New resurches in diagnosis of acute MI by bio markers

1. Circulating microRNA-208 as a
novel cardiac biomarker to
diagnose acute myocardial
infarction
Presented by TASKIA ALAM
Programme Name: Cardiovascular disease

2. Background:
 Acute myocardial infarction is a clinical
condition characterized by chest pain,
shortness of breath, nausea, feeling
and cold sweat as a result of decreased
coronary artery blood flow in the heart
following plaque formation. (Horne et
2000).
 Atherosclerosis plaque rupture
 Thrombus formation
 Occluded coronary artery
 Reduces blood supply result in cardiac
injury.
(Chang et al., 2020)

3. Aim of study:
To identify the correlation
between microRNA-208 and
acute myocardial infarction
(AMI).
To find out the potentiality of
microRNA-208 as a cardiac
biomarker to diagnose AMI.
Researches:
Study1(Li et al., 2019):
 To investigate the value of the
expression of miRNA-208,miRNA-
499 and miRNA-1303 in the early
diagnosis of acute myocardial
infarction (AMI).
Study 2(Agiannitopoulos et al., 2018):
 Certain miRNA (miR-208,miR-499)
are candidate biomarker for
cardiovascular disease including
AMI.
Study 3 (SALWA et al., 2019):
 To investigate the correlation of miRNA-
208 levels and AMI patients to evaluate
rapid, accurate and final diagnosis in ED.

4. Mechanism of miRNAs:
(Wang & Zheng, 2021)
Small endogenous single-stranded non-coding RNAs known as
microRNAs (miRNAs) are strongly associated with myocardial infarction
(MI) and bind with messenger RNA to block corresponding protein
synthesis pathway . There are many types of miRNAs including miR-1,miR-
133a,miR-499 and miR-208a.
miRNAs bind with Argonaut family proteins to form RNA-induced
silencing complex(RISC).
Apoptosis, necrosis, and autophagic cell death are regulated by
microRNAs and elevated miRNAs involved in numerous human
pathologies including cardiovascular disease.
(Sun et al., 2017).

5. Characteristics of the studies
Author
Name
Study design
and
geographic-
al region
Number of patient
the case/control
group(AMI/non-
and mean age
Patient characteristics The
biomarker
outcome Follow up
(Li et al.,
2019)
Case-control
study in
China
73
(41+32)
Mean age:
(62.9±11.04)
Typical chest pain within
3 h
miRNA-208
miRNA-499
miRNA-1303
The level of miR-208
was significantly
higher in the AMI
group.
October 2015-
october 2016
(Agiannitop
oulos et al.,
2018)
Case-control
study in
Greece
130
(80/50)
Mean age:
(62.12±10.99)
Patient with acute
ischemic chest pain
within 24hours
miRNA-208
miRNA-499
The concentration of
miR-208 was
significantly higher in
AMI patients.
October 2016-
May 2017
(SALWA et
al., 2019)
Case-control
study in
Egypt
48
(25/23)
Mean age:
(60.1±11.3)
patient with AMI and
unstable angina in
emergency department
miRNA-208 miRNA-208 was
found
to be increased up to
38.6 folds in AMI.
March 2018-June
2018

6. Results:
According to sensitivity and specificity of miRNA-208 the results of these studies are given below.
0.71
0.98
0.9
0.97 1 1
0
0.2
0.4
0.6
0.8
1
1.2
(Li et al., 2019) (Agiannitopoulos et
al., 2018)
(SALWA et al., 2019)
X-AXIS
Y-AXIS
Chart Title
Sensitivity Specificity
Author Sensitivity
(95%,CI)
Specificity
(95%,CI)
(Li et al., 2019) 0.71(0.54-0.84) 0.97 (0.84-1.0)
(Agiannitopoul
os et al., 2018)
0.98 (0.89-1.0) 1.0 (0.93-1.0)
(SALWA et al.,
2019)
0.90(0.84-0.96) 1.0(0.93-1.0)
Fig1: Sensitivity and specificity of 3 studies

7. Limitation:
(Li et al., 2019) (Agiannitopoulos et al.,
2018)
(SALWA et al., 2019)
 The highest myocardial
specificity and sensitivity
for the diagnosis of AMI is
miR-208, however its
diagnostic potency is not
greater than cTnI.
 The level of miRNA-208
was greater in ST elevated
MI but undetectable in
non-ST elevated MI.
Did not explore the positive
predictive value of miRNA-208
in AMI patient.

8. Conclusion:
1.This study emphasized the significance of
circulating miRNA-208 in the diagnosis of AMI, and
its distinctive benefits could serve as a basis for the
diagnosis of AMI or other cardiovascular diseases.
2. As a sensitive biomarker of acute AMI, miRNA-
208 has better diagnostic precision than the others
cardiac biomarker.
3.With 100% specificity, miRNA-208 is a very rapid
cardiac marker that rises within one hour of a MI.

9. Future
recommendation:
More studies involving a large population are
required to thoroughly assess miRNA-208 as useful
biomarkers in comparison to other cardiac markers,
particularly troponin I for quick and easy detection
of miRNAs in blood.

10. References:
 Horne, R., James, D., Petrie, K., Weinman, J., & Vincent, R. (2000). Patients' interpretation of
symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart, 83(4),
388-393.
 Chang, M.-L., Chiu, Y.-J., Li, J.-S., Cheah, K.-P., & Lin, H.-H. (2020). Analyzing impetus of regenerative
cellular therapeutics in myocardial infarction. Journal of Clinical Medicine, 9(5), 1277.
 Wang, W., & Zheng, H. (2021). Myocardial infarction: the protective role of miRNAs in myocardium
pathology. Frontiers in Cardiovascular Medicine, 8, 631817.
 Sun, T., Dong, Y.-H., Du, W., Shi, C.-Y., Wang, K., Tariq, M.-A., Wang, J.-X., & Li, P.-F. (2017). The role of
microRNAs in myocardial infarction: from molecular mechanism to clinical application.
International journal of molecular sciences, 18(4), 745.
 Sun, T., Dong, Y.-H., Du, W., Shi, C.-Y., Wang, K., Tariq, M.-A., Wang, J.-X., & Li, P.-F. (2017). The role
of microRNAs in myocardial infarction: from molecular mechanism to clinical application.
International journal of molecular sciences, 18(4), 745.
 Agiannitopoulos, K., Pavlopoulou, P., Tsamis, K., Bampali, K., Samara, P., Nasioulas, G., Mertzanos, G.,
Babalis, D., & Lamnissou, K. (2018). Expression of miR-208b and miR-499 in Greek patients with
acute myocardial infarction. in vivo, 32(2), 313-318.

11.  Yuan, L., Liu, X., Chen, F., Zhang, L., Chen, X., Huang, Q., Wu, D., Yang, C., & Han, Z.
(2016). Diagnostic and Prognostic Value of Circulating MicroRNA-133a in Patients with
Acute Myocardial Infarction. Clinical Laboratory, 62(7), 1233-1241.
 Zhao, C., Cheng, G., He, R., Hong, Y., Wan, Q., Wang, Z., & Pan, Z. (2015). Analysis and
clinical significance of microRNA-499 expression levels in serum of patients with acute
myocardial infarction. Genet Mol Res, 14(2), 4027-4034.
 Li, P., Li, S.-Y., Liu, M., Ruan, J.-W., Wang, Z.-D., & Xie, W.-C. (2019). Value of the
expression of miR-208, miR-494, miR-499 and miR-1303 in early diagnosis of acute
myocardial infarction. Life sciences, 232, 116547.
 SALWA, E. M., MOHAMED, Y., SABAH, F., & MOHAMED, A. A. (2019). Studies MicroRNA
208 as a Novel Cardiac Marker in Acute Coronary Syndrome in Egyptian Patients. The
Medical Journal of Cairo University, 87(June), 1585-1591.

12. THANK YOU