Circulating nucleic acids and hemostasis: biological basis behind their relationship and technical issues in assessment

Nucleic acids (NAs) constitute the backbone of cellular life permitting conservation, transmission, and execution of genetic information. In the past few years, new unexpected functions for NAs, projecting them also beyond nuclear and cellular boundaries have been recognized: circulating cell-free nucleic acids (cfNAs), histones, DNA-histone complexes, microRNAs (miRs) may have a regulatory role in physiological and pathological processes. In particular, several lines of evidence suggest that they can constitute unconventional mediators of thrombus formation, intervening both in hemostasis and thrombosis. Furthermore, in the past decade, the possibility to detect and quantify these in plasma and/or in serum has led to their ancillary use as potential markers in various medical conditions. The use of these as markers within the fields of thrombosis and hemostasis looks promising: the potential implications include the possibility to assess patients' risk profiles for thrombotic events and the identification of more directed targets for pharmacologic intervention. The major impediment is that, to date, the methods by which NAs are explored, still largely differ between published studies and standardized procedures are still lacking. Future research should focus on the physiological mechanisms underlying the activities of such mediators in specific thrombotic conditions and on the definition of reliable methods for their quantification in biological fluids.