The Future of Blood Testing Is the Immunome

Front Immunol. 2021 Mar 15;12:626793. doi: 10.3389/fimmu.2021.626793. eCollection 2021.


It is increasingly clear that an extraordinarily diverse range of clinically important conditions-including infections, vaccinations, autoimmune diseases, transplants, transfusion reactions, aging, and cancers-leave telltale signatures in the millions of V(D)J-rearranged antibody and T cell receptor [TR per the Human Genome Organization (HUGO) nomenclature but more commonly known as TCR] genes collectively expressed by a person's B cells (antibodies) and T cells. We refer to these as the immunome. Because of its diversity and complexity, the immunome provides singular opportunities for advancing personalized medicine by serving as the substrate for a highly multiplexed, near-universal blood test. Here we discuss some of these opportunities, the current state of immunome-based diagnostics, and highlight some of the challenges involved. We conclude with a call to clinicians, researchers, and others to join efforts with the Adaptive Immune Receptor Repertoire Community (AIRR-C) to realize the diagnostic potential of the immunome.

Keywords: T-cell receptor repertoire; adaptive immune receptor repertoire (AIRR); analyses; antibody repertoire; clinical laboratory testing; diagnostic test; immunome; immunomics.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptive Immunity*
  • Hematologic Tests* / trends
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Receptors, Antigen, T-Cell / immunology*


  • Receptors, Antigen, T-Cell