Cardiovascular disease is a major cause of morbidity and mortality around the globe, which is linked to athero-thrombosis. The risk factors for atherothrombosis, thus cardiovascular disease is impaired anti-thrombotic and antiinflammatory functions of the endothelium. Thrombosis is a hallmark of cardiovascular disease/complications characterised by increased platelet activation and increased secretion of platelet micro-particles that induce angiogenesis. This study determined the role of platelet micro-particles derived microRNA in the regulation of angiogenesis and migration, with a focus on the regulation of thrombospondin-1 release by platelet micro-particles delivered Let- 7a. The role of thrombospondin-1 receptors (integrin beta-1 and integrin associated protein) and downstream caspase-3 activation were explored by Let-7a inhibition prior to PMP treatment. MicroRNA dependent modulation of proangiogenic proteins including monocyte chemoattractant protein-1 and placental growth factor, and recruitment of activating transcription factor-4 protein to their promoter regions were explored. Main findings are: 1. Platelet micro-particles induce angiogenesis, migration, and release of novel cytokine subsets specific to platelet micro-particle’s RNA content. 2. The targeting of thrombospondin-1 mRNA by platelet micro-particles’ transferred Let-7a chiefly modulate the angiogenic effect on endothelial cells. 3. The inhibition of thrombospondin-1 translation enable platelet micro-particles to increase angiogenesis and migration in the presence of functional integrin beta-1 and integrin associated protein, and reduced cleaving of caspase-3. 4. Platelet micro-particle modulate the transcription of monocyte chemoattractant protein-1 and placental growth factor in a Let-7a dependent manner. 5. Let-7a induce angiogenesis ii independent of other platelet micro-particle’s microRNAs. Platelet micro-particle derived Let-7a is a master regulator of endothelial cell function in this model, which presents an opportunity for the development of new biomarkers and therapeutic approaches in the management of cardiovascular disease. Future studies should aim to confirm these findings in-vivo.

The glial cells of the brain and the peripheral nervous system retain the capacity to divide and proliferate throughout the lifespan of an individual and thereby have the propensity to give rise to the most adult neurological tumours. Among them, the tumours which arise from different kinds of glial cells are referred to as gliomas. Of the various types of gliomas, astrocytomas are the most common central nervous system neoplasms which make upto 60% of all the primary brain tumours. Being the most prevalent type, the WHO classifies them into grades ranging from I to IV based on their intensity of malignancy. Grade IV astrocytoma or Glioblastoma (GBM) is considered to be the most malignant form with a median survival of 14.6 months, in spite of all therapeutic modalities. GBM is further classified as primary and secondary GBM. Primary GBM manifests de novo without any early history of pre-malignant lesions, on the other hand secondary GBM arises progressively from lower grades over a period of 5-10 years. Like other malignancies, GBM also arises from various genetic and epigenetic variations. Epigenetic variations include all such mitotically and meiotically heritable traits that do not involve changes in DNA sequence. There are three major areas of epigenetics - DNA methylation, histone modifications and non-coding RNAs which are known to have profound effects on gene expression. A lot being known about the genetic derailments in GBM, in this study we looked into the epigenetic aspects of GBM. In our lab, we have carried out various high throughput studies, which unveiled the distorted landscape of DNA methylation and miRNA expression in GBM. This indicates that, in addition to the genetic mechanisms of gene alterations like mutations, copy number aberrations, protein coding genes are also affected by changes in methylation as well as by miRNA misregulation. The study has been divided into two parts. Part one of the study deals with the identification of chromobox homolog 7 (Cbx7), as a hypermethylated and downregulated gene in GBM. More importantly, Cbx7 is a member of the polycomb repressive complex and brings about its function through chromatin modifications. Here we have investigated the role of Cbx7 in gliomagenesis, and why it has to be silenced by methylation for tumorigenesis to ensue. In part two, we elucidated two unique ways of miRNA regulation in GBM. In the first section, we identified miR-326 as a PI3 kinase regulated miRNA and demonstrated its tumour suppressive role in GBM. In the other section, we analysed the copy number aberration data from TCGA and identified miR- 4484 as a miRNA subjected to deletion in GBM. We further went ahead to demonstrate its growth suppressive role in GBM. Part 1: Epigenetic regulation of the chromatin modifier Cbx7; chromobox homolog 7 DNA methylation is involved in the normal cellular control of expression and thereby plays a crucial role in maintaining the homeostasis of the cell. The phenomenon of DNA methylation keeps the various loci of the genome such as the germline specific genes and the repetitive transposable elements silenced, whereas the tumour suppressors and other growth modulator genes are spared from the methylation induced gene repression. One of the important steps that promote tumorigenesis is aberrant hypermethylation, which leads to the silencing of tumour-suppressor genes. Another important epigenetic phenomenon that affects the transcriptibility of the genome is histone modifications, which control the accessibility of the chromatin to the transcriptional machinery. In this section, we identified Cbx7, which happens to be an essential component of the chromatin modifying machinery, as an epigenetically regulated gene in GBM. We observed from the methylation array carried out in our lab, that Cbx7 was one of the highly methylated genes. We also validated that Cbx7 is downregulated in GBM and the same observation was further corroborated from other data sets. The hypermethylated state of Cbx7 was confirmed by DNA bisulphite sequencing and the expression levels of Cbx7 also got alleviated after 5-Aza-2′-deoxycytidine treatment, which is a DNA methylation inhibitor. This indicated that the down regulation of Cbx7 could be attributed to the methylation of its promoter region. In order to figure out the role of Cbx7 in GBM, we carried out transcriptome analysis of Cbx7 overexpressing cells compared to vector control condition by RNA sequencing. Gene ontology analysis revealed a significant enrichment of pathways involved in cell cycle, migration and invasion like processes. In fact, the exogenous overexpression of Cbx7 leads to cell death, reduced colony formation, retarded migration and invasion of cells. In order to explain the above phenotypes brought about by the exogenous expression of Cbx7, we further examined the RNA sequencing data and observed that many of the top most downregulated genes in Cbx7 overexpression state belonged to the Hippo signaling pathway. The effectors of the Hippo pathway, YAP and TAZ which essentially antagonize the pathway activity, are well known for their role in proliferation, migration and invasion in cancer. So we carried out a Gene Set Enrichment Analysis (GSEA) and found that there was a significant negative enrichment of YAP/TAZ targets in the Cbx7 regulated gene set. We validated some of these targets that were downregulated by Cbx7 overexpression. One of the most downregulated genes that we validated was Connective Tissue Growth Factor (CTGF), which also happens to be a bonafide target of YAP/TAZ. Independent downregulation of CTGF also resulted in reduced migration, thereby phenocopying the effects as were produced by Cbx7 overexpression. Moreover, we also observed that SAPK/JNK was the only kinase whose activity was abolished upon Cbx7 overexpression. Since CTGF is known to activate SAPK/JNK, we assessed the SAPK/JNK activity upon CTGF silencing. We found that levels of phospho-SAPK/JNK were significantly reduced in CTGF silenced condition. In addition to that, the inhibition of the SAPK/JNK by synthetic inhibitor also hampered the migration ability of the cells. We were also able to rescue the loss of migratory potential of glioma cells by the exogenous overexpression of CTGF in Cbx7 stable background. A similar rescue was also achieved by the overexpression of a constitutively active form of SAPK/JNK. This indicates that Cbx7 activates Hippo pathway to inhibit YAP/TAZ dependent transcription, resulting in the downregulation of CTGF, thereby inhibiting CTGF mediated activation of SAPK and thus resulting in the inhibition of glioma cell migration. PART 2: ROLE OF MIRNAS IN GLIOMA DEVELOPMENT AND PROGRESSION miRNAs are a class of small non-coding RNAs that are not translated into functional proteins but still contribute to numerous cellular processes, thereby adding yet another realm of regulation and control. miRNAs bring about gene regulation at the post-transcriptional level, either by degrading the mRNA or by translational repression and in this manner fine tune the expression of protein coding genes. miRNAs are often located in the most fragile sites of the genome which exposes them to grave genetic alterations, thus providing a circumstantial evidence of their etiological role in tumorigenesis. In a malignant state, miRNAs have been found to play pivotal roles in cellular transformation by altering various cellular phenotypes. Owing to their participation in diverse cellular functions, miRNAs have gained a strong foothold in gene regulation. Though a lot has been deciphered about the functional aspect of miRNAs, not much is known about the precise mechanisms which lead to their misregulation and therefore demands in-depth study. The expression of miRNAs can be modulated by a variety of genetic and epigenetic mechanisms. Section I: Role of miR-326 – a PI3 kinase regulated miRNA, in gliomagenesis The TCGA group in the year 2008 identified three major pathways which go disarray in GBM. These include the pro-tumorigenic receptor tyrosine kinase (RTK) pathway, and the p53 and the pRB tumour-suppressive pathways. The RTK signalling includes the PI3 kinase pathway, which is pivotal in gliomagenesis and many other cancers. This directed us to elucidate the set of miRNAs which are controlled by the aberrant functioning of the PI3 kinase pathway. We used synthetic inhibitor LY294002 to abrogate the PI3 kinase signalling and examined the miRNA profile in two glioma cell lines U87 and U251, which have an activated PI3 kinase pathway. Indeed the abrogation of the PI3 kinase pathway resulted in the modulation of a wide array of miRNAs. We validated miR-326 as one of the miRNAs that was upregulated upon PI3 kinase pathway abrogation. Furthermore, we observed that miR-326 was a down regulated miRNA in GBM and different glioma cell lines, as well as in many other publicly available data sets. We also observed that miR-326 is an intragenic miRNA and its host gene Arrestin β1 (ARRB1) also exhibited similar upregulation upon PI3K pathway inhibition. Over-expression of miR-326 resulted in various anti-tumorigenic affects like reduced proliferation, reduced migration and colony suppression. In order to find the targets of miR-326, we analysed the transcriptome by RNA sequencing upon pre-miR-326 transfection. We shortlisted and validated some of the genes which were getting regulated through miRNA over-expression and also explain the functional role of miR-326. Section II: Role of miR-4484 – a copy number deleted miRNA, in gliomagenesis In the TCGA study mentioned above, it was also unfurled that there are many genes in the RTK, p53 and pRB signalling pathways which are made dysfunctional through gene deletions and amplifications. We envisaged whether it is only the protein coding genes which are subjected to such regulations or the non-coding genes like miRNAs as well. In this pursuit, we identified miR-4484 as one of the miRNAs located in the deleted region of uroporphyrinogen III synthase (UROS) gene in the chromosome 11 of the GBM genome. As conceived, miR-4484 was observed to be a downregulated miRNA in association with its host gene UROS. We further elucidated that the downregulation was due to the co-deletion of a locus harbouring both the protein coding gene and the miRNA. In addition, upon over-expression of miR-4484, we observed reduced migration and colony formation, indicating its role as a tumour–suppressor. For seeking the targets of miR-4484, we extracted RNA from miR-4484 over-expression condition and subjected it to RNA sequencing. We shortlisted and validated some of the genes which were getting regulated through miRNA over-expression and possibly explain the functional role of miR-4484.

No description available.

Durch den Transfer der Gene des heterodimeren T-Zellrezeptors (TZR) mithilfe viraler Vektoren können T-Zellen programmiert werden, ein ausgewähltes Antigen spezifisch zu erkennen. In klinischen Studien wurden solche T-Zellen bereits mit Erfolg zur Immuntherapie von Krebs und viralen Infektionen eingesetzt. Genmodifizierte T-Zellen unterscheiden sich jedoch von normalen T-Zellen, weil sie neben den beiden zelleigenen auch die zwei übertragenen TZR-Gene exprimieren. Diese Situation erlaubt die Bildung vier verschiedener TZR-Heterodimere: der zelleigene TZR, der übertragene TZR und zwei gemischte TZR, bestehend aus je einer übertragenen und einer zelleigenen TZR-Kette. Gemischte TZR bergen das Risiko von Nebenwirkungen, weil sie durch Zufall gesundes Körpergewebe erkennen und so Autoimmunität auslösen könnten. In dieser Arbeit wurden deshalb virale Vektoren entwickelt, die gleichzeitig mit der Übertragung von neuen TZR-Genen den zelleigenen TZR durch RNA Interferenz (RNAi) unterdrücken. Mikro-RNA (miRNA), die in den Vektor MP71 eingefügt wurden, reduzierten den zelleigenen TZR in Maus-T-Zellen um mehr als 85%. Dies hatte zur Folge, dass beide Ketten des übertragenen P14-TZR in gleicher Menge auf der Zelloberfläche exprimiert wurden und die Bildung von gemischten TZR reduziert wurde. In einem Mausmodell der adoptiven T-Zelltherapie verhinderte die Unterdrückung des zelleigenen TZR die Entstehung von Autoimmunität, die andernfalls durch gemischte TZR verursacht wurde. Im Gegensatz dazu führte die Anwendung von gentechnisch optimierten P14-TZR-Genen weder zur angeglichenen Oberflächenexpression der P14-TZR Ketten noch zu weniger Autoimmunität im Mausmodell. Ein anderes Tierexperiment zeigte, dass die miRNA die Funktion der genmodifizierten T-Zellen nicht beeinträchtigte. Schließlich wurde ein viraler Vektor entwickelt und getestet, der die Expression des zelleigenen TZR in menschlichen T-Zellen effektiv unterdrückte und die Bildung von gemischten TZR reduzieren konnte. / T cells can be genetically modified using viral vectors. The transfer of genes encoding both chains of the heterodimeric T cell receptor (TCR) programs T cells to specifically react towards an antigen of choice. Such TCR gene-modified T cells were already successfully applied in clinical studies to treat cancer and viral infections. However, in contrast to nonmanipulated T cells these cells express the transferred TCR in addition to the endogenous TCR and this situation allows the assembly of four different TCR heterodimers: the endogenous TCR, the transferred TCR, and two mixed TCR dimers, composed of one endogenous and one transferred TCR chain. The formation of mixed TCR dimers represents a safety issue because they may by chance recognize self-antigens and thereby cause autoimmune side effects. To overcome this problem, an RNAi-TCR replacement vector was developed that simultaneously silences the endogenous TCR and expresses an RNAi-resistant therapeutic TCR. The expression of miRNA encoded by a retroviral MP71 vector in transduced mouse T cells reduced the surface levels of the endogenous TCR by more than 85%. The knockdown of the endogenous TCR in turn resulted in equal surface expression levels of both transferred P14 TCR chains and prevented the formation of mixed TCR dimers. Accordingly, the development of lethal mixed TCR dimer-dependent autoimmunity (TI-GVHD) in a mouse model of adoptive T cell therapy was dramatically reduced by the knockdown of the endogenous TCR. In contrast, the usage of genetically optimized TCR genes neither resulted in equal surface levels of both P14 TCR chains nor in reduced autoimmunity. A second mouse model demonstrated that the in vivo functionality of the transduced T cells was not negatively influenced by the expression of the miRNA. Finally, an RNAi-TCR replacement vector for human T cells was developed that effectively reduced the expression of the endogenous TCR and prevented the formation of mixed TCR dimers.

Tesis por compendio / [ES] Aproximadamente 57 millones de adultos sufren insuficiencia cardíaca en todo el mundo y el trasplante cardíaco sigue siendo el tratamiento de referencia, en ausencia de contraindicaciones, en pacientes con insuficiencia cardíaca avanzada. A pesar de las mejoras en el tratamiento inmunosupresor, uno de los principales eventos tras el trasplante es el rechazo agudo (rechazo celular agudo (RCA) y el rechazo mediado por anticuerpos (RMA). La biopsia endomiocárdica (BEM) es la técnica estándar para monitorizar el rechazo, pero presenta importantes limitaciones, como su carácter invasivo. Por lo tanto, la identificación de métodos no invasivos para reducir o eliminar la BEM es un campo de estudio abierto. La biopsia líquida es una alternativa potencial menos invasiva debido a su capacidad para reflejar los cambios fisiopatológicos producidos en los órganos durante un evento. Los enfoques ómicos han permitido el descubrimiento de moléculas libres circulantes en sangre como biomarcadores de enfermedad, destacando el potencial de los ARNs por su papel en procesos inflamatorios, especificidad tisular y estabilidad en fluidos biológicos. Por ello, esta Tesis Doctoral se ha centrado en identificar ARNs libres circulantes alterados en el torrente sanguíneo tras un trasplante de corazón desde un enfoque transcriptómico y estudiar la capacidad diagnóstica para su uso como biomarcadores de rechazo cardíaco (RCA [no rechazo (0R), leve (1R) y moderado-grave (≥2R)] y RMA [no rechazo (pRMA0) y rechazo histopatológico e inmunopatológico (pRMA2)]). Los resultados obtenidos en esta Tesis Doctoral mostraron una desregulación en varios biotipos de ARNs libres circulantes tras el trasplante cardíaco en condiciones de rechazo. Observamos alteraciones en genes relacionados con el sarcómero; y el gen que codifica la alfa-actina cardiaca (ACTC1) mostró la mejor capacidad diagnóstica (≥2R área bajo la curva (AUC)=1,000, p<0,0001). Además, determinamos los niveles de la proteína ACTC1 en una cohorte mayor de pacientes, corroborando los hallazgos previos (AUC=0,702, p<0,05). Además, identificamos varios miARNs alterados en el suero de pacientes con RCA, concretamente miR-144-3p mostró los mejores resultados. En la fase de validación tuvo una capacidad diagnóstica excelente para el rechazo ≥2R (AUC=0,801, p<0,0001); sin embargo, su capacidad para detectar el rechazo 1R fue limitada (AUC=0,631, p<0,01). Así pues, analizamos y validamos la combinación de miR-144-3p y miR-652-3p, otro miARN identificado en la fase de descubrimiento. La combinación mejoró el poder diagnóstico (≥2R AUC=0,892, p<0,0001; 1R AUC=0,794, p<0,0001). Además, analizamos por primera vez la presencia en suero de otros biotipos de ARNs no codificantes tras un trasplante cardíaco. En concreto, identificamos 5 lncARNs (AC008105.3, AC006525.1, AC011455.8, AL359220.1, y AC025279.1) con capacidad diagnóstica excelente para la detección de los grados ≥2R (AUC de 0,850 a 1,000) y 1R (AUC de 0,750 a 0,854). Por otro lado, identificamos 7 piARNs (piR-169894, piR-181318, piR-1981088, piR-2479902, piR-380748, piR-398377 y piR-401292) con un perfil de expresión coincidente en suero y BEM. A continuación, validamos la combinación de estos piARNs en una cohorte mayor independiente (≥2R AUC=0,819, p<0,0001; 1R AUC=0,721, p=0,001). Además, nuestro panel de piARNs mostró un excelente poder diagnóstico de RMA (AUC=0,967, p<0,0001). Nuestros resultados demuestran la existencia de alteraciones en la expresión de ARNs libres circulantes (mARN, miARN, lncARN y piARN) en pacientes con rechazo cardíaco tras un trasplante, demostrando además una potente capacidad diagnóstica para los diferentes grados de RCA, incluso para el grado de rechazo leve. Además, una adecuada combinación de ARNs libres circulantes muestra mayor precisión para el diagnóstico del RCA que la detección individual de cada molécula, mostrando una excelente capacidad de diagnóstico del RMA y permitiendo monitorizar la respuesta al tratamiento. / [CA] Aproximadament 57 milions d'adults patixen insuficiència cardíaca a tot el món i el trasplantament cardíac continua sent el tractament de referència en absència de contraindicacions en pacients amb insuficiència cardíaca avançada. Malgrat les millores en el tractament immunosupressor, un dels principals esdeveniments després del trasplantament és el rebuig agut (rebuig cel·lular agut (RCA) i rebuig mediat per anticossos (RMA)). La biòpsia endomiocàrdica (BEM) és la tècnica estàndard per a monitorar el rebuig agut. No obstant això, la BEM presenta importants limitacions, com el seu caràcter invasiu. Per tant, la identificació de mètodes no invasius per a reduir o eliminar la BEM és un camp d'estudi obert. La biòpsia líquida és una alternativa potencial per a substituir a la BEM a causa de la seua capacitat per a reflectir els canvis fisiopatològics produïts en els òrgans durant un rebuig. Els enfocaments òmics han permés el descobriment de molècules lliures circulants en el torrent sanguini com biomarcadors de malaltia, destacant el potencial dels ARNs pel seu paper en processos inflamatoris, especificitat tissular i estabilitat en fluids biològics. Per això, esta Tesi Doctoral s'ha centrat en identificar ARNs lliures circulants alterats en sang després d'un trasplantament de cor des d'un enfocament transcriptòmic i estudiar la capacitat diagnòstica per al seu ús com biomarcadors de rebuig cardíac (RCA [no rebuig (0R), lleu (1R) i moderat-greu (≥2R)] i RMA [no rebuig (pRMA0) i rebuig histopatològic i immunopatològic (pRMA2)]). Els resultats obtinguts en esta Tesi Doctoral van mostrar desregulació en diversos biotips d'ARN lliures circulants després del trasplantament cardíac en condicions de rebuig. Observem alteracions en gens relacionats amb el sarcòmer; i el gen que codifica l'alfa-actina cardíaca (ACTC1) va mostrar la millor capacitat diagnòstica (≥2R: àrea baix la corba (AUC)=1,000, p<0,0001). A més, determinàrem els nivells de proteïna ACTC1 en una cohort major de pacients, corroborant les troballes prèvies (AUC=0,702, p<0,05). A més, identificàrem alguns miARNs alterats en el sèrum de pacients amb RCA, concretament miR-144-3p va mostrar els millors resultats. En la fase de validació va tindre una capacitat diagnòstica excel·lent per al rebuig ≥2R (AUC=0,801, p<0,0001); no obstant això, la seua capacitat per a detectar el rebuig 1R va ser limitada (AUC=0,631, p<0,01). Així doncs, analitzàrem i validàrem la combinació de miR-144-3p i miR-652-3p, un altre miARN identificat en la fase de descobriment. La combinació va millorar el poder diagnòstic (≥2R AUC=0,892, p<0,0001 i 1R AUC=0,794, p<0,0001). A més, analitzem per primera vegada la presència en sèrum d'altres biotips de ARN no codificant després d'un trasplantament cardíac. En concret, identificàrem 5 lncARNs (AC008105.3, AC006525.1, AC011455.8, AL359220.1, i AC025279.1) amb capacitat diagnòstica excel·lent per a la detecció de graus ≥2R (AUC de 0,850 a 1,000) i 1R (AUC de 0,750 a 0,854). D'altra banda, identificàrem 7 piARNs (piR-169894, piR-181318, piR-1981088, piR-2479902, piR-380748, piR-398377, i piR-401292) amb un perfil d'expressió coincident en sèrum i BEM. A continuació, validàrem la combinació d'estos piARNs en una major cohort independent (≥2R AUC=0,819, p<0,0001 i 1R AUC=0,721, p=0,001). A més, el nostre panell de piARN va mostrar un excel·lent poder diagnòstic de RMA (AUC=0,967, p<0,0001). Els nostres resultats demostren l'existència d'alteracions en l'expressió de ARNs lliures circulants (mARN, miARN, lncARN i piARN) en pacients amb rebuig cardíac després d'un trasplantament, demostrant a més una potent capacitat diagnòstica per als diferents graus de RCA, fins i tot per al grau de rebuig lleu. A més, una adequada combinació de ARNs lliures circulants mostra major precisió per al diagnòstic del RCA que la detecció individual de cada molècula, mostrant també una excel·lent capacitat de diagnòstic del RMA i permetent monitorar la resposta al tractament. / [EN] Approximately 57 million adults globally suffer heart failure and heart transplantation remains the gold standard therapy, in the absence of contraindications, in advanced heart failure patients. Despite improvements in immunosuppressive treatment one of the main events after transplant is acute rejection (acute cellular rejection (ACR) and antibody-mediated rejection (AMR)). Endomyocardial biopsy (EMB) is the standard technique for monitoring acute rejection, but EMB presents important limitations such as its invasive nature. Therefore, the identification of non-invasive methods to reduce or eliminate surveillance EMB is an important and necessary open field of study. Liquid biopsy is a potential alternative to replace EMB due to its less invasive nature and capability to reflect pathophysiological changes produced in organs during an event. The omics approaches have allowed the discovery of free molecules circulating in the bloodstream as biomarkers of disease, highlighting the potential of RNAs for their role in inflammatory processes, tissue specificity and stability in biological fluids. Therefore, this Doctoral Thesis have focused on identifying altered circulating cell-free mRNAs, miRNAs, lncRNAs, and piRNAs in the bloodstream after heart transplantation from a transcriptomic approach and studying the diagnostic capacity for its use as biomarkers of cardiac rejection (ACR [non-rejection (0R), mild (1R) and moderate-severe (≥2R)], and AMR [non-rejection (pAMR0) and histopathologic and immunopathologic rejection (pAMR2)]). The results obtained in this Doctoral Thesis showed deregulation in several biotypes of cell-free RNAs after heart transplantation in rejection conditions. We observed alterations in genes related to the sarcomere; and the gene that encodes cardiac alpha-actin (ACTC1) showed the best diagnostic capacity (grade ≥2R: AUC=1.000, p<0.0001). Furthermore, we determined ACTC1 protein levels in a larger cohort of patients, corroborating previous findings (AUC=0.702, p<0.05). Moreover, we identified several miRNAs altered in the serum of patients with ACR, specifically miR-144-3p showed the best results. In the validation phase it had excellent diagnostic capacity for moderate-severe rejection (AUC=0.801 p<0.0001); however, its ability to detect mild rejection was limited (AUC=0.631, p<0.01). Thus, we analysed and validated the combination of miR-144-3p and miR-652-3p, another miRNA identified in the discovery phase. The combination improved diagnostic power for moderate-severe rejection (AUC=0.892, p<0.0001) and mild (AUC =0.794, p<0.0001) rejection. Furthermore, we analysed for the first time the presence in serum of other biotypes of ncRNA (lncRNA and piRNA) after heart transplantation. Specifically, we identified 5 lncRNAs (AC008105.3, AC006525.1, AC011455.8, AL359220.1, and AC025279.1) with excellent diagnostic capacity for detection of ≥2R (AUC of 0.850 to 1.000) and 1R (AUC of 0.750 to 0.854) grades. On the other hand, we identified 7 piRNAs (piR-169894, piR-181318, piR-1981088, piR-2479902, piR-380748, piR-398377, and piR-401292) with a coincident expression profile in serum and EMB. Next, we validated the combination of these piRNAs in a large independent cohort (grade ≥2R: AUC=0.819, p<0.0001 and grade 1R: AUC=0.721, p=0.001). Additionally, our piRNA panel showed excellent diagnostic power for AMR (pAMR2: AUC=0.967, p<0.0001). Our results demonstrate the existence of alterations in the expression of circulating free RNAs (mRNA, miRNA, lncRNA and piRNA) in patients with cardiac rejection after transplantation, also demonstrating a powerful diagnostic capacity for different grades of ACR, even for the grade of mild rejection. Besides, an appropriate combination of circulating free RNAs shows greater precision for the diagnosis of ACR than the single detection of each molecule, showing excellent AMR capacity diagnosis and allowing monitoring of the response to treatment. / This work was supported by the National Institute of Health “Fondo de Investigaciones Sanitarias del Instituto de Salud Carlos III” (Projects: PI17/01232, PI20/01469, PI20/00071, CP18/00145 and PMPTA22/00184) co-funded by European Union; Miguel Servet contracts: CP21/00041, CP18/00145 cofunded by European Union, European Social Fund (ESF) “The ESF invests in your future” co-funded by European Union; “Consorcio Centro de Investigación Biomédica en Red” [CIBERCV, under Grant CB16/11/00261]; Ministry of Science and Innovation (MCIN, 10.13039/501100011033) and State Investigation Agency (AEI) (Project CNS2022-135769) co-funded by European Union “Next Generation EU” and the European Recovery, Transformation and Resilience Plan (PRTR); Conselleria de educación, universidades y empleo (Project kuuy8uio, contract CIACIF/2022/429). / Pérez Carrillo, L. (2024). Identification of New Circulating Biomarkers for the Characterization and Non-Invasive Diagnosis of Cardiac Rejection [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/214192 / Compendio