Clinica Chimica Acta最新文献

{"title":"Non-coding RNAs as prognostic biomarkers in autoimmune disease","authors":"Maryam Rahnama ,&nbsp;Siamak Rezaeiani ,&nbsp;Navid Ghasemzadeh ,&nbsp;Milad Ahmadaghdami ,&nbsp;Arezoo Mesri ,&nbsp;Mortaza Taheri-Anganeh ,&nbsp;Ebrahim Mazloomi","doi":"10.1016/j.cca.2026.120884","DOIUrl":"10.1016/j.cca.2026.120884","url":null,"abstract":"<div><div>Autoimmune diseases comprise a broad spectrum of disorders in which both the innate and adaptive branches of the immune system malfunction, mistakenly attacking the body's own tissues and organs. This breakdown in self-tolerance is marked by the generation of autoantibodies that drive tissue damage. Identifying individuals who are likely to develop more aggressive disease at an early stage is crucial, as it enables earlier therapeutic intervention and improves long-term clinical outcomes. Yet, traditional diagnostic tools (such as autoantibody levels, inflammatory mediators, and acute-phase biomarkers) often fall short in reliably forecasting disease trajectory or predicting response to therapy due to their limited sensitivity and specificity. These shortcomings have intensified interest in more advanced molecular markers, particularly those uncovered through genomic, transcriptomic, and epigenetic analyses. Among these novel biomarker candidates, non-coding RNAs have emerged as especially promising regulators and indicators of autoimmune pathology. Their potential highlights the importance of directing future research toward large-scale, multicenter, longitudinal studies that combine multi-omics methodologies with machine-learning–driven analyses to develop reliable and clinically meaningful prognostic signatures. Ultimately, the identification of diverse biomarkers and innovative analytical methods will play a pivotal role in enhancing the diagnosis, prognosis, and treatment of autoimmune diseases. This review synthesizes current evidence on the prognostic value of ncRNAs, emphasizing their ability to predict future clinical outcomes such as disease severity, risk of organ-specific damage (e.g., lupus nephritis, rheumatoid joint erosion), likelihood of disease flare, and therapeutic response. We detail the mechanisms by which specific ncRNAs influence key pathogenic processes and explore their clinical application as stable, accessible biomarkers in liquid biopsies.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120884"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146135688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-omics biomarkers in psychiatric disorders diagnosis and stratification","authors":"Seyyed Hossein Khatami ,&nbsp;Sanam Anoosheh ,&nbsp;Marzieh Khodaparast ,&nbsp;Amir Maghsoudloonejad ,&nbsp;Ehsan Dadgostar ,&nbsp;Amir Asadi ,&nbsp;Mahya Kaveh ,&nbsp;Malihe Mehdinejad Haghighi","doi":"10.1016/j.cca.2026.120887","DOIUrl":"10.1016/j.cca.2026.120887","url":null,"abstract":"<div><div>The precise diagnosis and stratification of psychiatric disorders remain formidable challenges in modern medicine, hindered by the absence of objective biomarkers and reliance on subjective clinical criteria. Recent advances in multi-omics technologies, including genomics, transcriptomics, proteomics, metabolomics, and epigenomics, have revolutionized our understanding of complex neuropsychiatric conditions such as schizophrenia, bipolar disorder, major depressive disorder, and autism spectrum disorder. This review critically evaluates the current landscape of multi-omics research in psychiatry, highlighting methodological innovations, integrative strategies, and translational potential for biomarker discovery and clinical implementation. By synthesizing data across diverse molecular layers, multi-omics approaches enable a systems-level view of psychiatric disorders as multifactorial entities shaped by molecular, cellular, environmental, and neurocircuitry interactions. Despite promising advances in diagnostic accuracy and personalized treatment, significant barriers persist, including data heterogeneity, analytical complexity, and the translational gap between molecular signatures and clinical phenotypes. This review systematically explores the contributions of individual omics domains, emerging frameworks for multimodal data integration, the role of systems biology and network-based models, and the impact of large-scale consortia in driving clinical translation.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120887"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146135746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in phosphatases as new biomarker in personalized medicine","authors":"Shreya Garge ,&nbsp;Gayatri Gaikwad ,&nbsp;Vasanti Suvarna","doi":"10.1016/j.cca.2026.120880","DOIUrl":"10.1016/j.cca.2026.120880","url":null,"abstract":"<div><h3>Objectives</h3><div>Phosphatases are pivotal in regulating phosphorylation homeostasis by catalyzing biomolecular dephosphorylation, thereby modulating signaling pathways, metabolic networks, and cellular functions. Dysregulation of phosphatase activity is implicated in diverse pathologies, including hepatobiliary dysfunction, metabolic bone disorders, prostate cancer, and lysosomal storage syndromes. This review aims to critically evaluate optical biosensing strategies for phosphatase detection, with emphasis on isoform-specific diagnostics and clinical applicability.</div></div><div><h3>Methods</h3><div>A comprehensive analysis was conducted on emerging optical biosensing platforms, including nanomaterial-assisted colorimetric assays, ratiometric fluorescence sensors, localized surface plasmon resonance (LSPR), and surface-enhanced Raman spectroscopy (SERS). These modalities were assessed against key clinical criteria such as sensitivity, isoform specificity, multiplexing capability, and regulatory feasibility.</div></div><div><h3>Results</h3><div>Optical biosensors demonstrate significant advancements over conventional <em>p</em>-nitrophenyl phosphate (pNPP)-based assays, offering enhanced sensitivity, substrate stability, and isoform discrimination. Specific applications include detection of prostatic acid phosphatase (PAP) and tartrate-resistant acid phosphatase (TRAP) in oncology, lysosomal acid phosphatase in neurodegenerative conditions, and alkaline phosphatase in bone and liver pathologies. These platforms show promise for integration into theragnostic systems and digital health infrastructures.</div></div><div><h3>Conclusions</h3><div>Optical biosensing technologies represent a transformative approach to phosphatase detection, enabling real-time monitoring and predictive analytics in precision diagnostics. Their integration into clinical workflows could facilitate early disease detection, personalized treatment strategies, and improved patient outcomes.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120880"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NMR-based metabolic measures of chronic stable angina and myocardial infarction in patients with diabetes mellitus","authors":"Ashish Gupta ,&nbsp;Shiridhar Kashyap ,&nbsp;Khushbhu Meena ,&nbsp;Deepak Kumar ,&nbsp;Amit Gaurav ,&nbsp;Ankit Kumar Sahu ,&nbsp;Subhash Yadav ,&nbsp;Sudeep Kumar ,&nbsp;Aditya Kapoor","doi":"10.1016/j.cca.2026.120883","DOIUrl":"10.1016/j.cca.2026.120883","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Diabetes mellitus (DM) accelerates the onset and progression of coronary artery disease (CAD), yet metabolomic profiling in individuals with both conditions remains limited. NMR–based metabolomics offers a comprehensive assessment of metabolic alterations and may improve cardiovascular risk stratification. Hence, the objective of this study was to characterize serum metabolic signatures associated with varying CAD severity in diabetic patients and evaluate their relationship with conventional clinical measures.</div></div><div><h3>Methods</h3><div>Eighty-eight diabetic patients undergoing coronary angiography were categorized into three groups: normal coronaries (DNC), chronic stable angina (DCSA), and myocardial infarction (DMI). Serum was mechanically filtered (3-kDa cutoff) and analyzed using 800 MHz ¹H NMR spectroscopy. Spectral data underwent univariate ANOVA, PCA, PLS-DA, and OPLS-DA. Metabolites with VIP &gt; 1.0 were identified. ROC and regression analyses assessed discriminative performance and clinical–metabolic associations.</div></div><div><h3>Results</h3><div>Multivariate analyses showed clear separation among DNC, DCSA, and DMI. Seventeen metabolites distinguished the groups, with aspartate, methylguanidine, arginine, and creatinine identified as key metabolic signatures. Clinical measures—Troponin I, LDL, LDH, and total cholesterol—also demonstrated strong discriminatory ability. Combined ROC models achieved high sensitivity and specificity. Significant correlations linked myocardial injury and lipid dysregulation with nitrogen- and amino-acid–related metabolites.</div></div><div><h3>Conclusions</h3><div>Filtered-serum ¹H NMR metabolomics reliably differentiates CAD severity in diabetic patients, revealing metabolic signatures associated with oxidative stress, amino-acid disruption, and lipid imbalance. Integrating metabolic and clinical measures offers a promising precision-medicine approach for early detection and risk stratification in DM-related CAD.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120883"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing brigatinib in an oncological patient's hair: Evaluation of the time of disappearance after discontinuation and interpretation of concentrations obtained in regrowing hair after total loss","authors":"Nadia Arbouche ,&nbsp;Céline Traenklé ,&nbsp;Jean-Sébastien Raul ,&nbsp;Pascal Kintz","doi":"10.1016/j.cca.2026.120888","DOIUrl":"10.1016/j.cca.2026.120888","url":null,"abstract":"<div><div>Brigatinib (Alungrib®) is a next-generation anaplastic lymphoma kinase (ALK) inhibitor used for the treatment of ALK-rearranged non-small-cell lung cancer (NSCLC). While its quantification in blood and urine is well-documented, no study has investigated its incorporation in hair. Given the long-term administration of brigatinib, hair analysis could provide a valuable tool obtaining an historical profile of drug concentrations.</div><div>This study presents the first reported case of brigatinib detection in hair, analyzing the hair of an oncological subject who experienced total hair loss due to chemotherapy followed by hair regrowth. The investigation of brigatinib was performed on a 31 cm long strand of hair belonging to a subject who had been on brigatinib treatment for more than 3 years. Hair was analyzed following decontamination with dichloromethane, incubation in basic buffer in the presence of 2 ng MDMA-D5 and liquid-liquid extraction using a new method developed on a liquid chromatography- tandem mass spectrometry system. With a limit of quantification determined at 1 pg/mg, the method was applied to 31 × 1 cm hair segments.</div><div>Brigatinib was detected in all 31 hair segments, with concentrations varying over time (8–97 pg/mg) and peaking 22 months after hair regrowth. Despite a quite stable drug dosage, brigatinib levels fluctuated, suggesting an influence of chemotherapy-induced hair alterations on drug incorporation. Moreover, brigatinib remained detectable in hair up to eight months after treatment discontinuation.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120888"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synthetic data in the clinical laboratory: methods, applications, and future prospects","authors":"Tahir S. Pillay ,&nbsp;Barbara S. van Deventer ,&nbsp;Siphokazi Gwiliza ,&nbsp;Evette L. Subramoney ,&nbsp;Chantal van Niekerk","doi":"10.1016/j.cca.2026.120878","DOIUrl":"10.1016/j.cca.2026.120878","url":null,"abstract":"<div><div>Clinical laboratories face stringent privacy constraints, limited datasets for rare conditions, and rising demands to validate AI algorithms and workflows safely. Synthetic data—artificially generated data that preserve the statistical characteristics of real clinical data without exposing patient identities—has emerged as a powerful tool to address these challenges. This review provides a comprehensive overview of synthetic data in the context of laboratory medicine. We begin by defining synthetic data and describing the main generation methods, from rule-based simulations to modern generative models (including generative adversarial networks, variational autoencoders, and diffusion models) with examples of their use in healthcare. We then delve into key applications in the clinical laboratory: quality control and method validation, education and training, machine learning development, test utilization and workflow simulation, and external quality assessment. Advantages of synthetic data—such as enhanced privacy, scalability, flexibility in simulating rare events, and cost-effectiveness—are discussed with illustrative case studies. We also examine challenges and limitations, including concerns about data fidelity, bias amplification, risks of model overfitting or re-identification attacks, and the cautious stance of regulators that still require real patient data for approvals. Finally, we outline future directions for synthetic data in laboratory medicine, from hybrid real–synthetic datasets and privacy-enhancing techniques to evolving regulatory frameworks and the potential to democratize data access globally. While synthetic data cannot entirely replace real clinical data—especially for regulatory validation—it can significantly augment what laboratories can design, test, and achieve, provided it is used with careful validation and ethical safeguards.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120878"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laboratory data mining: monitoring of the local applicability of prolactin reference interval","authors":"Sun Xiang ,&nbsp;Zhu Jinwen ,&nbsp;Wei Chen ,&nbsp;Wang Qin","doi":"10.1016/j.cca.2026.120889","DOIUrl":"10.1016/j.cca.2026.120889","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to explore the feasibility and methodology of long-term monitoring the local applicability of reference intervals (RIs) by statistically analyzing the positive rates derived from Laboratory Information System (LIS) data.</div></div><div><h3>Methods</h3><div>The stability of the coefficient of variation (CV) of 2018–2020 positive rates was evaluated using 1/2 total allowable error (TEA). The ±1/2 TEA range around their mean was calculated to verify if the 2022–2024 positive rates were consistently outside this range. If so, prolactin results of first-visit patients with irregular menstruation were analyzed to exclude age and sample collection time effects, with discrepancies attributed to inappropriate RIs. <em>Re</em>-evaluation was performed using the local RI upper limit, with a reverse correlation analysis between the two periods' data.</div></div><div><h3>Results</h3><div>The 2018–2020 CV was 11.41% (within 1/2 TEA). The 2022–2024 positive rates exceeded the ±1/2 TEA range but fell within the acceptable scope after applying the new RI. Age and sample collection time were ruled out as discrepancy causes. Both periods' positive rates mutually conformed to each other's ± 1/2 TEA ranges.</div></div><div><h3>Conclusions</h3><div>The range of ±1/2 TEA around the mean positive rate, derived from LIS data analysis, is applicable for the long-term evaluation of the local applicability of reference intervals after detection system transition.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120889"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-coding RNAs as emerging biomarkers in melanoma","authors":"Qamar Abuhassan ,&nbsp;Mutaz Jamal Al-khreisat ,&nbsp;R. Roopashree ,&nbsp;Maitreyee Panda ,&nbsp;T. Sudhakar ,&nbsp;Vipasha Sharma ,&nbsp;Ashish Singh Chauhan ,&nbsp;Guzal Klebleeva","doi":"10.1016/j.cca.2026.120879","DOIUrl":"10.1016/j.cca.2026.120879","url":null,"abstract":"<div><div>Melanoma remains one of the most aggressive forms of skin cancer, with an increasing incidence and limited therapeutic success in advanced stages. Early detection and precise prognostic assessment are critical for improving patient outcomes, yet conventional biomarkers often lack sensitivity and specificity. In recent years, noncoding RNAs (ncRNAs), including microRNAs, long noncoding RNAs, and circular RNAs, have emerged as pivotal regulators of melanoma biology. These molecules modulate key pathways involved in tumor initiation, progression, metastasis, and therapeutic resistance while also demonstrating remarkable stability in biofluids, making them attractive candidates for minimally invasive diagnostics. This narrative review synthesizes current evidence on the role of ncRNAs as emerging biomarkers in melanoma, highlighting their potential utility in early detection, prognostic stratification, and prediction of therapeutic response. Furthermore, we discuss methodological advances in ncRNA profiling, translational challenges, and future directions for integrating ncRNA-based assays into clinical practice. By consolidating mechanistic insights and clinical relevance, this review underscores the promise of ncRNAs as transformative tools in precision oncology for melanoma management.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"585 ","pages":"Article 120879"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-omics biomarker detection in smoking induced COPD","authors":"Rahamat Unissa Syed ,&nbsp;Mohammed Khaled Bin Break ,&nbsp;Rihab Akasha ,&nbsp;Nancy Mohammad Elafandy ,&nbsp;Sally Hassan Abobaker ,&nbsp;Amna abakar Suleiman Khalifa ,&nbsp;Nayla Ahmed Mohammed Aboshouk ,&nbsp;Afrah Nashmi Alghaythi ,&nbsp;Lama Abdullah Altwalah ,&nbsp;Rawabi Mohammed Menwer Aldhafeeri ,&nbsp;Mohd Sajjad Ahmad Khan ,&nbsp;Gaurav Gupta","doi":"10.1016/j.cca.2026.120868","DOIUrl":"10.1016/j.cca.2026.120868","url":null,"abstract":"<div><div>Chronic obstructive pulmonary disease (COPD) is marked by heterogeneity, and traditional spirometric biomarkers fall short of fully capturing its underlying molecular complexity. This review discusses recent developments in multi-omics profiling, such as transcriptomics, proteomics, metabolomics, and epigenomics/acetylomics, to define biologically meaningful COPD endotypes and enhance their clinical categorization. Reproducible circulating protein markers identified in proteomic studies include surfactant protein D (SP-D), club cell secretory protein (CC16), fibrinogen, and inflammatory cytokines, which predict disease severity, risk of exacerbation, and mortality. Further evidence of dysregulated histone/protein acetylation and other post-translational modifications in chronic inflammation, steroid resistance, and disease progression is provided by epigenomic studies (such as DNA methylation, non-coding RNAs, and chromatin remodeling) and acetylomic analyses. Notably, integrative multi-omics solutions exhibit better outcomes than single-biomarker solutions by allowing the identification of molecular endotypes that are more likely to accommodate clinical heterogeneity. Nevertheless, it is significantly constrained by cohort and platform heterogeneity, including factors such as smoking exposure, age, comorbidities, treatment, and sample processing methods. Overall, the existing evidence highlights the importance of multi-omics integration in the further development of precision diagnostics and individualized management of COPD, bridging the gap between molecular pathology and clinical decision-making.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"584 ","pages":"Article 120868"},"PeriodicalIF":2.9,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor microenvironment and biomarker innovation in ovarian cancer: mechanistic insights into immune evasion, angiogenesis, and therapeutic resistance","authors":"Ye Liu ,&nbsp;Lijia Zhang ,&nbsp;Qian Wang ,&nbsp;Xinyue Li ,&nbsp;Xiaoling Feng","doi":"10.1016/j.cca.2026.120874","DOIUrl":"10.1016/j.cca.2026.120874","url":null,"abstract":"<div><div>Ovarian cancer remains one of the most lethal gynecologic malignancies, largely because of late-stage diagnosis, extensive intratumoral heterogeneity, and the dynamic complexity of the tumor microenvironment (TME). Emerging evidence highlights the TME as a central orchestrator of immune evasion, angiogenic remodeling, and therapeutic resistance, which are three mechanistic pillars that critically shape disease progression and treatment outcomes. This narrative review synthesizes current mechanistic insights into how stromal, immune, and vascular components interact to promote tumor survival and metastasis. We examine the roles of immunosuppressive cell populations, cytokine networks, and checkpoint pathways in facilitating immune escape; delineate angiogenic drivers and endothelial–tumor crosstalk that sustain aberrant vascularization; and explore TME-mediated mechanisms that underlie chemoresistance, targeted therapy failure, and limited immunotherapy responsiveness. Furthermore, we evaluate recent advances in biomarker discovery, including the identification of circulating ncRNAs, exosomal signatures, spatial immune profiles, and TME-derived molecular indicators, which hold promise for improving early detection, prognostication, and therapeutic stratification. By integrating mechanistic biology with translational biomarker innovation, this review outlines a forward-looking framework for leveraging TME-informed diagnostics and therapeutics to enhance precision oncology in ovarian cancer.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"584 ","pages":"Article 120874"},"PeriodicalIF":2.9,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}