As the global population ages, understanding the biological mechanisms linking muscle deterioration and cancer progression has become increasingly imperative. A groundbreaking study led by scientists at Duke-NUS Medical School in Singapore has illuminated a novel cellular communication pathway whereby ageing skeletal muscle influences tumor growth. This pioneering research reveals that sarcopenia, the age-related decline of muscle mass and strength, not only compromises mobility but may actively promote cancer development through alterations in extracellular vesicle secretion.
Extracellular vesicles, tiny membranous particles secreted by virtually every cell type, have emerged as critical conveyors of intercellular communication. These vesicles ferry a diverse cargo of proteins, lipids, and nucleic acids, including microRNAs, modulating the behavior of recipient cells in physiological and pathological contexts. The Duke-NUS team discovered that ageing muscles secrete significantly fewer extracellular vesicles, and those released are compositionally altered, particularly exhibiting a reduction in the microRNA known as miR-7a-5p. This small regulatory RNA is instrumental in suppressing tumorigenic pathways, suggesting that its decline may contribute to an environment conducive to cancer growth.
The study meticulously delineates how the biogenesis and release of muscle-derived extracellular vesicles are governed by the NOTCH-SDC2 signaling axis — a pathway previously recognized for its role in cell differentiation and tissue maintenance. With advancing age, the activity of this pathway diminishes, leading to disrupted formation of vesicles and impaired delivery of tumor-suppressive signals. Intriguingly, the researchers found that physical exercise could reverse this decline, reactivating the NOTCH-SDC2 pathway, restoring vesicle production, and reinstating the protective role of miR-7a-5p-containing extracellular vesicles.
These findings represent a significant advance in our understanding of sarcopenia’s impact beyond musculoskeletal decline, positioning weakened muscle as a contributor to oncogenesis. By establishing a direct molecular link between muscle ageing and tumor progression, the study opens promising avenues for novel therapeutic strategies aimed at harnessing or mimicking muscle-derived extracellular vesicles to inhibit cancer development.
Clinically, the observed correlation between low muscle mass and advanced cancer stages has often been attributed to poor patient fitness; however, this research highlights an active biological mechanism through which muscle health influences tumor biology. Co-investigator Dr. Kenon Chua emphasizes the clinical ramifications, underscoring that muscle-secreted molecules extend their benefits beyond physical function to systemic health. This insight reinforces the critical importance of maintaining muscle volume and quality through regular resistance and aerobic exercise, especially in older adults.
The implications extend to cancer prevention and management, suggesting that interventions aimed at preserving or enhancing muscle function could mitigate oncogenic risks. Furthermore, the specific decline of miR-7a-5p in extracellular vesicles presents an attractive biomarker candidate for assessing cancer susceptibility in individuals suffering from sarcopenia. Detecting such biomarkers could enable earlier identification of at-risk populations, facilitating timely intervention.
Future research directions include validating these mechanisms in human subjects and exploring the translational potential of muscle-derived extracellular vesicles. The ability to pharmacologically stimulate the NOTCH-SDC2 pathway or supplement miR-7a-5p may lead to innovative therapeutics that counteract age-associated cancer risks. Moreover, the study’s insights advocate for integrating physical activity programs into public health policies targeting healthy ageing.
Assistant Professor Tang Hong-Wen, the study’s senior author, remarks on the broader significance of the findings: the muscle-to-tumor communication pathway exemplifies how systemic tissue health influences malignancy, bridging disciplines across oncology, gerontology, and cellular biology. It also emphasizes the hidden complexity of extracellular vesicle-mediated signaling in maintaining tissue homeostasis and restraining disease progression.
This research was conducted under the HEAL (Healthy ageing, Executive function and Ambulatory Longevity) programme, a collaboration that underscores Singapore’s commitment to pioneering science aimed at improving the quality of life in elderly populations. Supported by a consortium of grants from Singapore’s Ministry of Education, the National Medical Research Council, and the National Research Foundation, the study exemplifies a successful synergy between fundamental biology and clinical relevance.
By integrating rigorous experimental methodologies, including high-resolution electron microscopy and molecular profiling, with translational objectives, the Duke-NUS team has unveiled new biological insights with far-reaching implications. The study underscores the crucial role of microRNAs in extracellular vesicle function and highlights the adaptability of their biogenesis pathways to lifestyle factors such as exercise.
In summary, this research reframes our understanding of muscle ageing not simply as a matter of diminished strength and mobility but as a dynamic contributor to systemic disease processes including cancer. The potential for exercise and related interventions to restore vesicle-mediated tumor suppression offers hope for innovative, holistic strategies against cancer that encompass musculoskeletal health as a critical component.
Subject of Research: Cells
Article Title: Sarcopenia promotes tumorigenesis by disrupting NOTCH-SDC2-regulated biogenesis of muscle-derived extracellular vesicles
News Publication Date: 17 June 2026
Web References: https://www.nature.com/articles/s41467-026-72410-y
References: Chen L-K, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment, American Medical Directors Association. 2019;21(3):300-307.e2.
Image Credits: Goh Kah Yong, Duke-NUS Medical School
Keywords: Sarcopenia, Extracellular Vesicles, MicroRNA, miR-7a-5p, NOTCH-SDC2 pathway, Muscle Ageing, Tumorigenesis, Cancer Biology, Exercise, Biomarkers, Cellular Communication, Healthy Ageing
