Crosstalk between KRAS and miRNAs in pancreatic cancer: Opportunities for its diagnosis, prognosis and therapeutic intervention (Review).

Pancreatic cancer, predominantly manifested as pancreatic ductal adenocarcinoma (PDAC), is a highly aggressive malignancy in which the dysregulated crosstalk between Kirsten rat sarcoma viral oncogene homolog (KRAS) and microRNAs (miRNAs) plays a critical role. It is one of the leading causes of cancer‑related mortality worldwide, with its global incidence more than doubling over the past 25 years. PDAC is characterized by rapid progression, invasiveness and profound resistance to conventional therapies, resulting in dismal prognosis. Its genetic profile is characterized by activating KRAS mutations, present in ~90% of cases. These mutations act as molecular switches that activate multiple intracellular signaling cascades and transcription factors, promoting uncontrolled proliferation, survival, migration and transformation. In addition to direct KRAS alterations, dysregulation of KRAS‑targeting miRNAs further amplify aberrant RAS signaling. Emerging evidences highlights the significant role of miRNAs in driving tumor initiation, progression and metastasis. Several tumor‑suppressive miRNAs that regulate KRAS signaling have demonstrated the capacity to suppress pancreatic tumor development in vitro and in preclinical models. Despite these advances, miRNA‑based therapies, including mimics or anti‑miRNA oligonucleotides targeting KRAS, remain largely unexplored in patients with PDAC. Further, circulating miRNAs show promise as non‑invasive biomarkers for disease detection, monitoring progression and assessment of tumor aggressiveness. The present review provided a concise overview of KRAS signaling and its frequent mutations in PDAC, examines strategies to target KRAS and discussed the crosstalk between KRAS and tumor‑suppressive miRNAs in regulating pancreatic tumorigenesis. It further explored diagnostic and prognostic miRNAs in pancreatic cancer. Collectively, these insights underscored the potential of miRNA‑based interventions to improve early detection, prognosis and targeted therapy in this lethal disease.