Fibroblast growth factor 23 concentrations in healthy term infants during the early postpartum period

Fibroblast growth factor 23 (FGF23) is a potent regulator of Pi and 1,25-(OH)2D homeostasis. Early postpartum infants show intriguing changes in serum levels of Ca, Pi, PTH and 1,25-(OH)2D. However, the role of FGF23 in the early neonatal mineral metabolism has not been clarified. In order to evaluate the significance of FGF23 during the early postpartum period, we examined the circulating FGF23 levels using an intact FGF23 ELISA and a C-terminal FGF23 ELISA either in 22 umbilical cord blood samples (the cord blood) or in 22 term infants at 5 days of life (the 5-day-old infant). We also compared these ranges with those of 11 healthy adults. Data were expressed as mean ± SD, and analyzed by two-way ANOVA, followed by the Tukey's test. C-terminal FGF23 in the cord blood, the 5-day-old infants and the healthy adults were 73.3 ± 22.4, 81.0 ± 28.2 and 39.0 ± 7.8 RU/ml, respectively. Intact FGF23 in the cord blood, the 5-day-old infants and the healthy adults were 3.9 ± 1.6, 21.8 ± 17.6, and 27.6 ± 7.3 pg/ml, respectively. Immunoprecipitation assays using anti-FGF23 antibodies demonstrated that the intact 32 kDa FGF23 was low and the fragmented FGF23 of 18 kDa was abundant in the cord blood compared with those in the healthy adults. In conclusion, our observations indicated that the intact FGF23/C-terminal FGF23 ratio was very low due to the fragmentation of FGF23 during the early postpartum period and might have a considerable contribution to the Pi homeostasis in the healthy term infants.