Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) enhance phosphate excretion by the proximal tubule of the kidney by retrieval of the sodium-dependent phosphate transporters (Npt2a and Npt2c) from the apical plasma membrane. PTH activates adenylyl cyclase (AC) through PTH 1 receptors and stimulates the cAMP/PKA signaling pathway. However, the precise role and isoform(s) of AC in phosphate homeostasis are not known. We report here that mice lacking AC6 (AC6 2/2 ) have increased plasma PTH and FGF-23 levels compared with wild-type (WT) mice but comparable plasma phosphate concentrations. Acute activation of the calcium-sensing receptor or feeding a zero phosphate diet almost completely suppressed plasma PTH levels in both AC6 2/2 and WT mice, indicating a secondary cause for hyperparathyroidism. Pharmacologic blockade of FGF receptors resulted in a comparable increase in plasma phosphate between genotypes, whereas urinary phosphate remained significantly higher in AC6 2/2 mice. Compared with WT mice, AC6 2/2 mice had reduced renal Npt2a and Npt2c protein abundance, with approximately 80% of Npt2a residing in lysosomes. WT mice responded to exogenous PTH with redistribution of Npt2a from proximal tubule microvilli to intracellular compartments and lysosomes alongside a PTH-induced dose-response relationship for fractional phosphate excretion and urinary cAMP excretion. These responses were absent in AC6 2/2 mice. In conclusion, AC6 in the proximal tubule modulates cAMP formation, Npt2a trafficking, and urinary phosphate excretion, which are highlighted by renal phosphate wasting in AC6 2/2 mice. 25: 282225: -283425: , 201425: . doi: 10.1681 Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) are the primary regulators of renal phosphate (P i ) excretion by the proximal tubule and critically involved in the regulation of P i balance and maintenance of plasma P i . PTH acts on the proximal tubule through the G s protein-coupled PTH 1 receptor (PTH 1 R) to stimulate adenylyl cyclase (AC) and, thus, the synthesis of cAMP and consecutive activation of protein kinase A (PKA). 1-3 After activation of PTH 1 R, the sodiumphosphate cotransporters Npt2a and Npt2c (approximately 70% and approximately 30% reabsorption of filtered P i , respectively) are retrieved from the apical plasma membrane, resulting in increased P i excretion. [4][5][6] In addition, cAMP-independent effects of PTH have been reported, 7 which may involve PTH 1 R action on phosphoinositide-specific phospholipase C (PLC) 8,9 and mitogen-activated protein kinases. 10,11 FGF-23 mediates its action in the proximal tubule through the FGF receptor/Klotho complex, which downregulates the expression of Npt2a and Npt2c. 12,13 Immunohistochemistry
J Am Soc Nephrol