14-Oct-2026
RNA 5-methylcytosine cancer biomarkers face a measurement gap, not a biology gap
Shanghai Jiao Tong University Journal CenterPeer-Reviewed Publication
This review argues that the central obstacle to the clinical translation of RNA 5-methylcytosine (m5C) in cancer is measurement, not biological plausibility. Although m5C regulates RNA maturation, export, stability, translation and decay, and altered m5C pathways have been linked to tumor progression, immune regulation and resistance phenotypes, current platforms support non-equivalent claims. LC-MS/MS provides calibrated bulk quantification but destroys site information; conversion and deaminase chemistries resolve candidate nucleotides but remain background-limited and largely semiquantitative; antibody enrichment and writer trapping yield regions or enzyme-dependent substrates without native site fractions; nanopore calls are model- and context-dependent. These limitations are amplified near the noise floor in FFPE tissue, small biopsies, plasma and extracellular-vesicle RNA, where a missing signal is a no-call rather than an unmodified cytosine. The authors conclude that no platform is yet adequate as a standalone reportable assay. Translation requires an intended-use-specific measurand, matrix-matched controls, calibrated site fractions, locked wet-laboratory and bioinformatic procedures, explicit limits of blank, detection and quantification, followed by independent clinical validation and comparison with established tests. Biological heterogeneity, tumor attribution, incremental value, feasibility and clinical utility also require prospective evaluation in parallel.
- Journal
- LabMed Discovery