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Many clinical trial conduted in most parts of the develoing world  including pre clinical evaluations  still use obsolete pathological markers for the assessment of renal , liver and cardiac pathology. There is no doubt that translational research has helped greatly in developing better and more sensitive biomarkers which are very helpful in predictive toxicities and pathology. Biological analytes such as BUN, Creatine, AST , Cholesterol etc are still obviously  in use to assess most clinical research end point, adverse events, quality of life and prognosis;  depending on the type of research design and clinical trial protocol. We all know that these parameters, though good to some extent, but may not be the best predictors of an insidiuous toxicity or pathology. Biomarkers such as Cystatin C (kidney), ALT1 (liver),  LDL-C particules and lipoprotein associated  lipoprotein A2 (LP-LPA2) (heart) have all been developed to help determine various toxicities and predictive pathologies of the associated organs. Assessing clinical research endpoint using more predictive markers results in the reduction of recall of approved drugs, helps in the approval of better drugs for different populations and reduces cost to Sponsors or CRO.  The question is , when shall  CRO, Sponsors begin to incorporate these biomarkers into clinical trial protocols ?   Please share your views.