MicroRNAs as novel biomarkers for prenatal fetal congenital heart diseasesystematic literature review

Adrianna Kondracka¹Paulina Gil-Kulik¹Magda Rybak-Krzyszkowska^2,3Jakub Marcin Staniczek⁴Anna Oniszczuk¹Bartosz Kondracki^1*

• ¹Medical University of Lublin, Lublin, Poland
• ²University Hospital Kraków, Kraków, Poland
• ³University Hospital Krakówtów, Kraków, Poland
• ⁴Medical University of Silesia, Katowice, Poland

IntroductionCHD accounts for about one-third of all congenital malformations and is the leading cause of infant mortality. Currently, the primary method for diagnosing CHD during pregnancy is fetal echocardiography. Several studies have observed significant differences in the expression levels of specific miRNAs between CHD fetuses and normal fetuses. This systematic review explores the potential of miRNAs as non-invasive biomarkers for the prenatal detection of CHD in fetuses. Material and methods The systematic review followed PRISMA guidelines, conducting a detailed search across PubMed, Scopus, and Web of Science using predefined terms related to microRNAs and congenital heart defects. Inclusion was limited to original, full-text articles in English, while non-English studies, reviews, and inaccessible full texts were excluded. ResultsStudies explored the potential of miRNAs as biomarkers for detecting congenital heart defects (CHD) in fetuses, employing diverse sample types such as maternal serum, umbilical cord blood, and amniotic fluid. Diagnostic methods primarily included fetal echocardiography, complemented by postnatal confirmation through surgery or autopsy. Gestational ages at sample collection ranged predominantly from the second trimester to narrower windows, reflecting methodological variability across studies.The included studies utilized advanced technologies, such as next-generation sequencing and microarrays, for discovery-phase experiments, while validation predominantly employed qRT-PCR techniques. Identified miRNAs showed heterogeneity in expression patterns and diagnostic potential, with several studies reporting high sensitivity, specificity, and AUC values for specific miRNAs like miR-146a-5p and miR-142-5p. While some miRNAs demonstrated exceptional diagnostic accuracy, others were only described in terms of differential expression, highlighting the variability and complexity of miRNA biomarker discovery for CHD.Conslusions The findings of this systematic literature review provide evidence that some miRNAs could serve as non-invasive biomarkers for the early detection of CHD in fetuses. However, each of the reviewed studies identified different miRNAs as potential biomarkers. This variability may stem from differences in experimental methodologies, including approaches to miRNA isolation, quantification techniques, and the types of biological materials analyzed. Such methodological heterogeneity, combined with small sample sizes and the diverse spectrum of CHDs, underscores the need for caution in interpreting these findings.