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Liquid biopsy for liver diseases
  1. Jelena Mann1,
  2. Helen L Reeves2,
  3. Ariel E Feldstein3
  1. 1 Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Department of Pediatrics, University of California, San Diego, California, USA
  1. Correspondence to Dr Ariel E Feldstein, Division of Pediatric Gastroenterology, Hepatology and Nutrition UCSD, San Diego, CA 92103-8450, USA; afeldstein{at}


With the growing number of novel therapeutic approaches for liver diseases, significant research efforts have been devoted to the development of liquid biopsy tools for precision medicine. This can be defined as non-invasive reliable biomarkers that can supplement and eventually replace the invasive liver biopsy for diagnosis, disease stratification and monitoring of response to therapeutic interventions. Similarly, detection of liver cancer at an earlier stage of the disease, potentially susceptible to curative resection, can be critical to improve patient survival. Circulating extracellular vesicles, nucleic acids (DNA and RNA) and tumour cells have emerged as attractive liquid biopsy candidates because they fulfil many of the key characteristics of an ideal biomarker. In this review, we summarise the currently available information regarding these promising and potential transformative tools, as well as the issues still needed to be addressed for adopting various liquid biopsy approaches into clinical practice. These studies may pave the way to the development of a new generation of reliable, mechanism-based disease biomarkers.

  • clinical trials
  • chronic liver disease
  • hepatocellular carcinoma
  • liver biopsy

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  • Contributors JM, HLR and AEF contributed equally. AEF developed the main concept of the manuscript. All authors contributed to review and revision and approved the final manuscript.

  • Funding This work was supported in part by grants from the US National Institutes of Health (R01 DK113592, U01 AA024206) to AEF, the UK Medical Research Council (grant MR/K10019494/1), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (grant UO1 AA018663), and the National Institute for Health Research Newcastle Biomedical Research Centre based at Newcastle Hospitals NHS Foundation Trust and Newcastle University to JM, and the Bobby Robson Foundation, CR UK Newcastle Experimental Cancer Medicine Center award C9380/A18084 and CR UK grant C18342/A23390 to HLR.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.