April 2016 saw the UK Biobank launch the largest ever body scanning project in the world.
Funded by the MRC, Wellcome Trust and British Heart Foundation, the Biobank will scan 100,000 people to provide images of their brains, hearts, bones, carotid arteries and abdominal fat. Head of Imperial’s Division of Brain Sciences, Professor Paul Matthews is one of the academic experts who has supported the creation of this resource. Here he explains how it could prove invaluable to all areas of medicine.
Building the bank
Over 10 years, the UK Biobank has recruited and gathered a wealth of high quality information from 500,000 people across the country. These people have donated blood, urine and saliva samples, provided detailed health, lifestyle and environment information and agreed to allow the biobank to follow their GP and hospital records throughout life.
Now we will be adding sophisticated imaging to enrich our understanding of the origins and progression of the major diseases of later life.
Getting the whole picture
One thing that makes the UK Biobank so special is that it is not a ‘disease collection’ of people suffering from a specific problem. That allows researchers to study people before they develop many diseases, follow them through life and understand better what factors determine their health outcomes. Intensive, simultaneous investigation across multiple organs can tell us, for example, how the onset of dementia may be influenced by diet, activity levels and lifestyle, and to decode the links between diseases in organs of the body and diseases of the brain.
Understanding disease before it begins
The UK Biobank, now with its imaging enhancement, will help us find those changes in the brain that herald the future onset of dementia when it may still be preventable. It will enable studies of contributory disease in different organ systems with large enough numbers of subjects sufficient to characterise risk factors of lifestyle, activity and diet—and ways of addressing them for better brain health. This could allow us to map out who is at risk and what can be done for them.
The complex interplay between different diseases
Many conditions such as dementia and diabetes have a complex interplay that we do not yet fully understand. We should be able to ask big questions. For example, is there a link between early dementia and excess fat around internal organs? Does this fat drive damaging, chronic inflammation in the brain?
If this were shown to be true it could lead to new ways of minimising the risk of dementia by focusing on factors we can already treat such as blood pressure, excess blood sugar and abnormal cholesterol.
Big studies to understand small factors
Large samples are an efficient way of addressing a range of public health issues and studying multiple diseases, all with investment in just one study. Large numbers are also important because the influences on disease made by lifestyle, exposures and genetics are small at a population level. Researchers need to study large numbers to be confident of the results, particularly if we’re trying to tease out the ways in which they interact.
Large samples are an efficient way of addressing a range of public health issues and studying multiple diseases at the same time. To understand a range of different health outcomes our challenge is to relate changes that occur in the body, well before the onset of disease, to the risk of disease in an individual.
Large numbers are also important because to understand the influences of lifestyle, exposures and genetics on the expression of disease at a population level, we need substantial statistical power, particularly if we’re trying to tease out the ways in which they interact.
The resource has been developed according to rigidly-maintained standard operating procedures with regular quality-control monitoring. The bank drew together world experts to get the best possible advice when choosing the methods to use for this state-of-the-art resource.
For the imaging study, more than 125 experts in the US, Europe, the UK and Australia have worked together over six years to design the protocols.
A key factor in its design was future proofing the data to allow researchers to ask new questions even many years from now. Tissues and other samples from the volunteers are carefully stored, and all of the volunteers have consented to being re-contacted, so that researchers can go back to them to involve them in further studies. Within the imaging component, UK Biobank is storing data in their primary form, to allow re-interrogation of data as analytical approaches improve.
The biobanking revolution
Individual health initiatives like UK Biobank are showing us the value of bringing together large amounts of different types of data. It is a powerful illustration of the value of data sharing. I also think that it is leading towards the notion of making biobanking for data and samples part of routine healthcare. That may fundamentally transform what happens over the next decade to the extent that we may no longer need to do extra studies like UK Biobank – they may just become embedded in the way we deliver healthcare.
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Mr Al McCartney
Faculty of Medicine Centre