Urinary Exosomal miRNA Profiling Reveals Sensitive Non-Invasive Diagnosis of Bladder Cancer

Abstract Unstructured miRNAs represent a transformative advancement in both research and clinical management of urinary bladder cancer (UBC), emerging as clinically significant molecular targets with the potential to revolutionize existing diagnostic standards. This study exploited the robust stability of miRNAs and profiled urinary miRNAs in UBC patients and controls through miRNA sequencing, revealing an expanded and altered miRNA repertoire in cancer samples. Validation in an independent cohort revealed fold changes for miR-6724-5p, miR-1273h-5p, miR-7704, miR-200-5p, and miR-10400-5p ranged from ∼46 to ∼2,777 (p < 0.01). Stage-specific analyses highlighted dynamic miRNA expression linked to tumor progression. Diagnostic evaluation identified an optimal three-miRNA panel comprising miR-6724-5p, miR-10400-5p, and miR-7704, achieving diagnostic accuracies (AUC > 70%) and high sensitivity (>90%). These data demonstrate the potential of urinary mature miRNAs as robust biomarkers for non-invasive detection and monitoring of UBC in early stages, supporting their translation into clinical diagnostic assays pending larger prospective studies. Structured Background Urinary microRNAs (miRNAs) are promising candidates due to their molecular stability and disease-specific expression. miRNAs represent a transformative advancement in both research and clinical management of urinary bladder cancer (UBC), emerging as actionable molecular targets with the potential to revolutionize existing diagnostic standards. Methods Small RNA sequencing was performed on urine samples from UBC patients and healthy controls to profile miRNA expression. Mature miRNAs were prioritized by exclusion of precursor forms using computational filtering. Validation by quantitative RT-PCR was conducted on an independent, age-matched cohort (n = 45). Diagnostic potential of candidate miRNAs was assessed by receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses. Results Sequencing identified 865 known and 11 novel miRNAs, with UBC samples showing greater miRNA diversity (708 known miRNAs) compared to controls (540). Ten miRNAs were significantly dysregulated in UBC (p < 0.05). Validation revealed fold changes for miR-6724-5p, miR-1273h-5p, miR-7704, miR-200-5p, and miR-10400-5p ranged from ∼46 to ∼2,777 (p < 0.01). Stage-specific analyses highlighted dynamic miRNA expression linked to tumor progression. A three-miRNA panel (miR-6724-5p, miR-10400-5p, miR-7704) demonstrated superior diagnostic performance (AUC > 70%, sensitivity > 90%). Conclusion Mature urinary miRNAs exhibit reproducible, stage-specific dysregulation in UBC and a combinatorial panel offers sensitive, specific non-invasive detection. These findings warrant further multicenter validation for clinical application.