miRNA in Pathophysiology of Peripartum Cardiomyopathy (PPCM): A Systemic Review

Abstract

Peripartum cardiomyopathy (PPCM) was recognized as a clinical entity in the early 1930s; however, the exact mechanism of the disease’s progression remains unknown. The highest incidence of PPCM is in African Americans, and the disease is associated with poor outcomes in elderly and multiparous women. The varying characteristics of patients suggest that genetic susceptibility of the disease could exist. PPCM can be associated with life threatening complications including cardiogenic shock, fatal arrhythmias, and thromboembolic events which can lead to death. Pregnant or lactating PPCM patients can further complicate how clinicians manage them. One recent hypothesis is that 16-kDa N-terminal prolactin fragment (16K PRL) plays a vital role in PPCM by inducing microRNA146a (miRNA146a) which reduces angiogenesis through downregulation of NRAS. miRNAs are small RNAs that were previously described as noncoding RNA that controls the posttranscriptional activity of mRNA. Recent animal studies have identified miRNA146a as a causative factor in PPCM; this discovery is promising and could have clinical implications in future. With growing evidence of miRNA’s involvement in disease, miRNA can add to our current understanding of pathology and could be a potential tool for diagnosis, prognosis, and therapy in PPCM.