Klotho: A new therapeutic target in diabetic retinopathy?

Abstract

The prevalence of diabetes mellitus is increasing in resource limited settings. Simultaneously, there has been an increase in the number of novel therapies for the management of diabetes mellitus. However, use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings. Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes, and thus most likely to benefit from the therapy, are less likely to have negative budget impact for funders. To improve access, and reduce morbidity and mortality, requires alignment amongst key stakeholders including patient advocacy groups, health care professional councils, national departments of health, the pharmaceutical industry, treasury and finance departments.

Serum α-Klotho and fibroblast growth factor 23 levels are not associated with non-proliferative diabetic retinopathy in type 1 diabetes mellitus

“…Recent studies suggest novel molecular processes that may influence the development and severity of diabetic retinopathy. Two molecules of interest on which these studies have focused are α-Klotho and fibroblast growth factor-23 (FGF 23) 4 – 6 .…”

“…Additionally, decreased levels of α-Klotho in the lens of diabetic rats results in a decline in antioxidant defence and contribute to increased inflammation 17 . Studies have also demonstrated that the Klotho protein plays a crucial role in preserving the viability of the retinal pigment epithelium by promoting the growth of mitochondria and reducing oxidative stress, inhibiting endothelial cell apoptosis, enhancing autophagy, and counteracting epithelial mesenchymal transition 4 , 18 , 19 . Furthermore, it indirectly suppresses the secretion of vascular endothelial growth factor (VEGF) from the retinal pigment epithelium, preventing neovascularization, a critical step in the development of diabetic retinopathy, and helps to maintain the normal structure of blood vessels in the choroidal layer 20 .…”

“…Many laboratories and clinical studies have suggested that Klotho could be a potential solution for diabetic retinopathy 4 , 15 . However, there have been very few studies that have explored the connection between serum α-Klotho, FGF 23 levels and diabetic retinopathy, particularly in type 1 diabetes.…”