Factors such as demographics, dietary intake, fasting status and time of day at sampling, cardiovascular risk factors and kidney function only account for approximately 12% of the variation in serum phosphate levels . Thus other selleck chemicals factors, such as genetic variability, are likely to influence phosphate homeostasis. Our hypothesis was that more subtle changes in FGF23
function could cause measureable alterations in phosphate metabolism and bone health. Upon sequencing of the FGF23 gene we discovered nine single nucleotide changes: seven SNPs, one deletion and one insertion. Three of these were common: rs3832879, rs7955866 and rs11063112. In two of the SNPs, rs3832879 and rs7955866, the variation was ALK tumor dichotomous; only AA homozygotes and Aa heterozygotes were present. Instrument analysis did not show a link between FGF23 genetic variation and S-FGF23 concentration. One reason could be the lack of aa homozygotes in our data and another reason might be that in this study we measured only total intact S-FGF23, not c-terminal FGF23. Rendina et al.  have shown association between rs7955866 (FGF23716T) and calcium nephrolithiasis with renal
phosphate leak and lower P-Pi concentrations. In our data, the 716CT genotype associated with lower P-Pi and higher U-Pi/U-Crea levels, which is in line with earlier results . We show for the first time an association between genetic variation in FGF23 (716CT genotypes or FGF23 diplotypes) and P-PTH concentrations in
the general population. Genetic variation in terms of diplotypes reinforced variation in PTH (a secondary outcome) and covered some of the variation in P-Pi, but not in S-FGF23. This implies that the genetic variation in FGF23 is not functional or that other compensating mechanisms exist. The only genome-wide association study focusing on genetic variants influencing serum phosphate concentrations, established statistically significant associations for five different genomic regions. The implicated regions contained genes encoding tissue-nonspecific alkaline phosphatase (ALPL), the calcium-sensing receptor (CASR), a regulator of G-protein signaling (RGS14), a kidney-specific sodium-phosphate transporter (SLC34A1), phosphodiesterase 7B (PDE7B), ectonucleotide pyrophosphatase/phosphodiesterase cAMP inhibitor 3 (ENPP3) and FGF6. Noticeably, the gene encoding the only FGF known to affect phosphate homeostasis, FGF23, is located only 133 kb upstream from the associating SNP in FGF6  and . This study implicated many different genes known to affect calcium and phosphate uptake, metabolism and secretion, but did not look into clinical phenotypes linked to the genetic changes. Hitherto only significant clinical phenotypes, such as hypophosphatemic rickets, fibrous dysplasia in McCune Albright-syndrome and Jansen metaphyseal condrodysplasia, have been coupled to mutations in genes affecting the transcription, function and metabolism of FGF23 and associated pathways.