From a Biomarker Perspective

Suresh Chandrasekaran, Business Unit Head “ Immuno & Molecular Diagnostics CPC Diagnostics.

What will the future be for Invitro Diagnostics (IVD)? Will IVD products only diagnose or prognose a disease condition. How will it further help in patient care management? What will the future be for IVD? The most commonly used cardiac

Marker was CK, and CK MB with some customers looking at doing some more esoteric tests. Today we have newer markers like Myoglobin, Troponins, NT Pro BNP, Copeptin etc. The most commonly used inflammatory and sepsis marker, fifteen years back we had CRP and we used to look at other basic assays. Today we have the likes of rocalcitonin, endotoxin and even a molecular diagnostics sepsis panel available. Procalcitonin is even used as both a diagnostics and prognostic tool.

The most commonly used nephrology marker were the Biochemistry parameters of creatinine and urea. Today we have newer markers like Cystatin C and yet another Prognostic and Diagnostic marker called NGAL. The most common marker for rheumatoid arthritis was Serum RF IgG and IgM. Today we have newer markers called Anti CCP, MCV, etc. For the routine ANA Diagnostics we used to do a screen by Human Epithelial cells and confirmation with a six antigen ANA Profile. Today we are looking at a 15 antigen ANA Profile apart from the ANA Screen.

Even for specialised assays like Downs Syndrome diagnosis, we were doing only second trimester screening, which was able to detect only around 68 percent risk assessment a decade ago. Today we have been able to evolve new biomarkers for first trimester in the form of PAPP-A and Free Beta HCG along with measurement of nuchal translucency to facilitate the laboratories to assess close to 92 percent detection rate of the risk of foetus developing Downs Syndrome.
The above are just some of the instances of how we have advanced with regard to Clinical Diagnostics. We are certainly moving into the era of Biomarkers, where newer technologies, newer techniques and newer markers will rule the roost.

Coming back to the present, this is the era where in we can be able to do multiplexing using the complex bead based rray like Luminex or do Microarray based on either fluidics, as seen in affymetrix platform, or a biochip based microarray, as seen in quite a few other instances. Further we will have newer technologies like proteomics, metabolomics and companion diagnostics gaining significance in the coming years.
We have seen evolution of Invitro Diagnostics from routine parameters to the Specialised Biomarkers in the key areas. The Biomarkers will continue to evolve as a key tool in not only diagnosis but also in prognosis. Majority of the new Biomarkers may not be the magic bullets, but they will certainly facilitate being associated as a Navigational tool towards diagnosis and prognosis of the specific disease conditions.


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