Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Downregulation of CSF-derived miRNAs miR-142-3p and miR-17-5p may be associated with post-dural puncture headache in pregnant women upon spinal anaesthesia

A regulação negativa dos miRNAs derivados do LCR miR-142-3p e miR-17-5p pode estar associada à cefaleia pós-punção dural em mulheres grávidas sob raquianestesia

Duygu Yücel

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Postdural puncture headache (PDPH) develops due to puncture of the dura mater. The risk factors that influence PDPH incidence are Body Mass Index (BMI), sex, spinal needle type, history of headache, and loss of Cerebrospinal fluid (CSF) volume, yet there is no consensus on these risk factors. The pathophysiology of PDPH is poorly understood. The molecular pathways that may lead to PDPH are unknown. In this study, CSF – derived microRNAs (miRNAs) were investigated for their potential to predispose to PDPH in a population of pregnant women.

Pregnant women going under cesarean section via spinal anesthesia were included in the study with the criteria of the subjects presenting American Society of Anesthesiologists (ASA) physical status I. Patients were classified into two groups as with PDPH (n = 10) and without PDPH (n = 12) based on International Headache Society’s PDPH definition. CSF-derived microRNAs were investigated for their differential expression levels in PDPH patients compared with the healthy controls using microfluidic gene expression platform.

Out of seventy-six miRNAs, two miRNAs, namely miR-142-3p and miR-17-5p, were significantly downregulated in PDPH patients (Mann-Whitney U test, p < 0,05). BMI and age did not influence PDPH occurrence. The mean visual analogue scale (VAS) of the PDPH patients was 6,8 out of 10.

We have shown that downregulation of miR-142-3p and miR-17-5p may predispose pregnant women to PDPH upon spinal anesthesia. However, which genes are targeted by miR-142-3p and miR-17-5p- mediated effect on PDPH remains to be elucidated.


Spinal anesthesia;  Postdural puncture headache;  Cerebrospinal fluid;  Biomarkers;  MicroRNAs


Introdução: A cefaleia pós-punção dural (CPPD) desenvolve-se devido à punção da dura-máter. Os fatores de risco que influenciam a incidência de CPPD são Índice de Massa Corporal (IMC), sexo, tipo de agulha espinhal, história de cefaleia e perda de volume do líquido cefalorraquidiano (LCR), mas não há consenso sobre esses fatores de risco. A fisiopatologia da CPPD é pouco compreendida. As vias moleculares que podem levar à CPPD são desconhecidas. Neste estudo, microRNAs derivados de LCR (miRNAs) foram investigados por seu potencial de predispor a CPPD em uma população de mulheres grávidas. Métodos: Gestantes submetidas à cesariana por raquianestesia foram incluídas no estudo com o critério dos sujeitos apresentarem estado físico I da Sociedade Americana de Anestesiologistas (ASA). As pacientes foram classificadas em dois grupos como com CPPD (n = 10) e sem CPPD (n = 12) com base na definição de CPPD da International Headache Society. MicroRNAs derivados de CSF foram investigados por seus níveis de expressão diferencial em pacientes com CPPD em comparação com os controles saudáveis usando a plataforma de expressão de genes microfluídicos. Resultados: Dos setenta e seis miRNAs, dois miRNAs, nomeadamente miR-142-3p e miR-17-5p, foram significativamente desregulados em pacientes com CPPD (teste U de Mann-Whitney, p < 0,05). IMC e idade não influenciaram a ocorrência de CPPD. A média da escala visual analógica (EVA) dos pacientes com CPPD foi de 6,8 em 10. Conclusão: Mostramos que a regulação negativa de miR-142-3p e miR-17-5p pode predispor gestantes a CPPD sob raquianestesia. No entanto, quais genes são direcionados pelo efeito mediado por miR-142-3p e miR-17-5p na CPPD ainda não foi elucidado.


Anestesia espinhal; Cefaleia pós-punção dural; Líquido cefalorraquidiano; Biomarcadores; MicroRNAs


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