A group of researchers from Universiti Putra Malaysia and several regional collaborators is bringing fresh hope to the future of cancer care by spotlighting a powerful but underappreciated player in the disease’s biology: extracellular RNA, or exRNA.

These microscopic molecules, often transported in nanosized vesicles called exosomes, are now being recognised not just as indicators of disease, but as potential weapons against it.

The review, published in ExRNA, highlights how these fragments of genetic material could fundamentally transform cancer detection, treatment, and monitoring; all in one streamlined approach.

Unlike traditional biopsies that require invasive tissue sampling, exRNAs offer a non-invasive alternative through what's known as a "liquid biopsy." Present in fluids like blood or urine, exRNAs are surprisingly stable and can reflect the genetic and molecular makeup of a tumour in real time.

This makes them particularly useful not only for early diagnosis, sometimes even before symptoms surface, but also for tracking how a tumour evolves, responds to treatment, or resists drugs.

Certain types of exRNAs, such as microRNAs and circular RNAs, have already shown exceptional promise in distinguishing between healthy individuals and those with various forms of cancer, from lung and pancreatic to colorectal and prostate.

Because these molecules are actively released by cancer cells, their presence and patterns act like molecular fingerprints, offering insights into a tumour’s behaviour, severity, and potential outcome.

But the power of exRNA doesn't stop at detection.

Researchers are also exploring how these molecules can be harnessed as therapeutic agents.

By engineering exosomes like the tiny, naturally occurring vesicles that carry exRNAs, scientists are beginning to design RNA-based therapies that can be delivered directly into cancer cells.

This method holds great promise for targeted treatment, minimising damage to healthy tissues while enhancing drug sensitivity and reducing resistance.

Early experiments have even shown that loading exosomes with tumour-suppressing RNA fragments can halt tumour growth or reverse drug resistance in preclinical models.

Despite these advances, the field is not without its challenges.

Standardising methods for isolating and analysing exRNAs remains a major hurdle, as does ensuring that therapeutic exosomes can consistently reach their targets within the body.

Moreover, large-scale production under clinical-grade conditions and the lack of clear regulatory pathways pose additional barriers before these techniques can be widely adopted in hospitals.

Nevertheless, researchers remain optimistic.

Rapid developments in artificial intelligence, bioengineering, and molecular diagnostics are paving the way for next-generation cancer tools that integrate exRNA with other biomarkers, allowing clinicians to build more accurate and personalised treatment strategies.

As the research community continues to unravel the complexities of how cancer communicates within the body, exRNAs are emerging as critical messengers and possibly game-changers in the mission to treat the disease more precisely and effectively.

The authors of the review believe that with continued investment and cross-disciplinary collaboration, exRNA-based tools could soon shift from the lab bench to the clinic, offering a future where cancer detection is easier, treatments are smarter, and patient outcomes significantly improved.

The full paper, titled "ExRNA as Theranostic Agents in Cancer: Current Progress and Future Perspectives," is freely available in ExRNA under an open-access licence.

Nik Abd Rahman, N.M.A., et al., ExRNA as theranostic agents in cancer: current progress and future perspectives. ExRNA, 2025.

Source: ELSP