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Eur Heart J. 2018 Apr 24. doi: 10.1093/eurheartj/ehy234. [Epub ahead of print]

Circulating non-coding RNAs in biomarker-guided cardiovascular therapy: a novel tool for personalized medicine?

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Biomedical Research Institute Sant Pau (IIB Sant Pau), Av. Sant Antoni Maria Claret 167, Pavelló del Convent, 08025 Barcelona, Spain.
Institute of Health Carlos III, CIBERCV, Av. Monforte de Lemos 5, 28029 Madrid, Spain.
Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), C/ Rosselló 161, 08036 Barcelona, Spain.
National Heart and Lung Institute, Imperial College London, Dovehouse Street, SW3 6LR, London, UK.
Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, C/ Sardenya 466, 08025 Barcelona, Spain.
Excellence Cluster REBIRTH, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.


Current clinical guidelines emphasize the unmet need for technological innovations to guide physician decision-making and to transit from conventional care to personalized cardiovascular medicine. Biomarker-guided cardiovascular therapy represents an interesting approach to inform tailored treatment selection and monitor ongoing efficacy. However, results from previous publications cast some doubts about the clinical applicability of biomarkers to direct individualized treatment. In recent years, the non-coding human transcriptome has emerged as a new opportunity for the development of novel therapeutic strategies and biomarker discovery. Non-coding RNA (ncRNA) signatures may provide an accurate molecular fingerprint of patient phenotypes and capture levels of information that could complement traditional markers and established clinical variables. Importantly, ncRNAs have been identified in body fluids and their concentrations change with physiology and pathology, thus representing promising non-invasive biomarkers. Previous publications highlight the translational applicability of circulating ncRNAs for diagnosis and prognostic stratification within cardiology. Numerous independent studies have also evaluated the potential of the circulating non-coding transcriptome to predict and monitor response to cardiovascular treatment. However, this field has not been reviewed in detail. Here, we discuss the state-of-the-art research into circulating ncRNAs, specifically microRNAs and long non-coding RNAs, to support clinical decision-making in cardiovascular therapy. Furthermore, we summarize current methodological and conceptual limitations and propose future steps for their incorporation into personalized cardiology. Despite the lack of robust population-based studies and technical barriers, circulating ncRNAs emerge as a promising tool for biomarker-guided therapy.


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