miRNA biomarkers and their molecular role in tuberculosis diagnosis

• Host miRNAs regulate immunity and aid Mycobacterium tuberculosis survival. • Dysregulated miRNA profiles are linked with TB progression and treatment response. • Key miRNAs (miR-21, miR-155, miR-223) act as diagnostic and prognostic biomarkers. • Biosensor platforms offer rapid, sensitive detection of TB-specific miRNA signatures. • Blood-based miRNA biomarkers enable reliable, minimally invasive TB diagnostics. • Integrating miRNA profiling with biosensors advances precision TB management. Microorganisms use host microRNAs (miRNAs) to evade immune responses and establish chronic infections. miRNAs, small non-coding RNAs, regulate gene expression post-transcriptionally, influencing host-pathogen interactions. Mycobacterium tuberculosis and other intracellular pathogens evade host immunity, promoting survival within macrophages. Dysregulated miRNA profiles in TB patients linked with disease progression, immune modulation, and treatment outcomes, serving as potential biomarkers. Biosensor technology emerged as a powerful tool for rapid and sensitive detection. MicroRNA-based diagnostics offers a promising approach for precision medicine in tuberculosis (TB) management. This review highlights the dual role of miRNAs in tuberculosis by elucidating their mechanistic contribution to host immune evasion and evaluating their potential as diagnostic biomarkers through emerging biosensor technologies. Despite these promising advances, challenges such as variability in miRNA expression across populations and the need for large-scale clinical validation remain, highlighting the importance of further research to translate miRNA-based diagnostics into routine clinical practice.