The role of FGF23/Klotho in mineral metabolism and chronic kidney disease

Chronic kidney disease (CKD) is a global health burden of growing incidence and prevalence. As renal function declines disturbances in mineral metabolism, such as hyperphosphatemia and secondary hyperparathyroidism, inevitably develop. These metabolic changes are closely associated with poor prognosis and survival. The bonederived hormone fibroblast growth factor-23 (FGF23) and its co-receptor Klotho represent a novel endocrine axis regulating mineral metabolism in health and disease. FGF23-Klotho signalling inhibits renal phosphate reabsorption and activation of vitamin D, and reduces secretion of parathyroid hormone (PTH). Serum levels of FGF23 rise at early stages of CKD, presumably due to increased phosphate load, and numerous studies identify elevated FGF23 as a predictor of adverse clinical outcome. In contrast, tissue expression of Klotho decreases in parallel with CKD progression and reaches low or undetectable levels in end-stage renal disease. Importantly, mice lacking Klotho develop numerous complications associated with accelerated ageing, and many patients with advanced CKD, a state of Klotho deficiency, display a similar senescentlike phenotype. Altogether, FGF23 excess and lack of Klotho may be key pathogenic factors in CKD. In the present thesis we sought to elucidate the role of renal and parathyroid FGF23-Klotho signalling in physiology and in CKD. In Study I we investigate Klotho levels in surgically resected parathyroid tissue specimen from CKD patients with secondary hyperparathyroidism, and find diminished Klotho expression paralleling the decline in renal function. Further, we demonstrate that FGF23 dose-dependently suppresses Klotho in bovine parathyroid cell culture, indicating a ligand-receptor regulatory process. In Study II we generate parathyroid-specific Klotho knockout mice (PTH-KL-/-) using Cre-Lox recombination. PTH-KL-/- mice display a normal gross phenotype with a preserved calcium-PTH axis. Their PTH response is similar to wild-type mice when treated with FGF23 or challenged with renal failure. Yet, FGF23 treatment activates the MAPK pathway in wild-type mice but not in PTH-KL-/- mice. Importantly, blocking of calcineurin with cyclosporine A abolishes the FGF23-mediated PTH suppression in PTH-KL-/- mice, whereas wild-type mice remain responsive. Thus, we identify a novel calcineurin-dependent pathway in the parathyroid glands that, in the absence of Klotho, mediates acute suppression of PTH secretion by FGF23. In Study III we develop a novel, non-surgical, mouse model of tubulointerstitial nephropathy. By adding various concentrations of adenine to the diet we define an adjustable protocol for inducing and maintaining uremia in mice. In Study IV we generate distal tubule-specific Klotho knockout mice (Ksp-KL-/-). In contrast to systemic Klotho knockout mice, Ksp-KL-/- mice are fertile with a normal gross phenotype. Adult Ksp-KL-/- mice are hyperphosphatemic, indicating attenuated effects of FGF23 on proximal tubular phosphate handling. Further, FGF23 is higher in Ksp-KL-/- mice than in wild-type mice with matched serum phosphate, suggesting phosphate-independent regulation of FGF23 in Ksp-KL-/- mice. Collectively, the studies presented in this thesis identify several novel and critical aspects of FGF23-Klotho signalling and function in health and disease, and provide important tools allowing for continuous investigation

A Holistic Treatment Approach for Individuals Experiencing Phantom Phenomena: An Occupational Therapy Approach

The prevalence of individuals who have had an amputation and experience adverse types of sensory input from the missing limb is very high (Hunter, Katz, & Davis, 2005). According to the literature, sensory input can be divided into non-painful sensations or painful sensations in the amputated limb often called phantom sensations. These pains and sensations can have many negative implications upon an individual\u27s occupational performance, and consequently directly implicate the need for occupational therapy. A large number of persons post-amputation experience pain and different sensations from their affected limb even after the healing process has finalized; the etiology behind why or how this occurs is unclear (Hunter, Katz, & Davis, 2005). Wilder-Smith, Hill and Laurent (2005) noted that painful sensations after an individual has gone through an amputation is common, however it is difficult to treat and there ~re very few studies regarding treatment trials. Because limb pain and sensations can have a negative impact on individuals and cause impairment in their daily functioning, further information is needed regarding occupation based treatment interventions to decrease the impact of these sensations within the context of occupational therapy settings

Student Food Security: Exploring Barriers to Health and Education Outcomes at The University of Saskatchewan

This thesis examines the relationship between post-secondary student status and household food insecurity. Food insecurity refers to uncertain or inadequate access to food due to financial constraints. This project aims to examine the demographic factors and household characteristics of students attending the University of Saskatchewan in an attempt to determine if certain characteristics are associated with an increased risk of experiencing food insecurity, and therefore if some students are more vulnerable to becoming food insecure compared to others. This research will also delve into perceptions of potential contributing factors to food insecurity among University of Saskatchewan students, as well as strategies used to manage food shortages, perceptions regarding implications for student health and learning outcomes, and some suggestions to support students who may be at risk of food insecurity. A sequential, multi-method research design was used. The first phase was a survey sent directly to a simple random sample of 4500 university students through their email (n = 1359, response rate = 30.2%). The results from the survey revealed that 39.5% of students reported some level of food insecurity in the previous twelve months, with 11% reporting marginal, 21% reporting moderate, and 7.5% reporting severe levels of food insecurity. Descriptive prevalence between several student demographic and household characteristics and increased odds of experiencing food insecurity were observed. The information obtained from the survey data was used to develop an interview guide aimed at further examining the problem. Interviews were conducted with employees at the University of Saskatchewan who work in a student support role (n = 5). The inclusion of interviews facilitated greater depth, richness and rigor to the study design. Thematic analysis of the interviews revealed several themes related to student food insecurity on campus including: (1) factors that may influence food insecurity at the University of Saskatchewan; (2) perceived implications of food insecurity on student learning and health outcomes; (3) coping mechanisms used by students during times of low food security; and (4) suggested strategies that may help reduce food insecurity at the University of Saskatchewan. The results from this exploratory research, one of the first studies of its kind in Canada, is consistent with what is being found by other studies. Food insecurity among post-secondary students is a serious public health and equity issue with critical implications for individuals and society. There is a need to better understand the barriers to food security among postsecondary students. Encouragement of other university campuses to engage in similar research projects will allow for intercampus comparisons to be made. The results can be used to guide policy decisions that will create more opportunities for success among post-secondary students

CDKN2A/p16INK4a expression is associated with vascular progeria in chronic kidney disease

Patients with chronic kidney disease (CKD) display a progeric vascular phenotype linked to apoptosis, cellular senescence and osteogenic transformation. This has proven intractable to modelling appropriately in model organisms. We have therefore investigated this directly in man, using for the first time validated cellular biomarkers of ageing (CDKN2A/p16INK4a, SA-β-Gal) in arterial biopsies from 61 CKD patients undergoing living donor renal transplantation. We demonstrate that in the uremic milieu, increased arterial expression of CDKN2A/p16INK4a associated with vascular progeria in CKD, independently of chronological age. The arterial expression of CDKN2A/p16INK4a was significantly higher in patients with coronary calcification (p=0.01) and associated cardiovascular disease (CVD) (p=0.004). The correlation between CDKN2A/p16INK4a and media calcification was statistically significant (p=0.0003) after correction for chronological age. We further employed correlate expression of matrix Gla protein (MGP) and runt-related transcription factor 2 (RUNX2) as additional pathognomonic markers. Higher expression of CDKN2A/p16INK4a, RUNX2 and MGP were observed in arteries with severe media calcification. The number of p16INK4a and SA-β-Gal positive cells was higher in biopsies with severe media calcification. A strong inverse correlation was observed between CDKN2A/p16INK4a expression and carboxylated osteocalcin levels. Thus, impaired vitamin K mediated carboxylation may contribute to premature vascular senescence

Особенности банковской системы США

В статье рассматриваются важнейшие моменты в истории банковской системы США, изменения в структуре американской банковской системе на разных этапах ее развития, особенности статуса национальных банков и банков штатов. Делается вывод о том, что своеобразие современной банковской системы США во многом определяется ее историей

A Transgenic Model Reveals the Role of Klotho in Pancreatic Cancer Development and Paves the Way for New Klotho-Based Therapy

Klotho; Càncer de pàncrees; Supressor del tumorKlotho; Cáncer de páncreas; Supresor de tumorKlotho; Pancreatic cancer; Tumor suppressorKlotho is an anti-aging transmembrane protein, which can be shed and can function as a hormone. Accumulating data indicate that klotho is a tumor suppressor in a wide array of malignancies, and designate the subdomain KL1 as the active region of the protein towards this activity. We aimed to study the role of klotho as a tumor suppressor in pancreatic ductal adenocarcinoma (PDAC). Bioinformatics analyses of The Cancer Genome Atlas (TCGA) datasets revealed a correlation between the survival of PDAC patients, levels of klotho expression, and DNA methylation, and demonstrated a unique hypermethylation pattern of klotho in pancreatic tumors. The in vivo effects of klotho and KL1 were examined using three mouse models. Employing a novel genetic model, combining pancreatic klotho knockdown with a mutation in Kras, the lack of klotho contributed to PDAC generation and decreased mousece survival. In a xenograft model, administration of viral particles carrying sKL, a spliced klotho isoform containing the KL1 domain, inhibited pancreatic tumors. Lastly, treatment with soluble sKL prolonged survival of Pdx1-Cre; KrasG12D/+;Trp53R172H/+ (KPC) mice, a model known to recapitulate human PDAC. In conclusion, this study provides evidence that klotho is a tumor suppressor in PDAC. Furthermore, these data suggest that the levels of klotho expression and DNA methylation could have prognostic value in PDAC patients, and that administration of exogenous sKL may serve as a novel therapeutic strategy to treat PDAC.This project was funded by the The Sami and Tova Sagol Foundation for the Study of Aging, the Margaret Stultz foundation for Pancreatic Cancer Research, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ministerio de Ciencia e Innovación ‘Proyectos I+D+I 2019, to M.C., (grant number PID2019-104034RB-I00) and by the TASMC excellence fund. to I.W

Tissue expression and source of circulating αKlotho

αKlotho (Klotho), a type I transmembrane protein and a coreceptor for Fibroblast Growth Factor-23, was initially thought to be expressed only in a limited number of tissues, most importantly the kidney, parathyroid gland and choroid plexus. Emerging data may suggest a more ubiquitous Klotho expression pattern which has prompted reevaluation of the restricted Klotho paradigm. Herein we systematically review the evidence for Klotho expression in various tissues and cell types in humans and other mammals, and discuss potential reasons behind existing conflicting data. Based on current literature and tissue expression atlases, we propose a classification of tissues into high, intermediate and low/absent Klotho expression. The functional relevance of Klotho in organs with low expression levels remain uncertain and there is currently limited data on a role for membrane-bound Klotho outside the kidney. Finally, we review the evidence for the tissue source of soluble Klotho, and conclude that the kidney is likely to be the principal source of circulating Klotho in physiolog

Spectral Decomposition of Regulatory Thresholds for Climate-Driven Fluctuations in Hydro- and Wind Power Availability

Abstract Climate-driven fluctuations in the runoff and potential energy of surface water are generally large in comparison to the capacity of hydropower regulation, particularly when hydropower is used to balance the electricity production from covarying renewable energy sources such as wind power. To define the bounds of reservoir storage capacity, we introduce a dedicated reservoir volume that aggregates the storage capacity of several reservoirs to handle runoff from specific watersheds. We show how the storage bounds can be related to a spectrum of the climate-driven modes of variability in water availability and to the covariation between water and wind availability. A regional case study of the entire hydropower system in Sweden indicates that the longest regulation period possible to consider spans from a few days of individual subwatersheds up to several years, with an average limit of a couple of months. Watershed damping of the runoff substantially increases the longest considered regulation period and capacity. The high covariance found between the potential energy of the surface water and wind energy significantly reduces the longest considered regulation period when hydropower is used to balance the fluctuating wind power

CDKN2A/p16INK4a expression is associated with vascular progeria in chronic kidney disease

Patients with chronic kidney disease (CKD) display a progeric vascular phenotype linked to apoptosis, cellular senescence and osteogenic transformation. This has proven intractable to modelling appropriately in model organisms. We have therefore investigated this directly in man, using for the first time validated cellular biomarkers of ageing (CDKN2A/p16INK4a, SA-β-Gal) in arterial biopsies from 61 CKD patients undergoing living donor renal transplantation. We demonstrate that in the uremic milieu, increased arterial expression of CDKN2A/p16INK4a associated with vascular progeria in CKD, independently of chronological age. The arterial expression of CDKN2A/p16INK4a was significantly higher in patients with coronary calcification (p=0.01) and associated cardiovascular disease (CVD) (p=0.004). The correlation between CDKN2A/p16INK4a and media calcification was statistically significant (p=0.0003) after correction for chronological age. We further employed correlate expression of matrix Gla protein (MGP) and runt-related transcription factor 2 (RUNX2) as additional pathognomonic markers. Higher expression of CDKN2A/p16INK4a, RUNX2 and MGP were observed in arteries with severe media calcification. The number of p16INK4a and SA-β-Gal positive cells was higher in biopsies with severe media calcification. A strong inverse correlation was observed between CDKN2A/p16INK4a expression and carboxylated osteocalcin levels. Thus, impaired vitamin K mediated carboxylation may contribute to premature vascular senescence

The person-centred approach to an ageing society

Modern care is often based on investigations such as laboratory markers and imaging - for example, X-ray or ultrasound. The results contribute to a diagnosis and, if judged necessary, treatment is initiated. This diseased-oriented approach is the prevailing mode of management in modern medicine. In contrast, person-centered care (PCC) takes the point of departure from each person\ub4s subjective experience of illness and its impact on daily life. A patient is considered as a person with emotions and feelings. PCC is considered present within clinical care according to a definition articulated by the Centre for Person Centred Care at the University of Gothenburg (GPCC) when three core components are present: elicitation of a detailed patient narrative; formulated partnership between caregiver and patient and documentation of the partnership in the patient record. Accordingly, when there is an illness requiring care and the person is attended using these components, PCC is being applied. In most situations today, PCC is not applied in terms of the narrative and is not fully elicited or the partnership and/or the documentation are not included. It is proposed that the challenge to Society arising from changing demographics can be addressed by implementing PCC and creating an alternative to existing healthcare. The importance and benefits of such an approach on a wider scale is not yet clear as research has been limited to date. Studies in selected patient populations (heart failure and hip fractures), however, have shown promising results. As the population ages, there will be a dramatic increase in healthcare consumption. Even with technological developments, there will be a need for tremendous resources to be dedicated to care. A new organization and attitude from healthcare policymakers and providers above and beyond the present model appears required in order to respond to this demand. As part of such change, person-centred care, with the interaction between healthcare providers and the person of the patient, can facilitate, compensate and develop more effective healthcare services for the future