MicroRNAs in Sarcopenia: A Systematic Review
Katsunori Yanai1 
Shohei Kaneko1 
Hiroki Ishii1 Akinori Aomatsu1,2 
Kiyonori Ito1 Keiji Hirai1 Susumu Ookawara1 
Kenichi Ishibashi3 
Yoshiyuki Morishita1*- 1Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- 2Division of Intensive Care Unit, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- 3Department of Medical Physiology, Meiji Pharmaceutical University, Tokyo, Japan
Sarcopenia, which is characterized by the loss of skeletal muscle, has been reported to contribute to development of physical disabilities, various illnesses, and increasing mortality. MicroRNAs (miRNAs) are small non-coding RNAs that inhibit translation of target messenger RNAs. Previous studies have shown that miRNAs play pivotal roles in the development of sarcopenia. Therefore, this systematic review focuses on miRNAs that regulate sarcopenia.
Introduction
Sarcopenia, defined by the loss of skeletal muscle loss, contributes to developing physical disabilities, various illnesses, and increasing mortality (1, 2). MicroRNAs (miRNAs) have attracted attention as potential biomarkers and targets for specific therapies. MiRNAs are small non-coding RNAs (21–25 bases) that are not translated into proteins but inhibit the function of their target messenger RNAs (mRNAs) by destabilizing them and inhibiting their translation (3, 4). Previous studies have shown that miRNAs play pivotal roles in the development of sarcopenia (1–82). Therefore, this systematic review focuses on miRNAs that regulate sarcopenia.
Mechanism of the Development of Sarcopenia
Several factors, including chronic inflammation, increased reactive oxidative species, increased fibrosis of muscle, and increased loss of motor neurons, have been reported to contribute to development of sarcopenia by progressing muscle atrophy that results in lower muscle mass (26, 46). These factors have been reported to be tightly controlled by many signaling pathways and effector proteins, including some crosstalk with the protein synthesis pathway (32). Among these signaling pathways, transforming growth factor-β1 (TGF-β1) is considered as the main signaling molecule in the development of sarcopenia (47). TGF-β1 activates many downstream profibrotic signaling molecules, including mothers against decapentaplegic (Smad), extracellular signal-regulated kinase (ERK), mitogen-activated protein kinase (MAPK), c-Jun N-terminal kinase (JNK), and p38, which contribute to increasing transdifferentiation of myoblasts into myofibroblasts, resulting in development of muscle atrophy and fibrosis (47). Chronic inflammation has also been considered to contribute to the development of sarcopenia through the production of numerous proinflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β, which promote muscle catabolism (64).
Search Method
We searched for basic and clinical studies published in English in the PubMed database from 2007 to 2019. The literature search was conducted between August 3 and 13, 2019. The following medical subject headings were used: (“microrna AND sarcopenia” [Title/Abstract]), (“mirna AND sarcopenia” [Title/Abstract]), (“microrna AND frail” [Title/Abstract]), (“mirna AND frail” [Title/Abstract]), (“microrna AND frailty” [Title/Abstract]), and (“mirna AND frailty” [Title/Abstract]). The words “frailty” and “frail” were used for this review because they are involved in the condition of sarcopenia. Studies whose titles and abstracts did not meet selection criteria were excluded from this review. The remaining studies were carefully checked for eligibility for inclusion in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [Figure 1; (83)]. The studies were included if (1) they reported the utility of miRNAs as potential biomarkers or targets for specific therapies of sarcopenia; and (2) they were published as full-text journal articles in English. Exclusion criteria were as follows: (1) they did not discuss specific miRNAs in sarcopenia; and (2) they included no description of sample settings. We could not perform a meta-analysis because the number of studies reporting miRNAs for sarcopenia was small, so statistical power would have been low.
Figure 1. Flow diagram of this study.
Results
Search Results
A flow diagram of this study is shown in Figure 1 and Supplemental Table 1. Computer and manual searches identified 254 potentially suitable publications. After the removal of duplicates, the titles and abstracts of 98 remaining papers were screened. Of these, 15 publications were excluded because they did not describe specific miRNAs in sarcopenia, and one publication was excluded because it lacked a description of the sample setting; 82 studies were included in the final systematic review (1–82), and 12 studies were included for extracting data (1, 5, 6, 16, 28, 38, 40, 42, 60, 64, 71, 82).
MicroRNAs in Sarcopenia
Many studies investigated expression changes of miRNAs in muscles and/or blood (serum or plasma) of patients with sarcopenia (Table 1) and/or animal models of sarcopenia [Table 2; (1, 5, 16, 28, 38, 40, 42, 60, 64, 71, 82)]. Several studies investigated the effects of modulating miRNA expression on phenotypic changes using cultured muscle cells in vitro and rodent models of sarcopenia in vivo [Table 3; (1, 6, 42, 60, 71)].
Table 1. Associations between miRNA expression levels and sarcopenia in patients.
Table 2. Associations between miRNA expression levels and sarcopenia in rodent models.
Table 3. Effects of modulation of miRNA expression on frailty and sarcopenia in cells in vitro and rodent frailty and sarcopenia models in vivo.
Changes of the Expression Levels of microRNAs in Sarcopenia
Expression of 13 miRNAs (miRNA-10a-3p,−19a,−21, 34a,−92a-3p, 185-3p, 194-3p,−203a-3p,−326,−424-5p,−532-5p,−576-5p, and−760) was found to be changed in the muscles and/or blood (serum or plasma) of patients with sarcopenia [Table 1; (1, 16, 40, 64, 82)]. Among them, expression of three miRNAs in muscle (miRNA-19a,−34a, and−424-5p,) (16, 82), eight miRNAs in plasma (miRNA-10a-3p,−92a-3p,−185-3p,−194-3p,−326,−532-5p,−576-5p, and−760) (40), and two miRNAs in serum (miRNA-21 and−203a-3p) (1, 64) was changed and associated with physical functions including shrinking, weakness, poor endurance and energy, slowness, and low physical activity levels and expression of many signaling molecules, such as protein kinase AMP-activated catalytic subunit alpha 1 (PRKAA1), 6-phosphofructo-2-kinase/fructose-2-,6-biphosphatase 3 (PFKFB3), transforming growth factor-β receptor 2 (TGF-βR2), vascular endothelial growth factor A (VEGFA), polymerase I receptor 1A (Pol I R1A), and upstream binding transcription factor (UBTF), which were shown to contribute to sarcopenia development [Table 1; (16, 64, 82)].
Expression of 10 miRNAs (miRNA-1-3p,−29,−29a-3p,−29b-3p,−98-5p,−133a-3p,−133b-3p,−181a,−434-3p, and−455-3p) was changed in muscles of rodent models of sarcopenia [Table 2; (5, 28, 38, 42, 60, 71)]. These miRNAs were associated with the expression levels of many signaling molecules, including tripartite motif containing 63 protein (TRIM63), F-box protein 32 (FBXO32), myeloblastosis-related protein B (B-myb), insulin-like growth factor-1 (IGF-1), p85, nerve growth factor (NGF), sirtuin 1 (Sirt1), eukaryotic translation initiation factor 5A1 (Elf5A1), paired-like homeodomain transcription factor 1 (PITX1), and retinoid X receptor-β (RXRB), which were shown to contribute to sarcopenia development [Table 2; (5, 28, 38, 42, 60, 71)].
Effects of microRNA Modulation on Sarcopenia
Several studies have reported that modulation of miRNAs has significant effects on sarcopenia in cultured myocytes in vitro (Table 3, Figures 2A,B). The specific miRNAs that have been reported to affect sarcopenia are described below.
Figure 2. (A) Roles of miRNAs in cultured myotubes, myoblasts, and myocytes in vitro. (B) Roles of miRNAs in rodent sarcopenia models in vivo. EIf5A1, eukaryotic translation initiation factor 5A1; miRNA, microRNA; PITX1, paired-like homeodomain transcription factor 1; RXRB, retinoid X receptor-β; Sirt1, sirtuin 1; MuRF1, muscle ring-finger protein-1.
MiRNA-181a
MiRNA-181a binds to the 3′-untranslated region of Sirt1 that is implicated in influencing aging, apoptosis, and inflammation (71). Overexpression of miRNA-181a using an miRNA-181a mimic by lipofection was shown to significantly decrease the myotube diameter, which was mediated by inhibiting its target Sirt1 in cultured myotubes of differentiated C2C12 cells, a subclone of mouse myoblasts. However, miRNA-181a knockdown using a miRNA-181a inhibitor led to an increase in the myotube diameter of cultured myotubes of differentiated C2C12 cells (71).
MiRNA-203a-3p
MiRNA-203a-3p binds to the 3′-untranslated region of baculoviral inhibitors of apoptosis repeat containing 5 (BIRC5), a member of the apoptosis inhibitor protein family that suppresses apoptosis via inhibition of the initiator caspase 9 and executers caspase 3 and 7 (84). MiRNA-203a-3p was upregulated in serum of colorectal cancer patients with sarcopenia as evaluated by a lower psoas muscle mass index compared with than in colorectal cancer patients without sarcopenia (1). Knockdown of miRNA-203a-3p using an miRNA-203-3p mimic by lipofection inhibited cell proliferation and induced apoptosis via increasing the expression level of the target BIRC5 in cultured human skeletal muscle cells (1).
MiRNA-434-3p
MiRNA-434-3p binds to the 3′-untranslated region of EIf5A1 that is involved in many cellular processes including cell division, apoptosis, and inflammation (60). Overexpression of miRNA-434-3p using an miRNA-434-3p mimic by lipofection inhibited the expression levels of EIf5A1, which prevented apoptosis of apoptosis-stimulated primary myocytes purified from hind limb muscles of C57BL/6J mice (60).
MiRNA-455-3p
Overexpression of miRNA-455-3p using an miRNA-455-3p mimic by lipofection inhibited the expression levels of PITX1 and RXRB, which are involved in muscle dystrophy and aging, resulting in a significant increase of the diameter of cultured myotubes differentiated from cultured mouse C2C12 myoblasts (42).
MiRNA-672-5p
Overexpression of miRNA-672-5p via tail vein injection of an miRNA-672-5p mimic in liposomes alleviated ovariectomy-induced sarcopenia in female BALB/c mice (6). Overexpression of miRNA-672-5p in ovariectomy-induced sarcopenia mice increased lean muscle mass but decreased the serum creatinine kinase level and increased Feret's diameter of muscle fibers with inhibited muscle atrogenes (Atrogin-1 and Murif1) that stimulate protein catabolism and negatively affect muscular health (6). Overexpression of miRNA-672-5p in ovariectomy-induced sarcopenia mice also increased osteoblastogenesis and mineralization, thereby reversing bone loss (6).
Discussion
Many miRNAs increase or decrease in muscles and blood of patients with sarcopenia and rodent models of sarcopenia. These expression changes are associated with the phenotypes of sarcopenia, such as lower physical functions and expression levels of many signaling molecules that mediate progression of sarcopenia. These lines of evidence suggest that miRNA levels in muscles and/or blood are potential biomarkers for sarcopenia. However, no study has reported the relationship between the expression changes of plasma/serum and muscle miRNAs in sarcopenia. It is necessary to investigate this relationship to clarify the mechanisms of miRNAs in each organ including muscles and their circulation form in blood for the development of sarcopenia as well as the utility of miRNAs in blood as biomarkers of sarcopenia. Additionally, several miRNAs have been demonstrated to affect sarcopenia in myocytes in vitro or rodent sarcopenia models in vivo. All studies reported the effects of miRNAs on sarcopenia in the setting of overexpression of these miRNAs as shown in Table 3. These results suggest that miRNAs are potential targets of gene therapy for sarcopenia. However, further studies are needed to investigate the mechanisms, target cells, and adverse effects of modulating these miRNAs. Additionally, so far, there is no clinical study that has directly investigated the functions of miRNAs in sarcopenia by modulation of their expression using a mimic and/or inhibitor. Future clinical studies will be necessary to confirm the effects of miRNAs on sarcopenia and their potential targets for gene therapy of sarcopenia. Our review has a number of limitations. First, we only searched for studies published in English. Second, we only used the PubMed database to identify publications. Third, meta-analysis could not be performed because the number of studies reporting miRNAs for sarcopenia was small, so statistical power would have been low. Therefore, further research is warranted to verify our conclusions.
Conclusion
Many miRNAs increase or decrease in muscles and blood of patients with sarcopenia and rodent models of sarcopenia. Additionally, several miRNAs have been demonstrated to affect sarcopenia in myocytes in vitro or rodent sarcopenia models in vivo. These results suggest that miRNAs are potential biomarkers and targets of gene therapy for sarcopenia. Further studies including clinical studies will be necessary to confirm the utility of miRNAs as biomarkers and targets for gene therapy of sarcopenia.
Author Contributions
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
Funding
This review was supported by AMED under Grant No. JP19ek0210094h0003 and JSPS KAKENHI under Grant No. JP17K09708.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments
We thank Mitchell Arico from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
Supplementary Material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2020.00180/full#supplementary-material
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Keywords: sarcopenia, microRNA, myotube, myocyte, myoblast, systematic review
Citation: Yanai K, Kaneko S, Ishii H, Aomatsu A, Ito K, Hirai K, Ookawara S, Ishibashi K and Morishita Y (2020) MicroRNAs in Sarcopenia: A Systematic Review. Front. Med. 7:180. doi: 10.3389/fmed.2020.00180
Received: 20 January 2020; Accepted: 17 April 2020;
Published: 28 May 2020.
Edited by:
Christos Argyropoulos, University of New Mexico, United StatesReviewed by:
Christiaan Leeuwenburgh, University of Florida, United StatesAnna Picca, Catholic University of the Sacred Heart, Italy
Copyright © 2020 Yanai, Kaneko, Ishii, Aomatsu, Ito, Hirai, Ookawara, Ishibashi and Morishita. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yoshiyuki Morishita, ymori@jichi.ac.jp