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Circulating exosomal miRNA in acute coronary syndrome: mechanisms; clinical relevance and future directions
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DOI：10.3389/fmolb.2026.1869889.png)
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Abstract
En 中文
Despite significant advances in diagnosis and treatment; Acute Coronary Syndrome (ACS) remains one of the leading causes of morbidity and mortality globally. It comprises ST-elevation myocardial infarction; non-ST-elevation myocardial infarction; and unstable angina; caused by complex mechanisms such as plaque rupture; thrombosis; erosion; and microvascular dysfunction. The development of high-sensitivity cardiac troponins has greatly improved the early detection of ACS. However; concerns remain about specificity; timing; and prognostic accuracy. Exosomal miRNAs (ExomiRs) show promise as minimally invasive biomarkers; aiding precise cell communication and protecting encapsulated miRNAs from degradation. During ischemic injury; ExomiRs released from cardiomyocytes act early; often before troponin elevation; and are involved in processes such as inflammation; apoptosis; angiogenesis; fibrosis; and ventricular remodelling. Specific ExomiR signatures have different roles in prognosis; subtype discrimination; and early ACS diagnosis. Future therapeutic potential may include advancements in translational strategies; such as antagomir-based miRNA modulation. Furthermore; the clinical adoption of these biomarkers; despite challenges such as pre-analytical variability; differences across study cohorts; a lack of standardised isolation protocols; and the need for large-scale validation; will significantly improve the sensitivity; specificity; and accuracy of predicting ACS.
Keywords:
acute coronary syndrome
myocardial infarction
ST-elevation myocardial infarction
clinical prognosis
non-ST-elevation myocardial infarction
unstable angina
exosomal miRNAs
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