NI FEATURE: TIMELESS REVERBERATIONS - COMMENTARY
|Year : 2015 | Volume
| Issue : 5 | Page : 644--646
Let us promote bio-banking in India for translational research
Emeritus Professor, Department of Neuropathology, Principal Co-ordinator, Human Brain Tissue Repository (Human Brain Bank), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
S K Shankar
Emeritus Professor, Department of Neuropathology, Principal Co-ordinator, Human Brain Tissue Repository (Human Brain Bank), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
|How to cite this article:|
Shankar S K. Let us promote bio-banking in India for translational research.Neurol India 2015;63:644-646
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Shankar S K. Let us promote bio-banking in India for translational research. Neurol India [serial online] 2015 [cited 2020 Aug 8 ];63:644-646
Available from: http://www.neurologyindia.com/text.asp?2015/63/5/644/166573
Bio-banking as a concept and an operationally special branch of science is an evolving field that will play a key role in the biomedical research both in the present and in the future. The “Time” magazine in 2009 had reported that, “Bio-banking is one of the ten ideas changing the world right now.” With advances in technology, the demand for well-annotated and properly preserved, bio-specimens has increased. Bio-banking involves the collection, processing, and storage of biological material, development of methods for preserving their tissue integrity, and distribution of these biological samples along with the related clinical data in an organized and credible form to the scientists. A well-managed bio-bank is a prerequisite for biomedical research in the field of neuro-oncology, to characterize the biology of emerging and re-emerging neuroinfections and to identify the cellular and genetic basis of neurodegenerative diseases. The existing bio-banks in India have a bias in their collection and archival of biological material for research that is influenced by several factors. These include the specific interests and expertise of the pathologists and the clinicians involved, the extent of institutional financial and administrative support available, the accessibility to the human biological material (that is to be collected in a viable state for subsequent archival) and the availability of methods to maintain quality control. The key to an effective utilization of the bio-banks lies in linking the clinical data to the archived samples and their optimum utilization by the investigators. It is needless to mention that informed consent from the patients or their close legal relatives is mandatory before collecting the resected material at surgery or at autopsy, storing it, and utilizing it for biomedical research and disseminating the knowledge acquired after studying the material while at the same time, preserving the confidentiality of the donor. These activities need to be governed by the respective Institutional Scientific Ethics Committees in the interest of the donor in order to preserve the conscience of the society, we live in.
To compare the scientific data generated from disease focused archiving facilities, there is a need for simultaneous harvesting of “relatively normal” tissue from the same organ (preferably age and gender matched). This is partly met by collecting tissues (without interfering with the legal process) from victims of road traffic accidents who die suddenly and have no prior history of suffering from a disease.
The bio-banks collect, preserve, and distribute fresh and fixed human tissue samples harvested at autopsy or during surgical resection. Similarly, biological tissue fluids such as the whole blood, serum, plasma, cerebrospinal fluid, saliva, urine, vitreous (from the eye), and synovial-peritoneal-pleural-pericardial fluids are collected by surgical/invasive procedures (like the lumbar puncture and other drainage techniques). In some instances, the remaining tissue fluid collected is banked after completion of the routine diagnostic procedures by automated analytical methods in small volumes. In the usual circumstances, in surgical/anatomy/pathology divisions, the diagnosis is completed on a limited number of 5 micron thick, formalin-fixed paraffin embedded tissue-sections and the remaining material is discarded for disposal as biological waste. By a change of perception, “this biological waste to be disposed off can be converted to precious human tissue resource material for banking and research.” In India, there are two bio-banks of significance, one - the Human Brain Bank at National Institute of Mental Health and Neurosciences, Bengaluru, and the other - Cancer Bio-bank attached to Advanced Centre for Treatment, Research and Education in Cancer-Tata Memorial Hospital, Mumbai.
It is essential to realize that many of the so called animal models, including newly developed transgenic animal models, do not reflect realistically, the biology of the neurodegenerative diseases such as the Alzheimer's disease, Parkinson's disease, and others. The majority of these animal models studied supposedly reflect less than 10% of the characteristics of the neurodegenerative diseases that have a genetic basis for their evolution. Various synucleinopathies and tauopathies associated with neurodegenerative diseases do not have comparable animal models. Similarly, appropriate equivalents in experimental animal models of psychiatric disorders such as schizophrenia and bipolar disorders are missing or have not yet been developed. These observations highlight the need to study the human brain collected at post-mortem. They also indicate the need to refrain from extrapolating the phenomenon and the biology observed in animal models to explain the pathophysiological phenomenon in human beings due to vast inter-species barriers and the genetic and epigenetic issues existing in nature that clearly distinguish the human biology from that in prevalent in experimental animals.
In India, the demographic and ethnic variability as well as the genetic polymorphisms are affecting the pharmacogenomics and bioavailability of medicines. This limits their immediate adaptation in routine clinical practice based on the extrapolation of the drug metabolism observed as a general phenomenon in the population. Though various sequences of magnetic resonance imaging and other imaging modalities are fast emerging as efficient technologies to study the internal parts of the body non-invasively, as per the current state of knowledge, they just remain shadows reflecting the actual physiology to a limited extent only. In the country, nonavailability of human autopsy material, due to the inherent reluctance of pathologists to perform the labor intensive clinical autopsies, the false sense of trust and reliance by the clinicians on the imaging techniques in order to observe the internal milieu of the patient's body, the lack of awareness about the value of clinical autopsies among the basic scientists, and the minimal mutual knowledge-based interaction between the clinicians, the pathologists and the researchers, have significantly hampered the growth of medical research and innovation. Unfortunately, the clinical autopsy procedures are not practiced in many places in the world including India even at the best centers conducting clinical and biomedical research so that medical litigation for a missed diagnosis can be avoided.
The emergence of genomics, transcriptomics, proteomics, phosphoproteomics, and the discovery of biomarkers has enhanced the need for fresh human tissue with well-preserved deoxyribonucleic acid (DNA) and protein integrity that is in a “near normal state.” Generally, blood leukocytic DNA is studied as it is expected to reflect the genetic diseases of all organs in the body. Recently, organ-specific DNA mutations in the same individuals have been recognized, underlining the genetic heterogeneity of the tissues in the same subject. This has necessitated the need to evaluate the ethnic and gender differences in the functional genomics of the right and left sides and of the various Brodmann areas of the human brain. Hence, a new line of research has emerged based on these differences. The progress in bio-banking in neuroscience has been slow although limited attempts are being made in some centers. India has missed the opportunities of optimally studying the human biological material that would have been possible to obtain in the aftermath of natural calamities. This strategy, if implemented effectively, would greatly help us in evolving strategies to combat the effects of these disasters. A few examples from India include the Bhopal gas tragedy, the Endosulfan toxicity in Kerala, the Buddha Nala pollution in Sutlej River by the industrial effluents, the high levels of radioactive material in the ecosystem in Malwa Region, Punjab, and the mushrooming of assisted reproduction technology related developmental disorders in the offsprings. The biological material obtained from these events was not banked to study, and therefore, no lessons were learnt to evolve the counter measures. Similarly, banking of various human biological tissues following outbreaks of viral infections is not practiced due to the phobia of a possible accidental spread of infection. The discovery as well as the evaluation of diagnostic and prognostic biomarkers that appear or are elevated following neurotrauma - polytrauma is an open field of study with immense clinical relevance.
The only way to confront the situation lies in banking of tissues and fluids for research in order to understand the biology, to develop vaccines and therapeutic strategies, and to form research consortia to share knowledge. The major advantages derived from this venture would be the development of skilled man-power possessing a vast “knowledge bank,” the initiation and evolution of innovative techniques in analytical bioinformatics, and the availability of integrative job opportunities for the next generation of young scientists.
Religion does not act as a barrier for the donation of human tissues as long as it is being done with the sole purpose of alleviating human suffering. Dispelling the misconceptions about harvesting tissues at autopsy facilitates philanthropic donation following one's death. If pursued with a mission mode, bio-banking can become a sustainable venture in the country, similar to the process of organ donation for transplantation. Many of the advanced medical institutions in the country can initiate local bio-banks of various tissues and enroll basic scientists in order to use it and to develop innovative strategies to combat diseases.
Let “Bio-banking” be one of the national priorities. Let the clinicians, pathologists, and basic scientists form a network. Once the philosophy of harvesting internal organs and body fluids for research becomes an integral part of the system, further work may progress on the funding strategies and sustainability. The neurologists, neurosurgeons, neuropathologists, and neuroscientists can work as a team and make a significant contribution to this concept of bio-banking - brain banking and make it a reality in the near future.
"I shall pass this way but once in life. If I may do any good, let it be now, for I shall not pass this way again” - (Stephen Grellet).
Let this not be a mere slogan but a mission for the welfare of future generations. Let us all strive to enhance the knowledge base by promoting bio-banking and translational research.[AUTHOR:1]