Relationship of microRNAs to the severity of the course of hemorrhagic fever with renal syndrome

The objective of the study was to conduct a systematic literature review and meta-analysis of published scientific evidence on the role of microRNAs in the severity of the course of hemorrhagic fever with renal syndrome (HFRS). Materials and methods. The review was conducted according to the PRISMA 2020 guidelines. The protocol of the review is registered with PROSPERO (CRD420250250652912). Only studies directly related to HFRS that examined microRNAs in the context of the disease were analyzed; clinical studies and in vitro and in vivo experimental work were taken into account, as well as literature reviews to collect additional references. Comprehensive searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and RINC databases. All retrieved references were imported into a bibliography manager (Zotero) to remove duplicates. Results. MicroRNAs are important participants in HFRS pathogenesis and correlate with disease severity. Elevated levels of miR-155 and miR-146a are clearly associated with severe course and may serve as prognostic biomarkers. Dysfunction of endothelial microRNAs (such as miR-126, miR-218, miR-410) may contribute to vascular leakage and shock in severe HFRS, although clinical evidence is limited. Antiviral microRNAs (e.g., miR-145-5p) represent a natural defense mechanism that could potentially be used therapeutically. Further studies, both large-scale clinical (including longitudinal monitoring of microRNAs in patients) and experimental (modeling the effects of microRNAs on the course of infection), are needed to transfer this knowledge into clinical practice. Key words: microRNA, hemorrhagic fever with renal syndrome, biomarker, severe HFRS, pathogenesis