Circulating microRNAs and Outcome in Patients with Acute Heart Failure.

BACKGROUND: The biomarker value of circulating microRNAs (miRNAs) has been extensively addressed in patients with acute coronary syndrome. However, prognostic performances of miRNAs in patients with acute heart failure (AHF) has received less attention. METHODS: A test cohort of 294 patients with acute dyspnea (236 AHF and 58 non-AHF) and 44 patients with stable chronic heart failure (CHF), and an independent validation cohort of 711 AHF patients, were used. Admission levels of miR-1/-21/-23/-126/-423-5p were assessed in plasma samples. RESULTS: In the test cohort, admission levels of miR-1 were lower in AHF and stable CHF patients compared to non-AHF patients (p = 0.0016). Levels of miR-126 and miR-423-5p were lower in AHF and in non-AHF patients compared to stable CHF patients (both p<0.001). Interestingly, admission levels of miR-423-5p were lower in patients who were re-admitted to the hospital in the year following the index hospitalization compared to patients who were not (p = 0.0001). Adjusted odds ratio [95% confidence interval] for one-year readmission was 0.70 [0.53-0.93] for miR-423-5p (p = 0.01). In the validation cohort, admission levels of miR-423-5p predicted 1-year mortality with an adjusted odds ratio [95% confidence interval] of 0.54 [0.36-0.82], p = 0.004. Patients within the lowest quartile of miR-423-5p were at high risk of long-term mortality (p = 0.02). CONCLUSIONS: In AHF patients, low circulating levels of miR-423-5p at presentation are associated with a poor long-term outcome. This study supports the value of miR-423-5p as a prognostic biomarker of AHF.

miRNAs as biomarkers of myocardial infarction: a step forward towards personalized medicine?

miRNAs are small noncoding RNAs known to post-transcriptionally regulate gene expression. miRNAs are expressed in the heart where they regulate multiple pathophysiological processes. The discovery of stable cardiac miRNAs in the bloodstream has also motivated the investigation of their potential as biomarkers. This review gathers the current knowledge on the use of miRNAs as novel biomarkers to improve risk stratification, diagnosis, and prognosis of patients with myocardial infarction. In the rapidly evolving era of biomarkers, the potential of miRNAs as promising tools to move personalized medicine a step forward is discussed.

Human muscle LIM protein dimerizes along the actin cytoskeleton and cross-links actin filaments.

The muscle LIM protein (MLP) is a nucleocytoplasmic shuttling protein playing important roles in the regulation of myocyte remodeling and adaptation to hypertrophic stimuli. Missense mutations in human MLP or its ablation in transgenic mice promotes cardiomyopathy and heart failure. The exact function(s) of MLP in the cytoplasmic compartment and the underlying molecular mechanisms remain largely unknown. Here, we provide evidence that MLP autonomously binds to, stabilizes, and bundles actin filaments (AFs) independently of calcium and pH. Using total internal reflection fluorescence microscopy, we have shown how MLP cross-links actin filaments into both unipolar and mixed-polarity bundles. Quantitative analysis of the actin cytoskeleton configuration confirmed that MLP substantially promotes actin bundling in live myoblasts. In addition, bimolecular fluorescence complementation (BiFC) assays revealed MLP self-association. Remarkably, BiFC complexes mostly localize along actin filament-rich structures, such as stress fibers and sarcomeres, supporting a functional link between MLP self-association and actin cross-linking. Finally, we have demonstrated that MLP self-associates through its N-terminal LIM domain, whereas it binds to AFs through its C-terminal LIM domain. Together our data support that MLP contributes to the maintenance of cardiomyocyte cytoarchitecture by a mechanism involving its self-association and actin filament cross-linking.

Adenosine stimulates the migration of human endothelial progenitor cells. Role of CXCR4 and microRNA-150.

BACKGROUND: Administration of endothelial progenitor cells (EPC) represents a promising option to regenerate the heart after myocardial infarction, but is limited because of low recruitment and engraftment in the myocardium. Mobilization and migration of EPC are mainly controlled by stromal cell-derived factor 1α (SDF-1α) and its receptor CXCR4. We hypothesized that adenosine, a cardioprotective molecule, may improve the recruitment of EPC to the heart. METHODS: EPC were obtained from peripheral blood mononuclear cells of healthy volunteers. Expression of chemokines and their receptors was evaluated using microarrays, quantitative PCR, and flow cytometry. A Boyden chamber assay was used to assess chemotaxis. Recruitment of EPC to the infarcted heart was evaluated in rats after permanent occlusion of the left anterior descending coronary artery. RESULTS: Microarray analysis revealed that adenosine modulates the expression of several members of the chemokine family in EPC. Among these, CXCR4 was up-regulated by adenosine, and this result was confirmed by quantitative PCR (3-fold increase, P<0.001). CXCR4 expression at the cell surface was also increased. This effect involved the A(2B) receptor. Pretreatment of EPC with adenosine amplified their migration towards recombinant SDF-1α or conditioned medium from cardiac fibroblasts. Both effects were abolished by CXCR4 blocking antibodies. Adenosine also increased CXCR4 under ischemic conditions, and decreased miR-150 expression. Binding of miR-150 to the 3' untranslated region of CXCR4 was verified by luciferase assay. Addition of pre-miR-150 blunted the effect of adenosine on CXCR4. Administration of adenosine to rats after induction of myocardial infarction stimulated EPC recruitment to the heart and enhanced angiogenesis. CONCLUSION: Adenosine increases the migration of EPC. The mechanism involves A(2B) receptor activation, decreased expression of miR-150 and increased expression of CXCR4. These results suggest that adenosine may be used to enhance the capacity of EPC to revascularize the ischemic heart.

MicroRNA-16 affects key functions of human endothelial progenitor cells.

The capacity of EPCs to repair injured tissues is limited. The role of miRNAs in EPCs is largely unknown. We tested whether miRNAs may be useful to enhance the regenerative capacity of EPCs. Early EPCs were isolated from human PBMCs, and late EPCs were amplified from enriched human peripheral CD34(+) cells. Expression profiles of miRNAs and mRNAs were obtained by microarrays. Among the miRNAs differentially expressed between early and late EPCs, five members of the miR-16 family (miR-15a/-15b/-16/-103/-107) were overexpressed in early EPCs. Web-accessible databases predicted 375 gene targets for these five miRNAs. Among these, two regulators of cell cycle progression (CCND1 and CCNE1) and one associated gene (CDK6) were less expressed in early EPCs. Administration of anti-miR-16 in early EPCs enhanced the expression of these three genes, and administration of pre-miR-16 in late EPCs decreased their expression. In early EPCs, antagonism of miR-16 allowed for cell-cycle re-entry, stimulated differentiation, enhanced IL-8 secretion, and promoted the formation of capillary-like structures by HUVECs. In conclusion, miR-16 regulates key biological pathways in EPCs. This may have important implications to enhance the capacity of EPCs to repair injured tissues.

Circulating microRNAs after cardiac arrest.

OBJECTIVE: Prediction of clinical outcome after cardiac arrest is clinically important. While the potential of circulating microRNAs as biomarkers of acute coronary syndromes is an active field of investigation, it is unknown whether microRNAs are associated with outcome in cardiac arrest patients. DESIGN: Prospective, single-center proof-of-concept study. SETTING: Eighteen-bed adult general intensive care unit of an academic tertiary care hospital in Luxembourg. PATIENTS: Twenty-eight patients with cardiac arrest treated by therapeutic hypothermia after cardiac resuscitation were enrolled. MEASUREMENTS AND MAIN RESULTS: Blood samples were obtained at 48 hrs after cardiac arrest for the determination of microRNA levels and neuron-specific enolase. Neurological outcome was determined by the cerebral performance category at discharge from the intensive care unit and at 6-month follow-up. Analysis of microRNA arrays and quantitative assessment by polymerase chain reaction identified two microRNAs, miR-122 and miR-21, overexpressed in patients with poor neurological outcome (cerebral performance category 3-5, n = 14) compared to patients with favorable neurological outcome (cerebral performance category 1-2, n = 14) (48-fold and three-fold, respectively). In vitro experiments showed that both miR-122 and miR-21 are produced by neuronal cells, indicating that the elevation of circulating levels of these microRNAs after cardiac arrest may reflect brain damage. miR-122 and miR-21 predicted neurological outcome with areas under the receiver operating characteristic curve of 0.73 and 0.77, respectively. Patients within the highest third of miR-122 or miR-21 values had elevated mortality rate (p = .02). Neuron-specific enolase was an accurate predictor of neurological outcome (areas under the receiver operating characteristic curve = 0.98) and mortality (p < .001). MicroRNA levels were not associated with myocardial damage or activation of inflammation. CONCLUSIONS: As compared to neuron-specific enolase, circulating microRNAs are modest but significant predictors of neurological outcome and mortality in this small group of patients with cardiac arrest. This motivates assessing the prognostic value of microRNAs in larger cohorts of cardiac arrest patients.

MicroRNAs in patients on chronic hemodialysis (MINOS study).

BACKGROUND AND OBJECTIVES: Diagnosis of acute myocardial injury with biomarkers is difficult in patients with advanced renal failure. Circulating microRNAs are promising new biomarkers of myocardial injury. It is unknown whether levels of microRNAs are affected in patients undergoing hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: High-sensitivity cardiac troponin T (hsTnT) and cardiac-enriched miR-499 were measured in 41 patients with ESRD undergoing hemodialysis and 41 controls. RESULTS: Levels of hsTnT and miR-499 were highly elevated in patients with ESRD compared with controls (>80-fold increase; P<0.001). Among patients with ESRD, 98% had positive hsTnT levels and 46% had positive miR-499 levels. Levels of troponins were not affected by hemodialysis. However, miR-499 levels were decreased after hemodialysis (6.5-fold decrease; P=0.002). CONCLUSIONS: Both miR-499 and troponins are elevated in patients with advanced renal failure. However, whereas levels of troponins are unaffected by hemodialysis, this is not the case for miR-499. Therefore, these observations mitigate the potential of miR-499 as a marker of myocardial injury in patients with ESRD.

Use of circulating microRNAs to diagnose acute myocardial infarction.

BACKGROUND: Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS: Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS: miRNA-208b and miR-499 were highly increased in MI patients (>10(5)-fold, P < 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non-ST-elevation MI (n = 113) (P < 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P < 10(-9)). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented <3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION: Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.