{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:00:09Z","timestamp":1785214809289,"version":"3.55.0"},"reference-count":128,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Mol. Biosci."],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3389\/fmolb.2026.1869889","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:25:47Z","timestamp":1785212747000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Circulating exosomal miRNA in acute coronary syndrome: mechanisms, clinical relevance and future directions"],"prefix":"10.3389","volume":"13","author":[{"given":"P. V.","family":"Varshini","sequence":"first","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debarati","family":"Halder","sequence":"additional","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tridip","family":"Mitra","sequence":"additional","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. H. Sruthi","family":"Anil Kumar","sequence":"additional","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. R.","family":"Muralidharan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajarajeswaran","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M.","family":"Dhileeban","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. N.","family":"Meenakshi Sundari","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Janardhanan","sequence":"additional","affiliation":[{"name":"Division of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology","place":["Kattankulathur, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jjcc.2010.05.005","article-title":"Pathophysiology of acute coronary syndrome assessed by optical coherence tomography","volume":"56","author":"Akasaka","year":"2010","journal-title":"J. Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2591","DOI":"10.3390\/biomedicines13112591","article-title":"Thyrotoxicosis and the heart: an underrecognized trigger of acute coronary syndromes","volume":"13","author":"Anghel","year":"2025","journal-title":"Biomedicines"},{"key":"B3","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/J.IHJ.2020.11.147","article-title":"Prognostic implications of thyroid hormone alterations in acute coronary syndrome\u2013A systematic review","volume":"73","author":"Arambam","year":"2021","journal-title":"Indian Heart J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/J.IHJ.2023.12.008","article-title":"Hypothyroidism in acute coronary syndrome \u2013 a prospective Indian study","volume":"76","author":"Arambam","year":"2024","journal-title":"Indian Heart J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.1161\/CIRCULATIONAHA.105.595520","article-title":"Inflammatory biomarkers in acute coronary syndromes: part I: introduction and cytokines","volume":"113","author":"Armstrong","year":"2006","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1590\/0104-1169.3389.2449","article-title":"Association of cardiovascular risk factors with the different presentations of acute coronary syndrome","volume":"22","author":"Brunori","year":"2014","journal-title":"Rev. Lat. Am. Enferm."},{"key":"B7","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.ijcard.2018.03.135","article-title":"Risk factors predisposing to acute coronary syndromes in young women \u226445 years of age","volume":"264","author":"B\u0119\u0107kowski","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e000946","DOI":"10.1161\/JAHA.114.000946","article-title":"Single intracoronary injection of encapsulated antagomir-92a promotes angiogenesis and prevents adverse infarct remodeling","volume":"3","author":"Bellera","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"B81","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1159\/000490932","article-title":"MicroRNA-142-3p induces atherosclerosis-associated endothelial cell apoptosis by directly targeting rictor","volume":"47","author":"Bing","year":"2018","journal-title":"Cell. Physiol. Biochem."},{"key":"B9","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/anec.12130","article-title":"ECG diagnosis and classification of acute coronary syndromes","volume":"19","author":"Birnbaum","year":"2014","journal-title":"Ann. Noninvasive Electrocardiol. Off. J. Int. Soc. Holter Noninvasive Electrocardiol. Inc."},{"key":"B10","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1002\/prca.201400114","article-title":"Exosomes in bodily fluids are a highly stable resource of disease biomarkers","volume":"9","author":"Boukouris","year":"2015","journal-title":"Proteomics Clin. Appl."},{"key":"B11","doi-asserted-by":"publisher","first-page":"FSO251","DOI":"10.4155\/fsoa-2017-0036","article-title":"The role of biomarkers in the diagnosis and risk stratification of acute coronary syndrome","volume":"4","author":"Chacko","year":"2017","journal-title":"Future Sci. OA"},{"key":"B12","doi-asserted-by":"publisher","first-page":"821","DOI":"10.12669\/pjms.36.4.2302","article-title":"Identification of risk factors of acute coronary syndrome in young patients between 18-40 years of age at a teaching hospital","volume":"36","author":"Cheema","year":"2020","journal-title":"Pak J. Med. Sci."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/2948578","article-title":"Role of cardiomyocyte-derived exosomal MicroRNA-146a-5p in macrophage polarization and activation","volume":"2022","author":"Chen","year":"2022","journal-title":"Dis. Markers"},{"key":"B14","doi-asserted-by":"publisher","first-page":"181","DOI":"10.2147\/CEOR.S43672","article-title":"Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative medicare population","volume":"5","author":"Chen","year":"2013","journal-title":"Clin. Outcomes Res. CEOR"},{"key":"B15","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1136\/postgradmedj-2019-136409","article-title":"Diagnostic and prognostic value of biomarkers in acute myocardial infarction","volume":"95","author":"Chen","year":"2019","journal-title":"Postgrad. Med. J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1002\/iub.2376","article-title":"Expression level and diagnostic value of exosomal NEAT1\/miR-204\/MMP-9 in acute ST-segment elevation myocardial infarction","volume":"72","author":"Chen","year":"2020","journal-title":"IUBMB Life"},{"key":"B17","doi-asserted-by":"publisher","first-page":"100038","DOI":"10.1016\/J.CLINSP.2022.100038","article-title":"Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction","volume":"77","author":"Chen","year":"2022","journal-title":"Clinics"},{"key":"B18","doi-asserted-by":"publisher","first-page":"23743","DOI":"10.3402\/jev.v3.23743","article-title":"Exosomes provide a protective and enriched source of miRNA for biomarker profiling compared to intracellular and cell-free blood","volume":"3","author":"Cheng","year":"2014","journal-title":"J. Extracell. Vesicles"},{"key":"B19","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1038\/s41467-019-08895-7","article-title":"Circulating myocardial microRNAs from infarcted hearts are carried in exosomes and mobilise bone marrow progenitor cells","volume":"10","author":"Cheng","year":"2019","journal-title":"Nat. Commun."},{"key":"B20","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/S41598-017-00070-6","article-title":"Serum microRNA-1 and microRNA-133a levels reflect myocardial steatosis in uncomplicated type 2 diabetes","volume":"7","author":"De Gonzalo-Calvo","year":"2017","journal-title":"Sci. Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.mvr.2018.10.009","article-title":"Improvement of microvascular endothelial dysfunction induced by exercise and diet is associated with microRNA-126 in obese adolescents","volume":"123","author":"Donghui","year":"2019","journal-title":"Microvasc. Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s11886-017-0840-3","article-title":"Prognostic biomarkers in acute coronary syndromes: risk stratification beyond cardiac troponins","volume":"19","author":"Eggers","year":"2017","journal-title":"Curr. Cardiol. Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.3390\/JCM9061674","article-title":"Identification of a miRNA based-signature associated with acute coronary syndrome: evidence from the FLORINF study","volume":"9","author":"Elbaz","year":"2020","journal-title":"J. Clin. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.vph.2015.02.008","article-title":"Exosomes and exosomal miRNAs in cardiovascular protection and repair","volume":"71","author":"Emanueli","year":"2015","journal-title":"Vasc. Pharmacol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15761\/mri.1000167","article-title":"Acute coronary syndromes and diagnostic methods","volume":"3","author":"Enes Demirel","year":"2019","journal-title":"Med. Res. Innov."},{"key":"B26","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2174\/1874192401408010061","article-title":"Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis","volume":"8","author":"Esteban","year":"2014","journal-title":"Open Cardiovasc Med. J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1016\/j.jacc.2013.11.055","article-title":"Novel biomarkers in acute coronary syndromes: new molecules, new concepts, but what about new treatment strategies?","volume":"63","author":"Filippatos","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"10107","DOI":"10.26355\/eurrev_202010_23230","article-title":"MicroRNA-338 in MSCs-derived exosomes inhibits cardiomyocyte apoptosis in myocardial infarction","volume":"24","author":"Fu","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1038\/S41586-021-04234-3","article-title":"MicroRNA sequence codes for small extracellular vesicle release and cellular retention","volume":"601","author":"Garcia-Martin","year":"2022","journal-title":"Nature"},{"key":"B30","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s11739-017-1612-1","article-title":"Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin","volume":"12","author":"Garg","year":"2017","journal-title":"Intern Emerg. Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2587104","DOI":"10.1155\/2023\/2587104","article-title":"Association of MicroRNA-146a with type 1 and 2 diabetes and their related complications","volume":"2023","author":"Ghaffari","year":"2023","journal-title":"J. Diabetes Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"23609","DOI":"10.18632\/aging.103563","article-title":"Inhibition of Exo-miR-19a-3p derived from cardiomyocytes promotes angiogenesis and improves heart function in mice with myocardial infarction via targeting HIF-1\u03b1","volume":"12","author":"Gou","year":"2020","journal-title":"Aging"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1330144","DOI":"10.3389\/fmolb.2024.1330144","article-title":"Exosomal microRNAs in breast cancer: towards theranostic applications","volume":"11","author":"Gulati","year":"2024","journal-title":"Front. Mol. Biosci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"219","DOI":"10.21037\/atm-20-2337","article-title":"Evaluation of exosomal miRNAs as potential diagnostic biomarkers for acute myocardial infarction using next-generation sequencing","volume":"9","author":"Guo","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1007\/S10528-025-11069-4","article-title":"miR-203 alleviates myocardial damage caused by acute coronary syndrome by inhibiting CA125","volume":"64","author":"Guo","year":"2026","journal-title":"Biochem. Genet."},{"key":"B36","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12943-022-01671-0","article-title":"Exosome biogenesis: machinery, regulation, and therapeutic implications in cancer","volume":"21","author":"Han","year":"2022","journal-title":"Mol. Cancer"},{"key":"B37","doi-asserted-by":"publisher","first-page":"29813","DOI":"10.1038\/S41598-024-81352-8","article-title":"Plasma exosomes from patients with coronary artery disease promote atherosclerosis via impairing vascular endothelial junctions","volume":"14","author":"Han","year":"2024","journal-title":"Sci. Rep."},{"key":"B38","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s12265-020-10040-5","article-title":"Cardiovascular exosomes and MicroRNAs in cardiovascular physiology and pathophysiology","volume":"14","author":"Henning","year":"2021","journal-title":"J. Cardiovasc Transl. Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/S00018-017-2595-9","article-title":"Current knowledge on exosome biogenesis and release","volume":"75","author":"Hessvik","year":"2018","journal-title":"Cell Mol. Life Sci. CMLS"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2905","DOI":"10.1016\/j.bioactmat.2021.02.014","article-title":"Exosome-guided bone targeted delivery of Antagomir-188 as an anabolic therapy for bone loss","volume":"6","author":"Hu","year":"2021","journal-title":"Bioact. Mater"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1038\/mtna.2016.12","article-title":"Combination of microRNA-21 and microRNA-146a attenuates cardiac dysfunction and apoptosis during acute myocardial infarction in mice","volume":"5","author":"Huang","year":"2016","journal-title":"Mol. Ther. Nucleic Acids"},{"key":"B42","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1039\/d2mo00257d","article-title":"Plasma extracellular vesicles microRNA-208b-3p and microRNA-143-3p as novel biomarkers for sudden cardiac death prediction in acute coronary syndrome","volume":"19","author":"Huang","year":"2023","journal-title":"Mol. Omics"},{"key":"B43","volume-title":"Exosomal Mirnas as Potential Biomarkers for Acute Myocardial Infarction","year":"2019"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/j.febslet.2015.04.036","article-title":"Mechanisms of RNA loading into exosomes","volume":"589","author":"Janas","year":"2015","journal-title":"FEBS Lett."},{"key":"B45","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.1161\/ATVBAHA.118.311145","article-title":"MicroRNA-199a-3p and MicroRNA-199a-5p take part to a redundant network of regulation of the NOS (NO synthase)\/NO pathway in the endothelium","volume":"38","author":"Joris","year":"2018","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"e140759","DOI":"10.1172\/jci.insight.140759","article-title":"MIR448 antagomir reduces arrhythmic risk after myocardial infarction by upregulating the cardiac sodium channel","volume":"5","author":"Kang","year":"2020","journal-title":"JCI Insight"},{"key":"B47","doi-asserted-by":"publisher","first-page":"515","DOI":"10.2337\/DB18-0470","article-title":"Circulating exosomal miR-20b-5p is elevated in type 2 diabetes and could impair insulin action in human skeletal muscle","volume":"68","author":"Katayama","year":"2019","journal-title":"Diabetes"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S43162-022-00178-W","article-title":"Traditional and novel diagnostic biomarkers for acute myocardial infarction","volume":"34","author":"Khalil","year":"2022","journal-title":"Egypt J. Intern Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1038\/nature04303","article-title":"Silencing of microRNAs in vivo with \u201cantagomirs.\u201d","volume":"438","author":"Kr\u00fctzfeldt","year":"2005","journal-title":"Nature"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2885","DOI":"10.1093\/nar\/gkm024","article-title":"Specificity, duplex degradation and subcellular localization of antagomirs","volume":"35","author":"Kr\u00fctzfeldt","year":"2007","journal-title":"Nucleic Acids Res."},{"key":"B51","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1161\/CIRCGENETICS.110.958975","article-title":"Increased microRNA-1 and microRNA-133a levels in serum of patients with cardiovascular disease indicate myocardial damage","volume":"4","author":"Kuwabara","year":"2011","journal-title":"Circ. Cardiovasc Genet."},{"key":"B52","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1515\/cclm-2019-0896","article-title":"Plasma vs. serum in circulating tumor DNA measurement: characterization by DNA fragment sizing and digital droplet polymerase chain reaction","volume":"58","author":"Lee","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"B53","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1536\/IHJ.23-269","article-title":"MiR-522-3p attenuates cardiac recovery by targeting FOXP1 to suppress angiogenesis","volume":"65","author":"Li","year":"2024","journal-title":"Int. Heart J."},{"key":"B54","doi-asserted-by":"publisher","first-page":"2232993","DOI":"10.1080\/07853890.2023.2232993","article-title":"A review on the current literature regarding the value of exosome miRNAs in various diseases","volume":"55","author":"Li","year":"2023","journal-title":"Ann. Med."},{"key":"B55","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/CIRCRESAHA.120.317244","article-title":"Mir-30d regulates cardiac remodeling by intracellular and paracrine signaling","volume":"128","author":"Li","year":"2021","journal-title":"Circ. Res."},{"key":"B56","doi-asserted-by":"publisher","first-page":"3105","DOI":"10.21037\/jtd-21-609","article-title":"Serum exosomal microRNA-146a as a novel diagnostic biomarker for acute coronary syndrome","volume":"13","author":"Li","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"B57","doi-asserted-by":"publisher","first-page":"132395","DOI":"10.1016\/j.ijcard.2024.132395","article-title":"Murine exosomal miR-30a aggravates cardiac function after acute myocardial infarction via regulating cell fate of cardiomyocytes and cardiac resident macrophages","volume":"414","author":"Li","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1080\/1354750X.2020.1803963","article-title":"Serum exosomal miR-122-5p is a new biomarker for both acute coronary syndrome and underlying coronary artery stenosis","volume":"25","author":"Ling","year":"","journal-title":"Biomark. Biochem. Indic. Expo. Response Susceptibility Chem."},{"key":"B59","doi-asserted-by":"publisher","first-page":"654","DOI":"10.3389\/fphys.2020.00654","article-title":"Serum exosomal MicroRNA-21, MicroRNA-126, and PTEN are novel biomarkers for diagnosis of acute coronary syndrome","volume":"11","author":"Ling","year":"","journal-title":"Front. Physiol."},{"key":"B60","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.omtn.2018.01.010","article-title":"miR-93-5p-Containing exosomes treatment attenuates acute myocardial infarction-induced myocardial damage","volume":"11","author":"Liu","year":"2018","journal-title":"Mol. Ther. Nucleic Acids"},{"key":"B61","doi-asserted-by":"publisher","first-page":"eabd0914","DOI":"10.1126\/scitranslmed.abd0914","article-title":"Cell type-specific microRNA therapies for myocardial infarction","volume":"13","author":"Liu","year":"2021","journal-title":"Sci. Transl. Med."},{"key":"B62","doi-asserted-by":"publisher","first-page":"104708","DOI":"10.1016\/J.ISCI.2022.104708","article-title":"MiR-203 is an anti-obese microRNA by targeting apical sodium-dependent bile acid transporter","volume":"25","author":"Liu","year":"2022","journal-title":"iScience"},{"key":"B63","doi-asserted-by":"publisher","first-page":"124","DOI":"10.3892\/mmr.2023.13010","article-title":"Exosomal microRNA-4516, microRNA-203 and SFRP1 are potential biomarkers of acute myocardial infarction","volume":"27","author":"Liu","year":"2023","journal-title":"Mol. Med. Rep."},{"key":"B64","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s13019-024-02740-9","article-title":"Diagnostic value of the creatine kinase-MB\/creatine kinase and neutrophil\/lymphocyte ratios in acute myocardial infarction","volume":"19","author":"Liu","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"B65","doi-asserted-by":"publisher","first-page":"3290372","DOI":"10.1155\/2018\/3290372","article-title":"MicroRNA-132, delivered by mesenchymal stem cell-derived exosomes, promote angiogenesis in myocardial infarction","volume":"2018","author":"Ma","year":"2018","journal-title":"Stem Cells Int."},{"key":"B66","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1186\/S13098-022-00942-6","article-title":"Roles of physical exercise-induced MiR-126 in cardiovascular health of type 2 diabetes","volume":"14","author":"Ma","year":"2022","journal-title":"Diabetol. Metab. Syndr."},{"key":"B67","doi-asserted-by":"publisher","first-page":"2076","DOI":"10.1111\/jcmm.17230","article-title":"MicroRNA-495-3p diminishes doxorubicin-induced cardiotoxicity through activating AKT","volume":"26","author":"Meng","year":"2022","journal-title":"J. Cell Mol. Med."},{"key":"B68","doi-asserted-by":"publisher","first-page":"10513","DOI":"10.1073\/pnas.0804549105","article-title":"Circulating microRNAs as stable blood-based markers for cancer detection","volume":"105","author":"Mitchell","year":"2008","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"B69","doi-asserted-by":"publisher","first-page":"1097337","DOI":"10.3389\/fendo.2023.1097337","article-title":"Prospecting of exosomal-miRNA signatures as prognostic marker for gestational diabetes mellitus and other adverse pregnancy outcomes","volume":"14","author":"Mitra","year":"2023","journal-title":"Front. Endocrinol."},{"key":"B70","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.atherosclerosis.2019.03.016","article-title":"Cardioprotective microRNAs: lessons from stem cell-derived exosomal microRNAs to treat cardiovascular disease","volume":"285","author":"Moghaddam","year":"2019","journal-title":"Atherosclerosis"},{"key":"B71","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10741-020-10001-9","article-title":"Therapeutic angiogenesis with exosomal microRNAs: an effectual approach for the treatment of myocardial ischemia","volume":"26","author":"Moghiman","year":"2021","journal-title":"Heart Fail Rev."},{"key":"B72","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1001\/jama.297.14.1551","article-title":"Nonvalidation of reported genetic risk factors for acute coronary syndrome in a large-scale replication study","volume":"297","author":"Morgan","year":"2007","journal-title":"JAMA"},{"key":"B73","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1093\/eurheartj\/eht530","article-title":"Biomarkers and acute coronary syndromes: an update","volume":"35","author":"Mueller","year":"2014","journal-title":"Eur. Heart J."},{"key":"B74","doi-asserted-by":"publisher","first-page":"e649","DOI":"10.1016\/S2666-7568(22)00189-1","article-title":"Clinical resource allocation for the mitigation of elder abuse","volume":"3","author":"Nandi","year":"2022","journal-title":"Lancet Healthy Longev."},{"key":"B75","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.gendis.2014.06.003","article-title":"The myriad essential roles of microRNAs in cardiovascular homeostasis and disease","volume":"1","author":"Neppl","year":"2014","journal-title":"Genes Dis."},{"key":"B76","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jelectrocard.2009.07.009","article-title":"Electrocardiographic classification of acute coronary syndromes: a review by a committee of the international society for holter and non-invasive electrocardiology","volume":"43","author":"Nikus","year":"2010","journal-title":"J. Electrocardiol."},{"key":"B77","doi-asserted-by":"publisher","first-page":"5680","DOI":"10.3390\/IJMS23105680","article-title":"Cardiovascular biomarkers: lessons of the past and prospects for the future","volume":"23","author":"Omran","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"B78","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1038\/s41419-020-2545-6","article-title":"Exosomal miR-25-3p from mesenchymal stem cells alleviates myocardial infarction by targeting pro-apoptotic proteins and EZH2","volume":"11","author":"Peng","year":"2020","journal-title":"Cell Death Dis."},{"key":"B79","doi-asserted-by":"publisher","first-page":"6005","DOI":"10.1111\/JCMM.14463","article-title":"miR-1, miR-499 and miR-208 are sensitive markers to diagnose sudden death due to early acute myocardial infarction","volume":"23","author":"Pinchi","year":"2019","journal-title":"J. Cell Mol. Med."},{"key":"B80","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12943-022-01525-9","article-title":"Liquid biopsy: exosomal microRNAs as novel diagnostic and prognostic biomarkers in cancer","volume":"21","author":"Preethi","year":"2022","journal-title":"Mol. Cancer"},{"key":"B82","doi-asserted-by":"publisher","first-page":"1330327","DOI":"10.3389\/fmolb.2023.1330327","article-title":"Prospecting the theragnostic potential of the psycho-neuro-endocrinological perturbation of the gut-brain-immune axis for improving cardiovascular diseases outcomes","volume":"10","author":"Rajan","year":"2023","journal-title":"Front. Mol. Biosci."},{"key":"B83","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.2174\/0118715303289859240214103350","article-title":"Inhibition of MiR-155 using exosomal delivery of antagomir can Up-Regulate PTEN in triple negative breast cancer","volume":"24","author":"Razaviyan","year":"2024","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"key":"B84","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3390\/metabo13040479","article-title":"Exosomes in cardiovascular disease: from mechanism to therapeutic target","volume":"13","author":"Reiss","year":"2023","journal-title":"Metabolites"},{"key":"B85","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1161\/CIRCULATIONAHA.108.814145","article-title":"MicroRNA-320 is involved in the regulation of cardiac ischemia\/reperfusion injury by targeting heat-shock protein 20","volume":"119","author":"Ren","year":"2009","journal-title":"Circulation"},{"key":"B86","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESc guidelines for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation of","volume":"37","author":"Roffi","year":"2016","journal-title":"Eur. Heart J."},{"key":"B87","doi-asserted-by":"publisher","first-page":"110448","DOI":"10.1016\/j.mehy.2020.110448","article-title":"Downregulation of microRNA-146a in diabetes, obesity and hypertension may contribute to severe COVID-19","volume":"146","author":"Roganovi\u0107","year":"2021","journal-title":"Med. Hypotheses"},{"key":"B88","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1136\/hrt.2004.051508","article-title":"Cardiovascular risk factors and clinical presentation in acute coronary syndromes","volume":"91","author":"Rosengren","year":"2005","journal-title":"Heart Br. Card. Soc."},{"key":"B89","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.atherosclerosis.2022.12.003","article-title":"Targeting and delivery of microRNA-targeting antisense oligonucleotides in cardiovascular diseases","volume":"374","author":"Saenz-Pipaon","year":"2023","journal-title":"Atherosclerosis"},{"key":"B90","doi-asserted-by":"publisher","first-page":"e2228","DOI":"10.1002\/hsr2.2228","article-title":"Exosomal miRNA\u201021\u20105p and miRNA\u201021\u20103p as key biomarkers of myocardial infarction","volume":"7","author":"Sahebi","year":"2024","journal-title":"Health Sci. Rep."},{"key":"B91","doi-asserted-by":"publisher","first-page":"e018999","DOI":"10.1161\/JAHA.120.018999","article-title":"Prospective study on plasma microrna-4286 and incident acute coronary syndrome","volume":"10","author":"Shen","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"B92","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/j.cjca.2014.12.026","article-title":"MicroRNA-208a increases myocardial endoglin expression and myocardial fibrosis in acute myocardial infarction","volume":"31","author":"Shyu","year":"2015","journal-title":"Can. J. Cardiol."},{"key":"B93","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.1016\/s0735-1097(24)04310-9","article-title":"Global prevalence of coronary artery disease: an update from the global burden of disease study","volume":"83","author":"Stark","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"B94","doi-asserted-by":"publisher","first-page":"31292","DOI":"10.3402\/jev.v5.31292","article-title":"Exosomal miRNAs as cancer biomarkers and therapeutic targets","volume":"5","author":"Thind","year":"2016","journal-title":"J. Extracell. Vesicles"},{"key":"B95","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1007\/s11886-001-0079-9","article-title":"The definitions of acute coronary syndrome, myocardial infarction, and unstable angina","volume":"3","author":"Thygesen","year":"2001","journal-title":"Curr. Cardiol. Rep."},{"key":"B96","doi-asserted-by":"publisher","first-page":"881","DOI":"10.3390\/DIAGNOSTICS11050881","article-title":"Past, present, and future of blood biomarkers for the diagnosis of acute myocardial infarction\u2014Promises and challenges","volume":"11","author":"Tilea","year":"2021","journal-title":"Diagnostics"},{"key":"B97","doi-asserted-by":"publisher","first-page":"246","DOI":"10.3390\/BIOLOGY12020246","article-title":"Extracellular vesicles in lung cancer: bystanders or main characters?","volume":"12","author":"Tin\u00e8","year":"2023","journal-title":"Biology"},{"key":"B98","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1038\/ncb1596","article-title":"Exosome-mediated transfer of mRNAs and microRNAs is a novel mechanism of genetic exchange between cells","volume":"9","author":"Valadi","year":"2007","journal-title":"Nat. Cell Biol."},{"key":"B99","doi-asserted-by":"publisher","first-page":"e015640","DOI":"10.1161\/JAHA.119.015640","article-title":"Sacubitril\/Valsartan improves cardiac function and decreases myocardial fibrosis Via downregulation of exosomal miR-181a in a rodent chronic myocardial infarction model","volume":"9","author":"Vaskova","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"B100","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1093\/eurheartj\/ehq013","article-title":"Circulating microRNA: a novel potential biomarker for early diagnosis of acute myocardial infarction in humans","volume":"31","author":"Wang","year":"2010","journal-title":"Eur. Heart J."},{"key":"B101","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/S11010-013-1606-X","article-title":"MicroRNA-1 prevents high-fat diet-induced endothelial permeability in apoE knock-out mice","volume":"378","author":"Wang","year":"2013","journal-title":"Mol. Cell Biochem."},{"key":"B102","doi-asserted-by":"publisher","first-page":"3639","DOI":"10.3892\/ETM.2018.6655\/ABSTRACT","article-title":"Reduced expression of microRNA-199a-3p is associated with vascular endothelial cell injury induced by type 2 diabetes mellitus","volume":"16","author":"Wang","year":"2018","journal-title":"Exp. Ther. Med."},{"key":"B103","doi-asserted-by":"publisher","first-page":"13671","DOI":"10.2147\/IJN.S498599","article-title":"Bubble ticket trip: exploring the mechanism of miRNA sorting into exosomes and maintaining the stability of tumor microenvironment","volume":"19","author":"Wang","year":"2024","journal-title":"Int. J. Nanomedicine"},{"key":"B104","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1038\/s41569-019-0273-3","article-title":"Non-atherosclerotic causes of acute coronary syndromes","volume":"17","author":"Waterbury","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"B105","doi-asserted-by":"publisher","first-page":"116632","DOI":"10.1016\/j.lfs.2019.116632","article-title":"miRNA-181a over-expression in mesenchymal stem cell-derived exosomes influenced inflammatory response after myocardial ischemia-reperfusion injury","volume":"232","author":"Wei","year":"2019","journal-title":"Life Sci."},{"key":"B106","doi-asserted-by":"publisher","first-page":"2754","DOI":"10.1161\/CIRCULATIONAHA.118.038529","article-title":"Cardiac troponin T and troponin I in the general population","volume":"139","author":"Welsh","year":"2019","journal-title":"Circulation"},{"key":"B107","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13287-020-1563-8","article-title":"Mesenchymal stem cell-derived exosomes ameliorate cardiomyocyte apoptosis in hypoxic conditions through microRNA144 by targeting the PTEN\/AKT pathway","volume":"11","author":"Wen","year":"2020","journal-title":"Stem Cell Res. Ther."},{"key":"B108","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.21037\/CDT-2025-368\/COIF","article-title":"Circulating exosomal miR-20b-5p and miR-1273g-3p were potential biomarkers for diagnosis and prognosis of acute coronary syndrome","volume":"15","author":"Weng","year":"2025","journal-title":"Cardiovasc Diagn Ther."},{"key":"B109","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1080\/15384101.2025.2485834","article-title":"Exosomes derived from mesenchymal stem cells ameliorate impaired glucose metabolism in myocardial Ischemia\/reperfusion injury through miR-132-3p\/PTEN\/AKT pathway","volume":"23","author":"Wu","year":"2024","journal-title":"Cell Cycle"},{"key":"B110","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1016\/S0140-6736(08)60623-6","article-title":"Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data","volume":"371","author":"Xavier","year":"2008","journal-title":"Lancet"},{"key":"B111","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.hlc.2017.03.165","article-title":"Early diagnostic performance of heart-type fatty acid binding protein in suspected acute myocardial infarction: evidence from a meta-analysis of contemporary studies","volume":"27","author":"Xu","year":"2018","journal-title":"Heart Lung Circ."},{"key":"B112","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12951-020-00601-w","article-title":"Exosomal miRNA-128-3p from mesenchymal stem cells of aged rats regulates osteogenesis and bone fracture healing by targeting Smad5","volume":"18","author":"Xu","year":"2020","journal-title":"J. Nanobiotechnology"},{"key":"B113","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3389\/FPHYS.2019.00123","article-title":"Circulating MiR-17-5p, MiR-126-5p and MiR-145-3p are novel biomarkers for diagnosis of acute myocardial infarction","volume":"10","author":"Xue","year":"2019","journal-title":"Front. Physiol."},{"key":"B114","first-page":"150","article-title":"Clinical profile and risk factors in acute coronary syndrome","volume":"1","author":"Yadav","year":"2010","journal-title":"Natl. J. Community Med."},{"key":"B115","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1080\/19390211.2025.2555013","article-title":"Vitamins and iron-deficiency gestational anemia \u2013 a review","volume":"22","author":"Yadav","year":"2025","journal-title":"J. Diet. Suppl."},{"key":"B116","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.jjcc.2009.12.010","article-title":"Difference in risk factors between acute coronary syndrome and stable angina pectoris in the Japanese: smoking as a crucial risk factor of acute coronary syndrome","volume":"55","author":"Yagi","year":"2010","journal-title":"J. Cardiol."},{"key":"B117","doi-asserted-by":"publisher","first-page":"6528","DOI":"10.62347\/vxnd1945","article-title":"Exosomal miRNA-let-7i-5p from bone marrow mesenchymal stem cells protects against myocardial infarction by inhibiting myocardial apoptosis","volume":"16","author":"You","year":"2024","journal-title":"Am. J. Transl. Res."},{"key":"B118","doi-asserted-by":"publisher","first-page":"118761","DOI":"10.1016\/j.biopha.2025.118761","article-title":"Exosomal microRNA in diabetic myocardial disorder: mechanisms, diagnosis, and treatment","volume":"193","author":"Yu","year":"2025","journal-title":"Biomed. Pharmacother."},{"key":"B119","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1038\/s41420-022-00909-6","article-title":"Mesenchymal stem cell-derived exosomal microRNA-182-5p alleviates myocardial ischemia\/reperfusion injury by targeting GSDMD in mice","volume":"8","author":"Yue","year":"2022","journal-title":"Cell Death Discov."},{"key":"B120","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.3390\/CELLS12101416","article-title":"Current strategies for exosome cargo loading and targeting delivery","volume":"12","author":"Zeng","year":"2023","journal-title":"Cells"},{"key":"B121","doi-asserted-by":"publisher","first-page":"6917","DOI":"10.2147\/IJN.S264498","article-title":"Exosome: a review of its classification, isolation techniques, storage, diagnostic and targeted therapy applications","volume":"15","author":"Zhang","year":"2020","journal-title":"Int. J. Nanomedicine"},{"key":"B122","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1111\/JCMM.16192","article-title":"Exosomes from microRNA-126 overexpressing mesenchymal stem cells promote angiogenesis by targeting the PIK3R2-mediated PI3K\/Akt signalling pathway","volume":"25","author":"Zhang","year":"2021","journal-title":"J. Cell Mol. Med."},{"key":"B123","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/J.PLACENTA.2025.10.002","article-title":"Exosomal miR-152-5p promotes trophoblast apoptosis by inhibiting the PI3K\/AKT\/FOXO3a signaling pathway via targeting VAMP3 in gestational diabetes mellitus","volume":"172","author":"Zhang","year":"2025","journal-title":"Placenta"},{"key":"B124","doi-asserted-by":"publisher","first-page":"10760296251407689","DOI":"10.1177\/10760296251407689","article-title":"Circulating exosomal MicroRNAs as potential biomarkers for pulmonary embolism","volume":"32","author":"Zhang","year":"2026","journal-title":"Clin. Appl. Thromb."},{"key":"B125","doi-asserted-by":"publisher","first-page":"616161","DOI":"10.3389\/fcell.2020.616161","article-title":"The role of exosomes and exosomal MicroRNA in cardiovascular disease","volume":"8","author":"Zheng","year":"2021","journal-title":"Front. Cell Dev. Biol."},{"key":"B126","doi-asserted-by":"publisher","first-page":"2546","DOI":"10.1002\/iub.2396","article-title":"Circulating exosomal microRNAs as emerging non-invasive clinical biomarkers in heart failure: mega bio-roles of a nano bio-particle","volume":"72","author":"Zhou","year":"2020","journal-title":"IUBMB Life"},{"key":"B127","doi-asserted-by":"publisher","first-page":"6901","DOI":"10.7150\/THNO.37357","article-title":"Exosomes from nicotine-stimulated macrophages accelerate atherosclerosis through miR-21-3p\/PTEN-mediated VSMC migration and proliferation","volume":"9","author":"Zhu","year":"2019","journal-title":"Theranostics"},{"key":"B128","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/nrc2543","article-title":"Tetraspanins: push and pull in suppressing and promoting metastasis","volume":"9","author":"Z\u00f6ller","year":"2009","journal-title":"Nat. Rev. Cancer"}],"container-title":["Frontiers in Molecular Biosciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmolb.2026.1869889\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:25:50Z","timestamp":1785212750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmolb.2026.1869889\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":128,"alternative-id":["10.3389\/fmolb.2026.1869889"],"URL":"https:\/\/doi.org\/10.3389\/fmolb.2026.1869889","relation":{},"ISSN":["2296-889X"],"issn-type":[{"value":"2296-889X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"1869889"}}