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microRNAs: What the Clinician Should Know About This New Frontier

As clinicians, we are often overwhelmed by the explosion of new discoveries in technology. When investigators of various aspects of obesity and diabetes moved from physiologic studies of β-cell function and insulin action in metabolic tissues, they moved into the realm of gene expression, gene array, and other laboratory techniques. These techniques were readily included in our understanding of the disorders. For example, enhanced hepatic glucose production secondary to impaired insulin release from the pancreas and hepatic insulin resistance was often associated with increased expression of important regulatory enzymes, such as glucose-6-phosphatase and PEPCK. The exquisite regulation of their gene expression is commonly measured as mRNA, a step before translation into the protein. More recently, we have had to come to grips with large-scale genome-wide association studies that relate the disease with single nucleotide polymorphisms—often only associations without definitive or identifiable causal relationships. Thus, while we could readily understand genetic mutations resulting in disease states, it was often less apparent how single nucleotide polymorphisms could explain diseases in the absence of genetic mutations (1).

If that wasn’t enough, we now are becoming overwhelmed by new physiologic and pathologic processes discovered more recently as the sequence of the whole genome is no longer …