RNA biomarkers in hemorrhagic stroke

Hemorrhagic stroke (HS), characterized by the rupture of cerebral blood vessels and bleeding into brain tissue, leads to high mortality and morbidity, necessitating improved methods for diagnosis, prognosis, and treatment. This chapter explores the pivotal role of ribonucleic acids (RNAs), particularly non-coding RNAs (ncRNAs) like microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), in the molecular pathology of HS and their potential as biomarkers and therapeutic targets. The chapter begins by classifying RNAs into coding and non-coding types, detailing their biogenesis, mechanisms of action, and the detection techniques used to analyze their expression, including next-generation sequencing, microarrays, quantitative polymerase chain reaction (qPCR), Northern blotting, fluorescence in situ hybridization (FISH), and artificial intelligence (AI)-based approaches. Emphasis is placed on how genetic variations, such as single-nucleotide polymorphisms (SNPs), influence RNA function and disease expression. This chapter investigates RNA-related signaling pathways implicated in HS, including NF-κB, PI3K/AKT, NLRP3 inflammasome, STAT3, ACSL4-related ferroptosis, and endoplasmic reticulum stress. These pathways regulate inflammation, apoptosis, blood-brain barrier integrity, and ferroptosis, with ncRNAs modulating them. Dysregulated RNAs in HS patients have potential for differentiating HS from ischemic stroke, assessing severity, predicting perihematomal edema, and identifying complications. Elevated miR-155 and altered expression of miR-126 and miR-182 are associated with poor outcomes and increased mortality. The chapter reviews RNA biomarkers and RNA-based therapies, highlighting their potential for earlier diagnosis, accurate prognosis, and targeted treatments in HS care, ushering in precision medicine for HS.