|Dr. Penno and Dr. Goldenberg
Inside a pair of towering, robotic containers befitting a sci-fi movie set, the temperature at All Children's Hospital gets just a bit chilly these days- as in a high of minus-20-degrees Celsius and a low of minus-80. But don't be fooled by the arctic thermometer readings of the space-age twins called SAM 1 and SAM 2. This is precisely the place where a new chapter of research is heating up.
Welcome to the future: the state-of the-art Johns Hopkins Medicine Pediatric Biorepository at All Children's Hospital.
With a helping hand from SAM (which stands for Sample Access Management), thousands of specimens can be quickly sorted and stored, reorganized or retrieved, all via a robotic arm controlled on the outside of the units. But above all, the new system preserves the specimens at a uniform temperature and highly protected setting, ensuring their value in research.
"We want to maintain the highest quality specimens. The value of the specimen can be lost in an instant - whether it takes too long to get to the lab, the temperature is wrong, or some other critical requirement of the specimen is not met," explains Sue Penno, Ph.D., interim director of the Johns Hopkins Medicine Pediatric Biorepository at ACH and past director of one of several biorepositories based on the Baltimore campus of Johns Hopkins. "If the freezer it's stored in goes down, that's the end of that specimen. And it's a huge loss for the researcher and for the patient."
That is why the entire All Children's research community is so excited about the arrival and implementation of the advanced technology. But Penno has good reason to feel an additional sense of satisfaction. She had envisioned a new, centralized repository for Johns Hopkins and had a plan on her desk in Baltimore, where she also serves as an associate professor in the Institute of Genetic Medicine.
"The plan for the new biorepository was there in the event anybody ever asked me," she explained. "It was just a matter of the leaders catching the vision, money, trying to get people together, and the right timing. And then one day, George Dover (pediatrician-in-chief at the Hopkins Children's Center) was chatting with one of Penno's colleagues about the possibility of creating a new repository that would store samples from multiple sources in a uniform, cutting-edge setting, and make them available for important research for years to come.
"My colleague says, 'Sue has a plan like that' and Dr. Dover came into my office and asked, 'Could you get this up and running?' " Penno recalls. "I told him that I could and he said, 'Let's do it.'
All Children's presented the ideal place to house the biorepository in a pediatric setting, well-aligned with the vision for academic transformation at All Children's following the integration with Johns Hopkins Medicine. The biorepository began to take shape with the blessings of Dover and All Children's president and vice dean Jonathan Ellen, M.D., and the involvement of Penno, Neil Goldenberg, M.D.,Ph.D., (director of research at All Children's Johns Hopkins Medicine and associate professor of pediatrics at Johns Hopkins), and a multidisciplinary committee, consisting of people from facilities to clinical lab to IT to research.
Located within the Clinical Laboratory, the biorepository is up-and-running with its pair of SAMs, each of which can manage up to 803 microplates or 60,000 microtubes. To maintain the integrity of the samples, the SAMs eliminate thaw cycles, while also limiting any introduction of moisture. And the system monitors the temperature range, even during the microtube loading process, to ensure the samples are never compromised.
The biorepository also has two storage containers, which Penno likens to "a great big thermos." At the bottom of it are three-to-four inches of liquid nitrogen, below the samples, which are stored in vapor nitrogen. That keeps them at minus-150-degrees Celsius, roughly the temperature of Pluto.
"I'm not so amazed by the technology as I am amazed that we have it," she says. "That we actually got it - that's the amazing part. There should be huge accolades for the All Children's visionaries who invested in this kind of operation. It shows a lot of foresight on their part for the future.
"They understood the vision and they shared the desire that we have to make samples available to researchers - high-quality samples, that (through biomedical discoveries) will help researchers to improve the health of children. A lot of academic centers have samples. That's not a big thing. But to have high-quality samples is a big thing. I think this is going to be a beautiful biorepository - I'm just so pleased with it."
Several pressing orders of business are on the biorepository's check list. A permanent director needs to be recruited. In addition, Penno is in the process of earning accreditation from CAP (College of American Pathologists).
The new biorepository represents an excellent collaboration tool, allowing teams of investigators the opportunity to study different aspects and questions within the same groups of children. The power of the biorepository is being leveraged by the iPICS cohort study and PREDICT studies cohort launched by All Children's Hospital Johns Hopkins Medicine. And it has the potential of linking the campuses of Hopkins and All Children's with a common database of samples.
"One of the hallmarks of our approach," comments Goldenberg, "is that we are keeping our eye on the ball of children's health. Many of the research studies that utilize the biorepository are designed as a hybrid of a study-specific repository of blood or tissue samples, as well as a sample bank for future studies.
"For example, a study might allow a patient with sickle cell disease to give permission to collect blood for specifically described aims on predicting brain injury in these children. However, the study also asks patients/parents for permission to keep remaining samples after this work is done, for future studies. Those future studies might try to identify early markers of asthma in kids with sickle cell disease and other disease (from other studies), across a variety of children who are prone to asthma.
"This way, we get as much use and new discovery as possible from of the donations of blood and tissue samples made by our patients who enroll in research studies...and also the most efficient and cost-effective use of our biorepository technology and personnel. Most importantly, through these types of study designs taking great advantage of our biorepository, we can have the broadest and deepest impact upon children's health."