<scp>MicroRNAs</scp> as potential architects of immune dysregulation and megakaryocytic failure in immune thrombocytopenia

Immune thrombocytopenia (ITP) is a complex autoimmune disorder characterized by accelerated destruction of peripheral platelets and impaired megakaryopoiesis. While the cellular effectors, dysregulated T cells, hyperactive B cells and phagocytic macrophages are well characterized, the upstream epigenetic mechanisms orchestrating this multicellular immune network remain largely elusive. This review explores the hypothesis that microRNAs (miRNAs) may serve as critical architects of immune dysregulation and bone marrow failure in ITP. We evaluate the clinical utility of circulating miRNAs as non-invasive biomarkers for diagnosis, risk stratification and predicting response to steroid and thrombopoietin receptor agonists therapies. Finally, we address current translational difficulties, such as data fragmentation and pre-analytical variables. We propose a roadmap for integrating functional validation with multi-omics, utilizing miRNA-based approaches to facilitate and advance precision medicine in ITP.