FGF-23

FGF-23 is a bone-derived hormone that governs phosphate homeostasis. Secreted by osteocytes and osteoblasts, it binds FGFR1, FGFR3 and FGFR4 in complex with the co-receptor α-klotho in kidney, promoting phosphate excretion by downregulating sodium-phosphate cotransporters and suppressing 1,25-dihydroxyvitamin D synthesis. Excess FGF-23 causes tumor-induced osteomalacia and X-linked hypophosphatemia, while inactivating mutations lead to familial tumoral calcinosis; in chronic kidney disease, rising FGF-23 tracks with cardiovascular risk. Circulating FGF-23 levels are additionally raised in heart failure, where they serve as a prognostic biomarker. Burosumab, an anti-FGF-23 antibody, treats X-linked hypophosphatemia. Recombinant FGF-23 is used in klotho-dependent signaling assays, phosphate-metabolism research and antibody-based diagnostics.