Identification of new circulating biomarkers for the characterization and non-invasive diagnosis of cardiac rejection
- Autores: Lorena Pérez Carrillo
- Directores de la Tesis: Estefanía Tarazón Melguizo (dir. tes.), Manuel Portolés Sanz (dir. tes.), Esther Roselló Lletí (dir. tes.), Adelaida García Gimeno (tut. tes.)
- Lectura: En la Universitat Politècnica de València ( España ) en 2024
- Idioma: inglés
- Tribunal Calificador de la Tesis: M. Eugenia González Barderas (presid.), Pilar Medina Badenes (secret.), Jesús Cosin Roger (voc.)
- Programa de doctorado: Programa de Doctorado en Biotecnología por la Universitat Politècnica de València
- Materias:
- Enlaces
- Tesis en acceso abierto en: RiuNet
- Resumen
Approximately 57 million adults globally suffer heart failure and heart transplantation remains the gold standard therapy, in the absence of contraindications, in advanced heart failure patients. Despite improvements in immunosuppressive treatment one of the main events after transplant is acute rejection (acute cellular rejection (ACR) and antibody-mediated rejection (AMR)). Endomyocardial biopsy (EMB) is the standard technique for monitoring acute rejection, but EMB presents important limitations such as its invasive nature. Therefore, the identification of non-invasive methods to reduce or eliminate surveillance EMB is an important and necessary open field of study. Liquid biopsy is a potential alternative to replace EMB due to its less invasive nature and capability to reflect pathophysiological changes produced in organs during an event. The omics approaches have allowed the discovery of free molecules circulating in the bloodstream as biomarkers of disease, highlighting the potential of RNAs for their role in inflammatory processes, tissue specificity and stability in biological fluids. Therefore, this Doctoral Thesis have focused on identifying altered circulating cell-free mRNAs, miRNAs, lncRNAs, and piRNAs in the bloodstream after heart transplantation from a transcriptomic approach and studying the diagnostic capacity for its use as biomarkers of cardiac rejection (ACR [non-rejection (0R), mild (1R) and moderate-severe (greater than or equal to2R)], and AMR [non-rejection (pAMR0) and histopathologic and immunopathologic rejection (pAMR2)]).
The results obtained in this Doctoral Thesis showed deregulation in several biotypes of cell-free RNAs after heart transplantation in rejection conditions. We observed alterations in genes related to the sarcomere; and the gene that encodes cardiac alpha-actin (ACTC1) showed the best diagnostic capacity (grade greater than or equal to2R: AUC=1.000, p<0.0001). Furthermore, we determined ACTC1 protein levels in a larger cohort of patients, corroborating previous findings (AUC=0.702, p<0.05). Moreover, we identified several miRNAs altered in the serum of patients with ACR, specifically miR-144-3p showed the best results. In the validation phase it had excellent diagnostic capacity for moderate-severe rejection (AUC=0.801 p<0.0001); however, its ability to detect mild rejection was limited (AUC=0.631, p<0.01). Thus, we analysed and validated the combination of miR-144-3p and miR-652-3p, another miRNA identified in the discovery phase. The combination improved diagnostic power for moderate-severe rejection (AUC=0.892, p<0.0001) and mild (AUC =0.794, p<0.0001) rejection. Furthermore, we analysed for the first time the presence in serum of other biotypes of ncRNA (lncRNA and piRNA) after heart transplantation. Specifically, we identified 5 lncRNAs (AC008105.3, AC006525.1, AC011455.8, AL359220.1, and AC025279.1) with excellent diagnostic capacity for detection of greater than or equal to2R (AUC of 0.850 to 1.000) and 1R (AUC of 0.750 to 0.854) grades. On the other hand, we identified 7 piRNAs (piR-169894, piR-181318, piR-1981088, piR-2479902, piR-380748, piR-398377, and piR-401292) with a coincident expression profile in serum and EMB. Next, we validated the combination of these piRNAs in a large independent cohort (grade greater than or equal to2R: AUC=0.819, p<0.0001 and grade 1R: AUC=0.721, p=0.001). Additionally, our piRNA panel showed excellent diagnostic power for AMR (pAMR2: AUC=0.967, p<0.0001).
Our results demonstrate the existence of alterations in the expression of circulating free RNAs (mRNA, miRNA, lncRNA and piRNA) in patients with cardiac rejection after transplantation, also demonstrating a powerful diagnostic capacity for different grades of ACR, even for the grade of mild rejection. Besides, an appropriate combination of circulating free RNAs shows greater precision for the diagnosis of ACR than the single detection of each molecule, showing excellent AMR capacity diagnosis and allowing monitoring of the response to treatment.
