Human physiology is dependent on an accurate phosphate (Pi) homeostasis. Defective Pi regulation causes hyper- or hypophosphatemia, which are associated with ectopic calcification or impaired bone mineralization, and a shortened life span. Current endocrine models of Pi homeostasis are incomplete. However, studies of acquired and hereditary disorders of Pi homeostasis have revealed new potential Pi regulating hormones, Phosphatonin(s). One of these is fibroblast growth factor-23 (FGF23). FGF23 is produced in bone and is secreted into the circulation. Mutations in FGF23 causes disturbed Pi regulation, without the appropriate counter-regulatory actions of parathyroid hormone or vitamin D. By the generation of FGF23 transgenic mice, which display phenotypic similarities to patients with hypophosphatemic disorders, we show that FGF23 exerts endocrine actions in the kidney and causes osteomalacia. Renal FGF23 actions severely decrease Pi reabsorption and expression of Klotho, a suggested age suppressor gene, known to be crucial in FGF23 receptor binding and activation. In bone, our transgenic model displays impaired osteoclast polarization, which should be detrimental to osteoclastic bone resorption in osteomalacia. However, in our model osteoclasts efficiently participate in bone matrix degradation. Furthermore, we investigated a large population-based cohort in order to elucidate the role of FGF23 in normal physiology. Importantly, we were able to demonstrate an association of FGF23 to parathyroid hormone, renal function and bone mineral density and we found a correlation of FGF23 to weight and body fat mass. The studies on which this thesis is based, demonstrate that FGF23 has phosphatonin-like properties and that the skeleton functions as an endocrine organ. In addition, the results indicate that FGF23 has a role in bone mineral and lipid metabolism, and that FGF23 is a possible diagnostic marker and therapeutic target for the future.

L'insuffisance rénale chronique (IRC) demeure un problème de santé publique du fait de l'augmentation de sa prévalence. Malgré l'amélioration de la prise en charge, le taux de mortalité reste plus élevé comparé à la population générale. Parmi les causes de décès, les maladies cardiovasculaires, d'origine multifactorielle (élargissement et hypertrophie des artères, athérosclérose, calcifications vasculaires et valvulaires) sont au premier plan. A côté des facteurs de risque classiques, des facteurs non traditionnels, liés aux perturbations métaboliques de l'IRC, ont été mis en évidence, comme l'inflammation, la malnutrition, le stress oxydant, les anomalies du métabolisme minéralo-osseux. La meilleure connaissance de la physiopathologie de la vasculopathie de l'IRC permet d'émerger de nouveaux biomarqueurs pour stratifier le risque cardiovasculaire chez l'IRC.OBJECTIFS-METHODOLOGIE GENERALE : Nous avons réalisé une approche biochimique pour explorer trois composantes du risque cardiovasculaire chez l'IRC : stress oxydant, perturbations qualitatives des HDL (high-density lipoprotein) et métabolisme minéralo-osseux.RESULTATS : Dans une première publication la production d'anion superoxyde a été évaluée, via une méthode de chemoluminescence, en fonction du stade de l'IRC. Alors que la surproduction de formes réactives de l'oxygène est bien connue au stade 5d et peut être liée à la procédure dialytique, il existe peu de données aux stades précoces. Notre étude a porté sur 136 patients IRC non dialysés des stades 1à 5. Les résultats montrent que la production de FRO est assurée aux stades 4 et 5. Un bas débit de filtration glomérulaire (MDRD<30ml/min/1.73m2), l'inflammation (fibrinogène >3.7g/l) et des taux anormaux d' HDL (<1.42mM et >1.75mM) apparaissent comme les principaux déterminants du stress oxydant chez l'IRC non dialysé.Alors que dans la population générale, un taux bas de HDL est reconnu comme un facteur de risque important, nous avons montré (publication 1) que des taux anormaux de HDL, bas comme hauts, étaient indépendamment associés au stress oxydant chez les sujets IRC. Dans une deuxième publication, nous avons précisé la composition des HDL en se basant sur d'éventuelles modifications qualitatives des protéines associées à la structure des lipoprotéines. Une étude protéomique a été réalisée chez 7 patients hémodialysés versus 7 sujets sains. Nous avons retrouvé 40 protéines exprimées différemment sur les 122 identifiées, dont l'apoCII, l'apoCIII qui sont significativement augmentées et la transferrine abaissée. Ces protéines interviennent dans de nombreuses fonctions comme la réponse inflammatoire, l'activation du complément, la régulation de l'oxydation des lipoprotéines, l'homéostasie des cations.Dans une troisième publication, l'épuration du FGF23, phosphatonine impliquée dans les anomalies du métabolisme minéralo-osseux, été étudiée chez l'hémodialysé chronique en fonction de la techniques de dialyse (hémodialyse (HD) high flux versus hémodiafiltration on line (OL-HDF)). Notre étude a porté sur 53 patients dans le groupe HD et 32 patients dans le groupe OL-HDF. Dans les deux groupes le taux de FGF23 en post-dialyse est significativement plus bas qu'en pré-dialyse. Cependant, le taux de réduction, la clairance et le KT/V du FGF23 sont significativement plus bas dans le groupe OL-HDF.CONCLUSION-PERSPECTIVES : Chez l'IRC, avec l'appariation de facteurs de risque non traditionnels, de nouveaux biomarqueurs ont émergés dans la stratification du risque cardio-vasculaire. Ces biomarqueurs peuvent devenir des bioacteurs et représenter de nouvelles cibles d'action et de prévention de l'atteinte cardio-vasculaire chez l'IRC. La complexité des mécanismes physiopathologiques impliqués, nous incite à proposer des approches multimarqueurs. Actuellement des études biocliniques se poursuivent en mettant en place des cohortes régionales de patients aux stades 1 à 5 et de patients incidents en dialyse. / BACKGROUND: Chronic kidney disease (CKD) is a public health problem because of its increasing prevalence. Despite care improvements, the mortality rate remains higher compared to general population. Among causes of death, cardiovascular diseases with multifactorial origins (enlargement and hypertrophy of arteries, atherosclerosis, vascular and valvular calcifications) are in the foreground. Besides the traditional risk factors, non-traditional factors associated with metabolic disorders in CKD were bring out, such as inflammation, malnutrition, oxidative stress, mineral and bone disorder. A better knowledge of vasculopathy physiopathology in CKD allows the emergence of new biomarkers to stratify cardiovascular risk in CKD.AIMS-METHODOLOGY: We performed a biochemical approach to explore three components of cardiovascular risk in CKD: oxidative stress, qualitative alterations of HDL (high-density lipoprotein) and mineral and bone disorder.RESULTS: In a first publication, the superoxide anion production, according to the stage of CKD, was assessed using a chemiluminescence method. While the overproduction of reactive oxygen species is well known at the 5d stage of CKD and may be related to the dialysis procedure, there are few data in the early stages. Our study included 136 non-dialysis patients at stages 1 to 5 of CKD. Results showed an enhanced superoxide production at the pre-dialysis phase, stages 4 and 5 of CKD. Reduced glomerular filtration rate (MDRD <30 ml / min / 1.73m2), inflammation (fibrinogène≥3.7g / l) and abnormal levels of HDL (<1.42mM and ≥1.75mM) appears as main determinants of oxidative stress in non-dialysis CKD patients.While in general population, a low HDL rate is recognized as an important risk factor, we showed (publication 1) that abnormal levels of HDL, low as high, were independently associated with oxidative stress in CKD subjects. In a second publication, we have defined the HDL composition based on qualitative changes in the structure of proteins associated with lipoproteins. A proteomic study was performed in 7 patients on hemodialysis versus 7 healthy subjects. We found 40 proteins differently expressed on the 122 identified, including apoCII, apoCIII which are significantly increased and transferrin lowered. These proteins are involved in many functions such as inflammatory response, complement activation, regulation of lipoprotein oxidation and homeostasis cations. In a third publication, the removal of FGF23, phosphatonin involved in mineral and bone metabolism, was studied in chronic hemodialysis according to the dialysis techniques (high flux hemodialysis (HD) versus on line hemodiafiltration (OL- HDF)). Our study included 53 patients in the HD group and 32 patients in the OL-HDF group. In both groups the rate of FGF23 in post-dialysis was significantly lower than in pre-dialysis. However, rate of reduction, clearance and KT / V of FGF23 were significantly lower in the OL-HDF group.CONCLUSION-PROSPECTS: In the IRC, with the appearance of non traditional risk-factors, new biomarkers have emerged in the stratification of cardiovascular risk. These biomarkers can become bioactors and represent novel targets of action and prevention in the cardiovascular disease in CKD. The complexity of the involved physiopatholological mechanisms, leads us to propose multimarkers approaches. Currently bioclinical studies continue with the constitution of regional cohorts of patients at stages 1 to 5 of CKD and incident dialysis.

Les fonctions endocriniennes des os sont médiées par au moins deux hormones, l’ostéocalcine et le facteur de croissance fibroblastique 23 « Fibroblast growth factor 23 » (FGF23), ces derniers sont secrétés par les cellules osseuses, les ostéoblastes et les ostéocytes. L’ostéocalcine est produite par les ostéoblastes et régule le métabolisme du glucose et énergétique. Elle améliore ainsi la tolérance au glucose et la sensibilité à l’insuline. Également, elle favorise la sécrétion d’insuline et la prolifération des cellules β, elle augmente la dépense énergétique et réduit l’accumulation de graisse. L'ostéocalcine est gamma-carboxylée au niveau de trois résidus d'acide glutamique (Glu), un processus qui inhibe sa fonction endocrinienne chez la souris et l'humain. Le pH acide de la lacune de résorption décarboxyle l'ostéocalcine et libère sa forme non carboxylée (ucOCN), la forme active de cette hormone. Nos connaissances sur la régulation des fonctions endocriniennes d’ostéocalcine sont encore limitées à sa gamma-carboxylation. Puisque cette hormone est secrétée par les ostéoblastes et les ostéocytes, des cellules endocriniennes non classique, nous avons émis l’hypothèse que l'ostéocalcine pourrait être soumise à d'autres modifications post-traductionnelles (PTMs) au niveau de la voie de sécrétion contrôlant ses fonctions endocriniennes. Dans la première partie de cette thèse, nous avons montré que le propeptide de l'ostéocalcine pouvait être clivé dans son extrémité C-terminale au niveau du motif de base « RLRR » par la pro-protéine convertase furine, un processus qui se produit indépendamment de la gamma-carboxylation de l'ostéocalcine. L’inactivation du gène codant pour la furine, spécifiquement dans les ostéoblastes et les ostéocytes chez la souris, abolit totalement le clivage de la pro-ostéocalcine et altère son activation et sa libération lors de la résorption osseuse. Par conséquent, ces souris sont caractérisées par un niveau bas d'ucOCN dans le sérum, ce qui entraîne une altération de la tolérance au glucose, une diminution de la sécrétion d'insuline et de la dépense énergétique ainsi qu’une augmentation de l'accumulation de graisses. De plus, ces souris ont une perte d'appétit indépendamment de l'ostéocalcine. La restriction de la nourriture pour les souris contrôles ou « pair feeding » rend le phénotype des souris déficientes en furine plus apparent. Il apparait à un plus jeune âge avec une résistance à l'insuline. Dans la deuxième partie de cette thèse, nous avons découvert que l'ostéocalcine de souris est O-glycosylée au niveau de la sérine 8, un processus qui se produit indépendamment de sa gamma-carboxylation et de son clivage. Cette modification, qui n'est pas présente chez l'ostéocalcine humaine, augmente la demi-vie de l'ostéocalcine de souris dans le plasma ex vivo et in vivo. Il est intéressant de noter que la tyrosine 12 dans l'ostéocalcine humaine correspond à la sérine 8 dans la séquence de la souris, tandis que la mutation Tyr12Ser est suffisante pour générer une ostéocalcine humaine O-glycosylée et lui conférer une demi-vie plus longue dans le plasma de la souris comparativement à la forme native. FGF23 est une hormone secrétée par les ostéoblastes et les ostéocytes. Elle régule la réabsorption de phosphate et la production de vitamine D dans le tubule proximal du rein. Sa fonction endocrine est inhibée par un clivage endoprotéolytique qui libère ses fragments N- et C-terminaux. La mutation du motif « RHTR », un site de clivage consensus pour les proprotéines convertases PC(s), a été identifié chez les patients atteints du rachitisme hypophosphatémique génétiquement déterminés ou « Autosomal dominant hypophosphatemic rickets » (ADHR). Ces patients se caractérisent par une augmentation du taux de FGF23 intact, une hypophosphatémie et une ostéomalacie. Malgré l’importance de FGF23 dans plusieurs maladies, l’identité de l’enzyme responsable du clivage de FGF23 n’est pas encore connue, même si la furine et la proprotéine convertase subtilisine/kexine type 5 (PC5) peuvent cliver FGF23 in vitro. Dans la troisième partie de cette thèse, nous tentons de répondre à cette question en utilisant des souris déficientes en furine et/ou PC5 spécifiquement dans les ostéoblastes et les ostéocytes. Sous des conditions physiologiques, l’inactivation du gène de furine dans les ostéoblastes et les ostéocytes augmente le niveau du FGF23 intact par 25%. Malgré cette augmentation ces souris maintiennent une phosphatémie normale et elles ne montrent pas de signe d’ostéomalacie. On a aussi montré qu’une déficience en fer, une condition qui augmente la production de FGF23 au niveau de l’ARN messager et protéique, le FGF23 est totalement en forme intact dans les souris déficientes en furine, montrant que le clivage de FGF23 est totalement inhibé dans cette condition. En revanche, l’injection d’érythropoïétine ou d’interleukine 1-β, des conditions qui augmentent la production de FGF23, induit une augmentation significative du taux de FGF23 total dans le sérum des souris déficientes en furine et/ou PC5 dans les ostéoblastes et les ostéocytes, tandis que le niveau du FGF23 intact n’a pas augmenté de la même façon, suggérant que la FGF23 est correctement clivée chez ces souris. D’une façon intéressante et malgré les défauts développementaux et le retard dans la minéralisation osseuse observée dans les souris complètement déficientes en PC5, la suppression conditionnelle de PC5 dans les ostéoblastes et les ostéocytes chez la souris n'a entraîné aucun défaut osseux. Cependant, l’inactivation du gène codant pour la furine dans les ostéoblastes et les ostéocytes chez la souris a augmenté les paramètres osseux trabéculaires et a diminué l'épaisseur de l’os cortical. De plus, ces souris ont eu une diminution de la densité minérale et la rigidité des os reflétant une mauvaise qualité osseuse. En résumé, nous avons décrit pour la première fois que la furine est un régulateur multifonctionnel de la fonction des ostéoblastes et des ostéocytes in vivo. Elle régule le métabolisme du glucose en assurant le clivage de la pro-ostéocalcine, qui est nécessaire à la maturation et à la bio-activité de l'ostéocalcine, et en régulant l'appétit indépendamment de l'ostéocalcine. Ces résultats suggèrent la présence d'ostéokines supplémentaires régulant l'appétit et contrôlées par la furine. De plus, dans les ostéoblastes, la furine régule partiellement le clivage de FGF23 en assurant une phosphatémie normale, suggérant que la régulation de l'accumulation de masse osseuse par la furine est indépendante du FGF23. En outre, nous avons découvert que l'ostéocalcine de souris est soumise à l’O-glycosylation, une modification qui n'est pas conservée chez l'humain, ni chez d’autres espèces, et qui augmente la demi-vie de l'ostéocalcine de souris. La glycosylation artificielle confère à l'ostéocalcine humaine une demi-vie plus longue, offrant ainsi une approche permettant d'augmenter potentiellement la bio-activité de l'ostéocalcine humaine dans les futures applications thérapeutiques de l'ostéocalcine dans les maladies humaines. / Bone endocrine functions are mediated by at least two hormones, osteocalcin and fibroblast growth factor 23 (FGF23) which are secreted by the bone cells, osteoblasts and osteocytes. Osteocalcin is an osteoblast-derived hormone regulating glucose and energy metabolism. It improves glucose tolerance and insulin sensitivity, promotes insulin secretion and β-cell proliferation, increases energy expenditure and reduces fat accumulation. Osteocalcin is gamma-carboxylated on three of its glutamic acid residues (Glu), a process that inhibits its endocrine function in mice and humans. It is the acidic pH in the resorption lacuna which decarboxylates osteocalcin releasing the uncarboxylated osteocalcin (ucOCN), the active form of this hormone. Our knowledge on osteocalcin regulation by post-translational modifications is limited to its gamma-carboxylation. Since osteocalcin is secreted by differentiated osteoblasts, a non-classical endocrine cell, we hypothesized that osteocalcin may be subjected to additional post translational modifications (PTMs) in the secretory pathway that regulates its endocrine functions. In the first part of the thesis we showed that osteocalcin’s putative pro-peptide is cleaved in its C-terminus at the basic motif «RLRR», by the proprotein convertase furin. This process occurs independently of osteocalcin gamma-carboxylation. Furin inactivation specifically in osteoblasts in mice totally abolishes osteocalcin processing and impairs its activation and release during bone resorption. Consequently, these mice have decreased serum level of ucOCN resulting in impaired glucose tolerance, reduced insulin secretion and energy expenditure, and increased fat accumulation. Moreover, these mice have a decrease in the appetite independently of osteocalcin. Pair feeding of control mice resulted in more apparent phenotype in furin deficient mice, as it appears at younger age alongside with insulin resistance. In the second part of this thesis, we discovered that mouse osteocalcin is O-glycosylated on serine 8, a process that occurs independently of its gamma-carboxylation and processing. This modification is not conserved in human or any other species and it increases mouse osteocalcin half-life in plasma ex vivo and in vivo. Interestingly, tyrosine 12 in human osteocalcin corresponds to the serine 8 in the mouse sequence. Tyr12Ser mutation was sufficient to O-glycosylate human osteocalcin and to confer this hormone a longer half-life in mouse plasma compared to the native form. FGF23 is a hormone secreted by osteoblasts and osteocytes which regulates phosphate reabsorption and vitamin D production in the kidney proximal tubule. Its endocrine function is inhibited by endoproteolytic cleavage which releases its N-terminal and C-terminal fragments. Mutations in the «RHTR» motif, a consensus cleavage site for proprotein convertases (PCs), were found in patients with autosomal dominant hypophosphatemic rickets (ADHR). These patients are characterized by an increased intact FGF23 levels, hypophosphatemia and osteomalacia. Despite the importance of FGF23 in the pathology of multiple diseases, the identity of the enzyme(s) involved in FGF23 cleavage is yet unclear, even though furin and the proprotein convertase subtilisin/kexin type 5 (PC5) were shown to cleave FGF23 in vitro. In the third part of the thesis, we addressed this question using mice model deficient in furin and/or PC5 in osteoblasts and osteocytes in mice. Under physiological conditions, furin inactivation resulted in a 25% increase in intact FGF23; however, these mice maintained normal phosphate level and did not shown any sign of osteomalacia. We also showed that under iron restriction, a condition that induce FGF23 expression at the mRNA and protein level, FGF23 processing is totally impaired in furin deficient mice. However, the injection of erythropoietin or interleukin 1-β, two conditions that increase FGF23 production, induce FGF23 serum level while it is still properly processed in mice deficient in furin and/or PC5 in osteoblasts and osteocytes. Interestingly, despite the patterning defects observed in global inactivation of PC5, conditional inactivation of PC5 in osteoblasts and osteocytes in mice did not result in any bone defect. However, furin inactivation in osteoblasts and osteocytes in mice increases trabecular bone parameters and decreases cortical thickness. Moreover, these mice have decreased bone mineral density and bone strength reflecting a poor bone quality. In summary, we described for the first time that furin is a pleotropic regulator of osteoblast and osteocyte function in vivo. It regulates glucose and energy metabolism by mediating pro-osteocalcin processing which is required for osteocalcin maturation and bioactivity, and by regulating appetite independently of osteocalcin. These findings suggest the presence of additional osteokines controlling appetite and which are regulated by furin. Moreover, furin partially regulates FGF23 processing while maintaining normal phosphate homeostasis, suggesting that the regulation of bone mass accrual by furin occurs independently of FGF23. Additionally, we discovered that mouse osteocalcin is subjected to O-glycosylation, a species-specific modification that is not conserved in humans or any other species and increases mouse osteocalcin half-life. Artificial O-glycosylation confer human osteocalcin a longer half-life, thus providing an approach to increase human osteocalcin bioactivity in future therapeutic applications of osteocalcin in human diseases.

Fibroblast growth factor-23 (FGF23) is a novel, bone-produced hormone that regulates renal phosphate (Pi) reabsorption and calcitriol metabolism. Disorders of mineral and bone metabolism, such as autosomal dominant hypophosphatemic rickets (ADHR) and hyperostosis-hyperphosphatemia syndrome (HHS), witness the importance of well-balanced serum levels of FGF23. Patients with chronic kidney disease (CKD) are highly morbid due to Pi retention/hyperphosphatemia and calcitriol deficiency, which lead to elevated serum levels of parathyroid hormone (PTH) and secondary hyperparathyroidism (sHPT). As a response to hyperphosphatemia, CKD patients have also remarkably high serum FGF23 levels, which are associated with cardiovascular risk factors and increased mortality in CKD. The overall aim of this dissertation was to discern a possible role of FGF23 in parathyroid biology. Our in vitro experiments on isolated bovine parathyroid cells demonstrate that FGF23 directly and dose-dependently suppresses the PTH production and secretion, while increasing the expression of the 25-hydroxyvitamin D3-activating enzyme 1α-hydroxylase. We investigated possible expressional changes in the FGF23 receptor co-factor Klotho in hyperparathyroid disorders and found that Klotho expression is decreased or absent and inversely correlated to serum calcium (Ca) in adenomas of primary HPT (pHPT). In the hyperplastic parathyroid glands of sHPT, Klotho expression declines in parallel with the kidney function and correlates with the glomerular filtration rate. Moreover, Klotho expression is suppressed by Ca and FGF23, increased by calcitriol, but unaffected by Pi and PTH in vitro. Finally, we identified a novel missense mutation in the gene encoding GALNT3, which is normally involved in the post-translational glycosylation of FGF23, as the cause of aberrant FGF23 processing in a patient with HHS. In summary, we provide evidence for a novel bone/parathyroid axis in which FGF23 functions as a direct, negative regulator of the PTH production. High extracellular Ca is a major determinant of the Klotho expression in pHPT, whereas the Klotho levels in sHPT may be attributed to a combination of the high FGF23 and Ca, and low calcitriol levels associated with CKD. Hence, the decreased Klotho expression in sHPT could explain the concomitantly high FGF23 and PTH levels, as well as the failure of FGF23 to prevent or mitigate the development of sHPT in CKD.

Fibroblast growth factor-23 (FGF23) was initially identified as the causative factor of autosomal dominant hypophosphatemic rickets. Further studies confirmed that FGF23 is predominantly expressed in the osteocytes and osteoblasts of bone and that circulating FGF23 acts on the kidney to inhibit renal phosphate reabsorption and 1,25(OH)2D3 hydroxylation. With the progression of chronic kidney disease (CKD), the kidneys become insufficient to maintain a normal systemic mineral homeostasis, resulting in various abnormalities of bone and mineral metabolism, generally referred to as Chronic Kidney Disease – Mineral and Bone Disorders (CKD-MBD). FGF23 increases early in the course of CKD in order to maintain normal serum phosphate levels; long before a significant increase in serum phosphate can be detected. Recent studies suggest that increased FGF23 levels are associated with progression of CKD, mortality, and the development of refractory secondary hyperparathyroidism. Because FGF23 is the very earliest marker of CKD-MBD, it is of particular interest to evaluate the relation between FGF23 and CKD-MBD abnormalities, in the setting of early CKD and also in individuals with normal renal function. In the present work, we show that FGF23 is linked to several dynamic measurements of vascular function, including endothelial dysfunction, arterial stiffness, and atherosclerosis. FGF23 is also positively associated with left ventricular mass index and an increased risk of having left ventricular hypertrophy. All associations were independent of serum phosphate and were strengthened in subjects with diminished renal function. Furthermore, we found significant evidence for an association between higher FGF23 and increased fat mass and dyslipidemia, which could represent a novel pathway linking FGF23 to cardiovascular disease. Finally, we show that FGF23 is a significant predictor of future fracture risk. Although these associations could be reflecting the increased risk associated with hyperphosphatemia and calcitriol deficiency, current evidence points towards FGF23 being more than an innocent bystander. At the very least, FGF23 holds promise of being a bio-marker of cardiovascular status and phosphate-related toxicity both in CKD and in the general population, and might be a therapeutic target that could improve the fatal prognosis in CKD patients.

Utilisation of New Biomarkers for the Optimalization of Diagnostics and Therapy of Tumors of the Gastrointestinal Tract Introduction: Tumor markers are standard diagnostic tools. They are mainly used to monitor the course of the disease and to check the efficacy of the treatment. It is important to observe dynamics. Changing the level of the biomarker can prevent clinical manifestation and lead to early diagnosis of relapse, which in turn means improving the quality of life, including prolonging survival. Recently, we have encountered a number of diagnostic algorithms that suggest algorithms for estimating the risk of tumor presence or the risk of progression of cancer, using statistical methods. Objectives: The aim of this work is to verify new biomarkers for the diagnosis of gastric cancer and to develop an optimal algorithm for their use. Further, to evaluate the importance of cytokeratin markers - Tissue Polypeptide Antigen (TPA) and Tissue Polypeptide Specific Antigen (TPS) for the diagnosis of metastatic colorectal carcinoma in the liver. To carry out a pilot study of FGF23 levels in people with colorectal carcinoma and other gastrointestinal tumors. Methods and patients: Patient samples were analyzed using immunoradiometric, chemiluminescence and fluorescence assays. For each solved problem,...

Indiana University-Purdue University Indianapolis (IUPUI) / FGF23 is the central regulator for phosphate homeostasis. Both FGF23 and phosphate dysregulation are highly related with the progression of chronic kidney disease (CKD), which is a global health problem. In previous studies, FGF23 was found to be produced in bone and targeting the kidneys to regulate phosphate reabsorption and excretion. In the FGF23 signaling axis, it binds a receptor complex (αKlotho and FGFRs) in the distal convoluted tubules (DCT) and causes its biological effects in the proximal tubules (PT). The mechanism of how the signals passing on from DCT to PT is not clear. In my research, experiments were focused on the FGF23 signaling pathway within the kidney to study the communication steps between tubular cells. HBEGF treatment was given to FGF23 signaling impaired mouse models resulting in significant change of genes regulated by FGF23, indicating that HBEGF was important in the FGF23 signaling axis. Then high quality rabbit anti-mouse HBEGF antibodies were made to better study HBEGF activity in vivo and in vitro. A new cell model was characterized to test FGF23 effects on HBEGF signaling using Western blots and immunofluorescence. Lastly, the location of HBEGF activity was examined in the kidney in vivo. Immunostaining suggested that HBEGF activated the mitogen activated protein kinase (MAPK) pathway. This mapping may provide important information for the molecular relationships between FGF23 and HBEGF.

Utilisation of New Biomarkers for the Optimalization of Diagnostics and Therapy of Tumors of the Gastrointestinal Tract Introduction: Tumor markers are standard diagnostic tools. They are mainly used to monitor the course of the disease and to check the efficacy of the treatment. It is important to observe dynamics. Changing the level of the biomarker can prevent clinical manifestation and lead to early diagnosis of relapse, which in turn means improving the quality of life, including prolonging survival. Recently, we have encountered a number of diagnostic algorithms that suggest algorithms for estimating the risk of tumor presence or the risk of progression of cancer, using statistical methods. Objectives: The aim of this work is to verify new biomarkers for the diagnosis of gastric cancer and to develop an optimal algorithm for their use. Further, to evaluate the importance of cytokeratin markers - Tissue Polypeptide Antigen (TPA) and Tissue Polypeptide Specific Antigen (TPS) for the diagnosis of metastatic colorectal carcinoma in the liver. To carry out a pilot study of FGF23 levels in people with colorectal carcinoma and other gastrointestinal tumors. Methods and patients: Patient samples were analyzed using immunoradiometric, chemiluminescence and fluorescence assays. For each solved problem,...

Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...

Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...