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Molecular pathophysiology of chronic kidney disease–mineral and bone disorder: Focus on the fibroblast growth factor 23–Klotho axis and bone turnover dynamics

Abstract Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a major complication of chronic kidney disease (CKD), characterized by disruptions in mineral metabolism, abnormal bone turnover and vascular calcification, which collectively increase the risk of fractures and cardiovascular disease. This review examines the molecular mechanisms underlying CKD-MBD, with a particular focus on the fibroblast growth factor 23 (FGF23)–Klotho axis – a key regulator of phosphate balance, vitamin D activation and parathyroid hormone secretion. In CKD, elevated FGF23 levels and reduced Klotho expression contribute to mineral homeostasis disturbances and bone abnormalities. The dysregulation of this pathway plays a central role in CKD-MBD pathophysiology and its associated complications.

US-China Biotech Competition

The progress of China's biotechnology industry will create opportunities for Indonesia as long as we are smart enough and can take advantage of it. To this day, it is difficult to deny that the United States is the most powerful country in the world and still dominates technological advancements in various fields. However, recent developments indicate that US dominance is beginning to be threatened by China's technological advancements. In the digital technology sector, the popularity of TikTok has even led the US government to consider banning the application made by a Chinese company, unless its shares are sold to US entrepreneurs. Most recently, the artificial intelligence (AI) service from China, DeepSeek, has emerged and shaken the dominance of its predecessors, such as ChatGPT and Meta, products of US technology companies.

Nobel Prizes and Favorite Research Trends

If genomics and AI research are becoming favorite research themes in developed countries, will our scientists follow suit? In October, the Royal Swedish Academy of Sciences awarded the 2024 Nobel Prizes in the categories of Medicine-Physiology, Chemistry, Physics, Literature, and Peace. Looking at the Nobel Prize winners in Medicine, Physics, and Chemistry, it appears that there has been rapid progress in genomic research and artificial intelligence (AI) and this is driving technological progress in the medical and health fields. What can we learn from this Nobel laureate?   New breakthrough The Nobel Prize in Medicine-Physiology was awarded to Victor Ambros and Gary Ruvkun from the United States (US). Both were considered to have contributed to their discovery that microRNA plays a role in regulating post-transcriptional gene activity. This discovery opens up opportunities to develop new ways to treat various diseases, including cancer and autoimmune diseases.

Human Genome Editing Controversy

Advances in molecular biology have brought medical science to a quantum leap. The advancement of science and technology is like a double-edged sword. It can be a blessing for humanity, but it can also be a disaster. This is the story of a secret experiment in China that has shocked the medical community and led to the imprisonment of its researcher. In 2018, He Jiankui, an associate professor at the Southern University of Science and Technology in Shenzhen, conducted an experiment to edit the genes or DNA of an embryo carried by a woman whose husband had HIV. Using clustered regularly interspaced short palindromic repeats-associated protein 9 (CRISPR-Cas9) technology, He edited the gene encoding CCR5, which is a receptor or entry point for the HIV virus into human body cells.

New Hope for Kidney Failure Patients

The success of the genetically engineered pig kidney transplant is a major breakthrough for the world of medicine and molecular biology. The world of medicine continues to develop, bringing new hope, including for patients with kidney failure. Not long ago, on March 16, 2024, a team of doctors at Massachusetts General Hospital, Boston, USA, successfully performed a genetically engineered pig kidney transplant into the body of Richard Slayman, a 62-year-old male patient. At that time, Richard felt happy and enthusiastic because he regained a normally functioning kidney and no longer had to undergo routine dialysis that had burdened him for years. This is the first successful attempt, as previous pig-to-human kidney transplants have always failed. In 2018, Richard had actually undergone a human kidney transplant from a deceased donor.