Yeah, I think that there are several barriers. One of them is it’s not so easy to draw spinal fluid as it is to collect a blood sample. The various ways you can do this, including a lumbar puncture or including placing a CSF reservoir in the brain or collecting it during a surgical procedure that the patient needs anyway, any of these modalities are still going to be less invasive than acquiring brain tissue...
Yeah, I think that there are several barriers. One of them is it’s not so easy to draw spinal fluid as it is to collect a blood sample. The various ways you can do this, including a lumbar puncture or including placing a CSF reservoir in the brain or collecting it during a surgical procedure that the patient needs anyway, any of these modalities are still going to be less invasive than acquiring brain tissue. So that’s one of my main arguments for doing it. But it still is much harder than just collecting a blood sample. And this depends on where the patient’s being treated and that institution’s level of comfort with collecting spinal fluid. And it also depends on how easily and quickly one can obtain spinal fluid. So that’s something that I think is just a natural barrier to sort of regular widespread use. And the only way to pick up the use in the field is to really prove the clinical importance, right? If you can show that this really is changing management, then it’s not such a big deal to put the patient through a lumbar puncture. But we have to show first how it’s important. And I think the other barrier is that, you know, it’s just what I just said is, you know, if you’re going to put the patient through collection of spinal fluid right now, how is that going to impact your management of the patient? How’s that going to change what you’re doing? And I would argue that there are probably a couple of select clinical scenarios right now where we already have assays that are good enough to have some clinical value. And I would say one example of that is if you have a patient with a new brain mass on MRI and it’s in a difficult location to sample, you know, the neurosurgeons feel uncomfortable sticking a needle in that part of the brain, for example, a brainstem tumor. That’s a case where right now you could draw a spinal fluid sample. And if you detect a certain mutation in the spinal fluid, you can make a diagnosis without having to put the patient through a very risky brain surgery. So that’s a use case where we’re already there. And I think it’s clear that it impacts management. The less, I think, less clear cases would be, let’s say you have a brain cancer patient, again, use glioblastoma as the example. And that person has had standard of care radiation and chemotherapy. And now they’ve got some progressing tumor, presumably, on the MRI scan. You’re not sure if it’s actually tumor or if it could just be benign changes from the radiation. In that scenario right now, it would be great if we had a liquid biopsy test, blood or spinal fluid that could clearly tell you, yes, that’s tumor growth. And if so, get an updated molecular profile on that recurrent tumor. We’re not there yet. I think that that is where we all want to be, But that’s probably the hardest, simultaneously the most important, but also the hardest clinical use to really build this up and prove that it’s going to change management. And I think we just need bigger studies, better studies, and ultimately we need better assays that are sensitive enough. But that’s where I think ultimately the field will be heading in the coming years.
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