The potential of circulating cell free RNA as a biomarker in cancer

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Abstract
Introduction: It is now clear that circulating cell-free ribonucleic acids (ccfRNAs), including mRNA and miRNA, are potential cancer biomarkers. As ccfmiRNA is relatively more stable than ccfmRNA, research should concentrate on i) developing novel methods to preserve the stability of ccfmRNA and ii) standardization of the protocol which includes extraction, detection and multi-center validation. Areas covered: This literature review concentrates on the potential of ccfRNA being used as a biomarker in cancer, with special focus on messenger RNAs (mRNAs) and microRNAs (miRNAs). Expert opinion: With the advancement of high throughput technologies such as RNA sequencing, a panel of biomarkers will be used for the diagnosis, prognosis and therapeutic monitoring of cancer patients. In order to achieve this important target, bioinformatics education to pathologists, scientists and technologists in molecular diagnostic laboratories are essential. Moreover, the panel of these new ccfRNAs biomarkers has to obtain approval or clearance from an authority such as the US Food and Drug Administration (FDA) and the standard of utilizing these new protocols has to be recognized via accreditation exercise. Therefore, there is still a long way to go before an extensively use of ccfRNA biomarkers in cancer patients can be realized.

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