Missing link: Viral RNA signatures in circulating exosomes as early diagnostic biomarkers for gastrointestinal cancers.

This editorial highlights the critical role of viral RNA signatures encapsulated within circulating exosomes as a potential missing link in the early diagnosis of gastrointestinal (GI) cancers. Current diagnostic methods for virus-associated GI malignancies often fall short in detecting infections at subclinical or pre-cancerous stages. We propose that viral RNA-loaded exosomes, by offering stable, specific, and non-invasive biomarkers, can bridge this gap and revolutionize early detection compared to conventional approaches. As highlighted by Zhang et al in their recent review, viral infections, such as hepatitis B and C viruses, Epstein-Barr virus, and human papillomavirus, are well-established contributors to the pathogenesis of various GI malignancies. However, current diagnostic methods often underperform in detecting these infections at subclinical or pre-cancerous stages. We highlight the shared points between virology, exosome biology, and oncology, reinforcing the importance of viral RNA-loaded exosomes as a "missing link" in the early detection of virus-associated GI cancers. We also discuss current challenges, translational opportunities, and the requirements for clinical validation of these promising biomarkers.