Liquid biopsy: current applications and future directions

This review starts with the historical background and biological features to classify mainly the liquid biopsy biomarkers, such as circulating tumor DNA, circulating tumor cells, extracellular vesicles, non-coding RNAs, tumor-educated platelets and tumor-associated antigens, and also summarizes the present classification approaches and advanced detection techniques for each biomarker type. On this basis, the potential clinical uses of liquid biopsy in oncology are discussed in detail, including the early cancer detection, the prediction of the responses to chemotherapy, radiotherapy and immunotherapy, the evaluation of the treatment effects, the monitoring of the residual diseases and the investigation into the tumor heterogeneity and the resistance mechanisms. Moreover, the discussion is extended to other non-oncological fields, involving the reproduction medicine, the transplantation medicine, the neurological disorders, the infectious diseases and various chronic diseases such as the metabolic dysfunction-related liver disease and fibrosis, pulmonary fibrosis, lupus nephritis and renal fibrosis as well as rheumatoid arthritis. Finally, based on the comprehensive summary given above, this review summarizes the current status of the research on liquid biopsy, points out the main obstacles which hinder its wide application in clinic, for example, the absence of standard procedures and the necessity of large-scale prospective validation, and suggests possible future trends like the integration of multi-omics, the use of artificial intelligence in the analysis and the approach towards routine clinical practice.