The coordinated regulation of CASC2/miR-200c/miR-20b and SIRT1/ACE-2/IL-6 Axes in COVID-19 pneumonia: Novel molecular diagnostic and therapeutic insights.

Pneumonia is an acute lung tissue infection that may be induced by various agents, like SARS-CoV-2 virus. The ongoing research focused on the molecular interplay between the lncRNA CASC2 and the miR-200c and miR-20b in tuning SIRT1 and ACE2 levels in Egyptian patients with COVID-19 pneumonia and to examine their correlation with clinical outcomes, inflammatory markers, and prospective role as diagnostic or prognostic biomarkers. One-hundred COVID-19 pneumonia patients, together with thirty healthy controls, were recruited, and blood samples were drawn. The gene expression of CASC2, miR-200c and miR-20b were measured using qRT-PCR, whereas the serum concentrations of SIRT1, ACE-2, and IL-6 were measured using ELISA. The gene expression of CASC2 and miR-20b were downregulated, and miR-200c was upregulated among pneumonic patients relative to healthy control subjects. Moreover, the concentration of SIRT1 and ACE-2 were markedly suppressed, whereas IL-6 was increased among pneumonic patients. CASC2, miR-200c, miR-20b, SIRT1, ACE-2 and IL-6 showed ideal performance as a diagnostic biomarker to discriminate between pneumonia patients and healthy controls. Logistic regression analysis revealed that CASC2, miR-20b, SIRT1, and ACE2 could decrease the odds of pneumonia, while miR-200c and IL-6 could increase the risk. Collectively, the present study explored the potential regulatory role of lncRNA CASC2, miR-200c, and miR-20b in modulating key pneumonia-associated targets, including SIRT1, ACE2, and IL-6. These non-coding RNAs may participate in the inflammatory and immune responses underlying pneumonia pathogenesis. Their particularised expression supports their potential utility as diagnostic or prognostic biomarkers and may introduce new targets for therapeutic modulation.