Dermot's diary #7

Liquid biopsies are reshaping precision medicine, enabling real-time monitoring of disease and treatment response. For laboratories, that means new workflows, technologies and opportunities to lead the shift.

The shift away from tissue biopsies towards liquid biopsies feels like a real innovation. How will that play out and what are the consequences for labs?

It's not just an innovation; it is a paradigm shift in precision medicine, particularly in oncology. Currently, liquid biopsies are largely acting as an adjunct to tissue biopsies, but liquid biopsies will become the standard of care for therapy selection, monitoring minimal residual disease (MRD), and tracking therapy resistance in real-time. Simply put, because blood can be drawn frequently, longitudinal tracking of a tumour's molecular profile becomes a reality – something impossible with invasive, single-timepoint tissue biopsies.

And remember, in cases where tumours are inaccessible, or when a patient is too compromised for surgery, liquid biopsies will completely replace tissue sampling. And of course, as sensitivity improves, the Holy Grail of multi-cancer early detection (MCED) screening via routine blood work will become a primary diagnostic tool.

So for labs there's a strategic pivot ahead – workflows that pivot toward handling plasma. They'll need specialised collection tubes that stabilise cfDNA during transit, as well as distinct, highly optimised nucleic acid extraction kits designed specifically for fragmented, low-yield circulating DNA. For Celtic Molecular Diagnostics and our partners, this is a massive opportunity and we look forward to being drivers on the journey.

And multiplexed real-time PCR panels are obviously front of mind. Again, what does that mean for labs and universities?

In oncology, multiplex real-time PCR panels have the advantage of lower cost and a quicker time to result than NGS panels while still allowing the clinician to determine appropriate therapies based on a he various mutations detected in the tumour genes.

And are you seeing LAMP and similar isothermal techniques being adopted in sub-Sarahan Africa?  They seem to feed into the World Health Organisation's ongoing drive for point-of-care.

LAMP has enormous potential for use in under resourced environments and in the development of molecular Point of Care assays. We look forward to this technology becoming more mainstream in the coming years.

And of course cholera remains a major concern. What role does testing have in tracking cross-border transmission and spread?

Standard PCR-based methods are obviously essential for early detection, but whole genome sequencing is needed to determine if simultaneous outbreaks in neighbouring countries are in fact genetically connected. We're uniquely positioned to help with both.