Cardiac Fibroblasts Produce Fibroblast Growth Factor 23 in Response to Hyperphosphatemia

Chronic Kidney Disease (CKD) is accompanied by pathologic cardiac remodeling, including cardiac hypertrophy and fibrosis. The decline in renal function results in elevations of serum concentrations of phosphate (hyperphosphatemia) and of the bone-derived hormone Fibroblast Growth Factor (FGF) 23. Clinical studies have shown that hyperphosphatemia and high circulating levels of FGF23 are associated with cardiovascular mortality in CKD. We previously found that FGF23 can directly target cardiac myocytes via FGF Receptor (FGFR) 4 and induce cardiac hypertrophy in rodents. Furthermore, decreasing serum FGF23 levels or pharmacological blockade of FGFR4 in rodent models of hyperphosphatemia and CKD reduces cardiac hypertrophy, but not cardiac fibrosis. To directly determine whether cardiac fibroblasts are resistant to FGF23 elevations, we isolated cardiac fibroblasts from adult mice and treated them with recombinant FGF23 protein, which did not induce proliferation, pro-fibrotic gene programs or differentiation into myofibroblasts. Similarly, cardiac fibroblasts isolated from mice receiving a high-phosphate diet did also not respond to FGF23, indicating that hyperphosphatemia does not prime cardiac fibroblasts for FGF23 responsiveness. However, cardiac fibroblasts derived from mice on high-phosphate diet produced and secreted FGF23. Our study suggests that cardiac fibroblasts are not a target but a source of FGF23 and that FGF23/FGFR4 signaling is a driver of cardiac hypertrophy but not fibrosis. Elevated phosphate appears to not only induce FGF23 production in bone but also in cardiac fibroblasts which in a paracrine manner might contribute to cardiac hypertrophy in scenarios of hyperphosphatemia, such as CKD.