African-American Male Biobank Available for Researchers

Racial health disparities are no secret to the medical community. While socioeconomics, lifestyle and poor access to healthcare are often to blame, physicians are increasingly identifying genetic variants that cause varying responses in disease and health.

For instance, African-American men have a 60 percent greater incidence of developing prostate cancer than white men and are more than twice as likely as white men to die from prostate cancer. African-American men are twice as likely to die from a stroke. African-Americans constitute about 12 percent of the U.S. population but account for 31 percent of end-stage renal disease.

“Genetic susceptibility to cancer, hypertension and other conditions combines with environment to trigger certain disease in minorities,” argues Cleveland Clinic urologist Charles Modlin, MD, MBA, and Founding Director of Cleveland Clinic’s Minority Men’s Health Center. “Prostate cancer in black men isn’t more aggressive just because of delayed presentation. There also are biological factors at play.”

Dr. Modlin is now taking steps to help researchers prove it.

He has developed the African-American Male Biobank, an offshoot of his Minority Men’s Health Center and annual Minority Men’s Health Fair at Cleveland Clinic. The growing collection of blood and urine samples is accompanied by a database of donor demographics, including age, medical history and family history. The biobank is approved by the Cleveland Clinic Institutional Review Board.

Dr. Modlin indicates that Cleveland Clinic’s African-American Male Biobank is one of only a very few African-American biobanks in the nation, and likely represents the only one designed to collect samples to be utilized in health disparities basic science research studies beyond the study of one disease.

100 percent participation

Biobank donors are primarily attendees of the Minority Men’s Health Fair, which Dr. Modlin calls a “friendly portal of entry” to the healthcare system. Medical personnel at the fair and at Minority Men’s Health Center weekly clinics educate random attendees on the importance of clinical research and ask if they’d like to participate in the biobank. Acceptance is close to 100 percent of those asked.

Attendees also can indicate their willingness to participate on their fair advanced registration form. Urine and blood samples are collected and documented at the fair.

Increasing the supply for genetic studies

“Our goal is to collect thousands upon thousands of samples so that investigators across the nation and around the world have enough specimens to conduct important innovative basic science investigations to discover the pathogenesis of a plethora of diseases and medical conditions which disproportionately afflict African-American males,” Dr. Modlin states. “Without such research, African-American males will continue to suffer and die prematurely from health disparities.”

Biobank samples are available to researchers worldwide studying the biogenesis of disease.

Historic reluctance

Historically, genetic samples from African-Americans have been in short supply, says Dr. Modlin, adding that the “lack of minority participation has skewed results.

“Much present-day medical research may in fact be less applicable to minorities,” he says, “considering that the vast majority of medications currently on the market have been developed through research utilizing only medical specimens from Caucasian males. By increasing minority participation in medical research, new medical therapies might be developed that are more effective in treating the many diseases that disproportionately afflict African-Americans and other minorities.”

The reasons African-Americans have been reluctant to participate in studies are complicated. Dr. Modlin points to lack of knowledge about the benefits of research and a generational distrust of the healthcare system — barriers that he hopes the African-American Male Biobank will help overcome.

Changing one-size-fits-all medicine

Including more minorities in research studies could be industry changing by improving the understanding of disease risks and identifying more effective treatments.

“We are beginning to see that African-American patients respond differently than white patients to certain medications,” says Dr. Modlin, “for instance, antihypertensives. Different mechanisms of action and differential metabolism of certain medications mean African-Americans in certain cases require higher doses of certain medications, such as antirejection medications following organ transplantation.”

The heart failure drug BiDil — hydralazine combined with isosorbide dinitrate (H-ISDN) — is another example. Retrospective analyses of V-HeFT I and II trials along with results of the A-HeFT trial found that H-ISDN reduced death from heart failure in African-Americans but had negligible effect in whites. The FDA approved BiDil for use in African-Americans, the first drug approved for only one racial group.

Investigators who use African-American Male Biobank samples in their research could advance more findings like these, notes Serpil Erzurum, MD, Chair of Cleveland Clinic’s Lerner Research Institute.

“We want to motivate researchers to study hereditary health disparities and stimulate the development of new therapies to address biological factors,” she says. “In many cases, one-size-fits-all medicine is no longer enough. We can do better.”

How researchers are using biobank samples

Cleveland Clinic researchers have already begun using biobank samples (now numbering more than 500) in their work. For example Qing Wang, PhD, of Cleveland Clinic’s Center for Cardiovascular Genetics and Department of Molecular Cardiology, is trying to discover genes responsible for or associated with coronary artery disease and heart attack in African-Americans. Study goals are to develop genetically based early detection methods for at-risk individuals; develop more effective, rational and specific therapeutic interventions; and, ultimately, prevent heart disease.

Other proposed projects using biobank samples include studying:

• Age-related changes in immunity in African-Americans, specifically racial differences in mediators and cell receptors in senescent immune system cells
• The link between obesity and many diseases prevalent in African-Americans (e.g., kidney disease, heart disease), specifically the mediators produced by fat on inflammatory cells
• Increased risk of kidney transplant rejection in African-Americans, potentially due to hyperimmunoactivity

Dr. Modlin welcomes investigators to use Cleveland Clinic’s African-American Male Biobank for studies on race-based health disparities. He plans to eventually include samples from African-American women as well, who also suffer from health disparities.

Initial funding for the biobank was from a Health Resources and Services Administration (U.S. Department of Health and Human Services) grant, which funded the -80° C freezers. “We are very much in need of additional funding to support the cost of research personnel associated with performing ongoing collection of biobank samples, and to meet the costs of maintaining and expanding the number of samples we have,” Dr. Modlin adds.

“We encourage researchers to stratify their studies by race to uncover unanticipated findings,” Dr. Modlin concludes. “Every physician should consider environmental and genetic factors when treating patients. Race matters in medicine.”