CRISPR-Cas12a-based liquid biopsy technology: challenges in large-scale clinical application

Liquid biopsy technology, which enables the acquisition of tumor-related biomarkers in a minimally invasive and reproducible manner, has been widely applied in clinical scenarios such as early tumor detection, treatment response assessment, minimal residual disease (MRD) monitoring, and recurrence surveillance. However, its clinical utility is still limited by the extremely low abundance of clinically relevant targets, the inhibitory effects of complex matrices, and the high variability in pre-analytical stages. As a next-generation programmable nucleic acid diagnostic platform, CRISPR-Cas12a combines the unique mechanisms of sequence-specific recognition and trans-cleavage signal amplification, demonstrating significant technical advantages and translational potential in the detection of low-abundance targets in liquid biopsies. Nevertheless, a mere improvement in analytical sensitivity is insufficient to support its large-scale clinical application; the robustness of detection methods, the reproducibility of results, and clinical interpretability remain the key factors currently restricting its clinical translation. This review summarizes the mechanism of CRISPR-Cas12a. Focusing on seven representative clinical biofluids, including blood, urine, and cerebrospinal fluid, it analyzes the technical difficulties and adaptation strategies associated with different matrices, and summarizes the performance differences of detection methods alongside the most clinically rational application scenarios across various biofluids. Furthermore, it explores the primary bottlenecks this technology faces when transitioning from laboratory proof-of-concept to routine clinical application, and provides a preliminary discussion on its future development directions based on existing research. Ultimately, this review aims to provide a reference for promoting the clinical translation of CRISPR-Cas12a liquid biopsy technologies and the broader implementation of precision medicine.