH. In ESRD, cholecalciferol administration increased 25(OH)D by (16.6 ± 6.6 ηg/mLP ≤.05) without changing 24,25(OH)2D, FGF-23 or PTH levels.Conclusion: Modest elevations of serum 25(OH)D levels after cholecalciferol treatment are sufficient to induce compensatory degradative pathways in patients with sufficient renal reserves, suggesting that optimal circulating 25(OH)D levels are approximately 20 ηg/mL In addition, catabolism of 25(OH)D may also contribute to the low circulating vitamin D levels in CKD, since elevations of FGF-23 in CKD are associated with increased 24,25(OH)2D after cholecalciferol administration.

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