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Veterinary Clinical Pathol - 2018 - Cirera - Evaluation of microRNA Stability in Feces From Healthy Dogs
Veterinary Clinical Pathol - 2018 - Cirera - Evaluation of microRNA Stability in Feces From Healthy Dogs
See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
DOI: 10.1111/vcp.12566
ORIGINAL RESEARCH
1
Department of Veterinary and Animal
Sciences, University of Copenhagen,
Background: Gastrointestinal cancer accounts for approximately 8% of all canine
Copenhagen, Denmark malignancies. Early detection of cancer may have a tremendous impact on both
2
Department of Veterinary Clinical treatment options and prognosis. MicroRNAs (miRNAs), a class of noncoding RNAs
Sciences, University of Copenhagen,
Copenhagen, Denmark that can be found stably expressed in body fluids and feces, have been suggested
as valuable human cancer biomarkers.
Correspondence
S. Cirera, Division of Animal Genetics, Objectives: The purpose of the study was to investigate the feasibility of detecting
Bioinformatics and Breeding, Department of miRNAs in canine feces and to determine the miRNA stability in fecal samples
Veterinary and Animal Sciences, Faculty of
Health and Medical Sciences, University of stored at different temperatures for different duration.
Copenhagen, Frederiksberg C, Denmark Methods: The levels of 4 Canine familiaris (cfa) miRNAs (cfa-miR-16, cfa-miR-20a,
E-mail: scs@sund.ku.dk
cfa-miR-21, and cfa-miR-92a) were investigated by quantitative real-time PCR(qPCR)
in fecal samples from 10 healthy dogs. Fecal samples were collected at 3 different
time points and samples from the first time point were stored at different tempera-
tures and for a different duration.
Results: A statistically significant difference was found in miRNA levels from
samples stored at room temperature compared with samples stored at 20°C for
cfa-miR-16 and cfa-miR-21. No significant difference was found in the level of the
investigated miRNAs over time.
Conclusions: Overall, miRNAs are present in dog feces at measurable levels. Some
miRNAs seem to be subject to a higher degree of degradation in samples stored at
room temperature for 24 hours compared with samples frozen after collection at
20°C. The investigated miRNAs were stably expressed over time. This study pro-
vides the basis for further research on miRNA expression profiles as biomarkers for
gastrointestinal cancer in dogs.
KEYWORDS
Biomarker, canine, diagnostics, feces, microRNA profiling, qPCR
Vet Clin Pathol. 2018;47:115–121. wileyonlinelibrary.com/journal/vcp © 2018 American Society for | 115
Veterinary Clinical Pathology
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116 | CIRERA ET AL.
investigated in dogs with various types of cancer7,8, to our knowl- T A B L E 1 . Breed, age, and sex of 10 healthy dogs included in the
edge, there are no studies investigating canine fecal miRNA profiles miRNA study.
alone or in association with diseases. Dog ID Breed Age Sex
MiRNAs are small noncoding RNAs that regulate gene expres- 1 Bernese Mountain dog 5 years, 10 months ME
sion at the posttranscriptional level. Their functionality includes 2 Labrador Retriever 6 years, 4 months ME
acting as proto-oncogenes or tumor suppressor genes.9 Circulating 3 Cross breed 1 year, 2 months ME
miRNAs have revealed surprising stability, which may be related
4 Labrador Retriever 1 year, 9 months FE
to the circulatory transport in association with proteins or inside
5 Cross breed 2 years, 3 months MN
vesicles.10,11
6 Miniature Bull Terrier 2 years, 2 months ME
Feces is a complex material due to the amount of bacterial and
7 Miniature Bull Terrier 7 years, 1 month FN
other contaminants that are co-purified when the RNA is isolated,
8 Labrador Retriever 1 year, 7 months FE
but is both easy to sample and a noninvasive collection method. Gut
epithelial cells and HOP homeobox (Hopx) protein-expressing cells 9 English Springer Spaniel 2 years, 1 month ME
are the main contributors to fecal miRNAs. These fecal miRNAs 10 French Bulldog 3 years, 4 months FN
encompass those included within extracellular vehicles (EV), such as ME indicates male intact; MN, male chemically neutered; FE, female
within microvesicles or exosomes, and those which are EV-free and intact; FN, female neutered.
where the miRNAs are associated with lipoproteins or argonaute
proteins, which form part of RNA silencing processes and are essen-
Collection and storage of fecal samples
tial components of the RNA-induced silencing complex.12 Moreover,
both stability of miRNAs in human fecal samples as well as the level To examine the stability of miRNAs from fecal samples and the level
of fecal miRNA expression over time in cancer patients have been and availability of the miRNAs at different time points, 10 fecal
previously assessed.13 samples of around 1 g for each dog were collected into cryo tubes,
We have recently shown that preanalytic aspects, including 6 samples at day 1, 2 samples at day 4, and 2 samples at day 7. The
miRNA sampling and storage protocols in canine serum and plasma, samples from day 1 of the study were stored as follows: 2 samples
are of the outmost importance since miRNAs degrade relatively fast were left at room temperature (22°C) for 24 h before freezing at
and some are more affected by degradation than others.14 Feces is 20°C; 2 samples were refrigerated (4°C) for 24 h before freezing
an easily accessible material that requires very little effort to collect at 20°C; and 2 samples were frozen within an hour of collection at
and would; therefore, serve as an excellent matrix for noninvasive 20°C. Furthermore, the owners of the dogs collected 2 fecal sam-
biomarkers. Therefore, it is of significant relevance to obtain informa- ples from their dogs at day 4, and 2 samples at day 7 after the initial
tion regarding the stability of miRNAs in fecal material. sample, and froze these samples at 20°C before transport to the
The objectives of this pilot study were (1) to investigate the pos- laboratory on dry ice, which were stored at 20°C before further
sibility of identifying miRNAs in fecal samples from healthy dogs at processing (for sampling protocol see Figure 1).
measurable levels and (2) to evaluate the stability of these miRNAs
under different storage conditions and over time.
Total RNA extraction
The performance of 2 kits was tested in this study following each
MATERIALS AND METHODS
manufacturer’s recommendations: Stool Total RNA Purification kit
(Norgen, Biotek Corporation, Thorold, ON, Canada) and miRNeasy Mini
Recruitment of dogs
kit (Qiagen, Hilden, Germany). Both kits isolate total RNA including
Ten healthy dogs were recruited for this study during September miRNAs transported in vehicles (ie, exosomes) or attached to lipopro-
and October 2016. The dogs included 3 Labrador Retrievers, 2 teins or argonaute proteins. In brief, the miRNeasy Mini kit (Qiagen) is
Miniature Bull Terriers, 2 Labrador Retriever mixed breeds, and one based on the extraction of total RNA using guanidine thiocyanate, phe-
each of the following: Bernese Mountain Dog, English Springer Spa- nol, and chloroform followed by column-based purification, which
niel, and French Bulldog. Six dogs were intact males and 4 were enriches for miRNAs. The Stool Total RNA Purification kit (Norgen) is
females (2 spayed), with an average age of 40.3 months (Table 1). also column-based and uses guanidine hydrochloride and ethanol for
The dogs were determined to be healthy by physical examination, extraction, but is free from both phenol and chloroform and is specifi-
routine hematology, serum biochemistry, and urinalysis of voided cally designed for extraction of total RNA from feces. Subsequently, all
mid-stream urine. Fecal flotation for intestinal parasites was per- samples were DNase treated (DNAse I, Qiagen) to degrade genomic
formed on feces from all dogs and only dogs with a negative result DNA. The amount and purity of the RNA samples were assessed by
were included in the study. This study was approved by the local OD measurements in a NanoDrop 1000 spectrophotometer (Thermo-
ethical administrative board at the Department of Veterinary Clinical Fisher Scientific, Waltham, USA) . The RNA quality was further
and Animal Sciences, University of Copenhagen. Owners signed a assessed by visual inspection after agarose gel electrophoresis. RNA
form of consent before participating in the study. stocks were kept in a 80°C freezer until further processing.
1939165x, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vcp.12566 by Veterinärmedizinische Universität Wien, Wiley Online Library on [03/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
CIRERA ET AL. | 117
RT
RT
+4
Fecal sample, day 1
+4
-20
Dog -20
-20
Fecal sample, day 4
-20
-20
Fecal sample, day 7
-20
F I G U R E 1 . Fecal sample collection protocol from 10 healthy dogs. From each dog, 10 fecal samples were collected. Day 1, the samples
were either kept at room temperature (RT), at +4°C (+4) or frozen at 20°C ( 20) directly. After 24 hours, all samples kept at either RT or +4
were frozen to 20⁰C. The owners of the dogs collected fecal samples at day 4 and day 7 and froze the samples immediately at 20°C.
T A B L E 2 . Mature sequences and forward and reverse primers for each miRNA tested. Primers were designed using miRprimer.18 Cel-miR-
39-3p was used as spike-in in the cDNA synthesis and was detected by qPCR in each sample.
miRNA Mature Sequence Forward Primer Reverse Primer
cfa-miR-16 UAGCAGCACGUAAAUAUUGGCG CAGTAGCAGCACGTAAATATTG CAGTTTTTTTTTTTTTTTCGCCAA
cfa-miR-20a UAAAGUGCUUAUAGUGCAGGUAG ACAGTAAAGTGCTTATAGTGCA GTCCAGTTTTTTTTTTTTTTTCTACCT
cfa-miR-21 UAGCUUAUCAGACUGAUGUUGA GCAGTAGCTTATCAGACTGATG GGTCCAGTTTTTTTTTTTTTTTCAAC
cfa-miR-92a UAUUGCACUUGUCCCGGCCUGU AGGTGTGTATAAAGTATTGCACTTGTCC CAGGTCCAGTTTTTTTTTTTTTTTACAG
cel-miR-39-3p UCACCGGGUGUAAAUCAGCUUG GTCACCGGGTGTAAATCAG CCAGTTTTTTTTTTTTTTTCAAGCTG
1939165x, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vcp.12566 by Veterinärmedizinische Universität Wien, Wiley Online Library on [03/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
118 | CIRERA ET AL.
RESULTS among data from day 1, 4, and 7 in all assays. Paired Student’s t-
tests were performed in 3 separate instances for each assay: day
Detection of miRNAs 1 compared to day 4, day 1 compared to day 7, and day 4 com-
pared to day 7. No statistically significant differences were found
All qPCR efficiencies were in the range of 80–110% except for the
in the levels of the 4 miRNAs among any of the collection days
cfa-miR-20a assay (71.7%). Due to the complexity of the sample
(Table 4).
material and time limitation, the efficiency of the cfa-miR-20a assay
was accepted and included for further analyses, though suboptimal.
Additionally, a visual inspection of raw quantitation cycle (Cq) values DISCUSSION
for the cel-miR-39-3p spike-in assay showed a total of 6 samples
with markedly higher Cq values compared with that of the other In this study, we identified all 4 tested miRNAs in the feces of
samples: dog number 4, 6, and 7 on day 4, and dog number 2, 4, healthy dogs. In addition, these miRNAs were stably expressed at
and 5 on day 7. These samples were considered technical outliers different time points when fecal samples were frozen at 20°C.
and were eliminated from further analysis. Levels of cfa-miR-16 and cfa-miR-21 assays differed significantly in
Detecting the 4 investigated miRNAs in fecal samples was feasi- the samples stored at RT compared with the samples frozen at
ble (Figure 2A,B). The yield of total RNA was higher for the Norgen 20°C. This implies that samples stored at RT suffer some degree of
kit but twice as much fecal material was used for RNA extraction degradation and that some miRNAs are more sensitive to degrada-
compared with the Qiagen kit. Nevertheless, the amount of miRNAs tion than others, which suggests that fecal samples to be used for
isolated with the Qiagen kit resulted in lower Cq values in the qPCR. miRNA profiling should be either frozen immediately or preserved in
The 260/230 ratio showing organic compound contamination was stabilizing buffer (ie, RNA later) shortly after collection. This result is
found to be relatively high with both kits, but generally higher for in agreement with another study performed in the serum and plasma
RNA extracted with Qiagen kit. Several samples processed with the of healthy dogs.14 It has been hypothesized that miRNA stability, like
Norgen kit showed low reliability when comparing the raw Cq values mRNA, is correlated with the number of adenosine–uridine (AU)
from the 2 cDNA replicates that differed by more than 1.5 cycles. nucleotide pairs in the miRNA sequence.20,21 Higher numbers of AU
Moreover, the Norgen kit produced a larger number of unacceptable pairs result in lower stability. Another explanation could be that the
melting curves (more than a single peak) compared with the Qiagen stability of each miRNA present in feces is influenced by the pro-
kit across the 4 assays, which indicated that more contaminants teins or extracellular vesicles they are transported in.22 The existing
were present in the samples isolated with the Norgen kit. Paired literature that describes miRNA stability in human feces is limited,
Student’s t-tests, in processed qPCR data, showed statistically signifi- although an earlier study estimated that degradation of miRNA in
cant differences between the performances of the 2 kits in all assays human feces occurs over a 72-h period and identified a 30% reduc-
(Figure 1, Table 1), with the Qiagen kit showing better overall tion in the original miRNA concentration during that time period and
performance. Hence, the subsequent statistical analyses were only the degradation happened primarily in the first 12 h.23 In the present
performed for the fecal samples processed with the Qiagen kit. study, cfa-miR-16 showed a 37% reduction and cfa-miR-21 showed
a 49% reduction over a 24 hour time period.
In directly frozen samples, no statistically significant differences
Comparison of miRNA stability between storage
were found between the amount of miRNA present in samples
conditions
collected on days 1, 4, or 7, for the 4 miRNAs tested, which sug-
The qPCR data obtained from all assays followed Gaussian distribu- gests that the expression levels of these miRNAs remained stable
tions. The F-tests confirmed equal variances between storage methods over time in healthy dogs under these conditions. In agreement
in all assays. Statistically significant differences were found in the with these findings, an earlier study17 found stable expression of 6
amount of extracted miRNA between storage methods for 2 miRNAs: miRNAs in fecal samples from 8 healthy people at 2 time points.
cfa-miR-16 (P = .047) and cfa-miR-21 (P = .019) (Figure 2A). Tukey’s However, miRNAs could have different behaviors, and profiling a
post hoc tests showed that the amounts of extracted miRNA from larger panel of miRNAs is, therefore, warranted to verify this con-
samples stored at RT and 20°C was significantly different in both clusion.
assays (see Table 3) with higher amounts in samples stored at 20°C. It was expected that all miRNAs present in the samples, including
stably expressed reference miRNAs, could be affected by the degra-
dation process that occurred in the samples. Therefore, the method
Comparison of miRNA profiles at different time points
chosen for correction of the qPCR data, in the present study, was
The samples, frozen directly at 20°C on day 1, 4, and 7 for each the use of a spike-in during cDNA synthesis (as suggested by the
dog, were compared for all assay a (Figure 2B). Because of the Exiqon company24). The spike-in miRNA cel-miR-39-3p was chosen
exclusion of outlier samples due to technical problems on the cel- for this purpose because it lacks homology with mammalian miRNA
miR-39-3p spike-in step (see above), the sample sizes were too small sequences25 and is included in standard spike-in kits from Exiqon.
to perform a normality test. The F-tests confirmed equal variances By adding the synthetic miRNA before cDNA synthesis, the
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CIRERA ET AL. | 119
amount of cel-miR-39-3p detected by qPCR will reflect the cDNA Feces contain several classes of inhibitors that may be preserved
levels for this particular miRNA produced during a reaction, which during the RNA isolation steps (ie, polysaccharides, glycolipids, and
is highly affected by contaminants carried over from the RNA iso- urea) along with chemical residues from the extraction procedure (ie,
lation step. phenol). All these compounds can compromise the quality of the
1939165x, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vcp.12566 by Veterinärmedizinische Universität Wien, Wiley Online Library on [03/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
120 | CIRERA ET AL.
T A B L E 3 . Mean differences, 95% CI of differences, and adjusted qPCR, is considered acceptable. Standard software programs can
P-values for Tukey’s post hoc tests performed on cfa-miR-16 and help to choose the most stable reference genes. Alternatively, qPCR
cfa-miR-21 in canine fecal samples stored under different conditions data can be corrected using an artificial miRNA, which is spiked-in at
(room temperature [RT], 4°C [+4°C] before being frozen at 20°C,
the beginning of the RNA isolation or at the beginning of the cDNA
and frozen directly at 20°C [ 20°C]). Significant results are
highlighted in gray. synthesis (Exiqon). It is important to emphasize that synthetic miRNA
spike-ins do not necessarily behave like endogenous miRNAs, and
Mean Adjusted
cfa-miR-16 Difference 95% CI of Difference P-Value when possible, normalization to stably-expressed endogenous miR-
NAs should always be performed.
RT vs +4°C 0.54 1.32 to 0.25 .192
Extraction of miRNAs from feces can result in co-extraction of
RT vs 20°C 0.61 1.03 to 0.20 .007**
products deriving from other sources than the dog itself, such as
+4°C vs 20°C 0.08 0.72 to 0.57 .942
intestinal parasites. In fact, a recent study found that the porcine
cfa-miR-21 Mean 95% CI of difference Adjusted
whipworm, Trichuris suis, can secrete extracellular vesicles containing
difference P-value
RNA, and also small RNAs and miRNAs.28 It is not known whether
RT vs +4°C 0.79 1.77 to 0.20 .12
canine intestinal parasites are able to secrete miRNAs or if these
RT vs 20°C 0.91 1.47 to 0.34 .004**
miRNAs share sequence homology with the nematode C elegans.
+4°C vs 20°C 0.12 0.71 to 0.47 .846
Therefore, caution should be exercised when using cel-miR-39-3p to
*P < .05, **P < .01. normalize qPCR data in studies similar to this. The healthy dogs in
our study were determined to be negative for intestinal parasites by
simple fecal flotation. Although this test is a standard test for detec-
T A B L E 4 . Paired Student’s t-tests of canine fecal samples for tion of intestinal parasites, the test has a moderate sensitivity and
quantification of miRNAs on collection days. The table shows the
specificity29; and as only 2 of the dogs received anthelmintics prior
mean difference (Mean dif), 95% CI of difference, and P-values of
the 3 separated paired Student’s t-tests were performed for each of to entering the study, it may be questionable whether all the dogs in
the 4 assays: cfa-miR-16, cfa-miR-20a, cfa-miR-21, and cfa-miR-92a. this study were truly free of intestinal parasites.
No statistically significant differences were found between the Fecal matter is a complex and heterogeneous matrix with great
amounts of extracted miRNA on any of the collection days. diversity in both general composition and microbiota, and it can vary
Threshold for statistical significance was set at P < .05. 1, day 1; 4,
greatly depending on genetics and lifestyle conditions including age,
day 4; 7, day 7.
breed, and diet.30,31 The complexity of the fecal samples generated
Assay Days Mean Dif 95% CI P-value
concern that unwarranted noise and interference with the RNA extrac-
cfa-miR-16 1 vs 4 0.26 0.73 to 0.21 .221 tion process would occur, and therefore, 2 kits commonly used for RNA
1 vs 7 0.3 1.26 to 0.66 .474 isolation from feces were tested. Although both kits succeeded in iso-
4 vs 7 0.56 1.83 to 0.71 .291 lating miRNA, a statistically significant difference was found between
cfa-miR-20a 1 vs 4 0.2 0.44 to 0.05 .094 the amounts of the 4 miRNAs that were isolated with the 2 kits, which
1 vs 7 0.34 1.25 to 0.56 39 highlights the importance of choosing a good RNA extraction method,
4 vs 7 0.44 1.61 to 0.73 .356 and then, using the same method for all the samples.
cfa-miR-21 1 vs 4 0.09 1.09 to 0.90 .825 There are several limitations to be addressed in the present
1 vs 7 0.31 0.90 to 0.27 .239 study. Firstly, a sample size of 10 dogs is considered of low power,
in particular, when several samples are needed to be excluded from
4 vs 7 0.53 1.78 to 0.73 .31
the analysis due to technical issues. A larger sample size would
cfa-miR-92a 1 vs 4 0.41 0.99 to 0.17 .132
increase the possibility of detecting small variations in miRNA
1 vs 7 0.52 1.73 to 0.70 .334
expression levels over time. Secondly, it is difficult to draw general
4 vs 7 0.53 2.35 to 1.29 .466
conclusions regarding the overall stability of the miRNA population
in feces from dogs, based on only 4 miRNAs, and a larger panel of
isolated RNA and result in downstream inhibition of the enzymatic miRNAs should be tested. Thirdly, only one synthetic miRNA was
reactions such as cDNA synthesis and qPCR. Specifically, cDNA syn- used as a spike-in for normalization of technical variability. In the
thesis is sensitive to inhibitors, which results in different reaction present study, 6 out of 50 total samples had to be excluded due to
efficiencies, and subsequently, different cDNA yields between sam- technical issues that occurred during the cDNA synthesis. Several
ples. To correct for differences in the cDNA amount as input mate- synthetic miRNAs could have been used to optimize the process.
rial for the qPCR, data need to be normalized using endogenous or
exogenous reference genes. Unfortunately, there is no standardized
way to perform this correction/normalization when working with cir- CONCLUSION
culating or fecal miRNAs.26 When looking at biologic variability, nor-
malizing to at least 2 stably expressed endogenous reference This study confirmed that it is feasible to identify miRNAs from the
genes27 to correct for variability in the cDNA amounts used in feces of healthy dogs using commercial kits for extraction of total
1939165x, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vcp.12566 by Veterinärmedizinische Universität Wien, Wiley Online Library on [03/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
CIRERA ET AL. | 121
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ACKNOWLEDGMENTS 14. Enelund L, Nielsen LN, Cirera S. Evaluation of microRNA stability in
plasma and serum from healthy dogs. Microrna. 2017;6:42–52.
We acknowledge the veterinary nurses at the University Hospital for
15. Balcells I, Cirera S, Busk PK. Specific and sensitive quantitative RT-
Companion Animals for excellent assistance during blood sampling. PCR of miRNAs with DNA primers. BMC Biotechnol. 2011;11:70.
We also thank the technical staff at the Veterinary Diagnostic Labo- 16. Rotelli MT, Di Lena M, Cavallini A, et al. Fecal microRNA profile in
ratory from the Department of Veterinary and Clinical Animal patients with colorectal carcinoma before and after curative surgery.
Int J Colorectal Dis. 2015;30:891–898.
Sciences for their help with analyses of blood and urine as well as
17. Link A, Balaguer F, Shen Y, et al. Fecal microRNAs as novel biomark-
fecal flotation assays. We also thank the technicians at the Genetics ers for colon cancer screening. Cancer Epidemiol Biomarkers Prev.
section at Department of Veterinary and Animal Sciences for help in 2010;19:1766–1774.
the laboratory work. Finally we thank the owners of the dogs for 18. Cirera S, Busk PK. Quantification of miRNAs by a simple and specific
qPCR method. Methods Mol Biol. 2014;1182:73–81.
participating in the study.
19. Busk PK. A tool for design of primers for microRNA-specific quanti-
tative RT-qPCR. BMC Bioinformatics. 2014;15:29.
20. Sethi P, Lukiw WJ. Micro-RNA abundance and stability in human
DISCLOSURE brain: specific alterations in Alzheimer’s disease temporal lobe neo-
cortex. Neurosci Lett. 2009;459:100–104.
The authors have indicated that they have no affiliations or financial
21. Balzano F, Deiana M, Dei Giudici S, et al. miRNA stability in frozen
involvement with any organization or entity with a financial interest plasma samples. Molecules. 2015;20:19030–19040.
in, or in financial competition with, the subject matter or materials 22. Diehl P, Fricke A, Sander L, et al. Microparticles: major transport
discussed in this article. vehicles for distinct microRNAs in circulation. Cardiovasc Res.
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23. Wu CW, Ng SS, Dong YJ, et al. Detection of miR-92a and miR-21 in
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