Sepsis represents a major cause of lethality during intensive care unit (ICU) treatment. Pharmacological treatment strategies for sepsis are still limited and mainly based on the early initiation of antibiotic and supportive treatment. In this context, numerous clinical and serum based markers have been evaluated for the diagnosis, the severity, and the etiology of sepsis. However until now, few of these factors could be translated into clinical use. MicroRNAs (miRNAs) do not encode for proteins but regulate gene expression by inhibiting the translation or transcription of their target mRNAs. Recently it was demonstrated that miRNAs are released into the circulation and that the spectrum of circulating miRNAs might be altered during various pathologic conditions, such as inflammation, infection, and sepsis. By using array- and single PCR-based methods, a variety of deregulated miRNAs, including miR-25, miR-133a, miR-146, miR-150, and miR-223, were described in the context of sepsis. Some of the miRNAs correlated with the disease stage, as well as patients’ short and long term prognosis. Here, we summarize the current findings on the role of circulating miRNAs in the diagnosis and staging of sepsis in critically ill patients. We compare data from patients with findings from animal models and, finally, highlight the challenges and drawbacks that currently prevent the use of circulating miRNAs as biomarkers in clinical routine.

Circulating MicroRNAs as Biomarkers for Sepsis

Sepsis is characterized as an uncontrolled host response to infection, and it represents a serious health challenge, causing excess mortality and morbidity worldwide. The discovery of sepsis-related epigenetic and molecular mechanisms could result in improved diagnostic and therapeutic approaches, leading to a reduced overall risk for affected patients. Accumulating data show that microRNAs, non-coding RNAs, and exosomes could all be considered as novel diagnostic markers for sepsis patients. These biomarkers have been demonstrated to be involved in regulation of sepsis pathophysiology. However, epigenetic modifications have not yet been widely reported in actual clinical settings, and further investigation is required to determine their importance in intensive care patients. Further studies should be carried out to explore tissue-specific or organ-specific epigenetic RNA-based biomarkers and their therapeutic potential in sepsis patients.

Non-coding RNAs and Exosomes: Their Role in the Pathogenesis of Sepsis.

Staphylococcus aureus Triggers Induction of miR-15B-5P to Diminish DNA Repair and Deregulate Inflammatory Response in Diabetic Foot Ulcers.

Over the past decade, evolutionarily conserved, noncoding small RNAs-so-called microRNAs (miRNAs)-have emerged as important regulators of virtually all cellular processes. miRNAs influence gene expression by binding to the 3'-untranslated region of protein-coding RNA, leading to its degradation and translational repression. In medicine, miRNAs have been revealed as novel, highly promising biomarkers and as attractive tools and targets for novel therapeutic approaches. miRNAs are currently entering the field of perioperative medicine, and they may open up new perspectives in anesthesia, critical care, and pain medicine. In this review, we provide an overview of the biology of miRNAs and their potential role in human disease. We highlight current paradigms of miRNA-mediated effects in perioperative medicine and provide a survey of miRNA biomarkers in the field known so far. Finally, we provide a perspective on miRNA-based therapeutic opportunities and perspectives.

/pdf/micrornas-as-clinical-biomarkers-and-therapeutic-tools-in-1tzrjdarlx.pdf

MicroRNAs as Clinical Biomarkers and Therapeutic Tools in Perioperative Medicine

Sepsis is one of the most common reasons for hospitalization. This condition is characterized by systemic inflammatory response to infection. International definition of sepsis mainly points out a multi-organ dysfunction caused by a deregulated host response to infection. An uncontrolled inflammatory response, often referred to as "cytokine storm", leads to an increase in oxidative stress as a result of the inhibition of cellular antioxidant systems. Oxidative stress, as well as pro-inflammatory cytokines, initiate vascular endothelial dysfunction and, in consequence, impair microcirculation. Microcirculation damage leads to adaptive modifications of cell metabolism. Moreover, mitochondrial dysfunction takes place which results in increased apoptosis and organ damage. Non-coding RNA fragments, especially miRNA molecules, may play an important role in the pathomechanism of sepsis. Numerous studies have indicated altered expression of various miRNAs in sepsis. miRNAs can be used as markers in the diagnosis and prognosis of disease development. In turn, intracellular miRNAs regulate the TLR4/NFκB pathway responsible for the expression of pro-inflammatory cytokine genes involved in the inflammatory response in sepsis. The understanding of detailed molecular mechanisms leading to organ damage can contribute to the development of specific therapy methods thereby improving the prognosis of patients with sepsis.

Molecular mechanisms of organ damage in sepsis: an overview

Infection in neonates, particular the neonatal sepsis continues to be a global problem with significant morbidity and mortality. The diagnosis of neonatal sepsis is complicated by nonspecific clinical symptomatology, a high-false negative rate, and a delay in obtaining blood culture results. MicroRNAs (miRNAs) have recently been used as finger prints for sepsis, and have been validated to be potential sepsis biomarker recently. In the present study, we investigated the level of several miRNAs, such as miR-15a, miR-16, miR-15b, and miR-223, which have been identified as a biomarker in adult sepsis, in neonatal sepsis patients, and then we analyzed the association of miR-15a/16 with the patient prognosis. Results demonstrated that the level of miR-15a/16 was up-regulated in neonatal sepsis patients than in normal neonatal subjects; however, no statistical difference was disclosed in the miR-15b and miR-223 level between two groups. And the ROC analysis indicated the miR-15a and miR-16 were potent fingerprints for diagnosing neonate sepsis. In order to explore the miR-15a/16 function on the lipopolysaccharide (LPS)-induced inflammatory pathway, the mice macrophage RAW264.7 cells were transiently transfected with miR-15a/16 mimics. And it was demonstrated that the miR-15a/16 transfection down-regulated the Toll-like receptor 4 (TLR4) and Interleukin-1 receptor-associated kinase 1 (IRAK-1) transcription level with a statistical difference in the LPS treated cells. And the suppression capability of miR-15a/16 on the expression of TLR-4 and IRAK-1 were evaluated by western blot. Thus, in present study, we identified miR-15a/16 as potential biomarker for the diagnosis and prognosis of neonatal sepsis, and the upregulated miR-15a/16 downregulated the LPS-induced inflammatory pathway.

miR-15a/16 are upreuglated in the serum of neonatal sepsis patients and inhibit the LPS-induced inflammatory pathway.

Objective: The influence of β2-microglobulin (β2-MG) on the prognosis of non-Hodgkin’s lymphoma (NHL) remains controversial. This study performed meta-analyses to evaluate the prognostic value of β2-MG on the overall survival (OS) of NHL. Methods: Through a search of relevant literature in PubMed, EMbase, Science Direct, OVID and Wanfang databases from 1980-2013, the hazard ratios (HRs) of OS between the normal β2-MG group and the increased β2-MG group were retrieved, and the results were combined using a fixed effect model and a random effect model. Subgroup analyses were performed based on univariate and multivariate analysis results, and sensitivity analyses were performed to estimate the changes of the combined HRs. In addition, funnel plots and fail-safe numbers were used to estimate publication bias. Results: A total of 17 qualified publications were included, with a cumulative total of 2,479 cases. The result of heterogeneity examination showed that there was heterogeneity among all studies (P < 0.001, I2 = 87%). In the random effect model, the combined HR was 2.71 (95% confidence interval [CI]: 1.91-3.85). The result of the total effect examination was statistically significant (Z = 5.59, P < 0.001). Conclusion: The increased β2-MG level was an independent risk factor for the prognosis of NHL.

Association of β2-microglobulin with the prognosis of non-Hodgkin's lymphoma: a meta analysis.

Effects of prophylactic oral ibuprofen on the closure rate of patent ductus arteriosus in premature infants

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miR-15a/16 are upreuglated in the serum of neonatal sepsis patients and inhibit the LPS-induced inflammatory pathway.

Association of β2-microglobulin with the prognosis of non-Hodgkin's lymphoma: a meta analysis.

Effects of prophylactic oral ibuprofen on the closure rate of patent ductus arteriosus in premature infants