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      Circulating fibroblast growth factor 23 levels and incident dementia: The Framingham heart study

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          Abstract

          Background

          Fibroblast growth factor 23 is an emerging vascular biomarker, recently associated with cerebral small vessel disease and poor cognition in patients on dialysis. It also interacts with klotho, an anti-aging and cognition enhancing protein.

          Objective

          To determine if circulating Fibroblast growth factor 23 (FGF23) is associated with new-onset cognitive outcomes in a community-based cohort of cognitively healthy adults with long-term follow-up.

          Methods

          We measured serum FGF23 levels in 1537 [53% women, mean age 68.7 (SD 5.7)] dementia-free Framingham Offspring participants at their 7 th quadrennial examination (1998–2001), and followed these participants for the development of clinical all-cause dementia and Alzheimer’s disease (AD). Secondary outcomes included MRI-based structural brain measures, and neurocognitive test performance at exam 7.

          Results

          During a median (Q1, Q3) 12-year (7.0, 13.3) follow up, 122 (7.9%) participants developed dementia, of whom 91 (5.9%) had AD. Proportional-hazards regression analysis, adjusted for age, sex, education, systolic blood pressure, antihypertensive medication, prevalent cardiovascular disease, diabetes mellitus, smoking status and apoE ε4 carrier status, revealed that higher serum FGF23 levels were associated with an increased risk of incident dementia and AD (Hazard ratio [HR] per 1 standard deviation increment in inverse transformed FGF23 level 1.25, 95% CI 1.02–1.53, and 1.32, 95% CI 1.04–1.69, respectively). There was no significant interaction according to presence/absence of significant renal impairment (eGFR <30 versus ≥30ml/min) and risk of dementia (based on 1537; p = 0.97).

          Conclusions

          Higher circulating FGF23 is associated with an increased risk of dementia, suggesting that FGF23-related biological pathways may play a role in the development of dementia.

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          Most cited references21

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          The meaning and use of the area under a receiver operating characteristic (ROC) curve.

          A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques.
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            The Framingham Offspring Study. Design and preliminary data.

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              Fibroblast growth factor 23 and Klotho: physiology and pathophysiology of an endocrine network of mineral metabolism.

              The metabolically active and perpetually remodeling calcium phosphate-based endoskeleton in terrestrial vertebrates sets the demands on whole-organism calcium and phosphate homeostasis that involves multiple organs in terms of mineral flux and endocrine cross talk. The fibroblast growth factor (FGF)-Klotho endocrine networks epitomize the complexity of systems biology, and specifically, the FGF23-αKlotho axis highlights the concept of the skeleton holding the master switch of homeostasis rather than a passive target organ as hitherto conceived. Other than serving as a coreceptor for FGF23, αKlotho circulates as an endocrine substance with a multitude of effects. This review covers recent data on the physiological regulation and function of the complex FGF23-αKlotho network. Chronic kidney disease is a common pathophysiological state in which FGF23-αKlotho, a multiorgan endocrine network, is deranged in a self-amplifying vortex resulting in organ dysfunction of the utmost severity that contributes to its morbidity and mortality.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 March 2019
                2019
                : 14
                : 3
                : e0213321
                Affiliations
                [1 ] Department of Neurology, Brigham & Women’s Hospital, Boston, MA, United States of America
                [2 ] Harvard Medical School, Boston, MA, United States of America
                [3 ] Framingham Heart Study, Framingham, MA, United States of America
                [4 ] Boston University School of Public Health, Boston, MA, United States of America
                [5 ] Boston University School of Medicine, Boston, MA, United States of America
                [6 ] Population Sciences Branch, National Heart, Lung and Blood Institutes of Health, Bethesda, MD, United States of America
                [7 ] Melbourne Dementia Research Centre, The Florey Institute for Neuroscience and Mental Health, Victoria, Australia
                [8 ] Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, United States of America
                Nathan S Kline Institute, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-3589-2964
                http://orcid.org/0000-0002-1115-4430
                Article
                PONE-D-18-35509
                10.1371/journal.pone.0213321
                6398923
                30830941
                57434a7d-d244-4c65-842a-d95812d7392f
                © 2019 McGrath et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 December 2018
                : 18 February 2019
                Page count
                Figures: 3, Tables: 6, Pages: 15
                Funding
                The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute contract no. N01-HC-25195 and no. HHSN268201500001I (RSV, SS, DL) and this research is supported by the Alzheimer’s association clinician scientist fellowship AACSF-18-566570 (ERM), NHLBI grants R01 HL60040 and R01 HL70100 (RSV, DL, SS), grants from the National Institute on Aging R01 AG054076, R01 AG049607, R01 AG033193, U01 AG049505, U01 AG052409 (SS) and the National Institute of Neurological Disorders and Stroke NS017950 and UH2 NS100605 (SS). Additional funding for the Systems Approach to Biomarker Research in Cardiovascular Disease (SABRe CVD) initiative was provided by the Division of Intramural Research, NHLBI, and the Population Sciences Branch, NHLBI (DL). https://www.alz.org; https://www.nia.nih.gov; https://www.ninds.nih.gov; https://www.nhlbi.nih.gov. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Physiology
                Growth Factors
                Fibroblast Growth Factor
                Biology and Life Sciences
                Physiology
                Endocrine Physiology
                Growth Factors
                Fibroblast Growth Factor
                Medicine and Health Sciences
                Physiology
                Endocrine Physiology
                Growth Factors
                Fibroblast Growth Factor
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Medicine and Health Sciences
                Neurology
                Dementia
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Neurodegenerative Diseases
                Alzheimer's Disease
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Diseases
                Physical sciences
                Chemistry
                Chemical compounds
                Organic compounds
                Vitamins
                Vitamin D
                Physical sciences
                Chemistry
                Organic chemistry
                Organic compounds
                Vitamins
                Vitamin D
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Vascular Dementia
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Vascular Dementia
                Medicine and Health Sciences
                Neurology
                Dementia
                Vascular Dementia
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Custom metadata
                The data used in these analyses can be obtained from the NHLBI and the NCBI dbGaP ( https://biolincc.nhlbi.nih.gov/home/ and https://www.ncbi.nlm.nih.gov/gap).

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