Urinary mRNA Profiling of Autophagy-Related Genes ATG5, ATG7, MAP1LC3B, and mTOR in Non-Muscle Invasive Bladder Cancer (NMIBC)

• Urinary mRNA of autophagy genes is altered in NMIBC patients. • Expression of ATG5, ATG7, LC3B, and mTOR differs in NMIBC urine. • Urine-based test may aid early NMIBC detection. • The approach offers a simple, non-invasive monitoring method. This study presents a novel urine-based molecular assay targeting the autophagy-related mRNA biomarkers MAP1LC3B, ATG5, ATG7, and mTOR for the non-invasive detection of Non-Muscle-Invasive Bladder Cancer (NMIBC). Autophagy, a crucial process for maintaining epithelial homeostasis and regulating cellular integrity, contributes to tumorigenesis when dysregulated. In a cohort comprising 62 NMIBC patients, 31 benign urogenital cases, and 31 healthy controls, quantitative real-time PCR (qRT-PCR) analysis revealed significant downregulation of MAP1LC3B, ATG5, and ATG7, along with substantial upregulation of mTOR (all P-values < 0.05). These expression patterns reflect impaired autophagic flux and a shift towards a tumor-permissive microenvironment. Diagnostic performance evaluation demonstrated that MAP1LC3B and mTOR achieved 80% sensitivity, while ATG5 and ATG7 reached 90% specificity, collectively outperforming conventional cytology. This mechanistically anchored biomarker panel provides a scalable, non-invasive platform for molecular surveillance and early detection of NMIBC. Our findings establish autophagy disruption as both a hallmark and a diagnostic opportunity in bladder cancer, paving the way for precision diagnostics rooted in epithelial biology.