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#303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

The Peter Attia Drive

Sun May 26 2024



Klotho Protein and Brain Health:

  • Klotho, a protein associated with longevity, decreases by half during aging, with levels peaking upon waking due to a circadian rhythm.
  • Chronic stress is linked to lower klotho levels, while exercise significantly boosts klotho levels by about 30% after 12 weeks.
  • Methylation around the clotho promoter inhibits its transcription and translation as individuals age, impacting klotho production.
  • Studies show a direct correlation between shorter telomeres and lower klotho levels, suggesting an interplay in aging processes.
  • Klotho enhances cognition in mice across different ages and disease models like Alzheimer's and Parkinson's diseases.

Discovery of Clotho Gene:

  • The clotho gene was serendipitously discovered in 1997 by Makoto Kuroo during hypertension studies in mice.
  • Clotho codes for a transmembrane protein primarily produced in the kidney before being released as soluble clotho into the blood or cerebrospinal fluid.

Mechanism of Action - GluN2B Receptors:

  • Clotho enhances cognition through NMDA receptors' subunit GluN2B at synapses, promoting memory formation and synaptic plasticity.
  • Overexpression of GluN2B improves neural connections and memory efficiency, indicating their role in brain function.
  • Blocking GluN2B inhibits clotho's ability to enhance cognition, highlighting their interplay in brain health.

Peripheral Administration of Clothoprotein:

  • Despite not crossing the blood-brain barrier, peripheral administration of clothoprotein results in cognitive enhancement within hours lasting for weeks.
  • Studies suggest that clothoprotein may act through messengers sent from the blood into the brain to enhance cognitive functions.

Klotho's Impact on Brain Health in Mice:

  • Klotho was found to enhance cognition in mice, with a single klotho injection leading to long-lasting effects.
  • The study showed that platelet factor four (PF4) released by activated platelets enhanced cognition in both young and aging mice.
  • Clotho stimulated platelets to release PF4, which improved cognitive function in mouse models of Parkinson's and Alzheimer's diseases.
  • In the experiments conducted, clotho demonstrated the ability to activate platelets, leading to the release of PF4, ultimately enhancing brain health and cognitive functions in mice.

Clotho's Cognitive Enhancement in Primates:

  • Rhesus macaques were used as a model system due to their genetic diversity and anatomical complexity similar to humans.
  • Monkeys treated with klotho demonstrated better performance than those receiving a placebo in spatial memory tasks.
  • A low physiologic dose of clotho immediately enhanced cognition in monkeys, lasting for at least three weeks.
  • The study design involved rigorous testing methodologies such as spatial delayed response tasks to assess cognitive improvements accurately.

Dosing Strategies and Efficacy Across Species:

  • In mice, very low doses of clotho significantly enhanced cognition, even more so than higher supraphysiologic doses.
  • Dosing strategies aimed to stay within physiological levels while also testing higher doses up to 10-20 times the natural level.
  • The minimum effective dose in mice was more than five times less than the peak physiologic dose.
  • Researchers carefully considered dosing regimens across species, ensuring that the dosages remained within physiological ranges while exploring potential therapeutic benefits.

Longevity Factor Klotho's Potential Therapeutic Role:

  • Clotho treatment extended lifespan and normalized cognition across the lifespan of APP mutant mice overexpressing clotho.
  • Clotho provided resilience against Alzheimer's toxins without reducing amyloid beta or tau levels in the brain.
  • The potential use of clotho as a therapeutic agent for neurodegenerative diseases like Alzheimer’s and Parkinson’s is being explored.
  • Studies have shown promising results indicating that clotho could potentially serve as a protective agent against neurodegenerative conditions through its positive impact on neural circuits associated with memory and cognitive functions.

Implications for Human Clinical Trials:

  • There is interest in moving towards human clinical trials with clotho as a potential therapy for cognitive decline associated with neurodegenerative diseases like Alzheimer’s disease.
  • Clotho may offer protective benefits by enhancing brain health through its impact on neural circuits involved in memory and cognitive functions.

Klotho Protein and Cognitive Function:

  • Klotho, a protein associated with longevity, plays a vital role in brain health and cognitive function, offering protection against neurodegenerative diseases like Alzheimer's and Parkinson's.
  • Testing different doses of klotho in monkeys showed that high doses did not harm cognition but also did not enhance it compared to low doses.
  • In mice, continuous cognitive improvement was observed with klotho, indicating the necessity of determining the optimal therapeutic dose before human trials.

Potential Longevity Effects of Klotho Injection:

  • The long-lasting effects of a single klotho injection are intriguing due to its potential organizational impact on synaptic plasticity and cognitive function over time rather than just immediate enhancements.
  • Speculation exists around the idea that klotho may have an extended effect beyond acute improvements seen with interventions like exercise boosts.

Genetic Variant KLVS Associated with Cloth O Gene:

  • KLVS refers to two specific genetic variations affecting clotho protein levels in individuals.
  • Heterozygotes carrying one copy of KLVS exhibit better cognition across aging studies compared to non-carriers or homozygotes.

Association Between KLVS and APOE4 Genes:

  • Individuals carrying both KLVS and APOE4 genes demonstrated decreased risk for developing Alzheimer's disease and lower amyloid beta deposition.
  • The protective effect of KLVS seemed consistent regardless of APOE4 status, potentially mitigating the negative impact of APOE4 on Alzheimer's risk.

Impact of Homozygosity for KLVS:

  • Homozygotes for KLVS produce lower levels of clotho compared to non-carriers or heterozygotes, showing about a 30% decrease in clotho levels.
  • Studies indicate that homozygosity leads to decreased clotho levels by approximately 30% compared to non-carriers.