A new review in Chinese Medical Journal synthesizes how circulating circRNAs could transform oncology across three frontiers: early detection, patient prognosis, and therapy monitoring. It also frames circRNAs not only as passive indicators, but as active biological regulators and, potentially, direct therapeutic targets.

Stability is the foundation. circRNAs persist in peripheral circulation and can be measured from specimens that extend beyond serum, including saliva, urine, cerebrospinal fluid, gastric juice, and platelet-derived material. This broadened sampling window could improve feasibility for repeated monitoring during cancer trajectories.

The review highlights the biological versatility of circRNAs in cancer. While circRNAs are often discussed as microRNA (miRNA) sponges that sequester miRNAs and alter downstream mRNA stability or translation, they can also bind proteins, influence alternative splicing of precursor mRNAs, and modulate epigenetic marks. In some contexts, circRNAs act as scaffolds that organize protein–protein interactions or function as decoys that re-route protein activity.

These mechanisms connect circRNAs to major cancer hallmarks, from sustained proliferation and metabolic reprogramming to immune evasion and drug resistance. Importantly, their levels may shift with tumor stage and correlate with clinically relevant events such as metastasis, enabling dynamic risk stratification.

For early diagnosis, the review emphasizes that diagnostic panels—rather than single biomarkers—can reach high performance, including in early-stage disease. Because circRNA signatures can reflect tumor evolution, they may serve as near real-time readouts of disease state.

Therapeutic monitoring is another key theme. Changes in circulating circRNA profiles may signal treatment response or emerging resistance, positioning circRNAs as functional drivers that could be therapeutically disrupted rather than merely measured.

The authors also address translational bottlenecks: standardizing sample handling, improving reproducibility, validating candidate panels in large prospective cohorts, and upgrading detection technologies. Approaches such as nanopore sequencing, droplet digital PCR, and CRISPR-based assays are discussed as potential enablers of clinical-grade performance.

Looking ahead, the review envisions a “circRNA-centric oncology” model in which endogenous circRNAs guide continuous tumor surveillance, while engineered circRNAs and related interventions offer programmable, pathway-targeted therapeutics.

Reference is available at DOI: 10.1097/CM9.0000000000004120.

Subject of Research: Not applicable
Article Title: Circulating circRNAs at the frontier of cancer detection, prognosis, and therapy
News Publication Date: 24-Jun-2026
Web References: http://dx.doi.org/10.1097/CM9.0000000000004120
References: 10.1097/CM9.0000000000004120
Image Credits: Credit: Chinese Medical Journal

Keywords: circular RNAs, circRNAs, liquid biopsy, cancer detection, prognosis, therapy monitoring, drug resistance, miRNA sponges, nanopore sequencing, droplet digital PCR

CircRNAs defy the traditional linear RNA paradigm by forming a continuous loop without 5’ caps or 3’ poly-A tails, granting them remarkable stability and resistance to exonucleases. This inherent stability allows circRNAs to persist within neural tissues, suggesting a role beyond mere transcriptional noise. Recent advances have elucidated their potential as regulatory molecules involved in gene expression modulation, splicing, and even protein translation—functions that could be pivotal in maintaining neuronal homeostasis.

Neuropsychiatric disorders, historically enigmatic in their origins, have often been linked to dysregulated gene expression and altered synaptic plasticity. The introduction of circRNAs into this framework redefines how we conceptualize the molecular mechanisms driving these conditions. Unlike linear RNAs that serve primarily as messengers, circRNAs act as molecular sponges for microRNAs, directly influencing the post-transcriptional regulation of genes implicated in neural development and synaptic function.

Emerging data suggest that specific circRNAs are differentially expressed in the brains of patients suffering from neuropsychiatric illnesses. For instance, particular circRNA species show altered expression profiles in cortical regions associated with cognition and mood regulation, signaling their potential utility as biomarkers for disease diagnosis and progression. Moreover, these expression patterns may provide clues to the underlying pathology, offering targets for therapeutic intervention.

Cutting-edge high-throughput sequencing technologies have catalyzed the identification and quantification of circRNAs in neural tissues with unprecedented precision. Integrating transcriptomics with proteomics and epigenetic profiling, researchers are now constructing comprehensive molecular maps that chart circRNA interactions within the neural milieu. These integrative approaches reveal complex networks where circRNAs influence neuronal gene circuits, synaptic architecture, and ultimately behavior.

A compelling aspect of circRNA research lies in their involvement in neurodevelopmental processes. During critical periods of brain maturation, circRNAs appear to govern the timing and extent of neurogenesis and synaptic pruning. Dysregulation at these junctures could disrupt neural circuitry, potentially predisposing individuals to neuropsychiatric vulnerabilities. Investigating the temporal dynamics of circRNA expression may therefore shed light on developmental windows critical for intervention.

The functional versatility of circRNAs extends into their potential role as templates for protein translation, a phenomenon recently uncovered that challenges the dogma of non-coding RNAs. In neural cells, circRNA-derived peptides might modulate signaling pathways or structural components, influencing synaptic efficacy and resilience. Deciphering these translational capacities opens a new dimension in understanding how circRNAs contribute to neural plasticity and pathology.

A major hurdle in the field remains the elucidation of the mechanistic pathways linking circRNA dysregulation to neuropsychiatric phenotypes. Experimental models employing CRISPR-based circRNA knockdown or overexpression are beginning to clarify causative relationships. Preliminary findings suggest that restoring circRNA equilibrium can ameliorate behavioral deficits in animal models, highlighting their therapeutic potential.

The translational implications of circRNA research are profound. Given their stability in biofluids and specificity to brain regions, circRNAs are promising candidates for minimally invasive biomarkers detectable in blood or cerebrospinal fluid. Harnessing this potential could revolutionize early diagnosis, treatment monitoring, and personalized medicine approaches for neuropsychiatric disorders.

Moreover, pharmacological strategies targeting circRNA biogenesis or function are on the horizon. Small molecules or antisense oligonucleotides designed to modulate circRNA levels could offer targeted therapeutic avenues without the off-target effects associated with broader gene expression manipulation. Such precision medicine approaches are poised to redefine treatment paradigms.

Ethical considerations and technical challenges remain as research progresses from bench to bedside. The intricate balance circRNAs maintain within neural networks necessitates cautious therapeutic modulation to avoid unintended neurobiological consequences. Genome-wide off-target effects, delivery mechanisms, and long-term safety profiles are critical aspects warranting rigorous investigation.

Collaborative interdisciplinary efforts integrating molecular biology, bioinformatics, neuropsychiatry, and clinical sciences are essential to fully exploit the promise circRNAs hold. Large-scale cohort studies coupled with advanced computational modeling will be instrumental in validating circRNA signatures and their predictive capacities across diverse populations.

The burgeoning field of circRNA research encapsulates a potent convergence of fundamental biology and clinical application. As the layers of complexity unfold, our comprehension of neuropsychiatric disorders transcends traditional frameworks, ushering in an era of molecular precision and hope for millions affected worldwide.

This transformative research not only enriches our understanding of brain function and dysfunction but also embodies the frontier of neurogenetics, where novel RNA species reshape the landscape of mental health diagnostics and therapeutics. Continued exploration into circRNAs promises to unravel the mysteries of the mind’s molecular architecture, offering unprecedented avenues for innovation in medicine.

Subject of Research: The role of circular RNAs in the pathophysiology and potential treatment of neuropsychiatric disorders.

Article Title: The emerging role of circular RNAs in neuropsychiatric disorders.

Article References: Huang, S., Song, Z., Pan, J. et al. The emerging role of circular RNAs in neuropsychiatric disorders. Transl Psychiatry (2025). https://doi.org/10.1038/s41398-025-03787-5

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41398-025-03787-5