SERUM TRACE ELEMENT IMBALANCE AND EXOSOMAL MICRORNA PROFILES IN EARLY RELAPSE ACUTE LEUKEMIA
Keywords:
Acute leukemia; Early relapse; Exosomes; Exosomal microRNA; Trace elements; Zinc; Copper; Selenium; Biomarkers; Molecular diagnostics; Relapse prediction; Pakistan.Abstract
Background
Acute leukemia relapse remains a major challenge despite improvements in chemotherapy and supportive treatment approaches. Early identification of patients at increased risk of relapse is essential for improving disease monitoring and treatment decisions. Recent evidence suggests that metabolic disturbances and molecular changes, including trace element imbalance and altered exosomal microRNA expression, may contribute to leukemia progression.
Objective
This study aimed to evaluate the association between serum trace element abnormalities and relapse-related exosomal microRNA profiles in acute leukemia patients.
Methods
An analytical case-control study was conducted at a tertiary care hospital in Lahore, Pakistan. Patients with acute leukemia were divided into two groups: early relapse cases and remission controls. Serum samples were collected for assessment of selected trace elements, including zinc, copper, and selenium. Exosomes were isolated from serum, and expression patterns of selected relapse-associated microRNAs were evaluated using molecular analysis techniques. Clinical, biochemical, and molecular findings were compared between both groups. Statistical analysis was performed to determine differences and possible relationships between trace element levels and exosomal microRNA expression.
Results
Early relapse patients demonstrated significant alterations in serum mineral profiles compared with remission controls. Reduced zinc concentration and increased copper levels were observed among relapse cases, resulting in a higher copper-to-zinc ratio. Exosomal microRNA analysis showed increased expression of miR-155, miR-125b, and miR-21, while miR-126 expression was reduced in relapse patients. The altered trace element pattern showed an association with abnormal exosomal microRNA signatures, suggesting a possible link between metabolic imbalance and molecular changes involved in leukemia recurrence.
Conclusion
The findings suggest that serum trace element abnormalities combined with exosomal microRNA alterations may provide valuable information regarding early relapse risk in acute leukemia. An integrated biomarker approach involving biochemical and molecular indicators may improve relapse prediction and support personalized monitoring strategies. Further multicenter studies with larger patient populations are required to validate these findings and establish their clinical application
