T he idea of fat cells and tissue being the passive storage site of excess energy has long been gone. Not surprisingly, fat cells (white adipose tissue) were first recognized as being the source of hormones controlling energy homeostasis because they secrete more leptin with increasing fat stores. (1) Leptin then crosses the blood-brain barrier to activate its receptor in the hypothalamic regions, thereby starting a complex feedback on energy intake and expenditure but also regulating other systems such as sexual maturation and reproduction (2) and bone homeostasis. (3) Indeed, a series of elegant studies of the Karsenty group clearly demonstrated that central activation of leptin signaling activates the sympathetic postganglionic neuronal system that ultimately decreases bone formation and increases bone resorption. (3,4) Leptin receptors are also found outside the hypothalamus in insulin-producing b cells, bone marrow stromal cells, osteoblasts and chondrocytes, and kidney cells. (5) This suggests a much wider spectrum of activities for this fat cell signal, not mediated by a central neuroendocrine system.A few years ago, Horiuchi's laboratory (6,7) described increased serum concentrations of 1,25-dihydroxyvitamin D 3 [1,25(OH) 2 D 3 ], calcium, and phosphate in leptin-deficient (ob/ob) mice owing to increased renal expression of CYP27B1 [¼ 25(OH)D 1a-hydroxylase] that could be corrected by intraperitoneal leptin injections. The same group (8) now expands this observation by demonstrating that leptin stimulates the osteoblast (osteocyte?) production of fibroblast growth factor 23 (FGF-23), which is thereafter responsible for the downregulation of CYP27B1 and of the sodium-phosphate cotransporters (NaPT-II). The overproduction of 1,25(OH) 2 D 3 also was present in mice with leptin receptor deficiency (db/db mice) but could not, in contrast to the ob/ob mice, be corrected by intraperitoneal leptin injection. FGF-23 therapy also corrected the overproduction of 1,25(OH) 2 D 3 in ob/ob mice (not reported for db/db mice). Addition of leptin to renal tubular cell cultures did not modify the local 1a-hydroxylase activity. (8) clearly demonstrating the indirect effects of leptin.What Are the Implications of These Observations?F irst, the new data further elucidate the complex regulation of the renal production of the vitamin D hormone. Indeed, it is now well established that calcium/calcium sensing receptordriven parathyroid hormone (PTH) secretion constitutes the major stimulus for renal 1a-hydroxylase and thus the production of systemic 1,25(OH) 2 D 3 while shutting down the expected renal activation of CYP24A1, the major degradation system for vitamin D metabolites. (9)(10)(11) The second systemic hormone, osteocytic FGF-23, is a negative regulator of renal 1a-hydroxylase activity, whereas both PTH and FGF-23 decrease the tubular reabsorption of phosphate by downregulation of NaPT-II. The PTH and FGF-23 hormones thus regulate vitamin D activation, as driven by calcium and phosphate, respectively (12)(13)(14) (Fig. 1...