X-inactive specific transcript (XIST) can determine sex differences in cardiovascular drug responses: focus on RNA therapeutics
Open Access
- 12 January 2026
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Pharmacology
- Vol. 16, 1716863
Abstract
Genetic, hormonal, anatomical, and environmental factors underlie sex differences in the prevalence and progression of cardiovascular disease and responses to therapeutics. The presence of two X chromosomes in the female genome decreases susceptibility to X-linked recessive disorders but imposes the need for random X chromosome inactivation as an epigenetic mechanism controlling gene dosage. Long non-coding RNA XIST is essential for transcriptional repression of genes on inactive X chromosome but may also act as a miRNA sponge for post-transcriptional regulation of gene expression and a scaffold for RNA binding proteins that provoke autoimmune responses. These features draw attention to XIST as an important drug development target by design or as an off target, including novel RNA therapeutics for genetic and cardiovascular diseases. Based on the extensive literature analysis, we postulate the hypothesis that XIST can determine sex differences in cardiovascular drug responses and propose several criteria for use in developing or evaluating responses to RNA therapeutics for cardiovascular disease in women. We hope that implementation of those criteria in the process of RNA therapeutics development may be helpful in reducing the risks of adverse effects in women.Keywords
Funding Information
- National Heart, Lung, and Blood Institute (GM126412)
This publication has 174 references indexed in Scilit:
- Participation of Women in Cardiovascular Trials From 2017 to 2023JAMA Network Open, 2025
- Epigenetic and transcriptomic consequences of excess X‐chromosome material in 47,XXX syndrome—A comparison with Turner syndrome and 46,XX femalesAmerican Journal of Medical Genetics Part C: Seminars in Medical Genetics, 2020
- What microRNAs could tell us about the human X chromosomeCellular and Molecular Life Sciences, 2020
- Xist attenuates acute inflammatory response by female cellsCellular and Molecular Life Sciences, 2020
- The long noncoding RNA XIST regulates cardiac hypertrophy by targeting miR‐101Journal of Cellular Physiology, 2019
- LncRNA XIST regulates myocardial infarction by targeting miR‐130a‐3pJournal of Cellular Physiology, 2018
- Skewed X‐chromosome inactivation plays a crucial role in the onset of symptoms in carriers of Becker muscular dystrophyThe Journal of Gene Medicine, 2017
- Increased number of sex chromosomes affects height in a nonlinear fashion: A study of 305 patients with sex chromosome aneuploidyAmerican Journal of Medical Genetics Part A, 2010
- Efficacy of systemic morpholino exon‐skipping in duchenne dystrophy dogsAnnals of Neurology, 2009
- Absence of correlation between skewed X inactivation in blood and serum creatine-kinase levels in Duchenne/Becker female carriersAmerican Journal of Medical Genetics, 1998