Integrated Transcriptomic Profiling Reveals MAPK14-Related Inflammatory Signalling Associated with Postoperative Atrial Fibrillation

Postoperative atrial fibrillation (POAF) affects up to half of patients after cardiac surgery and raises long-term risk of stroke and death. Why only some patients develop it, despite similar surgical exposure, remains poorly understood. We studied a pilot cohort of 20 patients undergoing cardiac surgery in Northwest England, comparing those who developed POAF within four days (n=10) with those who did not (n=10). Circulating plasma RNA was profiled using the NanoString nCounter Cardiovascular Disease panel, and differentially expressed genes were mapped onto protein-protein interaction networks using STRING and Cytoscape. Candidate genes were then validated by RT-qPCR in the same cohort, alongside serial ELISA measurement of plasma MAPK14 protein. Peripheral blood monocyte, neutrophil and total white blood cell counts were also compared between the two groups on postoperative Days 1, 2 and 4. Screening identified MAPK14, COX6C and COX7B as elevated in POAF, with PTPN12 reduced. These genes clustered within a connected inflammatory and stress-response network, and pathway enrichment pointed to immune activation. RT-qPCR confirmed higher MAPK14, COX6C and COX7B expression in POAF patients. Plasma MAPK14 rose after surgery in both groups, with the largest increase in POAF patients on day two, though this did not reach significance. Peripheral blood monocyte counts were significantly higher in POAF patients than in those without POAF at all three postoperative timepoints, whereas neutrophil and total white blood cell counts did not differ significantly between groups. These early findings identify a circulating plasma RNA signature linked to MAPK14-related inflammatory signalling as a candidate marker of POAF susceptibility, warranting confirmation in a larger, adequately powered cohort.