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Epigenetic-sensitive liquid biomarkers and personalised therapy in advanced heart failure: a focus on cell-free DNA and microRNAs
  1. Gelsomina Mansueto1,
  2. Giuditta Benincasa2,
  3. Nunzia Della Mura3,
  4. Giovanni Francesco Nicoletti4,
  5. Claudio Napoli1,3
  1. 1Clinical Department of Internal Medicine and Specialistics, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy
  2. 2Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy
  3. 3IRCCS SDN, Naples, Italy
  4. 4Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
  1. Correspondence to Dr Giuditta Benincasa, Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples 80132, Italy; dr.benincasa.giuditta{at}


Dilated cardiomyopathy (DCM) represents a common genetic cause of mechanical and/or electrical dysfunction leading to heart failure (HF) onset for which truncating variants in titin (TTN) gene result in the most frequent mutations. Moreover, myocyte and endothelial cell apoptosis is a key endophenotype underlying cardiac remodelling. Therefore, a deeper knowledge about molecular networks leading to acute injury and apoptosis may reveal novel circulating biomarkers useful to better discriminate HF phenotypes, patients at risk of heart transplant as well as graft reject in order to improve personalised therapy. Remarkably, increased plasma levels of cell-free DNA (cfDNA) may reflect the extent of cellular damage, whereas circulating mitochondrial DNA (mtDNA) may be a promising biomarker of poor prognosis in patients with HF. Furthermore, some panels of circulating miRNAs may improve the stratification of natural history of disease. For example, a combination of miR-558, miR-122* and miR-520d-5p, as well as miR-125a-5p, miR-550a-5p, miR-638 and miR-190a, may aid to discriminate different phenotypes of HF ranging from preserved to reduced ejection fraction. We give update on the most relevant genetic determinants involved in DCM and discuss the putative role of non-invasive biomarkers to overcome current limitations of the reductionist approach in HF management.

  • cardiovascular
  • diagnostics
  • apoptosis

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  • Handling editor Tahir S Pillay.

  • Contributors CN: genesis of idea. GM, GB, NDM: review of literature, design of tables and figures, initial draft of the manuscript. CN and GFN: critical and final review of the paper.

  • Funding This work was supported by PRIN2017F8ZB89 from Italian Ministry of University and Research (MIUR) (PI Professor Napoli). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Dr Giuditta Benincasa is a PhD student of Translational Medicine awarded with Educational Grant from ESC Congress 2019 and supported by Educational Grant from the University of Campania, Naples, Italy.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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