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Updated: Jan 13, 2026
Microfluidic Tools for Probing Fungal-Microbial Interactions at the Cellular Level
Published on: June 23, 2022
The Role of microRNAs and Cell-Free DNAs in Fungal Infections: Systematic Review and Meta-Analysis of the Literature
Ayse Kalkanci1, Fatma Bozdag2, Isil Fidan1
1Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara 06500, Türkiye.
Background:
Invasive fungal infections (IFIs) remain a major cause of morbidity and mortality among immunocompromised patients, despite advances in antifungal therapy. Conventional diagnostics are limited, highlighting the need for novel biomarkers. Circulating microRNAs (miRNAs) and cell-free DNA (cfDNA) have emerged as promising tools due to their roles in immune regulation, pathogen-host interactions, and disease monitoring. This systematic review and meta-analysis evaluate their diagnostic and prognostic potential in fungal infections.
Methods:
A systematic search of PubMed, Web of Science, SCOPUS, and EMBASE was conducted up to May 2025 in line with PRISMA guidelines (PROSPERO protocol CRD42021287150). Eligible studies included clinical research on confirmed fungal infections assessing cfDNA or miRNAs. Random-effects meta-analyses were performed for cfDNA, and miRNA findings were synthesized descriptively.
Results:
In total, 526 studies were included. cfDNA positivity was observed in 12% of all tested samples (95% CI: 0.06-0.22) and in 79% of patients with proven fungal infections (95% CI: 0.62-0.90), supporting its value as a minimally invasive, culture-independent diagnostic marker. Six studies on miRNAs identified disease-specific signatures, including miR-132 and miRNA panels for aspergillosis, with high diagnostic accuracy (AUC ≥ 0.98). miR-146a, miR-223, and miR-545 further correlated with prognosis and mortality.
Conclusions:
cfDNA and miRNAs show strong potential for early diagnosis, prognosis, and treatment monitoring in IFIs. Standardized methodologies and large-scale validation are essential for clinical translation.
Insights
Cell-free DNA (cfDNA) and microRNAs (miRNAs) show promise as biomarkers for diagnosing and monitoring invasive fungal infections (IFIs) in immunocompromised patients. Further validation is needed for clinical use.
Area of Science:
- Biomarker Discovery
- Molecular Diagnostics
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) pose significant risks to immunocompromised individuals.
- Current diagnostic methods for IFIs are often limited.
- Novel biomarkers are crucial for improved patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic and prognostic potential of circulating cell-free DNA (cfDNA) and microRNAs (miRNAs) in fungal infections.
Main Methods:
- A comprehensive systematic search of major scientific databases was performed.
- Studies involving confirmed fungal infections and assessment of cfDNA or miRNAs were included.
- Random-effects meta-analyses were conducted for cfDNA, and miRNA data were descriptively synthesized.
Main Results:
- cfDNA demonstrated value as a minimally invasive, culture-independent diagnostic marker for IFIs.
- Specific miRNAs (e.g., miR-132) showed high diagnostic accuracy for fungal infections like aspergillosis.
- Certain miRNAs correlated with prognosis and mortality in patients with IFIs.
Conclusions:
- Circulating cfDNA and miRNAs hold significant potential for early diagnosis, prognosis, and treatment monitoring of IFIs.
- Standardization of methodologies and large-scale validation are critical next steps for clinical implementation.
