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advantage of measuring the net effects of serum on IGF1R activation, as it does not ignore the modifying effects of IGFBPs, IGFBP proteases, and other factors that interact between IGFs and the IGF1R (3, 4) . One of these factors might be soluble Klotho (S-Klotho
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Nabeshima Y . Klotho, a gene related to a syndrome resembling human premature aging, functions in a negative regulatory circuit of vitamin D endocrine system . Molecular Endocrinology 2003 17 2393 – 2403 . ( https://doi.org/10.1210/me.2003-0048 ) 9
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phosphate ( 5 ). alpha Klotho (KLA) is a newly discovered antiaging protein mainly synthesized by kidney distal convoluted tubules and excreted by glomerular filtration ( 6 ). While the binding affinity of FGF23 to FGFR1 is rather low, KLA can significantly
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). FGF21 exerts its biological actions through binding to FGF receptors (FGFRs) and an essential co-receptor, β-klotho ( 7 ), forming the FGF21 receptor complex. FGF21 is produced predominantly in the liver ( 4 , 8 ). Adipose tissue is a primary target
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). Accordingly, parathyroidectomy reduces bone turnover, improves BMD and reduces long-term risk for fractures, as observed in CKD stage 5D patients ( 48 , 49 , 50 ). The phosphate/FGF23/Klotho axis The skeleton is the main storage site and one of the
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Murakami M Moriyama T Yamauchi-Takihara K. Klotho-related molecules upregulated by smoking habit in apparently healthy men: a cross-sectional study . Scientific Reports 2015 5 14230 . (doi:10.1038/srep14230) 11 Nakanishi K Nishida M Yamamoto R
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be useful in the monitoring of patients. Recent studies have identified a new serum biomarker that could potentially be used to complement GH and IGF1 as indicators of active acromegaly. Excessive levels of soluble Klotho (sKlotho) have been observed
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. Regulation and function of the FGF23/klotho endocrine pathways . Physiological Reviews 2012 92 131 – 155 . ( https://doi.org/10.1152/physrev.00002.2011 ) 13 Isakova T Xie H Barchi-Chung A Vargas G Sowden N Houston J Wahl P Lundquist A
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co-receptor α-Klotho (4) binds to the FGF receptor (FGFR) to initiate the internalisation of sodium P transporters NaPi-2a (SLC34A1) and NaPi-2c (SLC34A3) (5) . In diseased states where FGF23 concentration is elevated, the net result is an
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are elevated in various metabolic diseases, such as obesity, insulin resistance, and type 2 diabetes mellitus ( 67 , 68 ). In addition, serum concentrations of FGF21, soluble α-klotho, and interleukin 6 are significantly higher in male smokers