Recent studies suggest that vitamin D may play a role in intestinal Na(+)-dependent phosphate transport adaptation to variable levels of dietary P(i). Therefore, the goal of the current study was to assess Na(+)-dependent P(i) cotransport activity in transgenic mice to determine whether vitamin D is an essential mediator of this process. Intestinal brush-border membrane (BBM), Na(+)-dependent P(i) cotransport activity was significantly decreased in vitamin D receptor (VDR) null [VDR (-/-)] mice compared with wild-type (VDR+/+) mice. While intestinal Na-P(i) cotransporter (type IIb) mRNA levels were similar in VDR (-/-) and VDR (+/+) mice, type IIb Na-P(i) cotransporter protein expression was markedly suppressed in VDR (-/-) mice compared with VDR (+/+) mice. Furthermore, Na-P(i) cotransport activity in renal BBM was similar in VDR (-/-) and VDR (+/+) mice, but type IIa Na-P(i) cotransporter protein expression was decreased in VDR (-/-) mice. After administration of a low-P(i) diet, type IIb protein expression was significantly increased in VDR (+/+) and VDR (-/-) mice, and type IIb protein expression was present in the intestinal BBM of VDR (-/-) mice. These data demonstrate that intestinal Na-P(i) cotransport adaptation to a low-P(i) diet occurs independently of vitamin D.

Recent studies have demonstrated that klotho protein plays a role in calcium/phosphate homeostasis. The goal of the present study was to investigate the regulation of Na-P(i) cotransporters in klotho mutant (kl/kl) mice. The kl/kl mice displayed hyperphosphatemia, high plasma 1,25(OH)(2)D(3) levels, increased activity of the renal and intestinal sodium-dependent P(i) cotransporters, and increased levels of the type IIa, type IIb, and type IIc transporter proteins compared with wild-type mice. Interestingly, transcript levels of the type IIa/type IIc transporter mRNA abundance, but not transcripts levels of type IIb transporter mRNA, were markedly decreased in kl/kl mice compared with wild-type mice. Furthermore, plasma fibroblast growth factor 23 (FGF23) levels were 150-fold higher in kl/kl mice than in wild-type mice. Feeding of a low-P(i) diet induced the expression of klotho protein and decreased plasma FGF23 levels in kl/kl mice, whereas colchicine treatment experiments revealed evidence of abnormal membrane trafficking of the type IIa transporter in kl/kl mice. Finally, feeding of a low-P(i) diet resulted in increased type IIa Na-P(i) cotransporter protein in the apical membrane in the wild-type mice, but not in kl/kl mice. These results indicate that hyperphosphatemia in klotho mice is due to dysregulation of expression and trafficking of the renal type IIa/IIc transporters rather than to intestinal P(i) uptake.

FGF23 (fibroblast growth factor 23) is a novel phosphaturic factor that influences vitamin D metabolism and renal re-absorption of Pi. The goal of the present study was to characterize the role of the VDR (vitamin D receptor) in FGF23 action using VDR(-/-) (VDR null) mice. Injection of FGF23M (naked DNA encoding the R179Q mutant of human FGF23) into VDR(-/-) and wildtype VDR(+/+) mice resulted in an elevation in serum FGF23 levels, but had no effect on serum calcium or parathyroid hormone levels. In contrast, injection of FGF23M resulted in significant decreases in serum Pi levels, renal Na/Pi co-transport activity and type II transporter protein levels in both groups when compared with controls injected with mock vector or with FGFWT (naked DNA encoding wild-type human FGF23). Injection of FGF23M resulted in a decrease in 25-hydroxyvitamin D 1a-hydroxylase mRNA levels in VDR(-/-) and VDR(+/+) mice, while 25-hydroxyvitamin D 24-hydroxylase mRNA levels were significantly increased in FGF23M-treated animals compared with mock vector control- or FGF23WT-treated animals. The degree of 24-hydroxylase induction by FGF23M was dependent on the VDR, since FGF23M significantly reduced the levels of serum 1,25(OH)2D3 [1,25-hydroxyvitamin D3] in VDR(+/+) mice, but not in VDR(-/-) mice. We conclude that FGF23 reduces renal Pi transport and 25-hydroxyvitamin D 1a-hydroxylase levels by a mechanism that is independent of the VDR. In contrast, the induction of 25-hydroxyvitamin D 24-hydroxylase and the reduction of serum 1,25(OH)2D3 levels induced by FGF23 are dependent on the VDR.

To elucidate the precise physiological regulation of FGF-23, we characterized the mouse FGF-23 5Ј-flanking region and analyzed its promoter activity. The 5Ј-flanking region of the mouse FGF-23 gene contained a TFIID site (TATA box) and several putative transcription factor binding sites, including MZF1, GATA-1 and c-Ets-1 motifs, but it did not contain the typical sequences of the vitamin D response element. Plasmids encoding 554-bp (pGL/Ϫ0.6), 364-bp (pGL/Ϫ0.4) and 200-bp (pGL/Ϫ0.13) promoter regions containing the TFIID element and ϩ1-bp fragments drove the downstream expression of a luciferase reporter gene in transfection assays. We also found that FGF-23 mRNA was expressed in K-562 erythroleukemia cell lines but not in MC3T3-E1, Raji, or Hep G2 human carcinoma cells. Treatment with 1,25-dihydroxyvitamin D 3 in the presence of high phosphate markedly stimulated pGL/Ϫ0.6 activity, but calcium had no effect. In addition, the plasma FGF-23 levels were affected by the dietary and plasma inorganic phosphate concentrations. Finally, the levels of plasma FGF-23 in vitamin D receptor-null mice were significantly lower than in wild-type mice. The presents study demonstrated that vitamin D and the plasma phosphate level are important regulators of the transcription of the mouse FGF-23 gene. gene regulation; vitamin D receptor; phosphate homeostasis THE HOMEOSTASIS OF PLASMA PHOSPHATE is essential for many biological processes, including skeletal mineralization and energy metabolism. Recent investigations of diseases with abnormal phosphate homeostasis have revealed circulating phosphaturic hormones, collectively called phosphatonin (6, 23). Common clinical features, including hypophosphatemia resulting from renal phosphate wasting and impaired mineralization of bone are shared by X-linked hypophosphatemic rickets (XLH), tumor-induced osteomalacia (TIO), and autosomal-dominant hypophosphatemic rickets (ADHR; see Refs. 28,31,and 32), and the presence of a phosphatonin has been suspected in patients with these diseases because their plasma calcium and parathyroid hormone (PTH) levels are usually normal (8,9).Genetic studies of ADHR and TIO have identified fibroblast growth factor (FGF)-23 as a likely candidate for phosphatonin (28,31). In addition, continuous exposure to recombinant FGF-23 reproduces hypophosphatemic osteomalacia and the inappropriately low plasma levels of 1,25-dihydroxyvitamin D 3 [1,25(OH) 2 D 3 ; see Ref. 28]. Also, a mutant form of FGF-23 (FGF-23R179Q), which is derived from disease-causing missense mutations of ADHR, is resistant to proteolytic processing that normally converts the biologically functional full-length polypeptide into inactive fragments (3, 33). Furthermore, elevated circulatory levels of FGF-23 occur not only in patients with TIO but also in those with XLH (35). These findings indicate that excess FGF-23 activity causes the hypophosphatemia and impaired mineralization of bone that is associated with phosphatonin (6, 21).In a previous study, we demonstrated that the mutant FGF-23 su...

Hereditary hypophosphatemic rickets with hypercalciuria results from mutations of the renal type IIc Na-Pi cotransporter gene, suggesting that the type IIc transporter plays a prominent role in renal phosphate handling. The goal of the present study was to investigate the regulation of the type IIc Na-Pi cotransporter by parathyroid hormone (PTH). Type IIc Na-Pi cotransporter levels were markedly increased in thyroparathyroidectomized (TPTX) rats. Four hours after administration of PTH, type IIc transporter protein levels were markedly decreased in the apical membrane fraction but recovered to baseline levels at 24 h. Immunohistochemical analyses demonstrated the presence of the type IIc transporter in the apical membrane and subapical compartments in the proximal tubular cells in TPTX animals. After administration of PTH, the intensity of immunoreactive signals in apical and subapical type IIc transporter decreased in the renal proximal tubular cells in TPTX rats. Colchicine completely blocked the internalization of the type IIc transporter. In addition, leupeptin prevented the PTH-mediated degradation of the type IIa transporter in lysosomes but had no effect on PTH-mediated degradation of the lysosomal type IIc transporter. In PTH-treated TPTX rats, the internalization of the type IIc transporter occurred after administration of PTH(1-34) (PKA and PKC activator) or PTH(3-34) (PKC activator). Thus the present study demonstrated that PTH is a major hormonal regulator of the type IIc Na-Pi cotransporter in renal proximal tubules. phosphate transporter; proximal tubule; regulation INORGANIC PHOSPHATE (P i ) reabsorption in the renal proximal tubule is required for body P i homeostasis, and Na ϩ -dependent P i (Na-P i ) transporters in the brush-border membrane (BBM) of proximal tubular cells mediate the rate-limiting step in the overall P i -reabsorptive process (17, 19 -21). The type IIa and type IIc Na-P i cotransporters are expressed in the apical membrane of proximal tubular cells and mediate Na-P i cotransport, and the extent of P i reabsorption in the proximal tubules is determined largely by the abundance of the type IIa Na-P i cotransporter (17, 19 -21, 28). Indeed, Na-P i cotransporter type IIa-deficient mice (Npt2a Ϫ/Ϫ mice) exhibit increased urinary P i excretion, hypophosphatemia, and an appropriate adaptive increase in the circulating concentration of 1,25(OH) 2 D 3 (2, 28). Additional biochemical findings in Npt2aϪ/Ϫ mice include hypercalcemia, hypercalciuria, decreased serum parathyroid hormone (PTH) levels, and elevated serum alkaline phosphatase activity (2, 28). These biochemical features are typical of patients with hereditary hypophosphatemic rickets with hypercalciuria (HHRH), a Mendelian disorder of renal P i reabsorption (6, 30). However, in contrast to patients with HHRH, Npt2a Ϫ/Ϫ mice do not exhibit rickets and osteomalacia (2, 7, 28), and linkage analyses indicated that the Npt2a gene is not a candidate for HHRH patients (9, 33).More recently, two groups demonstrated that HHRH results f...