Biobanks in Developing Countries- Needs and Feasibility

Biobanks in Developing Countries- Needs and Feasibility -...

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16 NOVEMBER 2007 VOL 318 SCIENCE 1074 O ver 90% of the global burden of disease is in developing coun- tries, yet only 10% of global research addresses many of these diseases. Between 1975 and 1999, ~1% of new mar- keted drugs were for tropical diseases and tuberculosis ( 1 ). Repositories of biological samples linked with medical data from individuals (bio- banks) are infrastructures for sustained research on the bio- logical determinants of dis- ease and promise to acceler- ate the discovery of vaccines, drugs, and diagnostics. How- ever, the distribution and focus of current biobanks sug- gests that their discoveries will not sufficiently benefit those living in developing countries. Innovative use of recent technological advan- ces and existing infrastructure platforms make biobanks cost-effective and feasible in devel- oping countries. Biobanks as a Platform The Human Genome Project, annotation of millions of single-nucleotide polymor- phisms (SNPs) within the genome, develop- ment of ultrahigh-throughput genotyp- ing, small-molecule detection methods, and powerful software to analyze the mass of data that is generated, now make possible the discovery of the allelic and biological vari- ants that underlie complex diseases (such as cardiovascular diseases, cancer, diabetes, tuberculosis, and AIDS). Common genetic variants likely involve moderate effects, such as a relative risk of 1.2. Reliable assess- ment of these variants in different popula- tions (including documenting any interac- tions between genes and other risk factors) requires studies with thousands, or even tens of thousands, of cases and controls. A few biobanks have already been estab- lished in developing countries such as the Chinese Kadoorie study ( 2 ), the Mexican biobank ( 3 )and the Gambian national DNA bank ( 4 )(see table, above). The Chinese and Mexican biobanks were designed primarily to discover correlates of noncommunicable diseases in adults over age 35 years, and the Gambian study is relatively small. These studies are not sufficiently representative of the major causes of death and disability in developing countries or of the age groups at which disease strikes. In particular, HIV/ AIDS, tuberculosis, and malaria require larger studies in diverse populations. Disease Burdens in Developing Countries More than 75% of the 5 million deaths world- wide due to HIV/AIDS, tuber- culosis, or malaria are in devel- oping countries. Even infec- tious diseases have cofactors, which make their acquisition or conversion to clinical dis- ease more likely, such as smoking and tuberculosis ( 5 ). Genetic or undiscovered copathogens may help ex- plain the unprecedented in- creases in HIV-1 in eastern and southern Africa. Natural resistance to HIV-1 appears to be evolving among select populations ( 6 )tha t are con- stantly being challenged by the virus. Understanding how the immune systems have so
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Biobanks in Developing Countries- Needs and Feasibility -...

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