FSTL1 comprises a secretion signal, a Follistatin- and a Kazal-like domain, two EF-hand domains, and a von Willebrand factor type C domain . The human FSTL1 protein sequence (Genbank: Q12841) is highly similar to the mouse sequence (Genbank Q62356), with a high degree of similarity in the remaining 272 amino acids .
FSTL1 is involved in multiple signaling pathways and biological processes, including vascularization and regulation of the immune response . It displays expression changes during development and disease, such as cardiovascular disease, cancer, and arthritis . The cardioprotective role of FSTL1 has been intensively studied, though its mechanism of action remains elusive .
FSTL1 binds to various receptors, including DIP2A, TLR4, and BMP receptors, but other molecular partners likely exist . The glycosylation state of FSTL1 is a determinant of its biological activity, with the glycosylated form promoting proliferation in cardiomyocytes and the non-glycosylated form working anti-apoptotic . Additionally, the glycosylation state shows differences between species and tissues, which might underlie the differences observed in in vitro studies .
FSTL1 has been reported to be upregulated in the sera of patients with various cardiovascular diseases (CVDs) . It is associated with CVD and predicts poor outcomes . Animal studies have shown that FSTL1 has a protective effect in various models of heart disease, including inhibiting inflammation, preventing remodeling and fibrosis, and promoting angiogenesis and hypertrophy .