RNA was isolated from 300 µL serum using NucleoSpin miRNA Plasma of Macherey Nagel (Dürer, Germany), following the protocol and instructions provided by the manufacturer. This method is a phenol-free protocol based on a silica membrane technology for purification that provides higher miRNA concentrations.14 (link) Carriers or spike-in controls have not been used, and any prior DNase-digestion was performed. Serum samples do not contain significant amounts of DNA; therefore, digestion is not recommended. Total RNA was eluted in 20 µL of RNase-free water. RNA input was normalized by using equal volumes of serum (300 µL).