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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of biomarkers for the assessment of respiratory diseases is yet another step on the path towards what is known as precision medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This approach&#44; in which each patient receives individualized treatment based on the characteristics of their disease&#44; is applicable not only at the time of diagnosis but also during the entire clinical course of the disease&#46; In the field of respiratory diseases&#44; the use of biomarkers is especially helpful for assessing and selecting the best treatment in many diseases&#44; such as bronchial asthma&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> diffuse interstitial lung diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and various infectious processes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To give an example of personalized medicine in pulmonology&#44; various biomarkers in the field of bronchial asthma&#44; such as eosinophil counts in peripheral blood or the measurement of nitric oxide in exhaled air &#40;FeNO&#41;&#44; have been associated with underlying biological processes and the future risk of unfavorable outcomes or response to certain treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This evidence has led to these biomarkers being included in clinical practice guidelines for the diagnosis and evaluation of patients with bronchial asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For years&#44; biomarkers have been studied in most depth in the analysis of body fluids to assist clinical decision-making in the diagnosis&#44; prognosis&#44; and treatment of certain diseases&#46; The use of biomarkers in pulmonology is logical&#44; given that in a large number of respiratory diseases&#44; it is unfeasible to determine biological processes by analyzing pathological lung tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The concept of liquid biopsy involves taking a body fluid &#40;mainly peripheral blood&#44; but also urine&#44; bronchoalveolar lavage&#44; and other body fluids&#41; and using it to isolate cells from epithelial tissues or other derived material&#44; such as circulating tumor cells &#40;CTC&#41;&#44; circulating tumor-derived factors &#40;ctDNA&#41;&#44; or cell-free tumor DNA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Liquid biopsy has probably been studied more closely in the field of medical oncology&#46; Currently&#44; the detection of CTCs by liquid biopsy in medical oncology offers an individualized patient-specific molecular study as an alternative to invasive tumor detection procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; it seems logical that in certain circumstances or in diseases which involve the destruction or alteration of tissue by non-tumor-related processes&#44; other cells or substances may also be released<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> that can be detected by liquid biopsy&#46; This has already been demonstrated in the field of liver diseases&#44; where similar results to those observed in tumor diseases are emerging&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In non-tumor-related respiratory diseases&#44; the need to find new biomarkers is guiding lines of basic research in all areas&#44; including interstitial lung disease&#44; bronchial asthma&#44; and chronic obstructive pulmonary disease &#40;COPD&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> driven in part by the low specificity of the biomarkers available to date and the need for more information on the course of respiratory diseases&#46; In this context&#44; the use of biomarkers from liquid biopsy could be a way of obtaining samples of lung parenchyma &#40;without the use of invasive techniques&#44; such as bronchoscopy or lung biopsy&#41;&#44; facilitating&#44; moreover&#44; monitoring of the disease through repeated sampling&#46; Furthermore&#44; if we combine this information with data obtained from other techniques such as radiological imaging&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> we will have taken the first steps towards personalized respiratory medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first application of liquid biopsy in the field of a non-tumor-related respiratory disease&#44; COPD&#44; has been recently reported&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This liquid biopsy technique is based on the positive selection of epithelial cells using antibodies against epithelial markers &#40;cytokeratin&#41;&#44; combined with an antibody directed against a specific marker of type II pneumocytes in lung epithelial tissue &#40;cd44v6&#41;&#46; This study found that by isolating cell material using liquid biopsy&#44; circulating pulmonary cells &#40;CPC&#41; can be identified in the peripheral blood of up to 40&#37; of patients with COPD&#44; and that the isolation of these CPCs is associated with more severe disease&#44; suggesting their role as a highly specific biomarker that is potentially useful in both the diagnosis and prognostic assessment of COPD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This&#44; of course&#44; is a first step&#44; and more in-depth knowledge will be needed to determine the usefulness of peripheral blood in liquid biopsy and its diagnostic and prognostic applications&#46; It may even be useful for predicting response to different treatments in non-tumor-related lung diseases&#44; especially in those that involve destruction or alteration of the pulmonary parenchyma&#44; such as cystic fibrosis&#44; alpha 1-antitrypsin deficiency&#44; or idiopathic pulmonary fibrosis&#46; We hope that the results of new projects already underway<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> can help determine whether this 21st century technique will be able to respond to the needs of 21st century patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research was made possible by a research grant provided by the <span class="elsevierStyleGrantSponsor" id="gs0005">University of Granada</span> to Dr Romero Palacios&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">Dr Alc&#225;zar-Navarrete states that he has received personal funding&#44; grants for research projects&#44; and non-financial assistance in the last 5 years from GSK&#44; Novartis AG&#44; Boehringer Ingelheim&#44; Chiesi&#44; Laboratorios Menarini&#44; and Astra-Zeneca&#44; unrelated to this article&#46; Dr Alc&#225;zar-Navarrete has also registered Patent No&#46; P201730724&#46; Dr Romero Palacios states that he has received personal funding&#44; grants for research projects&#44; and non-financial assistance in the last 5 years from GSK&#44; Novartis AG&#44; Boehringer Ingelheim&#44; Chiesi&#44; and Esteve&#44; unrelated to this article&#46; Dr Romero Palacios has also registered Patent No&#46; P201730724&#46;</p></span></span>"
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Editorial
The use of non-tumor-related liquid biopsy in respiratory medicine
Biopsia líquida no tumoral: aplicación en neumología
Bernardino Alcázar- Navarretea,b,c,
Corresponding author
balcazar@telefonica.net

Corresponding author.
, Pedro J. Romero- Palaciosb, en nombre de la International Society of Liquid Biopsy (ISLB)
a AIG de Medicina, Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Granada, Spain
b Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, Spain
c Centro de investigación en red de enfermedades respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of biomarkers for the assessment of respiratory diseases is yet another step on the path towards what is known as precision medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This approach&#44; in which each patient receives individualized treatment based on the characteristics of their disease&#44; is applicable not only at the time of diagnosis but also during the entire clinical course of the disease&#46; In the field of respiratory diseases&#44; the use of biomarkers is especially helpful for assessing and selecting the best treatment in many diseases&#44; such as bronchial asthma&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> diffuse interstitial lung diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and various infectious processes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To give an example of personalized medicine in pulmonology&#44; various biomarkers in the field of bronchial asthma&#44; such as eosinophil counts in peripheral blood or the measurement of nitric oxide in exhaled air &#40;FeNO&#41;&#44; have been associated with underlying biological processes and the future risk of unfavorable outcomes or response to certain treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This evidence has led to these biomarkers being included in clinical practice guidelines for the diagnosis and evaluation of patients with bronchial asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For years&#44; biomarkers have been studied in most depth in the analysis of body fluids to assist clinical decision-making in the diagnosis&#44; prognosis&#44; and treatment of certain diseases&#46; The use of biomarkers in pulmonology is logical&#44; given that in a large number of respiratory diseases&#44; it is unfeasible to determine biological processes by analyzing pathological lung tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The concept of liquid biopsy involves taking a body fluid &#40;mainly peripheral blood&#44; but also urine&#44; bronchoalveolar lavage&#44; and other body fluids&#41; and using it to isolate cells from epithelial tissues or other derived material&#44; such as circulating tumor cells &#40;CTC&#41;&#44; circulating tumor-derived factors &#40;ctDNA&#41;&#44; or cell-free tumor DNA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Liquid biopsy has probably been studied more closely in the field of medical oncology&#46; Currently&#44; the detection of CTCs by liquid biopsy in medical oncology offers an individualized patient-specific molecular study as an alternative to invasive tumor detection procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; it seems logical that in certain circumstances or in diseases which involve the destruction or alteration of tissue by non-tumor-related processes&#44; other cells or substances may also be released<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> that can be detected by liquid biopsy&#46; This has already been demonstrated in the field of liver diseases&#44; where similar results to those observed in tumor diseases are emerging&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In non-tumor-related respiratory diseases&#44; the need to find new biomarkers is guiding lines of basic research in all areas&#44; including interstitial lung disease&#44; bronchial asthma&#44; and chronic obstructive pulmonary disease &#40;COPD&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> driven in part by the low specificity of the biomarkers available to date and the need for more information on the course of respiratory diseases&#46; In this context&#44; the use of biomarkers from liquid biopsy could be a way of obtaining samples of lung parenchyma &#40;without the use of invasive techniques&#44; such as bronchoscopy or lung biopsy&#41;&#44; facilitating&#44; moreover&#44; monitoring of the disease through repeated sampling&#46; Furthermore&#44; if we combine this information with data obtained from other techniques such as radiological imaging&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> we will have taken the first steps towards personalized respiratory medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first application of liquid biopsy in the field of a non-tumor-related respiratory disease&#44; COPD&#44; has been recently reported&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This liquid biopsy technique is based on the positive selection of epithelial cells using antibodies against epithelial markers &#40;cytokeratin&#41;&#44; combined with an antibody directed against a specific marker of type II pneumocytes in lung epithelial tissue &#40;cd44v6&#41;&#46; This study found that by isolating cell material using liquid biopsy&#44; circulating pulmonary cells &#40;CPC&#41; can be identified in the peripheral blood of up to 40&#37; of patients with COPD&#44; and that the isolation of these CPCs is associated with more severe disease&#44; suggesting their role as a highly specific biomarker that is potentially useful in both the diagnosis and prognostic assessment of COPD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This&#44; of course&#44; is a first step&#44; and more in-depth knowledge will be needed to determine the usefulness of peripheral blood in liquid biopsy and its diagnostic and prognostic applications&#46; It may even be useful for predicting response to different treatments in non-tumor-related lung diseases&#44; especially in those that involve destruction or alteration of the pulmonary parenchyma&#44; such as cystic fibrosis&#44; alpha 1-antitrypsin deficiency&#44; or idiopathic pulmonary fibrosis&#46; We hope that the results of new projects already underway<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> can help determine whether this 21st century technique will be able to respond to the needs of 21st century patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research was made possible by a research grant provided by the <span class="elsevierStyleGrantSponsor" id="gs0005">University of Granada</span> to Dr Romero Palacios&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">Dr Alc&#225;zar-Navarrete states that he has received personal funding&#44; grants for research projects&#44; and non-financial assistance in the last 5 years from GSK&#44; Novartis AG&#44; Boehringer Ingelheim&#44; Chiesi&#44; Laboratorios Menarini&#44; and Astra-Zeneca&#44; unrelated to this article&#46; Dr Alc&#225;zar-Navarrete has also registered Patent No&#46; P201730724&#46; Dr Romero Palacios states that he has received personal funding&#44; grants for research projects&#44; and non-financial assistance in the last 5 years from GSK&#44; Novartis AG&#44; Boehringer Ingelheim&#44; Chiesi&#44; and Esteve&#44; unrelated to this article&#46; Dr Romero Palacios has also registered Patent No&#46; P201730724&#46;</p></span></span>"
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ISSN: 15792129
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