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Annexin A5 is a recombinant human protein belonging to the annexin family, known for its high affinity binding to phosphatidylserine in a calcium-dependent manner. It exhibits anti-inflammatory, anticoagulant, and anti-apoptotic properties. Mechanistically, annexin A5 inhibits pro-inflammatory responses by blocking lipopolysaccharide (LPS) and high-mobility group box-1 (HMGB1) binding to the Toll-like receptor 4/MD2 complex on cell surfaces. This leads to suppression of downstream signaling pathways such as MAPK and PI3K/Akt and ultimately reduces NF-κB activation and cytokine release (e.g., TNF-α, IL-1β). Preclinical studies have demonstrated that recombinant human annexin A5 improves organ function and survival in rodent models of sepsis by these mechanisms. Additionally, it has been shown to inhibit thrombin formation in sepsis models and downregulate tissue factor expression on cell surfaces. Annexin A5 is also widely used as an apoptosis marker due to its ability to bind exposed phosphatidylserine on apoptotic cells[1][3][6][7]. The drug candidate SY-005 (recombinant human annexin A5) has undergone phase 1 safety testing in healthy volunteers and phase 2 trials for severe COVID-19[7].
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