Exosomal miRNA as a biomarker for diagnosis and prognosis, and a new target for regulating treatment resistance in DLBCL: a research progress narrative review

Background and Objective: Exosomes, as key mediators of intercellular communication, carry microRNAs (miRNAs) that play central roles in anticancer drug resistance by regulating the immune status of the tumor microenvironment (TME) and drug-metabolic pathways. In recent years, advances in single vesicle analysis have greatly promoted mechanistic studies on exosomal miRNAs in diffuse large B-cell lymphoma (DLBCL). This article aims to comprehensively review recent advances in the study of exosomal miRNAs in DLBCL. This review explores the value of exosomal miRNAs as tumor biomarkers in diagnosis and prognostic evaluation of DLBCL, and provides an in-depth analysis of molecular networks underlying DLBCL drug resistance mediated through exosomal miRNAs. Methods: This study conducted a literature review by searching the PubMed and Web of Science databases to identify the latest research findings regarding the roles of exosomal miRNAs as tumor biomarkers in diagnosis and prognostic evaluation of DLBCL, and the mechanisms by which exosomal miRNAs regulates DLBCL drug resistance. Based on these findings, a narrative review was generated. Key Content and Findings: This article introduces the biogenesis of exosomal miRNA and research progress on exosomal miRNAs as biomarkers in the diagnosis and prognosis of DLBCL. It summarizes the research progress on the mechanisms of exosomal miRNA in regulating therapeutic resistance in DLBCL. And it also discusses the current translational studies using exosomal miRNAs to control drug resistance in DLBCL, and challenges of using extracellular vesicle (EV)-derived miRNAs. These advances will help provide more new strategy for reversing DLBCL drug resistance in the future. Conclusions: Exosomal miRNAs can serve as biomarkers for the diagnosis and prognostic assessment of DLBCL and are associated with DLBCL treatment resistance. Currently, there has been significant progress in research on the mechanisms by which exosomal miRNAs regulate DLBCL resistance, with some mechanisms already validated. It is expected that through more in-depth in vivo and in vitro studies in the future, mature therapeutic targets can be developed.