MicroRNAs in Aneurysmal Subarachnoid Hemorrhage: A Stage-Specific Model Linking Rupture, Vasospasm, and Outcome.

Area of Science:

• Neuroscience
• Biomarker Discovery
• Genetics

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) is a critical cerebrovascular event with complex, multi-stage pathophysiology.
• Current diagnostic and prognostic tools for aSAH lack molecular biomarkers to predict disease trajectory.
• MicroRNAs (miRNAs) are stable molecules found in biofluids, implicated in vascular and neuronal processes relevant to aSAH.

Purpose of the Study:

• To synthesize existing research on miRNA dynamics in aSAH across its distinct pathophysiological stages.
• To propose a stage-specific conceptual model for miRNA biomarkers in aSAH.
• To integrate findings from dual-biofluid (blood and CSF) profiling for a comprehensive understanding.

Main Methods:

• Systematic review and translational synthesis of published literature on miRNAs in aSAH.
• Analysis of dual-biofluid profiling data (blood and CSF) to identify specific miRNA signatures.
• Categorization of miRNA signatures according to four key stages of aSAH: rupture, EBI, vasospasm, and outcome.

Main Results:

• miR-29a, miR-200a-3p, and miR-451a identified as robust rupture-associated biomarkers with distinct expression patterns in blood and CSF.
• CSF miRNAs (miR-221-3p, miR-9-3p, miR-183-5p) predict vasospasm within 24 hours.
• miR-24 and miR-21-5p correlate with aSAH severity and poor neurological outcomes.

Conclusions:

• A stage-specific framework for miRNA biomarkers in aSAH is proposed, linking endothelial injury, vascular dysfunction, and brain damage.
• This model provides a foundation for developing multi-marker panels for aSAH.
• Future research should focus on prospective validation and precision medicine strategies for aSAH management.