Edited by: Ovidiu Constantin Baltatu, Khalifa University, United Arab Emirates
Reviewed by: Yingli Lu, Shanghai Jiao Tong University, China; Zhen Yang, Shanghai Jiaotong University, China
This article was submitted to Translational Medicine, a section of the journal Frontiers in Medicine
†These authors have contributed equally to this work
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Chinese clinical biobanks were built rapidly in grade A tertiary hospitals. However, the general information of biorepositories in China remained largely unknown. The aim of this study was to investigate the size, collections, biospecimens distribution and other characteristics of Chinese biobanks in grade A tertiary hospitals. In 2018, we launched a national survey among biobank leaders to provide a comprehensive understanding of Chinese grade A tertiary hospital biobanks. A total of 70 biobank managers or directors completed an online questionnaire to collect information about the biorepositories. Nearly 20% of biobanks stored over one million specimens, while almost one-third of biobanks stored 50–200,000 specimens. In general, plasma and serum were the specimens most commonly stored. For the use of collections, biospecimens were most commonly applied by internal clinical departments. Further analyses revealed that the large-scale biobanks were characterized by earlier establishment, more types of specimens in storage and distribution compared with small-scale biobanks. Moreover, specimens in large-scale biobanks were more commonly used for basic research (62.86% vs. 34.29%,
Human biobanks are repositories of human biological specimens (e.g., blood, tissues, cells, etc.) and associated information (
The demands for high-quality biological samples also increased significantly in China due to the rapid development of medical research (
It should be noted that most Chinese clinical biobanks were affiliated with medical institutions. In 2017, a Chinese survey among 42 hospital biobanks showed that most clinical biobanks stored more than 30,000 specimens and were established for <10 years (
A total of 198 biobank managers or directors were identified in a WeChat group of biobank leaders across China (
Flow diagram of the study.
In 2018, a survey platform (SO JUMPTM) was used to collect information about the biobanks. According to the practical situation of Chinese biobanks, the online questionnaire consists of 59 items including following components: (1) general characteristics (institutions & managers, equipment, services, operating cost & funding support); (2) specimen collection (number and types of samples, location of specimen acquisition, etc.); (3) specimen distribution (number, types and users of samples, access policies, purposes of biospecimen collection, etc.); (4) information management system; (5) biobanking staff (educational background, degree, work experience, income, training, etc.); (6) standard operation procedures and quality control; (7) ethical issues and certifications. This study investigated the relationship between the scale of biobanks and sample collection or distribution of grade A tertiary hospital biobanks in China.
Statistical analyses were performed using SPSS 21.0 (SPSS Inc., Chicago, IL, USA). Pearson χ2 test or continuity chi square test was used to compare the groups with categorical variables. All statistical tests were two-sided. Statistical significance was defined as
A total of 70 biobanks were included in the analyses.
Number of biobanks in the different categories of sample size.
<10,000 | 5 | 7.10% |
10,000–49,999 | 9 | 12.90% |
50,000–199,999 | 21 | 30.00% |
200,000–499,999 | 8 | 11.40% |
500,000–999,999 | 13 | 18.60% |
1,000,000–2,000,000 | 7 | 10.00% |
>2,000,000 | 7 | 10.00% |
The large-scale biobanks were characterized by earlier establishment, more types of specimens in storage and distribution compared with small-scale biobanks (all
Basic characteristics of the biobanks.
Year of establishment | |||||
≤ 5 years | 12 | 34.30% | 23 | 65.70% | 0.009 |
>5 years | 23 | 65.70% | 12 | 34.30% | |
Types of specimens in storage | |||||
<9 | 14 | 40% | 23 | 65.71% | 0.031 |
≥10 | 21 | 60% | 12 | 34.29% | |
Types of specimens for distribution (2015–2017) | |||||
<6 | 12 | 34.29% | 23 | 65.71% | 0.009 |
≥6 | 23 | 65.71% | 12 | 34.29% | |
Number of new specimens in storage annually (2015–2017) | |||||
≤ 10,000 | 4 | 11.40% | 14 | 40.00% | 0.006 |
>10,000 | 31 | 88.60% | 21 | 60.00% | |
Number of specimens for distributed annually (2015–2017) | |||||
≤ 5,000 | 14 | 40.00% | 26 | 74.30% | 0.004 |
>5,000 | 21 | 60.00% | 9 | 25.70% | |
Biospecimen management system | |||||
Developed | 35 | 100.00% | 28 | 80.00% | 0.017 |
No | 0 | 0.00% | 7 | 20.00% | |
Clinical information system | |||||
Developed | 31 | 88.57% | 21 | 60.00% | 0.006 |
No | 4 | 11.43% | 14 | 40.00% | |
Biospecimen quality control | |||||
Developed | 32 | 91.43% | 24 | 68.57% | 0.017 |
No | 3 | 8.57% | 11 | 31.43% | |
Standard operation procedure (SOP) for biospecimen procurement | |||||
Developed | 33 | 94.30% | 29 | 82.90% | 0.260 |
No | 2 | 5.70% | 6 | 17.10% | |
SOP for biospecimen processing | |||||
Developed | 29 | 82.90% | 28 | 80.00% | 0.759 |
No | 6 | 17.10% | 7 | 20.00% | |
SOP for biospecimen collection | |||||
Developed | 32 | 91.40% | 26 | 74.30% | 0.057 |
No | 3 | 8.60% | 9 | 25.70% | |
SOP for biospecimen distribution | |||||
Developed | 30 | 85.70% | 26 | 74.30% | 0.232 |
No | 5 | 14.30% | 9 | 25.70% |
Detailed analyses showed that the types of specimens in storage were comparable between large- and small-scale biobanks (all
Percentage of biobanks storing different types of specimens. FFPE, formalin-fixed paraffin-embedded tissue; CSF, cerebrospinal fluid.
We further analyzed the number of types of specimens in storage (
Number of types of specimens stored in large- and small-scale biobanks.
1 | 1 | 2.86% | 1 | 2.86% | 2 | 2.86% |
2 | 0 | 0.00% | 1 | 2.86% | 1 | 1.43% |
3 | 0 | 0.00% | 2 | 5.71% | 2 | 2.86% |
4 | 1 | 2.86% | 1 | 2.86% | 2 | 2.86% |
5 | 0 | 0.00% | 2 | 5.71% | 2 | 2.86% |
6 | 2 | 5.71% | 2 | 5.71% | 4 | 5.71% |
7 | 2 | 5.71% | 3 | 8.57% | 5 | 7.14% |
8 | 4 | 11.43% | 7 | 20.00% | 11 | 15.71% |
9 | 4 | 11.43% | 4 | 11.43% | 8 | 11.43% |
10 | 10 | 28.57% | 1 | 2.86% | 11 | 15.71% |
11 | 2 | 5.71% | 6 | 17.14% | 8 | 11.43% |
12 | 3 | 8.57% | 1 | 2.86% | 4 | 5.71% |
13 | 2 | 5.71% | 0 | 0.00% | 2 | 2.86% |
14 | 1 | 2.86% | 1 | 2.86% | 2 | 2.86% |
15 | 1 | 2.86% | 2 | 5.71% | 3 | 4.29% |
16 | 1 | 2.86% | 1 | 2.86% | 2 | 2.86% |
17 | 1 | 2.86% | 0 | 0.00% | 1 | 1.43% |
The top 10 specimens distributed in different scale of biobanks in 2015–2017 were also similar (
Percentage of biobanks distributing different types of specimens. FFPE, formalin-fixed paraffin-embedded tissue; CSF, cerebrospinal fluid. *
Number of types of specimens distributed by large- and small-scale biobanks (2015–2017).
1 | 2 | 5.71% | 6 | 17.14% | 8 | 11.43% |
2 | 0 | 0.00% | 4 | 11.43% | 4 | 5.71% |
3 | 6 | 17.14% | 6 | 17.14% | 12 | 17.14% |
4 | 1 | 2.86% | 5 | 14.29% | 6 | 8.57% |
5 | 3 | 8.57% | 2 | 5.71% | 5 | 7.14% |
6 | 6 | 17.14% | 3 | 8.57% | 9 | 12.86% |
7 | 3 | 8.57% | 3 | 8.57% | 6 | 8.57% |
8 | 7 | 20.00% | 3 | 8.57% | 10 | 14.29% |
9 | 1 | 2.86% | 2 | 5.71% | 3 | 4.29% |
10 | 2 | 5.71% | 0 | 0.00% | 2 | 2.86% |
11 | 0 | 0.00% | 1 | 2.86% | 1 | 1.43% |
12 | 2 | 5.71% | 0 | 0.00% | 2 | 2.86% |
13 | 2 | 5.71% | 0 | 0.00% | 2 | 2.86% |
We also analyzed the organization and department that used specimens (
Users and research purposes of biospecimens in large- and small-scale biobanks.
Clinical departments | 27 | 77.14% | 18 | 51.43% | 0.025 |
Key clinical departments | 20 | 57.14% | 15 | 42.86% | 0.232 |
Basic research | 22 | 62.86% | 12 | 34.29% | 0.017 |
Clinical research | 20 | 57.14% | 10 | 28.57% | 0.016 |
Domestic research institutes | 17 | 34.29% | 2 | 5.71% | 0.003 |
International collaboration | 5 | 14.29% | 0 | 0% | 0.063 |
Drug discovery | 5 | 14.29% | 2 | 5.71% | 0.426 |
We further described the geographical distribution of grade A tertiary hospital biobanks in China. Most large-scale biobanks were built in East China (40.0%) and North China (34.3%). On the other hand, small-scale biobanks were distributed more evenly across different areas of the country (
This study is the first national survey to examine the relationship between the scale and collections or biospecimen distribution of grade A tertiary hospital biobanks in China. Our survey revealed diversity in collections, distribution and utilization of biospecimens among the biobanks. This study also showed that the geographic distribution of the grade A tertiary hospital biobanks was unbalanced in China. Most biobanks were built in East and North China which had relatively high levels of economic development. This may reflected that East China and North China had more top research hospitals compared with other areas in China. In addition, several national projects were led by hospitals in East China and North China to promote and activate translational medicine. For example, the project of Significant New Drugs Development was led by Beijing Union Medical College Hospital. While Shanghai Clinical Biobank Project was led by several Shanghai grade A tertiary hospitals.
In the present study, Chinese hospital biobanks varied in size. The number of stored biological samples ranged from <10,000 to over 2,000,000 in different biobanks. Notably, the scale of Chinese academic hospital biobanks was larger than that of western biorepositories. In this study, nearly 40% of biobanks had more than 500,000 biospecimens in storage, while only 8% of the U.S. biobanks stored similar number of samples in 2012. In a European study across 23 countries, 77% of biobanks had <50,000 samples and 25% of them were defined as small-sized biobanks using a cutoff point of 1,000 samples (
For storage and distribution, although almost half of Chinese academic hospital biobanks stored at least 10 types of samples, biobanks affiliated with specialized hospitals such as obstetrics and gynecology hospitals had limited choices and stored relatively few types of specimens. The present study also revealed that large-scale biobanks stored and distributed more types of biological samples. In this study, blood-derived specimens including plasma and serum were the most commonly stored samples among the surveyed biobanks. This finding was consistent with the U.S. survey (
In our study, the types of biospecimens available for distribution were different between small- and large-scale biobanks. Chinese large-scale biobanks distributed significantly more FFPE tissues and frozen tissues than small-scale biobanks. FFPE tissues have been widely collected and used by hospitals for histopathological assessment and diagnosis of various diseases. Interestingly, previous studies suggested that the use of FFPE tissues have increased significantly in cancer research and proteomics studies (
In this survey, the usage of biospecimen in Chinese biobanks was diverse, ranging from research to drug discovery. Furthermore, large-scale biorepositories distributed more biospecimens for clinical or basic research compared with small-scale biobanks. However, our study revealed that most biobanks distributed fewer biospecimens than they collected. In line with our findings, a U.S. survey showed that 69% of the 456 biobank managers considered the underutilization of biobank resources as a substantial concern (
On the other hand, the insufficient utilization of biospecimens was accompanied by the rapid construction of biobanks in China. The continuous development of biobanks primarily reflect the high demands on high-quality biological samples for research. These biobanks provided important materials for translational research. However, domestic and international collaboration was not active in Chinese grade A tertiary hospital biobanks. The cooperation was even less common in small-scale biobanks. One possible explanation is that the purpose of some biobanks was to provide biospecimens for internal needs of the key departments and research projects within the hospitals. Previous studies also reported that the differences in sample quality, informed consent and access policies could hamper the sharing of samples and data among biobanks (
Because most biospecimens in the grade A tertiary hospital biobanks were acquired from the patients, the biobanks were able to collect rare biospecimens in clinical settings. For example, the percentage of biobanks storing cerebrospinal fluid (CSF) in our study was higher than that in the U.S. biobanks (46 vs. 19%) (
Our study has limitations. The study population only consisted of grade A tertiary hospital biobanks. However, because of medical resources and were equipped with suitable research facilities, most biobanks were established by grade A tertiary hospitals in China. As the number of biobanks is increasing significantly in China, further investigations were needed to gain a better understanding of Chinese biobanks development.
In conclusion, our study found a significant difference in scale, collections and biospecimen distribution between large-scale and small-scale biobanks. Although surveyed biobanks had relatively large collections, the underutilization of stored biospecimens and lack of sharing could harm the development of clinical and biological researches. Biobank managers should identify the scientific needs of biological samples and recognize the importance of exchanging information to optimize the utilization.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
CW and HT designed the study. YC, CW, and HT contributed to data analysis. YC, CS, ZB, CW, and HT drafted the manuscript. YZ, EJ, XZ, and TC critically revised the manuscript. All the authors have read and approved the final manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YL declared a shared affiliation, though no other collaboration, with one of the authors ZB to the handling Editor.
We would like to thank all the people who kindly participated in this survey.
The Supplementary Material for this article can be found online at:
Geographical distribution of grade A tertiary hospital biobanks in China.
Top 10 of specimens in storage and distribution.