In addition, Courbabaisse et al. has shown, at least in vitro, that C-terminal FGF23 increases adult rat ventricular cardiomyocyte size by stimulation of FGF receptor 4 in the absence of co-stimulatory factor alpha-klotho, and in sickle cell disease patients that elevated cleaved FGF23 levels were associated with heart hypertrophy [48]. This evidence concerns the gene KL and sickle cell disease.