MicroRNAs in cardiovascular disease

MicroRNAs (miRNAs) have emerged as crucial post-transcriptional regulators of gene expression, playing a significant role in the pathogenesis and progression of cardiovascular diseases (CVDs). These small, non-coding RNA molecules influence key biological processes such as inflammation, fibrosis, endothelial dysfunction, and ion-channel remodeling-mechanistic hallmarks of conditions like myocardial infarction (MI), heart failure, and arrhythmias. Their unique stability in circulating bodily fluids makes them promising biomarkers for early diagnosis, risk stratification, and prognosis. Approximately 70 percent of circulating miRNAs investigated in MI models have shown validated diagnostic utility, outperforming some conventional biomarkers in early detection. Beyond diagnostics, miRNAs are being explored as therapeutic targets. Two primary strategies include antisense oligonucleotide (ASO)-based inhibitors and miRNA mimics, both of which have advanced to early-phase clinical trials. Notably, miR-92a and miR-132 inhibitors have reached phase II trials for ischemic heart disease and heart failure, respectively. The concept of theranoMiRNAs, miRNAs with both diagnostic and therapeutic potential, offers a novel paradigm for precision cardiology. However, challenges such as targeted delivery, off-target effects, and regulatory hurdles remain. Advances in artificial intelligence, bioinformatics, and nanotechnology are expected to overcome these barriers, accelerating the clinical translation of miRNA-based strategies. As research progresses, miRNAs are poised to transform cardiovascular diagnostics and therapeutics, ushering in a new era of personalized medicine.