Current Status and Future Opportunities in Lung Precision Medicine Research with a Focus on Biomarkers. An American Thoracic Society/National Heart, Lung, and Blood Institute Research Statement

Abstract

Background: Thousands of biomarker tests are either available or under development for lung diseases. In many cases, adoption of these tests into clinical practice is outpacing the generation and evaluation of sufficient data to determine clinical utility and ability to improve health outcomes. There is a need for a systematically organized report that provides guidance on how to understand and evaluate use of biomarker tests for lung diseases.Methods: We assembled a diverse group of clinicians and researchers from the American Thoracic Society and leaders from the National Heart, Lung, and Blood Institute with expertise in various aspects of precision medicine to review the current status of biomarker tests in lung diseases. Experts summarized existing biomarker tests that are available for lung cancer, pulmonary arterial hypertension, idiopathic pulmonary fibrosis, asthma, chronic obstructive pulmonary disease, sepsis, acute respiratory distress syndrome, cystic fibrosis, and other rare lung diseases. The group identified knowledge gaps that future research studies can address to efficiently translate biomarker tests into clinical practice, assess their cost-effectiveness, and ensure they apply to diverse, real-life populations.Results: We found that the status of biomarker tests in lung diseases is highly variable depending on the disease. Nevertheless, biomarker tests in lung diseases show great promise in improving clinical care. To efficiently translate biomarkers into tests used widely in clinical practice, researchers need to address specific clinical unmet needs, secure support for biomarker discovery efforts, conduct analytical and clinical validation studies, ensure tests have clinical utility, and facilitate appropriate adoption into routine clinical practice.Conclusions: Although progress has been made toward implementation of precision medicine for lung diseases in clinical practice in certain settings, additional studies focused on addressing specific unmet clinical needs are required to evaluate the clinical utility of biomarkers; ensure their generalizability to diverse, real-life populations; and determine their costeffectiveness.

The acute respiratory distress syndrome biomarker pipeline: crippling gaps between discovery and clinical utility

“…[10][11][12][13] Prior reviews of biomarkers in acute respiratory distress syndrome (ARDS), a serious critical care illness in dire need of validated and clinically useful biomarkers, have largely served as diligent but descriptive approaches outlining new technologies or summarizing the pathobiology of current biomarkers. [14][15][16][17][18][19][20] In contrast, this current review is highly divergent from prior reports and seeks to discuss the current state of ARDS biomarkers in the context of the drug development pipeline and to highlight the gaps between discovery and clinical implementation while proposing potential paths forward. Our intent is to shift the paradigm from a focus on biomarker discovery that is currently relegated to demonstrating a correlation between a specific biomarker and either the development of ARDS or ARDS severity, to a focus on the clinical utility and implementation of the biomarker within well-defined contexts of use including subject stratification in clinical trials.…”

Pleural Fluid suPAR Levels Predict the Need for Invasive Management in Parapneumonic Effusions

“…However, uncertainty persists around patient selection and optimal timing of both fibrinolytics and surgical intervention given the difficulty of predicting the course of pleural infection at baseline. Given its ability to predict the development of complicated effusions, suPAR may be an opportunity to use biomarkers in lung precision medicine to identify which patients are likely to require admission for drainage and early rescue treatments, addressing a "specific clinical unmet need" (30).…”

Harmonization of chest CT scans for different doses and reconstruction methods

“…The characterization of computed tomography (CT) density measures is crucial for the development of image‐based biomarkers for disease diagnosis, prognostication, and monitoring . The main purpose of quantitative imaging (QI) techniques is to reduce functional, biological, and morphological processes to a measurable quantity employing medical imaging.…”