FGF23 effects within the vasculature: more insights into Atherosclerosis?

Abstract

FGF23 is a major phosphate regulatory hormone mostly knonw by its phosphaturic effects and its association with chronic kidney disease. More recently, FGF23 role in cardiovascular disease pathophysiology has received increasing attention. More specifically, several authors have provided epidemiologic data regarding the association between higher plasma levels of FGF23 and the risk of atherosclerotic disease. However, the mechanisms underlying this relationship remain unclear although some studies have shown evidence of FGF23 specific actions within the cardiovascular system. Though its hypertrophic myocardial actions have been well described, FGF23 effects within the vasculature appear much less clear. Considering how FGF23-Klotho axis might affect both structural (vascular calcification) and functional (endothelial dysfunction) components of the vascular wall, it appears that FGF23 has an anticalcific effect but, on the other hand, it was found to be associated with impaired vasoreactivity mostly by decreasing peripheral endothelium-dependent vasodilatation, indirectly pointing to endothelium injury. The objective of the present work is to review the main mechanisms underlying FGF23 effects within the vasculature both in physiologic and pathophysiologic conditions.