Introduction: Peripheral artery disease (PAD) is an atherosclerotic occlusive disease that leads to reduced blood flow to the lower extremities and endothelial dysfunction. Some patients develop critical limb ischemia (CLI), a severe manifestation of PAD defined as chronic ischemic rest pain with higher risk of amputation. Major risk factors for both PAD and CLI is type 2 diabetes. However, the pathophysiological contribution of microRNAs (miRNAs), in diabetic CLI progression remains poorly elucidated. Methods: By overlapping plasma miRNA sequencing in PAD patients that develop CLI with a mouse model, miRNAs were identified in the progression of diabetic limb ischemia. In this study, we describe miR-1282, a previously uninvestigated miRNA that was the highest upregulated miRNA in high-risk diabetic CLI human subjects. Results: Preliminary studies uncover a mouse ortholog of human miR-1282, a cis-antisense miRNA, that strongly inhibits the expression of SERF2 (small EDRK-rich factor 2), a protein-coding gene located on the opposite DNA strand in both human and mouse endothelial cells. SERF2 is predicted to affect the formation of aggresomes, the inclusion bodies of misfolded proteins; however, its molecular function is also poorly understood. MiR-1282 expression was decreased by diabetic stimuli such as hypoxia and glucose; and its expression inversely correlated with SERF2 expression in endothelial cells. Our in vitro studies indicate that miR-1282 mimic overexpression or SERF2 siRNA-mediated inhibition reduced a range of endothelial angiogenic assays and inhibits apoptosis. Proteomics by tandem mass-tag mass-spectrometry and transcriptomics by RNA-Seq suggest that miR-1282 likely regulates protein quality control system (SERF2, BAG1, BAG3, and HSPB8) and regulated cell death (CASP3, SLC7A11, and CTH), among others. Intriguingly, intramuscular administration of miR-1282 significantly improved blood flow recovery by laser doppler imaging in the hindlimbs of diabetic db/db mice compared to control injected mice. Conclusion: Taken together, the cis-antisense regulatory network of miR-1282-SERF2 axis reveals novel insights in the progression of diabetic CLI.
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