Metabolic syndrome is directly linked with atherosclerotic burden and cell-free nucleic acids (cf-NA) analysis has recently
emerged as a novel research tool in atherosclerosis practice and research. cf-NA are nucleic acids (DNA, mRNA, miRNA, mitochondrial
DNA) found in plasma and cell-free fractions of various other biological fluids. They have all the characteristics of the nucleic acids in
the cells of their origin, thus constituting an emerging field for non-invasive assessment. Initially, quantitative and qualitative analysis of
cf-NA has been accepted as clinically useful in non-invasive prenatal diagnosis, and in the diagnosis and monitoring of numerous cancers.
As to atherosclerosis, cf-NA analysis poses an important challenge in diagnosis and prognostic evaluation of acute coronary syndrome,
in prediction of cardiovascular disease, in non-invasive early detection of atherosclerosis and understanding its pathological
mechanism in vivo, in assessing various issues of treatment for atherosclerosis in vivo, and in the unique simultaneous measurement of
mRNA levels and protein concentrations in a single sample of plasma. Examples of its use are presented in this review. Besides the advances
in technologies, the precise evaluation and optimization of pre-analytical and analytical aspects of cf-NA analysis have impacted
importantly on the reliability of test results. We have, therefore, reviewed the most important analytical considerations. Further clinical
studies and analytical improvements will answer the question as to whether cf-NA, as novel biomarkers, can be reliably applied clinically
in non-invasive, early diagnosis and monitoring of the vulnerable atherosclerotic plaques of patients who could suffer from acute coronary
Cell-free nucleic acids, atherosclerosis, non-invasive application, research tool, analytical considerations.
Faculty of Pharmacy, Askerceva 7, 1000 Ljubljana, Slovenia.