This review highlights recent advances in understanding the roles of non-coding RNAs, particularly microRNAs (miRNAs), and extracellular vesicles, such as exosomes, in cancer biology. These molecules are central to intercellular communication, tumorigenesis, metastasis, and therapeutic resistance. Exosomes, nanoscale vesicles secreted by cells, carry oncogenic cargos that reshape distant microenvironments, suppress immunity, and promote metastasis. Breast cancer (BC), the most common cancer among women, serves as a model for exploring exosome-based diagnostics, therapeutics, and biological insights.
miRNAs, small non-coding RNAs, regulate gene expression post-transcriptionally and act as tumor suppressors or oncogenes depending on their targets. For example, miR-320a and miR-142 inhibit BC progression, while miR-21 promotes metastasis. Encapsulated within exosomes, miRNAs serve as biomarkers and functional effectors. Exosomal miRNAs like miR-21, miR-155, and miR-10b are upregulated in BC patients and correlate with tumor stage and prognosis. Unique miRNA fingerprints in circulating exosomes also help distinguish BC subtypes (e.g., luminal, triple-negative, HER2-positive) via liquid biopsies.
Exosomes facilitate intercellular communication by transferring cargo, including miRNAs, to recipient cells, modulating the tumor microenvironment (TME). Engineered exosomes show promise in delivering tumor-suppressive miRNAs to reverse epithelial-mesenchymal transition (EMT), restore chemosensitivity, and reactivate immune surveillance. Beyond biomarkers, exosomes act as dynamic ecosystem engineers by transforming fibroblasts into cancer-associated fibroblasts (CAFs) and polarizing macrophages toward immunosuppressive phenotypes.
Clinically, exosome-based liquid biopsies enable real-time monitoring of treatment response and early relapse detection. Exosome-based vaccines and engineered exosomes as nanocarriers for targeted drug delivery represent revolutionary approaches. Challenges remain in standardizing isolation methods, scaling production, and addressing regulatory and ethical concerns. Nevertheless, exosomes hold immense potential for precision medicine, offering innovative diagnostic tools and therapies in oncology.
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Prevention, Early Detection and Screening Received: 2025/11/15 | Accepted: 2026/02/3