Klotho is an aging-suppression protein predominantly expressed in kidney, parathyroid glands, and choroids plexus of the brain. The extracellular domain of Klotho, a type-1 membrane protein, is secreted into urine and blood and may function as an endocrine or paracrine hormone. The functional role of Klotho in the kidney remains largely unknown. Recent studies reported that treatment by the extracellular domain of Klotho (KLe) increases cell-surface abundance of transient receptor potential vanilloid type isoform 5, an epithelial Ca 2ϩ channel critical for Ca 2ϩ reabsorption in the kidney. Whether Klotho regulates surface expression of other channels in the kidney is not known. Here, we report that KLe treatment increases the cell-membrane abundance of the renal K ϩ channel renal outer medullary potassium channel 1 (ROMK1) by removing terminal sialic acids from N-glycan of the channel. Removal of sialic acids exposes underlying disaccharide galactose-Nacetylglucosamine, a ligand for a ubiquitous galactoside-binding lectin galectin-1. Binding to galectin-1 at the extracellular surface prevents clathrin-mediated endocytosis of ROMK1 and leads to accumulation of functional channel on the plasma membrane. Intravenous administration of KLe increases the level of Klotho in urine and increases urinary excretion of K ϩ . These results suggest that Klotho may have a broader function in the regulation of ion transport in the kidney.Mice homozygous for hypomorphic insertional mutation in the Klotho gene exhibit multiple phenotypes closely resembling human aging, including shortened life span, muscle and skin atrophy, pulmonary emphysema, osteopenia, hyperphosphatemia, and vascular and soft tissue calcification (Kuro-o et al., 1997). The encoded protein, Klotho, is a type-1 single-pass membrane protein with a large extracellular domain, a membrane-spanning segment, and a short (ϳ20 amino acids) intracellular carboxyl terminus (Kuro-o et al., 1997). Overexpression of Klotho extends life span in mice, supporting that Klotho is an aging-suppression molecule (Kurosu et al., 2005).The biological function of Klotho and how Klotho deficiency causes aging remain elusive. Klotho is predominantly expressed in distal renal tubules of the kidney, parathyroid glands, and choroids plexus of the brain (Kuro-o et al., 1997;Kurosu et al., 2005;Imura et al., 2007). The large extracellular domain of Klotho is cleaved by a membrane-anchored protease ADAM10 and secreted into blood, urine, and cerebrospinal fluid Kurosu et al., 2005;Chen et al., 2007). The presence of the extracellular domain of Klotho in blood, urine, and cerebrospinal fluid suggests that it may function as an endocrine or paracrine hormone. Recent studies have revealed distinct biological functions for membrane Klotho and the extracellular domain of Klotho Article, publication date, and citation information can be found at http://molpharm.aspetjournals.org. doi:10.1124/mol.109.055780.ABBREVIATIONS: FGF, fibroblast growth factor; KLe, extracellular domain of Klotho; KL1...