UK Biobank

UK Biobank is a large long-term biobank study in the United Kingdom (UK) which is investigating the respective contributions of genetic predisposition and environmental exposure (including nutrition, lifestyle, medications etc.) to the development of disease. It began in 2007.^[1][2][3][4]

Based in Stockport, Greater Manchester, it is incorporated as a limited company^[5] and registered charity^[6] in England and Wales, and registered as a charity^[7] in Scotland.^[8][9][10]

Design

The study is following about 500,000 volunteers in the UK, enrolled at ages from 40 to 69. Initial enrollment took place over four years from 2006, and the volunteers will be followed for at least 25 years thereafter.

Prospective participants were invited to visit an assessment centre, at which they completed an automated questionnaire and were interviewed about lifestyle, medical history and nutritional habits; basic variables such weight, height, blood pressure etc. were measured; and blood and urine samples were taken. These samples have been preserved so that it is possible to later extract DNA and measure other biologically important substances. During the whole duration of the study it is intended that all disease events, drug prescriptions and deaths of the participants are recorded in a database, taking advantage of the centralized UK National Health Service.^[11][12]

During the initial physical examination, basic feedback was provided to the participant regarding their weight, height, BMI, blood pressure, lung vital capacity, bone density and intra-ocular pressure; however if any other medical problems were detected, neither the participant nor their physician would be notified. Problems detected later, such as genetic risk factors, were not conveyed to either participant or physician ("to ensure that volunteers are not penalised by insurance companies, for example, which may require customers to disclose the results of any genetic tests.").^[13]

From 2012, researchers were able to apply to use the database (though they are not given access to the volunteers, who will remain strictly anonymous). A typical study using the database might compare a sample of participants who developed a particular disease, such as cancer, heart disease, diabetes or Alzheimer's disease, with a sample of those that did not, in an attempt to measure the benefits, risk contribution and interaction of specific genes, lifestyles, and medications.

Development

An incremental approach was adopted to developing the study procedures and technology, using systems designed and developed by the Clinical Trial Service Unit. This consisted of a series of pilot studies of increasing complexity and sophistication with interludes for assessment of results and additional scientific input. In-house trials were conducted during 2005, and a fully integrated clinic was run at Altrincham, Manchester throughout Spring 2006 where 3,800 individuals were assessed. On August 22, 2006, it was announced that the main programme would recruit men and women aged between 40 and 69 based from up to 35 regional centres.,^[14] however recruitment proved more efficient than hoped and only 22 centres had been opened when the recruitment target of 500,000 was reached in 2010.

Initial information collected

The study was initially launched with a visit consisting of the following:

• A paperless consent process
• A touchscreen questionnaire on lifestyle and general health
• Touchscreen tests of memory
• An interview with a nurse on detailed medical history
• Measurement of blood pressure
• Measurement of sitting and standing heights
• Measurement of weight
• Body composition measurement using impedance
• Measurement of grip-strength
• Breath spirometry
• Ultrasound bone densitometry of ankle
• Collection of blood and urine samples

Once the visit-based assessment method was proven, the range of investigations was extended to include:

• Test of hearing discrimination
• Measurement of arterial pulse-wave velocity
• Measurement of visual acuity
• Measurement of intra-ocular pressure
• Lens refractometry
• Fundus image of retina
• Optical coherence tomography scan of retina
• Electrocardiogram during exercise
• Collection of saliva sample
• Dietary assessment

Ethics and governance

The UK Biobank project operates within the terms of an Ethics and Governance Framework.^[15][16][17] The Framework describes a series of standards to which UK Biobank will operate during the creation, maintenance and use of the resource and it elaborates on the commitments that are involved to those participating in the project, researchers and the public more broadly. The independent UK Biobank Ethics and Governance Council provides advice to the project and monitors its conformity with the Framework.^[18] The Council also advises more generally on the interests of research participants and the general public in relation to the project.

The UK Biobank Board is accountable to the members of the company (the Medical Research Council and The Wellcome Trust) and acts as company directors and as charity trustees. It is chaired by Prof Sir Michael Rawlins.^[19]

Recruitment

Following the initial pilot stage in 2006 2005 period, the main study began in April 2007 and by the end of that year 50,000 people had taken part. Recruitment reached 100,000 in April 2008, 200,000 in October 2008, 300,000 in May 2009, 400,000 in November 2009 and passed the 500,000 target in July 2010. Participant enrolment was declared complete in August 2010.^[20]

Usage

The UK Biobank dataset was opened to applications from researchers in March 2012.^[21] The resource is available to scientists from the UK and outside, whether they work in the public or private sector, for industry, academia or a charity, subject to verification that the research is health-related and in the public interest. By the end of 2015 over 1,000 researchers had registered to use the resource and over 200 research projects were completed or underway.

Extensions

Since the completion of recruitment several new types of data have been added:

• During 2011-12 participants who supplied an email address were asked to assist by completing web-based dietary questionnaires, with the aim of combining a series of daily 'snapshots' to form a picture of overall nutrition. Over 200,000 of the participants responded.
• During 2012-13 25,000 participants were asked to attend an assessment centre to repeat the initial measurements.
• Information from UK death and cancer registries is being linked to the main dataset.
• Data from NHS hospital inpatient records is being linked to the main dataset.

Ongoing developments

A number of projects are currently underway to generate additional data:

• During 2013-15 Activity Monitors were distributed to 100,000 interested participants. These created a one-week-long snapshot (with centisecond resolution) of the levels of actual physical activity.^[22] Results are due to be released in early 2016.
• A genomic assay involving over 800,000 SNPs has been conducted. Results from an initial 150,000 participants were released in 2015 with the remainder due in late 2016.
• A set of additional assays on the blood samples is being conducted with results expected in to be released in batches during 2016-17.
• A new type of assessment centre opened in 2014 to collect imaging data. The visit extends the initial dataset to include MRI scans of brain and chest regions, whole body DXA, ultrasound measurements of the carotid arteries and 12-lead ECG. Initial data on 4,000 participants was released at the end of 2015 and it is planned to scan 100,000 participants by 2021.

Future plans

There are several plans, either provisional or underway, for enhancing the resource:

• Data from NHS hospital outpatient records and GP visits will be linked to the main dataset.
• Several web-based questionnaires are under development, including cognitive function and occupational history.

Opinion

The project has been generally praised for its ambitious scope and unique potential. A scientific review panel concluded, the "UK Biobank has the potential, in ways that are not currently available elsewhere, to support a wide range of research".^[20] Colin Blakemore, chief executive of the MRC, predicted it "will provide scientists with extraordinary information" ^[14] and "grow into a unique resource for future generations." ^[20]

There was some early criticism, however. GeneWatch UK, a pressure group that claims to promote the responsible use of genetic information, asserted that the complexity of the programme could result in the finding of "false links between genes and disease",^[20] and expressed concern that the genetic information from patients could be patented for commercial purposes. Biobank's chief executive described such a risk as "extremely low, if it exists at all." ^[14]

The method of recruiting participants was also initially controversial. Participants were sent letters of invitation based on names, addresses, and dates of birth provided by the NHS to the UK Biobank organisers. Although compliant with UK data protection law,^[23] some people objected to the NHS passing on such data to third parties without explicit consent, and also had concerns about the data security in such a large project.

Funding

The UK Biobank is funded by the UK Department of Health, the Medical Research Council, the Scottish Executive, and the Wellcome Trust medical research charity. The cost of the initial participant recruitment and assessment phase was 62 million GBP.^[24]

Related projects

EPIC (European Prospective Investigation into Cancer and Nutrition) is a similar study that was started in 1992 involves over 500,000 participants from ten European countries. It is specifically designed to study the respective roles of diet and genes in the development of cancer.^[11][25]

In 2006, a similar project by the U.S. National Human Genome Research Institute know as "The American project" was proposed.^[13]

The China Kadoorie Biobank study collected questionnaire and physical data and blood samples on 510,000 adults between 2004-2008 with the aim of investigating chronic diseases (e.g. heart attack, stroke, diabetes, and cancer). Participants have been linked to mortality registers and nationwide health systems and a sub-group are retested every few years.^[26]

In 1996 a private company deCODE genetics Inc. planned to obtain biobank samples, health and genealogical data from the whole population of Iceland - then about 270,000 people.^[27] The company hoped to use the data to identify genes associated with diseases^[28] and use that information to develop new drugs. deCODE genetics obtained data and DNA samples on 140,000 Icelanders^[29] but filed for Chapter 11 bankruptcy in 2009^[30] and as of January 2015 its systems and databanks had been spun off to another company NextCODE Health,^[31] owned by WuXi PharmaTech.^[32] In 2015, the Chief Executive of deCODE said that with the DNA and family tree they had data collected in Iceland, they could in theory predict which Icelandic women had a high risk of getting breast cancer. However the data had been collected antonymously.^[33]

The Estonian Genome Project was started in 2000 with the aim of improving public health in the country.^[34] Initially it was hoped to obtain biological samples and health data from 70% of the 1.4 million population of Estonia.^[35] The project ran into financial difficulties and, as of December 2013, the project had data from 52,000 adult gene donors and the aim had been adjusted downwards to collect genealogical, genome and health data from 5% of the population.^[36]

References

Wellcome Trust
Centres and institutes	Current Francis Crick Institute Gurdon Institute Sainsbury Wellcome Centre for Neural Circuits and Behaviour Science Learning Centres WTC for Cell-Matrix Research WTC for Gene Regulation and Expression WTC for Human Genetics WTC for Mitochondrial Research WTC for Molecular Parasitology WTC for Neuroimaging WTC for Stem Cell Research Wellcome Trust Sanger Institute Former Wellcome Trust Centre for the History of Medicine Wellcome Research Laboratories
Projects and facilities	1000 Genomes Project Big Picture Cambridge Biomedical Campus Cancer Genome Project ChEMBL COSMIC cancer database DECIPHER Diamond Light Source eLife Ensembl Farmcare Genome Reference Consortium Human Genome Project Malawi Liverpool Wellcome Trust MEROPS Pfam Rfam UK Biobank Wellcome Collection Wellcome Genome Campus Wellcome Library WormBase
Board of Governors	Tobias Bonhoeffer Alan Brown Damon Buffini William Burns Kay Davies Michael Ferguson Bryan Grenfell Richard Hynes Anne Johnson Eliza Manningham-Buller Peter Rigby
Executive Board	Jeremy Farrar Stephen Caddick Simon Chaplin Tim Livett Clare Matterson Ted Smith Danny Truell
Former directors	Peter Williams (1965–1991) Bridget Ogilvie (1991–1998) Michael Dexter (1998–2008) Mark Walport (2003–2013)
Other key people	William Castell Dominic Cadbury Harold Cook Oliver Franks Roger Gibbs Henry Dale Roy Porter David Steel John Sulston Henry Wellcome
Awards and fellowships	Capital Awards Collaborative Awards in Science Investigator Awards in Science Institutional Strategic Support Fund Science Strategic Award Sir Henry Dale Fellowship Sir Henry Wellcome Postdoctoral Fellowship Wellcome Book Prize Wellcome Image Awards Wellcome Trust Centre Wellcome Trust Principal Research Fellow Wellcome Trust Senior Research Fellow
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