Exosomal miRNAs as biomarkers in predicting chemotherapy-induced cardiotoxicity in patients with cancer (Review).

With the advancements made in oncology, such as molecularly targeted therapies and immune checkpoint inhibitors, their use has significantly improved the outcomes of patients with cancer. In addition, these advancements have led to an increased incidence of cardiotoxicity, ranging from subclinical dysfunction to severe cardiomyopathy. Hence, it is imperative to enable the early detection and prevention of cardiotoxicity to mitigate irreversible cardiac damage. Exosomal microRNAs (miRNAs) have emerged as promising non-invasive biomarkers due to their stability in biological fluids and their ability to reflect early myocardial stress and damage. Unlike traditional biomarkers such as troponins, which indicate damage after myocardial injury has occurred, miRNAs can detect subclinical changes earlier, enabling timely intervention. Exosomal miRNAs not only serve as diagnostic biomarkers, but also provide therapeutic potential by modulating molecular pathways associated with cardiotoxicity. Understanding the regulatory mechanisms of miRNA expression in chemotherapy-induced cardiotoxicity can pave the way for personalized cardioprotective strategies, minimizing cardiovascular complications during cancer therapy. The present review discusses the role of various miRNAs as biomarkers for the early diagnosis of cardiotoxicity induced by chemotherapeutic agents.