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miR-21-5p antagomir is a synthetic, chemically modified antisense oligonucleotide designed to specifically bind and inhibit microRNA-21-5p (miR-21-5p). In multiple myeloma (MM), miR-21-5p is significantly enriched in tumor-derived exosomes and acts as a key mediator of bone marrow microenvironment remodeling. By targeting the 3' untranslated region (UTR) of TGF-β1, miR-21-5p modulates the TGF-β1/SMAD signaling axis, driving the transformation of mesenchymal stem cells into cancer-associated mesenchymal stem cells (CA-MSCs). These CA-MSCs subsequently promote osteolysis and confer resistance to proteasome inhibitors like bortezomib through the secretion of CXCL12 and RANKL. Treatment with miR-21-5p antagomir, particularly when delivered via liposomal formulations, has demonstrated the ability to reverse these pathological changes, restore drug sensitivity, and reduce bone destruction in preclinical models of multiple myeloma.
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