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Soluble Klotho protein (sKlotho) is a circulating endocrine hormone and a cleaved form of the transmembrane α-Klotho protein, which is primarily expressed in the kidneys. It is under preclinical development as a recombinant protein therapeutic for the treatment of chronic kidney disease (CKD), acute kidney injury (AKI), cardiovascular conditions, and age-related cognitive decline. Soluble Klotho acts as an obligate co-receptor for fibroblast growth factor 23 (FGF23) to regulate phosphate excretion and vitamin D metabolism. Additionally, it exerts FGF23-independent cytoprotective, anti-oxidative, anti-inflammatory, and anti-fibrotic effects by modulating Wnt/β-catenin, TGF-β1/Smad, and IGF-1 signaling pathways, thereby protecting tissues from oxidative stress and cellular senescence.
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