FAQs
1. What is the typical process for a novel biomarker to move from discovery to clinical use?
The typical process involves three stages. It begins with discovery, which identifies potential biological candidates. This is followed by validation to test sensitivity in large cohorts, and consequently, the marker’s accuracy is confirmed. Ultimately, the process reaches qualification, thereby establishing clinical utility through the necessary regulatory approvals.
2. Are all biomarkers physical substances, or can clinical observations qualify?
No. A biomarker is any measurable indicator. While often molecular, it can also be a physiological or digital measurement. Examples include gait speed tracked by a sensor or a specific pattern of tissue change observed in imaging.
3. What does it mean for a biomarker to be “surrogate”?
A surrogate biomarker is an indicator used as a substitute for a definitive clinical endpoint, such as survival or irreversible progression. It is measured because it is easier, faster, or cheaper to assess in clinical trials.
Reference
1. Strimbu, K., & Tavel, J. A. (2010). What are biomarkers?. Current Opinion in HIV and AIDS, 5(6), 463-466.
2. Mayeux, R. (2004). Biomarkers: potential uses and limitations. NeuroRx, 1(2), 182-188.
3. Pepe, M. S., Feng, Z., Janes, H., et al. (2008). Pivotal evaluation of the accuracy of a biomarker used for classification or prediction: standards for study design. Journal of the National Cancer Institute, 100(20), 1432-1438.
4. Mattsson-Carlgren, N., Palmqvist, S., Blennow, K., et al. (2020). Increasing the reproducibility of fluid biomarker studies in neurodegenerative studies. Nature communications, 11(1), 6252.
5. Wang, Q., Chaerkady, R., Wu, J., et al. (2011). Mutant proteins as cancer-specific biomarkers. Proceedings of the National Academy of Sciences, 108(6), 2444-2449.
6. Sitinjak, B. D. P., Murdaya, N., Rachman, T. A., et al. (2023). The potential of single nucleotide polymorphisms (SNPs) as biomarkers and their association with the increased risk of coronary heart disease: a systematic review. Vascular health and risk management, 289-301.
7. Monroy-Iglesias, M. J., Crescioli, S., Beckmann, K., et al. (2022). Antibodies as biomarkers for cancer risk: a systematic review. Clinical and Experimental Immunology, 209(1), 46.
8. Yang, H. Y., & Lee, T. H. (2015). Antioxidant enzymes as redox-based biomarkers: a brief review. BMB reports, 48(4), 200.
9. Gounden, V., Devaraj, S., & Jialal, I. (2024). The role of the triglyceride-glucose index as a biomarker of cardio-metabolic syndromes. Lipids in Health and Disease, 23(1), 416.
10. Zhou, X., Mao, J., Ai, J., et al. (2012). Identification of plasma lipid biomarkers for prostate cancer by lipidomics and bioinformatics. PloS one, 7(11), e48889.
11. Levenson, V. V. (2010). DNA methylation as a universal biomarker. Expert review of molecular diagnostics, 10(4), 481-488.
12. Isharwal, S., Miller, M. C., Marlow, C., et al. (2008). p300 (histone acetyltransferase) biomarker predicts prostate cancer biochemical recurrence and correlates with changes in epithelia nuclear size and shape. The Prostate, 68(10), 1097-1104.
13. Petrucelli, N., Daly, M. B., & Pal, T. (2023). BRCA1-and BRCA2-Associated Hereditary Breast and Ovarian Cancer. In GeneReviews®[Internet]. University of Washington, Seattle.
14. Duffy, M. J. (2020). Biomarkers for prostate cancer: prostate-specific antigen and beyond. Clinical Chemistry and Laboratory Medicine (CCLM), 58(3), 326-339.
15. Desai, M., Stockbridge, N., & Temple, R. (2006). Blood pressure as an example of a biomarker that functions as a surrogate. The AAPS journal, 8(1), 17.
16. Ladejobi, A. O., Medina-Inojosa, J. R., Shelly Cohen, M., et al. (2021). The 12-lead electrocardiogram as a biomarker of biological age. European Heart Journal-Digital Health, 2(3), 379-389.
17. Ahookhosh, K., Gsell, W., Tielemans, B., et al. (2025). Respiratory rate as a X-ray-based biomarker for the longitudinal assessment of lung function and pathology. Frontiers in Medicine, 12, 1621104.
18. Javitt, D. C., Spencer, K. M., Thaker, G. K., et al. (2008). Neurophysiological biomarkers for drug development in schizophrenia. Nature Reviews Drug Discovery, 7(1), 68-83.
19. Cardiff, R. D., Gregg, J. P., Miller, J. W., et al. (2006). Histopathology as a predictive biomarker: strengths and limitations. The Journal of nutrition, 136(10), 2673S-2675S.
20. Bonmatí, L. M., Alberich-Bayarri, A., García-Martí, G., et al. (2012). Imaging biomarkers, quantitative imaging, and bioengineering. Radiología (English Edition), 54(3), 269-278.
21. Coravos, A., Khozin, S., & Mandl, K. D. (2019). Developing and adopting safe and effective digital biomarkers to improve patient outcomes. NPJ digital medicine, 2(1), 14.
22. Lun, H., Yang, W., Zhao, S., et al. (2019). Altered gut microbiota and microbial biomarkers associated with chronic kidney disease. Microbiologyopen, 8(4), e00678.
23. Disis, M. L. (2011). Immunologic biomarkers as correlates of clinical response to cancer immunotherapy. Cancer immunology, immunotherapy, 60(3), 433-442.
24. Kaviraj, A., Unlu, E., Gupta, A., et al. (2014). Biomarkers of environmental pollutants. BioMed Research International, 2014, 806598.
25. Aydin, S., Ugur, K., Aydin, S., et al. (2019). Biomarkers in acute myocardial infarction: current perspectives. Vascular health and risk management, 1-10.
26. Li, H., Bai, R., Zhao, Z., et al. (2018). Application of droplet digital PCR to detect the pathogens of infectious diseases. Bioscience Reports, 38(6), BSR20181170.
27. Ankeny, J. S., Court, C. M., Hou, S., et al. (2016). Circulating tumour cells as a biomarker for diagnosis and staging in pancreatic cancer. British journal of cancer, 114(12), 1367-1375.
28. Wang, J., Tan, G. J., Han, L. N., et al. (2017). Novel biomarkers for cardiovascular risk prediction. Journal of geriatric cardiology: JGC, 14(2), 135.
29. Barron, J. J., Cziraky, M. J., Weisman, T., et al. (2009). HER2 testing and subsequent trastuzumab treatment for breast cancer in a managed care environment. The oncologist, 14(8), 760-768.
30. Lyons, T. J., & Basu, A. (2012). Biomarkers in diabetes: hemoglobin A1c, vascular and tissue markers. Translational Research, 159(4), 303-312.
31. Gao, Y., Cao, Z., Yang, X., et al. (2017). Proteomic analysis of acetaminophen‐induced hepatotoxicity and identification of heme oxygenase 1 as a potential plasma biomarker of liver injury. PROTEOMICS–Clinical Applications, 11(1-2), 1600123.
32. Ryan, P. B., Burke, T. A., Cohen Hubal, E. A., et al. (2007). Using biomarkers to inform cumulative risk assessment. Environmental Health Perspectives, 115(5), 833-840.
33. Krüger, S., Graf, J. Ü., Kunz, D., et al. (2002). Brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure. Journal of the American College of Cardiology, 40(4), 718-722.
34. Dhingra, R., Gona, P., Nam, B. H., et al. (2007). C-reactive protein, inflammatory conditions, and cardiovascular disease risk. The American journal of medicine, 120(12), 1054-1062.
35. Koenig, W., & Khuseyinova, N. (2007). Biomarkers of atherosclerotic plaque instability and rupture. Arteriosclerosis, thrombosis, and vascular biology, 27(1), 15-26.
36. Esselen, K. M., Cronin, A. M., Bixel, K., et al. (2016). Use of CA-125 tests and computed tomographic scans for surveillance in ovarian cancer. JAMA oncology, 2(11), 1427-1433.
37. Perrier, A., Gligorov, J., Lefevre, G., et al. (2018). The extracellular domain of Her2 in serum as a biomarker of breast cancer. Laboratory Investigation, 98(6), 696-707.
38. Wang, R., Wang, Q., & Li, P. (2023). Significance of carcinoembryonic antigen detection in the early diagnosis of colorectal cancer: A systematic review and meta-analysis. World Journal of Gastrointestinal Surgery, 15(12), 2907.
39. Chung, J. K. O., Xue, H., Pang, E. W. H., et al. (2017). Accuracy of fasting plasma glucose and hemoglobin A1c testing for the early detection of diabetes: A pilot study. Frontiers in Laboratory Medicine, 1(2), 76-81.
40. Maddaloni, E., Bolli, G. B., Frier, B. M., et al. (2022). C‐peptide determination in the diagnosis of type of diabetes and its management: A clinical perspective. Diabetes, Obesity and Metabolism, 24(10), 1912-1926.
41. Lue, L. F., Guerra, A., & Walker, D. G. (2017). Amyloid beta and tau as Alzheimer’s disease blood biomarkers: promise from new technologies. Neurology and therapy, 6(Suppl 1), 25-36.
42. Mollenhauer, B., Dakna, M., Kruse, N., et al. (2020). Validation of serum neurofilament light chain as a biomarker of Parkinson’s disease progression. Movement Disorders, 35(11), 1999-2008.
43. Ning, L., & Wang, B. (2022). Neurofilament light chain in blood as a diagnostic and predictive biomarker for multiple sclerosis: A systematic review and meta-analysis. PLoS One, 17(9), e0274565.
44. Pasternak, A. O., Lukashov, V. V., & Berkhout, B. (2013). Cell-associated HIV RNA: a dynamic biomarker of viral persistence. Retrovirology, 10(1), 41.
45. Kaur, M., Tiwari, S., & Jain, R. (2020). Protein based biomarkers for non-invasive Covid-19 detection. Sensing and Bio-Sensing Research, 29, 100362.
46. Monroy-Iglesias, M. J., Crescioli, S., Beckmann, K., et al. (2022). Antibodies as biomarkers for cancer risk: a systematic review. Clinical and Experimental Immunology, 209(1), 46.
47. Vacante, M., Borzì, A. M., Basile, F., et al. (2018). Biomarkers in colorectal cancer: Current clinical utility and future perspectives. World journal of clinical cases, 6(15), 869.
48. Buyse, M., Michiels, S., Sargent, D. J., et al. (2011). Integrating biomarkers in clinical trials. Expert review of molecular diagnostics, 11(2), 171-182.
49. Sanders, T., Liu, Y., Buchner, V., et al. (2009). Neurotoxic effects and biomarkers of lead exposure: a review. Reviews on environmental health, 24(1), 15.
50. Sugeeta, S. S., Sharma, A., Ng, K., et al. (2021). Biomarkers in bladder cancer surveillance. Frontiers in Surgery, 8, 735868.
51. Guarna, M. M., Hoover, S. E., Huxter, E., et al. (2017). Peptide biomarkers used for the selective breeding of a complex polygenic trait in honey bees. Scientific reports, 7(1), 8381.
52. Sim, D., Brothers, M. C., Slocik, J. M., et al. (2022). Biomarkers and detection platforms for human health and performance monitoring: a review. Advanced Science, 9(7), 2104426.
53. Enroth, S., Johansson, Å., Enroth, S. B., et al. (2014). Strong effects of genetic and lifestyle factors on biomarker variation and use of personalized cutoffs. Nature communications, 5(1), 4684.
54. McDermott, J. E., Wang, J., Mitchell, H., et al. (2013). Challenges in biomarker discovery: combining expert insights with statistical analysis of complex omics data. Expert opinion on medical diagnostics, 7(1), 37-51.
55. Andreoletti, M., Haller, L., Vayena, E., et al. (2024). Mapping the ethical landscape of digital biomarkers: A scoping review. PLOS Digital Health, 3(5), e0000519.
56. Xiao, Y., Bi, M., Guo, H., et al. (2022). Multi-omics approaches for biomarker discovery in early ovarian cancer diagnosis. EBioMedicine, 79.
57. Kilgour, E., Rothwell, D. G., Brady, G., et al. (2020). Liquid biopsy-based biomarkers of treatment response and resistance. Cancer cell, 37(4), 485-495.
58. Mann, M., Kumar, C., Zeng, W. F., et al. (2021). Artificial intelligence for proteomics and biomarker discovery. Cell systems, 12(8), 759-770.
59. Sempionatto, J. R., Lasalde-Ramírez, J. A., Mahato, K., et al. (2022). Wearable chemical sensors for biomarker discovery in the omics era. Nature Reviews Chemistry, 6(12), 899-915.
60. Hori, S. S., & Gambhir, S. S. (2011). Mathematical model identifies blood biomarker–based early cancer detection strategies and limitations. Science translational medicine, 3(109), 109ra116-109ra116.
61. Schmidt, K. T., Chau, C. H., Price, D. K., et al. (2016). Precision oncology medicine: the clinical relevance of patient‐specific biomarkers used to optimize cancer treatment. The Journal of Clinical Pharmacology, 56(12), 1484-1499.
