Mesothelin in pancreatic cancer: clinical applications and analytical considerations

One of the most prevalent and aggressive kinds of pancreatic cancer (PC) worldwide is pancreatic ductal adenocarcinoma (PDAC). It has no preliminary symptoms and poses significant challenges for diagnosis in the early stages. Due to late diagnosis, it shows resistance to standard treatment. Despite improvements in cancer care, the five-year data depict a low survival rate. Current status of PDAC demands exploration of effective, non-surgical biomarkers that can facilitate rapid diagnosis, prognosis, and monitoring of treatment, which has put mesothelin (MSLN) in the spotlight. MSLN is a transmembrane glycoprotein found mainly in healthy mesothelial tissues, but gets significantly overexpressed in 80 %–90 % of PDAC cases. This protein has a major function in the adhesion of tumor cells, their invasion, and chemotherapy resistance, highlighting its importance in disease progression. Serum MSLN is a soluble MSLN and is found in the blood; it has potential for diagnosis. However, several challenges limit its use in clinical settings, including individual differences, low sensitivity and specificity, and variable test performances. This presented review explores the function of serum MSLN in PDAC and discusses its biological importance, regulatory mechanisms, and expression patterns. We also review current and new testing methods, which include enzyme-linked immunosorbent assay (ELISA), electrochemiluminescence, and biosensors based on nanotechnology. This review compares MSLN with existing biomarkers and discusses its impact on prognosis, treatment monitoring, and targeted therapies. This review highlights the potential of serum MSLN levels and provides important directions for future research and clinical validation.