title: The Three Sisters of Fate in Multiple Sclerosis: Klotho (Clotho), Fibroblast Growth Factor-23 (Lachesis), and Vitamin D (Atropos).
abstract: BACKGROUND
  The klotho (Klt)-fibroblast growth factor-23 (FGF-23)-vitamin D axis is the main component of calcium (Ca) and phosphorus (P) metabolisms; on the contrary, it is also secreted from the choroid plexus (CP).
  
  
  OBJECTIVE
  This study is aimed at evaluating serum soluble Klt (sKlt), FGF-23, and 25-(OH)-vitamin D levels in multiple sclerosis (MS) patients.
  
  
  METHODS
  Thirty-two relapsing-remitting MS patients (11 males and 21 females; mean age 38.3 years) and 31 age-sex matched healthy controls (12 males and 19 females; median age 38.5 years) were included in this study. All patients were diagnosed with MS according to the criteria of McDonald.
  
  
  RESULTS
  Serum sKlt, FGF-23, and P levels were significantly higher in MS patients compared to the control group (p < 0.01, p < 0.01, and p = 0.02, respectively). Serum 25-(OH)-vitamin D and Ca levels were significantly lower in MS patients (p < 0.01 and p = 0.04, respectively).
  
  
  CONCLUSIONS
  Klt, which is secreted from CP, could be a response to the inflammatory condition in MS. Elevated FGF-23 levels suppress 1α-hydroxylase and upregulates 24α-hydroxylase, which results in a decrease in 1,25-(OH)2D3levels. Thus, the neuroprotective and immunomodulatory effects of vitamin D might not be seen in MS patients.
authors.affiliation: Central Laboratories, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Hamit Yasar
authors.initials: HY
authors.lastname: Ellidag
authors.affiliation: Central Laboratories, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Necat
authors.initials: N
authors.lastname: Yilmaz
authors.affiliation: Neurology Clinic, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Kurtulus
authors.affiliation: Biochemistry Laboratory, Maternity and Children's Hospital, Batman, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Aydin
authors.affiliation: Central Laboratories, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Esin
authors.initials: E
authors.lastname: Eren
authors.affiliation: Nephrology Clinic, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Ayca
authors.initials: A
authors.lastname: Inci
authors.affiliation: Nephrology Clinic, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Dolu
authors.affiliation: Department of Biochemistry, Tepecik Education and Research Hospital of Ministry of Health, Izmir, Turkey.
authors.forename: Fatma Demet Arslan
authors.initials: FD
authors.lastname: Ince
authors.affiliation: Central Laboratories, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Giray
authors.affiliation: Neurology Clinic, Antalya Education and Research Hospital of Ministry of Health, Antalya, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Yaman
keywords: Choroid plexus; Demyelinization; Fibroblast growth factor-23; Klotho; Multiple sclerosis; Oligodendrocyte; Vitamin D