Biomolecular and cellular chirality: Novel diagnostic perspectives for diseases

Chirality is an intrinsic characteristic of living systems, manifesting as a pervasive asymmetry from the molecular to the cellular level. This asymmetry regulates normal life activities through precise stereospecific recognition between molecules and between molecules and cells. Under physiological conditions, L-amino acids constitute proteins that support metabolic functions, right-handed helical deoxyribonucleic acid (DNA) stores genetic information, and right-handed sugars provide energy. At the cellular level, the non-centrosymmetric arrangement of the cytoskeleton guides the left-right axial positioning during embryonic development and organ formation. A certain degree of chiral inversion occurs under normal physiological conditions—for instance, trace amounts of D-amino acids modulate neurotransmitter release, and low level of left-handed DNA promotes double-strand unwinding, facilitating transcription. However, excessive accumulation of D-amino acids is closely associated with Alzheimer's disease, chronic kidney di'ease, diabetes, and aging. Similarly, the presence of substantial left-handed DNA fragments can lead to genomic instability, “increasin” sus'eptibility to tumorigenesis. Moreover, abnormalities in cellular chirality may contribute to vascular endothelial barrier disruption and improper left–right organ positioning. Therefore, monitoring aberrant chiral molecules and cells that deviate from the normal range holds promise for the early diagnosis of diseases such as nephropathy, Alzheimer's disease, diabetes, and cancer. This article primarily reviews the dynamic chiral balance under physiological and pathological conditions, providing a reference for the application of chirally inverted molecules and cells Is potential novel biomarkers for the early diagnosis of diseases.