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  • Renalase as a novel biomarker for heart failure diagnosis
  • Laila Rejali,1,* Hashem Nayeri,2
    1. Department of Biochemistry, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
    2. Department of Biochemistry, Falavarjan Branch, Islamic Azad University, Isfahan, Iran


  • Introduction: Heart failure (HF) is a response to a previous cardiovascular injury presented that leads to increased intra-cardiac pressures or decreased cardiac output. Many biomarkers have been proposed for the timely diagnosis and prognostication of patients with heart failure. Renalase is an amine oxidase, which contains a flavin adenine dinucleotide–binding region that predominantly originates from the kidneys, as well as the heart, it is known to effectively degrade circulating catecholamines and to play a crucial role in human ischemia-related diseases.
  • Methods: Methods: PubMed databases were screened using the following search terms: ("renalase") AND (“heart failure.")
  • Results: Recent studies have shown that renalase exerts a more prominent cytoprotective role, independent of its catalytic activity, functioning as a cytokine with anti-inflammatory and anti-apoptotic properties, thus promoting cell survival. It was also reported that renalase prevented cardiac hypertrophy and interstitial fibrosis, as well as the adverse remodeling of the heart, by inhibiting profibrotic gene expression. Stojanovic et al. collected data from 75 H F participants and 35 community-based healthy volunteers. A comparison among patients with HF, including HF with a mid-range LV ejection fraction (LVEF, HFmrEF, 40–49 %) and HF with a preserved LVEF (HFpEF, LVEF ≥ 50 %), showed that the HF patients presented a higher plasma renalase concentration than patients in the control group and that this concentration was the highest in patients with a reduced LVEF (LVEF < 40 %). These findings suggested that the plasma renalase level could be measured to differentiate patients with an LVEF below 40 % and may serve as a potent biomarker for identifying HF patients with a reduced LVEF. Moreover, they also demonstrated that in patients with a reduced LVEF, high plasma renalase concentrations were positively correlated with LV hypertrophy and closely related to an increased LV mass index. A study demonstrated that elevated plasma renalase concentration (above 113 ng/mL), regardless of the LVEF, presents an independent risk factor for an increase in plasma concentrations of all evaluated cardiac remodeling biomarkers. Moreover, patients who presented with both, reduced EF (EF≤45) and elevated renalase levels were identified as the set with the greatest likelihood of having the highest plasma cardiac remodeling biomarker concentrations. Also demonstrated that HFrEF patients presented with higher renalase concentrations than HFpEF. Moreover, when both, elevated plasma renalase and heart failure, regardless of the EF being reduced or preserved, are present, that "partnership" represents a significant risk factor for an increase in the cardiac remodeling biomarkers` plasma concentration. However, regarding biomarkers from different pathophysiological domains, BNP and cystatin C, only the combination of elevated renalase and reduced EF demonstrates significance as a risk factor for their plasma elevation.
  • Conclusion: Plasma renalase concentration provided significant discrimination for the prediction of ischemia in patients with CHF and appeared to have similar discriminatory potential to that of BNP. Although further confirmatory studies are warranted, renalase seems to be a relevant biomarker for ischemia prediction, implying its potential contribution to ischemia-risk stratification.
  • Keywords: Renalase, Heart failure, Cardiac remodeling biomarkers