Clinical Research in Cardiology

, Volume 108, Issue 3, pp 341–343 | Cite as

Plasma FGF23 does not rise during physical exercise as a physiological model of sympathetic activation

  • Insa E. EmrichEmail author
  • Marc Baier
  • Adam M. Zawada
  • Tim Meyer
  • Danilo Fliser
  • Jürgen Scharhag
  • Gunnar H. Heine
Letter to the Editors


After the failure of conventional pharmacological strategies for cardiovascular prevention in chronic kidney disease (CKD) [1, 2], the phosphaturic hormone FGF23 emerged as a promising therapeutic target for novel cardioprotective interventions in CKD [3, 4]. Elevated FGF23 has been found associated with cardiovascular disease both in experimental studies and in non-interventional human cohort studies [5]. Nevertheless, our understanding of the physiological regulation of FGF23 is incomplete, and its deciphering appears mandatory.

The rise of FGF23 which inevitably occurs during CKD progression cannot be fully explained by canonical pathways within the chronic kidney disease—mineral and bone disorders (CKD-MBD) spectrum [5]. Instead, non-canonical factors may contribute to high plasma FGF23 in CKD patients. Recently, murine data suggested increased sympathetic activity to induce FGF23 synthesis [6].

However, the physiological relevance of such a rise of FGF23 caused by increased...

Supplementary material

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Supplementary material 1 (DOCX 14 KB)
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Supplementary material 2 (DOCX 23 KB)


  1. 1.
    Marz W, Kleber ME, Scharnagl H et al (2017) HDL cholesterol: reappraisal of its clinical relevance. Clin Res Cardiol 106(9):663–675CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Linz D, Denner A, Illing S et al (2016) Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs. Clin Res Cardiol 105(8):639–647CrossRefGoogle Scholar
  3. 3.
    Grabner A, Schramm K, Silswal N et al (2017) FGF23/FGFR4-mediated left ventricular hypertrophy is reversible. Sci Rep 7(1):1993CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Leifheit-Nestler M, Grabner A, Hermann L et al (2017) Vitamin D treatment attenuates cardiac FGF23/FGFR4 signaling and hypertrophy in uremic rats. Nephrol Dial Transplant 32:1493–1503CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Heine GH (2015) Mineral metabolism in heart disease. Curr Opin Nephrol Hypertens 24(4):310–316Google Scholar
  6. 6.
    Kawai M, Kinoshita S, Shimba S, Ozono K, Michigami T (2014) Sympathetic activation induces skeletal Fgf23 expression in a circadian rhythm-dependent manner. J Biol Chem 289(3):1457–1466CrossRefGoogle Scholar
  7. 7.
    Myrstad M, Aaronaes M, Graff-Iversen S, Ariansen I, Nystad W, Ranhoff AH (2016) Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clin Res Cardiol 105(2):154–161CrossRefGoogle Scholar
  8. 8.
    Stegmann H, Kindermann W, Schnabel A (1981) Lactate kinetics and individual anaerobic threshold. Int J Sports Med 2(3):160–165CrossRefGoogle Scholar
  9. 9.
    Arab C, Vanderlei LCM, da Silva Paiva L et al (2018) Cardiac autonomic modulation impairments in advanced breast cancer patients. Clin Res Cardiol. Google Scholar
  10. 10.
    Fournier S, Iten L, Marques-Vidal P et al (2017) Circadian rhythm of blood cardiac troponin T concentration. Clin Res Cardiol 106(12):1026–1032CrossRefGoogle Scholar
  11. 11.
    Silverman HG, Mazzeo RS (1996) Hormonal responses to maximal and submaximal exercise in trained and untrained men of various ages. J Gerontol A Biol Sci Med Sci 51(1):B30–B37CrossRefGoogle Scholar
  12. 12.
    Sagnol M, Claustre J, Pequignot JM, Fellmann N, Coudert J, Peyrin L (1989) Catecholamines and fuels after an ultralong run: persistent changes after 24-h recovery. Int J Sports Med 10(3):202–206CrossRefGoogle Scholar
  13. 13.
    Lombardi G, Corsetti R, Lanteri P et al (2014) Reciprocal regulation of calcium-/phosphate-regulating hormones in cyclists during the Giro d’Italia 3-week stage race. Scand J Med Sci Sports 24(5):779–787CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Insa E. Emrich
    • 1
    Email author
  • Marc Baier
    • 1
  • Adam M. Zawada
    • 1
  • Tim Meyer
    • 2
  • Danilo Fliser
    • 1
  • Jürgen Scharhag
    • 2
    • 3
  • Gunnar H. Heine
    • 1
  1. 1.Internal Medicine IV, Nephrology and HypertensionSaarland University Medical CenterHomburgGermany
  2. 2.Institute of Sports and Preventive MedicineSaarland UniversitySaarbrückenGermany
  3. 3.Outpatient’s Clinic for Prevention, Rehabilitation and Sports MedicineTechnical University MunichMunichGermany

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