Aqueous humor exosomal microRNAs may provide additional information on the intraocular molecular environment in HSV-1 anterior uveitisNew ways to track eye inflammation from herpes virus

Herpes simplex virus type 1 (HSV-1) anterior uveitis is a recurrent inflammatory disease in which aqueous humor (AH) polymerase chain reaction (PCR) can provide virological confirmation but offers limited information on the molecular features of the intraocular environment. Extracellular vesicles (EVs) are constitutively present in the physiologically acellular AH and carry selectively packaged molecular cargo, including microRNAs (miRNAs), making them a relevant source of local biological information. This narrative review examines the rationale for investigating AH-derived EV-associated miRNAs in HSV-1 anterior uveitis by integrating evidence from ocular EV research, miRNA studies in uveitis and experimental models of HSV-1 infection. Studies in ocular disease have shown that AH-derived EVs can be isolated and molecularly characterized despite the small sample volumes available, while systemic and intraocular miRNA profiling has identified disease-associated signatures across several forms of uveitis. Experimental HSV-1 studies further demonstrate that both host- and virus-derived miRNAs regulate viral replication, latency and ocular immunopathology. In infectious uveitis, comprehensive AH miRNA profiling has already been shown to be technically feasible. To date, no study has directly characterized AH-derived EV-associated miRNAs in HSV-1 anterior uveitis. Their investigation is therefore supported by biological plausibility and indirect methodological evidence and may complement viral DNA detection by providing additional information on the local intraocular molecular environment.