Circulating miRNAs as Promising Biomarkers to Evaluate ECMO Treatment Responses in ARDS Patients

Abstract

The use of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) has increased in the last decade. However, mortality remains high, and the complexity of ECMO requires individualized treatment. There are some biomarkers to monitor progression and predict clinical outcomes of ARDS. This project aims to advance the management of ARDS patients treated with ECMO by exploring miRNA expression in whole blood. The analysis was conducted on two groups with different length of ECMO: Group A (longer runs) and group B (shorter runs). We analyzed miRNAs before ECMO cannulation, and at 7 and 14 days of ECMO support. Our results showed that in the group B patients, 11 deregulated miRNAs were identified, and showed an opposite trend of expression compared to the group A patients. In silico analysis revealed that these 11 miRNAs were related to processes involved in the pathogenesis and evolution of ARDS. This scenario could represent homeostatic mechanisms by which, in ECMO responsive patients, pathways activated during ARDS progression are switched-off. Circulating miRNAs could represent promising biomarkers to monitor the evolution of ARDS under ECMO support. Further studies may shed light on this topic to improve a personalized approach in such a complex setting of patients.

Challenges in the Extracorporeal Membrane Oxygenation Era

“…An interesting review by Marchiori et al reviewed the current scientific literature about ECMO donors, focusing on the use of ECMO tissues as allografts [8]-a topic that will be probably become relevant in the next years. As an ideal conclusion of this chapter, two original studies focused on outcomes of ARDS patients supported by ECMO; Chiu [9] showed that propensity score-matched ARDS patients treated with ECMO are more likely to survive than patients on conventional protective mechanical ventilation, and this benefit seemed greater for the most severe patients and when the extracorporeal support was initiated early (i.e., within 48 h); Martucci and colleagues [10] defined a set of microRNAs which may provide new insights on the processes involved in the pathogenesis and evolution of ARDS and may represent promising biomarkers to evaluate ongoing treatments and for prognostication.…”