Go Small – Win Big (Nobel Prize!): Exosomes and MicroRNAs

Abstract

Background: Victor Ambros and Gary Ruvkun received the 2024 Nobel Prize (Physiology or Medicine) for describing microRNAs (small non-coding RNAs – miRNAs). MiRNAs, essential for cellular function throughout the body, are a major “cargo” of extracellular vesicles (EVs) or exosomes – a principal means of cell-to-cell communication. MiRNAs related to the diagnosis and treatment of various surgical conditions are rapidly being identified.

Methods: PubMed searches using terms <microRNA and brain>, <microRNA and spine>, <exosome and brain>, <exosome and spine>, etc, were made. Based on the article title, potentially relevant abstracts were reviewed and full articles addressing neurosurgical conditions downloaded.

Results: Searches for <microRNA and brain> and <microRNA and spine> alone yielded > 5000 articles, with ~ 400 published in the past year. Over 120 articles were downloaded, nearly all published in the past two years. After summarizing the biogenesis and functions of exosomes and miRNAs, and their relation to stem cells, examples where miRNAs can enhance diagnosis and/or treatment are given:

(1) Malignant brain tumors: miRNAs can aid diagnosis (biomarkers), enhance immunotherapy, improve chemotherapy response (e.g. temozolomide).

(2) Meningiomas: circulating miRNAs can monitor tumor growth/regression, reducing the need for CT/MRI scans.

(3) Stroke/vasospasm: miRNAs can be an ultra-early biomarker for ischemic stroke and can ameliorate both secondary brain damage and vasospasm.

(4) Trauma: miRNAs can be biomarkers and ameliorate neuroinflammation.

(5) Neurodegenerative disorders: miRNAs can be both predictive and therapeutic for Alzheimer’s dementia and other neurodegenerative disorders.

(6) Mood disorders: miRNAs contribute to the pathogenesis (and potential treatment) of depression, bipolar disorder, etc.

(7) Degenerative spine disease: miRNAs can ameliorate disc degeneration and ligamentum flavum hypertrophy (lumbar stenosis).

Conclusions: Given the impact miRNAs and exosomes is having on the diagnosis and treatment of various surgical/neurosurgical conditions, collaboration with our research colleagues on miRNAs and exosomes is prudent.