MicroRNAs and Alarmins in Cardio-Oncology: Biomarkers and Therapeutic Implications in Skin and Breast Cancer.

Cardio-oncology explores the complex interplay between cancer biology and cardiovascular health, particularly the cardiotoxic effects of cancer therapies. Both microRNAs (miRNAs) and alarmins have emerged as key molecular mediators linking tumor progression and cardiac stress, representing promising biomarkers and therapeutic targets. In skin and breast cancer, specific miRNAs, including miR-21, miR-155, miR-34a, and the miR-200 family, regulate tumor proliferation, invasion, metastasis, and therapy resistance. Alarmins such as NPM, HMGB1, HSPs, IL-33, and S100 proteins modulate inflammatory signaling, oxidative stress, and tissue remodeling, contributing to both tumor progression and cardiomyocyte dysfunction. These molecules are also implicated in chemotherapy- and targeted therapy-induced cardiotoxicity, including apoptosis, fibrosis, and impaired cardiac function. This review highlights the dual role of miRNAs and alarmins in tumor biology and cardiovascular toxicity, emphasizing their potential as circulating biomarkers for early detection and monitoring. Therapeutic strategies targeting this axis-including miRNA mimics/inhibitors and alarmin modulators-may provide synergistic benefits by reducing cardiotoxicity while suppressing tumor growth. Understanding miRNA-alarmin relationships, including direct interactions such as the NPM/miR-200c axis, as well as their broader regulatory networks in cardio-oncology, offers novel avenues for precision medicine, enabling integrated approaches to monitor, prevent, and treat therapy-related cardiac complications in patients with skin and breast cancers.