And impaired cognition. In an atherosclerotic mouse model, the in vivo gene delivery of Klotho protects against endothelial dysfunction [12]. HMG-CoA reductase inhibition enhances the Klotho protein expression in the kidneys and inhibits atherosclerosis in rats with chronic blockade of nitric oxide synthase [13]. Emerging evidence suggests that a deficiency of Klotho is an early biomarker for CKD [14,15,16,17] and acute kidney injury [18]. There are two forms of Klotho, a membrane form and a secreted form, 25033180 and each has distinct functions. Membrane Klotho acts as an obligate co-receptor for FGF23, a bone-derived hormone that induces phosphate excretion into the urine [19]. Secreted Klotho is involved in the regulation of nitric oxide production in the endothelium [20,21], maintenance of endothelial integrity and permeability [22], calcium homeostasis in the kidneys [23] and inhibition of intracellular insulin and insulin-like growth factor-1 signaling [24]. Secreted Klotho Dimethylenastron site proteins are present in human sera and cerebrospinal fluid, suggesting that post-translational cleavage results in the release of Klotho proteins from the cell membrane [25]. The extracellular domain of Klotho is clipped by the membrane-anchored proteases ADAM10 and ADAM17 in order to generate the secreted form [26]. Recently, a sensitive and specific assay was developed for the measurement of soluble Klotho in humans [27]. Low serum Klotho levels have been reported to be associated with poor skeletal muscle strength [28] and the prevalence of CVD [29] and all-cause mortality [30] in community-dwelling adults. The expression of local vascular Klotho has been observed to decrease in human arteries in patients with CKD compared to healthy individuals [31]. Low serum Klotho levels have been reported in patients with diabetes mellitus [32]. However, whether the serum Klotho levels are closely related to signs of vascular dysfunction such as arterial stiffness in patients with CKD is largely unknown. We hypothesized that low serum Klotho levels are associated with signs of vascular dysfunction such as arterial stiffness in patients with CKD. To address this hypothesis, we measured the serum Klotho levels and extensively investigated the relationship between the serum Klotho level and signs of vascular dysfunction, including endothelial dysfunction, arterial stiffness, atherosclerosis and vascular calcification, in CKD patients. The data presented here suggest that a decrease in the serum soluble Klotho level is an independent biomarker of pronounced arterial stiffness in patients with CKD.and 14 with other agents). MedChemExpress ML 281 Antihyperlipidemic agents were administered to 35 patients and antidiabetic agents were administered to 16 patients. The median serum Klotho level was 616.3 pg/mL, with an interquartile range of 460.0 to 755.5 pg/ mL, the value of which was comparable to that reported in a previous study of CKD patients [17] and was higher than that in hemodialysis patients [33,34].Table 1. Baseline characteristics of the study subjects.CKD patients (n = 114) Age (year) Male 1081537 sex, n ( ) Cause of CKD, n Glomerulonephritis Nephrosclerosis Diabetic nephropathy Others Current medication, n ARBs/ACEIs CCBs MBP (mmHg) Serum calcium (mg/dL) Serum phosphate (mg/dL) FECa ( ) FEPi ( ) Intact PTH (pg/mL) 25D (ng/mL) 1,25D (pg/mL) FGF23 (pg/mL) Serum Klotho (pg/mL) LDL-cholesterol (mg/dL) HDL-cholesterol (mg/dL) Triglycerides (mg/dL) HbA1c (NGSP) ( ) CRP (mg/dL) eGFR (ml/min/1.73 m2) Albumin.And impaired cognition. In an atherosclerotic mouse model, the in vivo gene delivery of Klotho protects against endothelial dysfunction [12]. HMG-CoA reductase inhibition enhances the Klotho protein expression in the kidneys and inhibits atherosclerosis in rats with chronic blockade of nitric oxide synthase [13]. Emerging evidence suggests that a deficiency of Klotho is an early biomarker for CKD [14,15,16,17] and acute kidney injury [18]. There are two forms of Klotho, a membrane form and a secreted form, 25033180 and each has distinct functions. Membrane Klotho acts as an obligate co-receptor for FGF23, a bone-derived hormone that induces phosphate excretion into the urine [19]. Secreted Klotho is involved in the regulation of nitric oxide production in the endothelium [20,21], maintenance of endothelial integrity and permeability [22], calcium homeostasis in the kidneys [23] and inhibition of intracellular insulin and insulin-like growth factor-1 signaling [24]. Secreted Klotho proteins are present in human sera and cerebrospinal fluid, suggesting that post-translational cleavage results in the release of Klotho proteins from the cell membrane [25]. The extracellular domain of Klotho is clipped by the membrane-anchored proteases ADAM10 and ADAM17 in order to generate the secreted form [26]. Recently, a sensitive and specific assay was developed for the measurement of soluble Klotho in humans [27]. Low serum Klotho levels have been reported to be associated with poor skeletal muscle strength [28] and the prevalence of CVD [29] and all-cause mortality [30] in community-dwelling adults. The expression of local vascular Klotho has been observed to decrease in human arteries in patients with CKD compared to healthy individuals [31]. Low serum Klotho levels have been reported in patients with diabetes mellitus [32]. However, whether the serum Klotho levels are closely related to signs of vascular dysfunction such as arterial stiffness in patients with CKD is largely unknown. We hypothesized that low serum Klotho levels are associated with signs of vascular dysfunction such as arterial stiffness in patients with CKD. To address this hypothesis, we measured the serum Klotho levels and extensively investigated the relationship between the serum Klotho level and signs of vascular dysfunction, including endothelial dysfunction, arterial stiffness, atherosclerosis and vascular calcification, in CKD patients. The data presented here suggest that a decrease in the serum soluble Klotho level is an independent biomarker of pronounced arterial stiffness in patients with CKD.and 14 with other agents). Antihyperlipidemic agents were administered to 35 patients and antidiabetic agents were administered to 16 patients. The median serum Klotho level was 616.3 pg/mL, with an interquartile range of 460.0 to 755.5 pg/ mL, the value of which was comparable to that reported in a previous study of CKD patients [17] and was higher than that in hemodialysis patients [33,34].Table 1. Baseline characteristics of the study subjects.CKD patients (n = 114) Age (year) Male 1081537 sex, n ( ) Cause of CKD, n Glomerulonephritis Nephrosclerosis Diabetic nephropathy Others Current medication, n ARBs/ACEIs CCBs MBP (mmHg) Serum calcium (mg/dL) Serum phosphate (mg/dL) FECa ( ) FEPi ( ) Intact PTH (pg/mL) 25D (ng/mL) 1,25D (pg/mL) FGF23 (pg/mL) Serum Klotho (pg/mL) LDL-cholesterol (mg/dL) HDL-cholesterol (mg/dL) Triglycerides (mg/dL) HbA1c (NGSP) ( ) CRP (mg/dL) eGFR (ml/min/1.73 m2) Albumin.