Nephrotic Syndrome (NS), is a well-defined combination of clinical and laboratory findings characterized by proteinuria, hypoalbuminemia, hyperlipidemia and edema . According to the National Vital Statistics Report 2012, NS and associated kidney diseases are the 9th leading cause of deaths in USA. Due to cumulative steroid therapy, intermittent hyperlipidemia and overt proteinuria, thromboembolism turned up as one of the major complications of NS. The incidence of thromboembolism is 25% in adults and 3% in children.

The major risk factors during the series of events starting from NS to cardiovascular disease includes hyperlipidemia, elevated oxidative stress, deregulated Extra Cellular Matrix (ECM) proteases, imbalanced pro-coagulant-anti-coagulant proteins and hypoalbuminemia. The present study deals with the role of an anticoagulant protein called Annexin A5 (AnxA5) and its function as a cardiac risk factor in NS. Annexin is a multiprotein family consisting of more than 160 proteins. AnxA5 is a glycoprotein which binds to negatively charged phospholipids, with high affinity and in a calciumdependent manner. This characteristic of AnxA5, also inhibits the prothrombinase complex and the tenase complex in-vitro, resulting in potent anticoagulant activity. AnxA5 can bind to the phosphatidyl-serine of apoptotic cells, and thereby inhibiting the procoagulant and proinflammatory activities of the dying cells. The level of circulating AnxA5 reflects the severity of cell damage and inflammation. An excellent review gives further information on its detailed structure, properties and boundless functions.

AnxA5 levels were elevated immediately after Myocardial Infarction (MI) and it was observed to correlate with the extent of apoptosis. Immunocytochemical studies identified AnxA5 and A6 in both myocytes and non-myocytes in a variety of species. Most of these reported increased concentrations of AnxA5 along the sarcolemma and Z line in cardiomyocytes. During end-stage heart failure the levels of Annexin A6 fall in cardiomyocytes whereas those of annexins A2 and A5 rise. The high levels of plasma AnxA5 in patients with acute MI, cardiac arrest and severe trauma reflects the severity of damage of the myocardium and/or other visceral organs, and measurement of plasma AnxA5 concentration may help to assess the prognosis of patients brought to the emergency room.

Kamel et al. studied the urinary AnxA5 concentration in NS and it was found to be elevated in responders of cyclophosphamide. Twenty four-hour urinary AnxA5 excretion may be a prognostic marker in children with NS [10]. Matsuda et al. suggested that a high urinary AnxA5 concentration may be an indicator of acute renal injury. No studies have investigated the role of AnxA5 as a cardiac risk factor in NS patients. Therefore, the present study measures the serum AnxA5 levels in NS cases before and after steroid therapy and compare with that of the healthy controls. Correlation of AnxA5 with lipid profile and atherogenic Index was also performed to assess the cardiovascular risk.

IPBM cordially invites you to submit your research work on this topic. We accept Research/ Review/ Case reports/ Short communication/ Commentary articles. Submissions can be made online through Editorial tracking system present in our journal homepage or through email as an attachment to mailto:biomarkers@imedjournals.com

Regards
Denise Williams
Managing Editor
Biomarkers Journal