Biliary colic (BC), characterized by intermittent pain due to gallstone-related bile duct obstruction, remains poorly understood at the molecular level. Circulating exosomal microRNAs (miRNAs) have emerged as potential biomarkers for various diseases. This study aimed to identify exosomal miRNA profiles in BC patients and explore their therapeutic implications.

Analysis of plasma exosomal miRNAs from 10 BC patients during acute attacks and 10 healthy controls (HC) revealed distinct expression patterns separating BC from HC groups. Integration of differential expression analysis, WGCNA, and LASSO regression identified 7 key miRNAs (hsa-miR-142-3p, hsa-miR-32-5p, hsa-miR-374a-3p, hsa-miR-155-5p, hsa-miR-425-3p, hsa-miR-584-5p, hsa-miR-185-5p) strongly associated with BC. Support vector machine models using these miRNAs achieved excellent diagnostic performance (AUC = 1.0, where AUC represents Area Under the Curve). miRNA-targeting drugs including Remlarsen and Cobomarsen showed potential for therapeutic intervention.