IGFBP7 (insulin-like growth factor-binding protein 7) is a secreted protein that functions as a multivalent regulator of cellular homeostasis and tissue remodeling. Primary function: IGFBP7 binds IGF1 and IGF2 with relatively low affinity and acts as a ligand for CD93 to regulate angiogenesis 1. Additionally, it stimulates prostacyclin production and cell adhesion. Mechanism: IGFBP7 operates through multiple pathways—it functions downstream of TGF-β signaling in cardiac fibroblasts 2 and interacts with pyruvate kinase M2 (PKM2) to promote lipid accumulation and fibrosis via SREBP1-dependent mechanisms in renal tubular epithelial cells 3. In senescent endothelial cells, IGFBP7 overexpression exacerbates cardiac dysfunction by suppressing oxidative phosphorylation in cardiomyocytes 4. Disease relevance: IGFBP7 elevation is implicated in heart failure pathogenesis 2, chr4 kidney disease progression through renal fibrosis 3, and acute kidney injury (AKI) 5. Clinical significance: Urinary IGFBP7 combined with TIMP-2 demonstrates superior diagnostic accuracy (AUC 0.80) for predicting moderate-to-severe AKI compared to established biomarkers 5, and genome-wide studies implicate IGFBP7 variants in hyperemesis gravidarum pathogenesis 6. Inhibition of IGFBP7 via vaccine therapy or pharmacological antagonism may provide therapeutic benefits for heart failure and CKD.