Abstract-In this study, to search for novel preeclampsia (PE) biomarkers, we focused on microRNA expression and function in the human placenta complicated with PE. By comprehensive analyses of microRNA expression, we identified 22 microRNAs significantly upregulated in preeclamptic placentas, 5 of which were predicted in silico to commonly target the mRNA encoding hydroxysteroid (17-) dehydrogenase 1 (HSD17B1), a steroidogenetic enzyme expressed predominantly in the placenta. In vivo HSD17B1 expression, at both the mRNA and protein levels, was significantly decreased in preeclamptic placentas. Of these microRNAs, miR-210 and miR-518c were experimentally validated to target HSD17B1 by luciferase assay, real-time PCR, and ELISA. Furthermore, we found that plasma HSD17B1 protein levels in preeclamptic pregnant women reflected the decrease of its placental expression. Moreover, a prospective cohort study of plasma HSD17B1 revealed a significant reduction of plasma HSD17B1 levels in pregnant women at 20 to 23 and 27 to 30 weeks of gestation before PE onset compared with those with normal pregnancies. The sensitivities/specificities for predicting PE at 20 to 23 and 27 to 30 weeks of gestation were 0.75/0.67 (cutoff valueϭ21.9 ng/mL) and 0.88/0.51 (cutoff valueϭ30.5 ng/mL), and the odds ratios were 6.09 (95% CI: 2.35-15.77) and 7.83 (95% CI: 1.70 -36.14), respectively. We conclude that HSD17B1 is dysregulated by miR-210 and miR-518c that are aberrantly expressed in preeclamptic placenta and that reducing plasma level of HSD17B1 precedes the onset of PE and is a potential prognostic factor for PE. (Hypertension. 2012;59:265-273.) • Online Data Supplement Key Words: preeclampsia Ⅲ microRNA Ⅲ biomarker Ⅲ placenta Ⅲ prospective cohort study T he pathophysiology and etiology of preeclampsia (PE) remain largely unknown, and its final diagnosis can only be made when symptoms have regressed after delivery. 1 Thus, it is of clinical significance to predict PE before its onset. Dysregulation of the serum levels of angiogenic/ antiangiogenic factors has been demonstrated previously; examples include placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), and soluble endoglin. [2][3][4] However, these proteins may not sufficiently characterize the clinical features and pathophysiological mechanisms of PE onset. 5 If there are any other parameters of which serum levels change in PE, they may illustrate the pathophysiology of PE in a manner different from the previous studies.MicroRNAs (miRNAs), small noncoding RNAs of Ϸ22 nucleotides in length, play a critical role in posttranscriptional gene regulation. 6,7 Although many miRNAs are ubiquitously expressed in mammals, some miRNAs exhibit specific expression patterns in an organ-or cell-type-dependent manner. 8 For instance, miRNAs derived from the miRNA cluster in human chromosome 19, a primate-specific miRNA cluster encompassing 46 miRNAs in the human genome, 9 have been demonstrated to exhibit a placenta-specific expression pattern. 10 Although a few studi...