Molecular signature analysis: using the myocardial transcriptome as a biomarker in cardiovascular disease

With the emergence of microarray technology, it is now possible to simultaneously assess the expression of tens of thousands of gene transcripts, providing a resolution and precision of phenotypic characterization not previously possible. In the field of cardiomyopathy, microarray studies have largely focused on gene discovery, identifying differentially expressed genes characteristic of diverse disease states, through which novel genetic pathways and potential therapeutic targets may be elucidated. However, gene expression profiling may also be used to identify a pattern of genes (a molecular signature) that serves as a biomarker for clinically relevant parameters. One study thus far does demonstrate that a molecular signature can accurately identify etiology in cardiovascular disease, supporting ongoing efforts to incorporate expression-profiling-based biomarkers in determining prognosis and response to therapy in heart failure. Microarray research in cardiomyopathy is still in its earliest stages. Nevertheless, the ultimate potential application of transcriptome-based molecular signature analysis is individualization of the management of patients with heart failure, whereby a patient with a newly diagnosed cardiomyopathy could, through molecular signature analysis, be offered an accurate assessment of prognosis and how individualized medical therapy could affect his or her outcome.