• First systematic analysis of serum exosomal miRNA profiles in TB-DILI patients, identifying 128 differentially expressed miRNAs.
• miR-122-5p is upregulated and may serve as an early diagnostic biomarker, expressed 24 hours earlier than ALT elevation.
• Exosomal miRNAs are stable and tissue-specific, offering a non-invasive approach for early detection of drug-induced liver injury.
• Target gene enrichment indicates roles in GTPase activity regulation, cell migration, and BMP signaling, providing insights into DILI pathogenesis.