"Forward-Thinking" in U.S. Biobanking

Variation among DNA banking consent forms: points for clinicians to bank on

Deoxyribonucleic acid (DNA) banking is an important laboratory service that preserves the option of future genetic testing. DNA bank consent forms are a critical tool to facilitate thorough and valid informed consent. The objectives of this study were to assess the level of consistency of current clinical DNA banking consent forms with the American Society of Human Genetics (ASHG) and the American College of Medical Genetics and Genomics (ACMG) guidance and to explore variation among the forms. The content analysis matrix included key points identified from the ASHG and ACMG documents (including benefits/risks, sample storage, access, disposition, and communication) and additional points beyond the ASHG and ACMG documents identified from the consent forms themselves during the analysis process. Forms were assessed for language addressing each point. Five consent forms were identified and analyzed for twelve key points and eight additional points. The average consistency for key points was 10.8/12 (range 8/12 to 12/12). The range for additional points was 1/8 to 5/8. There was variation across forms in the details provided related to key and additional points. Gaps in clinical DNA banking consent forms are barriers to achieving informed consent. Clinicians can consider the consent key and additional points discussed here to supplement and enrich their clinical DNA banking informed consent discussions, promote stewardship, and maximize downstream utility of banked DNA. The identification of multiple additional points beyond the ASHG and ACMG documents' key points indicates a need for this guidance to be updated.

Economics of Biobanking: Business or Public Good? Literature Review, Structural and Thematic Analysis

This paper reviewed the relevant scientific literature on the business and economics of biobanking to explore key themes and paradigms. The structural properties of the literature were investigated, such as key authors, journals, studies, as well as co-citation and co-authorship networks; the study revealed that the research on business and economics is a niche area within the vast biobanking literature. The research is concentrated in a relatively small number of journals, institutions, and countries, which is rather surprising given the substantial public investment in and concerns about biobank sustainability. The structural analysis also suggested major themes in research on biobanking business and economics and noted shifts in focus on specific themes. The commercialisation of samples is more acknowledged than before but under the condition of equitable sharing of benefits across various stakeholders. Most biobanks are heavily subsidised by the public sector and are considered public goods rather than business enterprises. This is OK, but underutilisation of specimens and low rates of cost recovery suggest that the current mainstream operating model is hardly sustainable. With many biobanks maturing, long-term sustainability became a key topic of the discussion on biobanking trends.

The Availability of Human Biospecimens to Support Biomarker Research

Preserved biospecimens held in biobank inventories and clinical archives are important resources for biomarker research. Recent advances in technologies have led to an increase in use of clinical archives in particular, in order to study retrospective cohorts and to generate data relevant to tissue biomarkers. This raises the question of whether the current sizes of biobank inventories are appropriate to meet the demands of biomarker research. This commentary discusses this question by considering data concerning overall biobank and biospecimen numbers to estimate current biospecimen supply and use. The data suggests that biospecimen supply exceeds current demand. Therefore, it may be important for individual biobanks to reassess the targets for their inventories, consider culling unused portions of these inventories, and shift resources towards providing prospective custom biobanking services.

Returning actionable genomic results in a research biobank: Analytic validity, clinical implementation, and resource utilization

Over 100 million research participants around the world have had research array-based genotyping (GT) or genome sequencing (GS), but only a small fraction of these have been offered return of actionable genomic findings (gRoR). Between 2017 and 2021, we analyzed genomic results from 36,417 participants in the Mass General Brigham Biobank and offered to confirm and return pathogenic and likely pathogenic variants (PLPVs) in 59 genes. Variant verification prior to participant recontact revealed that GT falsely identified PLPVs in 44.9% of samples, and GT failed to identify 72.0% of PLPVs detected in a subset of samples that were also sequenced. GT and GS detected verified PLPVs in 1% and 2.5% of the cohort, respectively. Of 256 participants who were alerted that they carried actionable PLPVs, 37.5% actively or passively declined further disclosure. 76.3% of those carrying PLPVs were unaware that they were carrying the variant, and over half of those met published professional criteria for genetic testing but had never been tested. This gRoR protocol cost approximately $129,000 USD per year in laboratory testing and research staff support, representing $14 per participant whose DNA was analyzed or $3,224 per participant in whom a PLPV was confirmed and disclosed. These data provide logistical details around gRoR that could help other investigators planning to return genomic results.

Advancing Professionalization of Biobank Business Operations: Performance and Utilization

Biobanks are now in the spotlight as key enablers supporting preclinical, clinical, and environmental research. Awareness of their value has increased along with the need for these infrastructures to be sustained through business-focused practices. Following our 2017 pilot survey on biobank business planning, we initiated a more comprehensive 38-question multiple-language worldwide survey on biobank sustainability. Two hundred seventy-six biobanks of various sizes and stages of business planning (in place, in progress or none) responded. About two-thirds were established in the last 10 years. Survey results confirm our hypothesis that biobanks with business plans or preparing such plans are trending toward more professional structures. Specific survey data focusing on performance metrics and utilization, as related to sustainability, are presented. Biobanks most frequently measured basic performance metrics (sample utilization, samples collected, samples distributed, internal projects supported). Metrics less often reported included sample and data quality, cost recovery, citations, and publications, typically correlating with higher levels of biobank complexity and professionalism. Biobanks reported supporting projects for both internal and external use, with support of projects within their own organizations as the main driver of biobanks, independent of business plan status. Having a business plan seemed to be a key factor for biobanks that had developed sustained support for external commercial projects. While under half of the biobanks reported both target and actual utilization rates, the responses provided valuable data on utilization. Target utilization rates were much higher (2.5 to 5 times higher) than the rate of actual use. Many of the biobanks report less than 10% utilization. Biobanks with low utilization rates make sustainability a very distant and likely unreachable goal. Our survey has provided some basic data about biobank business planning globally. Continued research should be done, with the data and information shared within the community for the good of all biobank stakeholders.

Advancing Professionalization of Biobank Business Operations: A Worldwide Survey

Quality specimens from biobanks are key resources to support reproducible research. Sustaining biobanks requires robust management. We recently published a pilot survey that indicated that over half the participating biobanks had business plans in place and another third were working on business planning. While the results provided a clue to the status of business planning in biobanking, it was concluded that a longer and more in-depth survey and analysis were required. In April 2017, an extended survey was distributed worldwide in English, French, Chinese, German, and Spanish, through multiple channels. The survey was built using the Survey Monkey tool. Our hypothesis was that those biobanks that already have a business plan also have a more professional management structure. The questions were designed to understand more details about each biobank's business operations and communications. A total of 276 biobanks participated (China 65, France 40, United States 34, Spain 27, Germany 24, Australia 23, and rest of the world 63). About two thirds of the biobanks were established in the last 10 years. The responses provided data on the size of biobanks answering the survey, their status of business planning, and how and through what mediums they are communicating with customers. Biobanks with a business plan or preparing to have one showed a clear trend of having a customer strategy for marketing the samples and communicating with customers. No trend could be seen regarding websites and activities in social media. We confirmed our hypothesis that biobanks that have or are in the process of preparing a business plan are showing a trend toward more professional structures. In the biobanking community, the business mind-set and use of the business plan as a management tool have not quite arrived.

Which Results to Return: Subjective Judgments in Selecting Medically Actionable Genes

BACKGROUND

Advances in genomics have led to calls for returning information about medically actionable genes (MAGs) to patients, research subjects, biobank participants, and through screening programs, the general adult population. Which MAGs are returned affects the harms and benefits of every genetic testing endeavor. Despite published recommendations of selection criteria for MAGs to return, scant data exist regarding how decision makers actually apply such criteria.

METHODS

The process and criteria used by researchers when selecting MAGs for a preventive genomic sequencing program targeting the general adult population were examined. The authors observed and audio-recorded the gene selection meetings, and analyzed meeting transcripts, gene scoring sheets, and meeting handouts.

RESULTS

To select MAGs, the committee imported, from a preexisting project, "a semiquantitative metric" that scores genes on five criteria. Numerous subjective judgments and conceptual challenges in defining and applying the five criteria complicated the selection process. Criteria-related challenges also included the limited evidence available about facts fundamental to the scoring decisions and the emergence and application of criteria that were not part of the original metric.

CONCLUSIONS

When identifying MAGs appropriate for screening and return, decision makers must expect and prepare to address such issues as the inevitability of subjective judgments, limited evidence about fundamental decision-making elements, the conceptual complexity of defining criteria, and the emergence of unplanned criteria during the gene selection process.