Expression of Serum microRNAs is Altered During Acute Graft-versus-Host Disease.

Acute graft-versus-host disease (aGvHD) is the most frequent and serious complication following hematopoietic stem cell transplantation (HSCT), with a high mortality rate. A clearer understanding of the molecular pathogenesis may allow for improved therapeutic options or guide personalized prophylactic protocols. Circulating microRNAs are expressed in body fluids and have recently been associated with the etiology of aGvHD, but global expression profiling in a HSCT setting is lacking. This study profiled expression of n  = 799 mature microRNAs in patient serum, using the NanoString platform, to identify microRNAs that showed altered expression at aGvHD diagnosis. Selected microRNAs ( n  = 10) were replicated in independent cohorts of serum samples taken at aGvHD diagnosis ( n  = 42) and prior to disease onset (day 14 post-HSCT, n  = 47) to assess their prognostic potential. Sera from patients without aGvHD were used as controls. Differential microRNAs were investigated in silico for predicted networks and mRNA targets. Expression analysis identified 61 microRNAs that were differentially expressed at aGvHD diagnosis. miR-146a ( p  = 0.03), miR-30b-5p ( p  = 0.007), miR-374-5p ( p  = 0.02), miR-181a ( p  = 0.03), miR-20a ( p  = 0.03), and miR-15a ( p  = 0.03) were significantly verified in an independent cohort ( n  = 42). miR-146a ( p  = 0.01), miR-20a ( p  = 0.03), miR-18 ( p  = 0.03), miR-19a ( p  = 0.03), miR-19b ( p  = 0.01), and miR-451 ( p  = 0.01) were differentially expressed 14 days post-HSCT in patients who later developed aGvHD ( n  = 47). High miR-19b expression was associated with improved overall survival (OS) ( p  = 0.008), whereas high miR-20a and miR-30b-5p were associated with lower rates of non-relapse mortality ( p  = 0.05 and p  = 0.008) and improved OS ( p  = 0.016 and p  = 0.021). Pathway analysis associated the candidate microRNAs with hematological and inflammatory disease. Circulating biofluid microRNAs show altered expression at aGvHD onset and have the capacity to act as prognostic and diagnostic biomarkers. Their differential expression in serum suggests a role for circulatory microRNAs in aGvHD pathology, which warrants further investigation.