title: αKlotho and Chronic Kidney Disease.
abstract: Alpha-Klotho (αKlotho) protein is encoded by the gene, Klotho, and functions as a coreceptor for endocrine fibroblast growth factor-23. The extracellular domain of αKlotho is cleaved by secretases and released into the circulation where it is called soluble αKlotho. Soluble αKlotho in the circulation starts to decline in chronic kidney disease (CKD) stage 2 and urinary αKlotho in even earlier CKD stage 1. Therefore soluble αKlotho is an early and sensitive marker of decline in kidney function. Preclinical data from numerous animal experiments support αKlotho deficiency as a pathogenic factor for CKD progression and extrarenal CKD complications including cardiac and vascular disease, hyperparathyroidism, and disturbed mineral metabolism. αKlotho deficiency induces cell senescence and renders cells susceptible to apoptosis induced by a variety of cellular insults including oxidative stress. αKlotho deficiency also leads to defective autophagy and angiogenesis and promotes fibrosis in the kidney and heart. Most importantly, prevention of αKlotho decline, upregulation of endogenous αKlotho production, or direct supplementation of soluble αKlotho are all associated with attenuation of renal fibrosis, retardation of CKD progression, improvement of mineral metabolism, amelioration of cardiac function and morphometry, and alleviation of vascular calcification in CKD. Therefore in rodents, αKlotho is not only a diagnostic and prognostic marker for CKD but the enhancement of endogenous or supplement of exogenous αKlotho are promising therapeutic strategies to prevent, retard, and decrease the comorbidity burden of CKD.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, United States; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States.
authors.forename: J A
authors.initials: JA
authors.lastname: Neyra
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, United States; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: ming-chang.hu@utsouthwestern.edu.
authors.forename: M C
authors.initials: MC
authors.lastname: Hu
mesh_terms: D000818:Animals; D015415:Biomarkers; D002318:Cardiovascular Diseases; D044127:Epigenesis, Genetic; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors; D005786:Gene Expression Regulation; D005966:Glucuronidase / Q000172:deficiency / Q000235:genetics / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000378:metabolism; D000090265:Klotho Proteins; D008903:Minerals / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D008903:Minerals; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D005966:Glucuronidase; D000090265:Klotho Proteins
keywords: Cardiovascular disease; Chronic kidney disease; FGF23; Hyperphosphatemia; Klotho; Uremic cardiomyopathy; Vascular calcification