Circulating MicroRNAs for Diagnosis of Acute Pulmonary Embolism: Still a Long Way to Go

Abstract

Venous thromboembolism (VTE) represents the third most frequent cause of acute cardiovascular syndrome. Among VTE, acute pulmonary embolism (APE) is the most life-threatening complication. Due to the low specificity of symptoms clinical diagnosis of APE may be sometimes very difficult. Accordingly, the latest European guidelines only suggest clinical prediction tests for diagnosis of APE, eventually associated with D-dimer, a biomarker burdened by a very low specificity. A growing body of evidence is highlighting the role of miRNAs in hemostasis and thrombosis. Due to their partial inheritance and susceptibility to the environmental factors, miRNAs are increasingly described as active modifiers of the classical Virchow’s triad. Clinical evidence on deep venous thrombosis reported specific miRNA signatures associated to thrombosis development, organization, recanalization, and resolution. Conversely, data of miRNA profiling as a predictor/diagnostic marker of APE are still preliminary. Here, we have summarized clinical evidence on the potential role of miRNA in diagnosis of APE. Despite some intriguing insight, miRNA assay is still far from any potential clinical application. Especially, the small sample size of cohorts likely represents the major limitation of published studies, so that extensive analysis of miRNA profiles with a machine learning approach are warranted in the next future. In addition, the cost-benefit ratio of miRNA assay still has a negative impact on their clinical application and routinely test.

Identification of Genes and miRNAs Associated with TAFI-Related Thrombosis: An in Silico Study

“…In the context of clinical applications, the combination of miRNA biomarkers and/or miRNA microchips with commonly used biomarkers for thrombotic diseases such as D-dimer has been proposed as a promising predictive tool for PE occurrence and prognosis [ 56 ]. In addition, it has been reported that the implementation of machine learning approaches will be a requisite in the future for establishing the sensitivity of miRNAs and their clinical relevance in acute PE, which represents the most serious complication of venous thromboembolism, thus necessitating early diagnosis and treatment [ 57 ]. These reports denote the importance of investigating miRNA-mediated gene expression regulation in the context of hemostasis and thrombosis.…”

Diagnostic accuracy of adropin as a preliminary test to exclude acute pulmonary embolism: a prospective study

“…Apelin, fibulins, haemopexin, a2-macroglobulin, Ig a1-chain C region, TNF-α, HMGB1, neutrophil-to-lymphocyte ratio and albumin are among the other biomarkers whose effectiveness has been investigated in the diagnosis of pulmonary embolism [21][22][23][24][25][26]. miRNA studies on this subject have stated that these new methods and technologies can be deployed to discover new specific clinical diagnosis and risk stratification biomarkers, diagnostic schedules, and treatment protocols for pulmonary embolism [27,28]. In our study, the relationship between adropin and PE was investigated (Fig.…”

Extracellular traps and the role in thrombosis

“…VTE, which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE) ( 96 ), ranks third among all causes of acute cardiovascular syndrome ( 97 ). DVT causes post-thrombotic syndrome, whereas PE causes chronic pulmonary hypertension.…”