Research Paper Volume 15, Issue 15 pp 7381—7396

Associations between klotho and telomere biology in high stress caregivers

Ryan L. Brown1, , Elissa E. Epel1, , Jue Lin2, , Dena B. Dubal3, , Aric A. Prather1, ,

  • 1 Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94107, USA
  • 2 Department of Biochemistry and Biophysics, University of California, San Francisco, CA 94107, USA
  • 3 Department of Neurology and Weill Institute of Neurosciences, University of California, San Francisco, CA 94107, USA

Received: March 24, 2023       Accepted: July 6, 2023       Published: August 14, 2023
How to Cite

Copyright: © 2023 Brown et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Aging biomarkers may be related to each other through direct co-regulation and/or through being regulated by common processes associated with chronological aging or stress. Klotho is an aging regulator that acts as a circulating hormone with critical involvement in regulating insulin signaling, phosphate homeostasis, oxidative stress, and age-related inflammatory functioning. Both klotho and telomere length are biomarkers of biological aging and decrease with age; however, the relationship between them is not well understood. Here we test the association between klotho levels and the telomere length of specific sorted immune cells among a healthy sample of mothers caregiving for a child with autism spectrum disorder (ASD; i.e., experiencing higher caregiving stress) or a child without ASD, covarying age and body mass index, in order to understand if high stress associated with caregiving for a child with an ASD may be involved in any association between these aging biomarkers. In 178 caregiving women (n = 90 high-stress mothers of children with ASD, n = 88 low-stress mothers of neurotypical children), we found that klotho levels were positively associated with telomere length in PBMCs (an effect driven by CD4+ and CD8+CD28− T cells) among high-stress mothers of children with an ASD but not among low-stress mothers of neurotypical children. There were no significant associations between klotho and telomerase activity in either group, across cell types assessed here. Our results suggest that klotho levels and telomere length may be associated through a coordinated downregulation of longevity factors occurring under higher stress caregiving conditions.


ASD: autism spectrum disorder; PBMC: peripheral blood mononuclear cells; TL: telomere length; TA: telomerase activity.