Judith Giri
Amy Price2
May Chu- 1Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
- 2Department of Community and Family Medicine (CFMED), Dartmouth-Hitchcock Clinics, Hanover, NH, United States
Background: Frequent outbreaks of diseases such as Ebola, dengue fever, Zika, and COVID-19 have highlighted the urgent need for equitable and timely access to high-quality biological specimens and associated data for diagnostics, vaccine development, and research. However infectious disease collections and biorepositories frequently have narrow mandates, prioritize internal goals, and lack global coordination. The Virtual Biorepository System (VBS) aims to transform this landscape by connecting local biorepositories, especially in low- and middle-income countries (LMICs), into a federated, trust-based network that promotes global equity, access, and resilience during public health emergencies.
Methods: Under the CONTAGIO (Cohort Networks to be Activated during Outbreaks) program, a pilot known as “10x10” was launched to test the feasibility of the VBS model. Ten founding member institutions from LMICs were selected based on location, specimen sharing and biorepository experience, interest, and willingness to engage for at least three years. Each site agreed to collect and share ten mL of plasma or serum from ten individuals, allowing assessment of molecular/immunological testing capacity and shipping logistics, and development of governance and a sustainable business model. Coordination was managed virtually through regular meetings and workshops, with the Center for Global Health (CGH) being the managing partner as well as co-technical lead along with University Aix-Marseille.
Results: Participating sites included national reference labs, accredited biorepositories, academic institutions, and newer biorepositories. Motivations for participation included networking opportunities, capacity building, contributing to epidemic preparedness, and increasing knowledge of regulatory and logistical challenges related to specimen sharing. Benefits reported by sites emphasized enhanced collaboration, technical capacity development, and alignment with global outbreak response efforts.
Discussion: The 10x10 pilot demonstrates the practical implementation of the VBS model and identifies known and emerging barriers to specimen access. Its LMIC-focused design enhances the representativeness of samples for diagnostic and vaccine development, addressing long-standing equity gaps. Lessons from the pilot will inform scale-up and refinement of governance, data harmonization, and sustainability strategies.
Conclusions: The VBS, through the 10x10 pilot, has shown strong early feasibility and collaboration, reinforcing the demand for an equitable biorepository system for preparedness. Continued development under the CONTAGIO program will build global biobanking capacity and improve epidemic preparedness, particularly in underrepresented regions.
1 Introduction
As outbreaks and epidemics of diseases such as Ebola, dengue fever, Zika, and COVID-19 continue to emerge, re-emerge, and spread, the need for reliable access to quality biological specimens and their associated data for vaccine efficacy studies, diagnostic test development, and research, has become increasingly evident (1–4). In preparatory work, several current barriers have been identified, especially early in an outbreak, including identifying reliable, trusted sources of high-quality biospecimens and associated data for calibrating results, and the complexity and understanding of regulations impacting timely sharing of samples across borders1 (5). There is also a critical need for biological specimens that are more representative of regions where emerging infectious diseases are most prevalent (6–8).
Infectious disease biorepositories frequently operate under narrowly defined, disease-specific mandates that emphasize institutional research priorities at the expense of broader global preparedness. The absence of open and transparent access mechanisms constitutes a significant barrier to a timely and effective outbreak response, particularly in under-resourced settings. The Virtual Biorepository System (VBS) is a paradigm shift: instead of a large central facility, it is designed to connect existing local repository sites, starting in low-and-middle income countries (LMIC). This system, leverages local strengths while enhancing biobanking capacity, and ensuring global alignment with decisions made by the collective federation. The VBS model is built on an infrastructure of trust, transparency, and sustainability. This design is intended to reduce costs while maximizing resilience and responsiveness during public health emergencies.
2 What makes the VBS different?
2.1 Local ownership, global impact
Unlike most traditional biorepository models, VBS enables local stakeholders to retain stewardship over specimen collections, while contributing to a globally coordinated and standardized effort.
2.2 Equity by design
It intentionally includes underrepresented geographies, populations, and specimens, addressing disparities that have historically limited the generalizability of global health research.
2.3 Agility and scalability
The design avoids the high overhead of centralized facilities and is more rapidly adaptable to changing needs; availability of characterized specimens and associated data that can be quickly shared, enabling faster mobilization and outbreak responses.
2.4 Co-creation, not imposition
Extensive consultations—including interviews, stakeholder surveys, and workshops (5)—have informed the design, ensuring the system reflects the real needs and concerns of specimen providers and users alike.
2.5 Proof of concept
A demonstration project is currently underway to test VBS’s feasibility and refine its operational model. This pilot work is being conducted as a sub-working package under the CONTAGIO (Cohort Networks To be Activated Globally In Outbreaks) initiative, which focuses on ethically repurposing global cohort data for use as part of necessary architecture for rapid outbreak response (https://www.contagio.network).
Looking ahead, as infectious disease threats escalate in frequency and scope, the VBS offers a timely and transformative added biobanking system to centralized biorepositories. It is not to compete with other approaches but to broaden biobanking capacities for defined public health and research uses. In this report we will describe the formation, purpose, and goals of the VBS and its feasibility pilot, referred to as the 10x10, and how the outcomes from this pilot will inform the operations of the VBS.
3 Methods
3.1 The VBS and the 10X10 feasibility pilot
A pilot project will test VBS concept’s feasibility by recruiting ten founding members residing in LMIC settings. Our pilot will take up to 3 years and then, at a workable scale, expand to ensure global representation by increasing the number of contributing sites. The managing partner for VBS is the CGH, https://coloradosph.cuanschutz.edu/research-and-practice/centers-programs/globalhealth) at Colorado School of Public Health of the University of Colorado (coordination), and CGH and the European Virology Archive-Global (EVA-G, www.european-virus-archive.com) at Aix Marseille University serve as co-technical leads, facilitating specimen characterization and testing.
The pilot phase will ask the local sites to collect human plasma/serum from healthy individuals for use as reference specimens for development of vaccines, diagnostics, and research (5). Each site will collect ten mL of plasma/serum from ten qualifying individuals (hence, the 10X10). These specimens will allow the VBS to address potential barriers in data format and terminology and to adopt common governance and standardized operational protocols (SOPs), which will be developed by the 10x10 members to harmonize activities across geographically distributed sites and diverse organizational types. We will gradually expand in multiple rounds through recruiting by founding sites and inviting other qualifying networks and biorepositories interested in sharing specimens to join our effort.
3.2 Recruiting member sites
We identified institutions/clinics based on their participation with other biorepository or disease-networks sharing specimens and through peer-recommendations. We prepared a four-point criteria to select qualified sites (Table 1) including geographic location, biorepository experience, interest in participating in the VBS activities, and willingness to remain engaged with this project for the duration of the pilot. This selection approach ensured that the sites were equipped with required capabilities and commitment to contribute effectively to the project. Following agreement to join, we conducted a survey followed by discussion to collect their capabilities and perspectives (Table 2).
Table 1. Minimum qualifying criteria for selection of 10x10 members.
Table 2. Description of 10x10 members.
3.3 Networking and communication
Building connectivity and familiarity among the sites has been facilitated through joint workshops, surveys and with regular communications through emails and video conferencing. The launch workshop in November 2023 at the University of Heidelberg (CONTAGIO secretariat) was our introductory face-to-face meeting. Another in-person meeting is scheduled later in 2025. Our video conferencing calls are repeated in the morning and again in the evening to cover the 15-hour time zone differences so that everyone can participate.
3.4 Characterization of the collected specimens
The samples collected for the pilot 10X10 project will be blood samples from donors that meet requirements for blood donation for the respective countries. Initial characterization will be to detect common blood-borne pathogens as dictated by their national blood bank regulations to ensure safety of the samples for distribution. These include common pathogens, such as HIV, while others have unique local and national requirements, such as West Nile virus. Aix-Marseilles University will provide reference panels and SOPs for molecular (PCR) testing through the EVA-G website, and CGH will assist with immunological testing for pathogens. Both universities have the technical capabilities to address these expected variances between countries.
A draft specimen collection protocol will address the general requirements and will be adaptable to local needs. Together both technical co-leads will facilitate sample evaluations at each of the 10x10 member sites, or arrange for exchanging samples between sites to complete the sample characterization.
3.5 Ethical considerations
Ethical compliance is a key requirement for all VBS members. The 10x10 pilot project is a collaborative initiative in which all participating sites are equal partners. While the 10x10 project itself does not centrally require ethical approval, each contributing site is independently responsible for obtaining local institutional ethics review and approval prior to sample collection. Participating sites will ensure that informed consent is obtained in accordance with local and national regulations and ethical standards. All specimens shared with the VBS will be de-identified, and no personally identifiable information will be collected or transferred. An overarching governance document for the VBS will be developed with participation of 10x10 sites and will be adapted by each site to meet local requirements. The governance framework will establish clear guidance to protect both data and donor privacy, ensuring trust and accountability. A template for informed and broad consent will also be developed for standardization across the sites, while allowing each member to adapt the documents to their local and national ethics requirements. Each consent form will explicitly address the intended sharing of specimens. As outlined in the Results section, the pilot demonstration project is part of the broader CONTAGIO program, with experts in data protection and ethics across different countries, and will provide guidance and support to ensure compliance with diverse regulatory requirements.
4 Results
4.1 CONTAGIO, the umbrella program for the VBS 10X10
The VBS 10x10 pilot project is integrated within the larger CONTAGIO program as a Work Package 4 (WP4). This integration within the broader program provides critical project linkages to the other WPs addressing public health law, data sharing, ethics management and benefit sharing. This allows for access to expertise to augment and support our work.
WP4 has specific milestones and deliverables, with an expected completion of 3 years from inception. The three WP4 working groups focus on foundational VBS aspects: 1) governance: developing a governance manual including access policies and protocols for specimen and data management); 2) mapping regulatory requirements and exploring benefits of participating in the 10x10 project, and 3) capacity building to characterize collected specimens and business plan development for long term organizational, financial, and operational sustainability.
4.2 The founding 10x10 members
We identified ten founding sites for the 10x10 pilot project, based on the criteria for selection in Table 1.
The locations of the 10x10 sites in Figure 1, reflect the VBS goal of broader and preferential LMIC representation. The diversity, and future expansion, are crucial for creating representative collections, especially for creating the initial reference samples. The global research and diagnostic development activities based in well-resourced settings and the baseline specimens used as background or controls, may not be representative of the populations where those diagnostic tests and research projects are being used (6, 7).
Figure 1. Map of the 10X10 members.
The 10x10 members were recruited primarily from infectious diseases and public health research and clinical settings reflecting the umbrella CONTAGIO programs’ preparedness focus. The member sites vary in scientific scope, experience and purpose. Members represent national reference laboratories, accredited biobanks, academic and regional centers, and organizations with less experience and with more recently developed biorepositories or clinical laboratory specimen collections (Table 2). This variety offers an opportunity to assess the potential feasibility of a much larger federated system and identify local and regional hurdles that may impede specimen sharing, a key objective of the pilot. The varied experiences and purposes for collection offer valuable perspectives.
4.3 Assessing readiness for biobanking and sample characterization
To estimate the capacity for sample management and characterization, sites were asked to provide information in writing and discussions about their experience with blood-derived specimens, types of laboratory diagnostic (clinical or research) tests performed, availability of sample management SOPs and data management tools.
Based on the information gathered, it appears that all participating sites have capabilities needed to accomplish the goals of the pilot project and perform molecular (PCR) and serological/antigen tests for required pathogens in their laboratories. Should any sites have gaps in capabilities, the co-technical leads may facilitate exchange of specimens for characterization with preference to link with another 10x10 member that has the required capability, or if too costly or difficult, to be sent for testing to the co-technical leads. It is anticipated that some future VBS members may have restrictions on shipping and sharing specimens outside their country, in particular due to a country’s laws on Nagoya Protocol benefits sharing (9), and data protection and ethics constraints. In such cases specimens and kits may have to be shipped to these sites for testing.
4.4 Reasons for joining the 10x10 partnership
During the conceptual development of the VBS, we asked stakeholders about the importance of providing benefits for participation in the federated system in order to maintain functional and organizational sustainability. Information collected from prior surveys, interviews and workshops identified some general desirable benefits1 (5). We wanted to understand specifically the motivations of 10x10 participants to join the pilot project as their replies could provide insights towards development of a robust and durable global system. We gathered initial information from the 10x10 members in an informal questionnaire, with the results shown in Table 2.
Based on the information provided by sites, networking and capacity building were indicated as primary motivations for participation (Table 2). Of the 9 participating sites (one site recently joined and has not yet responded), 8 identified networking and capacity building as reasons for participating. In addition, 7 out of 8 sites expressed an interest in contributing to the development of the VBS as means of strengthening development of diagnostics and vaccines. These responses indicate a shared desire for collaborative growth and commitment to contributing to epidemic preparedness and solving hurdles that currently impede development of needed interventions.
Sharing expertise and building knowledge were also significant motivators, and 4 out of 8 sites identified this benefit as a reason for joining. This indicates the value placed on collaborative learning and the commitment to development of best practices for the 10x10 and future VBS and will have greater impact by improving global biobanking capacity.
Specific interests expressed by some partners included contributing specimens to the VBS as it matures and expands, assisting with harmonization of standards, and increasing knowledge about regulations impacting sharing of specimens. Some sites commented also that they welcomed the opportunity to represent their country/organization in this international effort and to contribute to developing a VBS governance framework that will be adaptable to low resource settings.
The 10x10 working groups will continue to gather information about desired benefits to inform future design and development of a sustainable business plan. A more detailed survey and a planned in person meeting of all 10x10 members will provide opportunities for gathering more points of view.
4.5 Building the 10x10 team: a participatory decision process
A guiding principle of the VBS implemented in the 10x10 project is to create a partnership built on trust and respect for differences in culture, language, and ethical and regulatory requirements of member sites.
Though we set out with the premise that “biorepository” and “biobank” are interchangeable terms, we found differences in use of the terms quite early during the first meeting when the project was launched. To ensure consistency and communication, a consensus working definition was developed through surveying and discussing with the members, until a consensus was adopted. Understanding the reasons for different usage of terms, especially when specified by national biobank regulations or local preferences (10) proved to be valuable for the entire team.
The same participatory process has been applied also to defining the criteria for the eligible population for collection of the first set of specimens. The 10x10 sites will be collecting blood as baseline specimens in 2025-2026, guided by blood bank donor eligibility requirements. Here too, a consensus working definition of “healthy control” has been defined by the group for the minimal criteria for a specimen donor that each site must adapt to local requirements. The working definition will provide us with a process and direction to ensure continued harmonization of our processes. Accomplishing these tasks of characterizing and sharing specimens is vital for building confidence in the VBS model and proving practical utility.
5 Discussion
The VBS and its 10x10 pilot project are built upon core principles of transparency, equitable sharing, and collaboration1 (5), which are crucial for fostering trust and ensuring the fair distribution of resources and benefits within a global biobanking system.
The VBS aims to address important current barriers to access biospecimens that impede effective response to global health emergencies (1, 3, 4), The VBS provides a structured solution using a different approach from many earlier efforts: it is designed to focus primarily in LMICs and local biobanks, instead of some earlier efforts that collected biospecimens from various parts of the world, and maintained them in centralized facilities in countries and organizations with resources needed to sustain the costly efforts (8).
The VBS and its 10x10 pilot project also differentiates itself from other similar biobanking initiatives for infectious diseases with pathogen collections by focusing on specimens for serology to fill a need for diagnostic tests and vaccine development (11), this was chosen through our Delphi prioritization effort. A grassroots approach was used to develop the VBS concept, based on information gathered directly from biospecimen providers, users, and partners with similar initiatives1 (5). As the implementation proceeds, we will continue to organize workshops and surveys to ensure that the VBS remains flexible and responsive to changing needs.
5.1 Expanding the VBS based on lessons learned from 10x10
Lessons learned from 10x10 will inform the creation of basic tools necessary for VBS growth, including a governance framework guiding organizational structure, sample access policies, ethical practices, and legal and regulatory requirements for sharing specimens and associated data. The tools developed for the 10x10 pilot project will be essential for a scalable and sustainable global biobanking system.
One of the challenges for the VBS, as for all biobanking networks consisting of multiple individual collections and biobanks, is to ensure uniform quality across all member sites. The governance document, developed and adopted by the 10x10 members, will include specific criteria for specimen and data quality and guidance for minimal data requirements. Only specimens that meet the recommended quality criteria will be included in the 10x10 project collection. SOPs for both sample and data management, as well as templates for informed consent and material and transfer agreements, will be included in the resources available to 10x10, linking with existing resources promoting best biobanking practices (12). Standardization across the network will be crucial for ensuring data quality, interoperability, and the efficient flow of specimens. As described in the Results, access to shared biobanking expertise and best practices is one of the benefits 10x10 partners hope to derive from participation. Ensuring high quality and consistent characterization of specimens will be essential for their utility in research and development of assays and vaccines (13).
Another challenge is ensuring that VBS resources will be known and visible to specimen users and providers, and that metadata associated with biospecimens will remain linked for future use. We found that one of the advantages of being part of the larger CONTAGIO program, focused on data harmonization, will be access to expertise and partners with existing platforms and bio-specimen management tools. Biorepository registries or “locators” have been for various disease specific collections, such as FINDDx (https://www.finddx.org/what-we-do/cross-cutting-workstreams/biobank-services/), BBMRI ERIC (https://www.bbmri-eric.eu/), EMBL (https://www.ebi.ac.uk/biosamples/), and others, and we intend to list our 10x10 and later VBS in relevant registries for infectious diseases. A locator function can provide visibility to 10x10 and VBS member biorepositories and collection and will enable investigators and developers of tests and vaccines to identify reliable sources of specimens required for their work. Finding reliable sources of quality specimens, especially early in an outbreak, has been one of the major hurdles and gaps from our experiences and information gathered earlier (5). With the help of the locators the VBS coordinator will function as a “navigator” facilitating linking VBS participating biorepositories and specimen collections with investigators in need of specimens. The member biorepositories and investigators requiring specimens will then coordinate sharing and transfer of specimens and associated de-identified data. The governance manual of the VBS will provide guidance and template of documents as needed, to ensure that all ethical, legal, and regulatory requirements are met.
An anticipated aspect of international biobanking to be taken into consideration is the complexity and country- and region-specific differences in regulatory requirements that impact sample sharing. Navigating the landscape of international regulations is critical for ensuring legal and ethical compliance in global specimen sharing. Two approaches have been used for the VBS and the pilot 10x10 projects: conducting webinars with experts in international regulations to educate the biobanking and stakeholder community, and mapping the requirements for each site, starting with the 10 initial member sites. This will be scalable to include future expansion of members (Figure 2).
Figure 2. VBS development timeline and future expansion. Legend: Future planning will include expansion through a buddy system with members recruiting more members. The graphics, images 75864655 and 238825159 in Figure 2 were licensed from 453 Shutterstock.com, 23 June 2025.
To fulfill its main purpose of minimizing or eliminating the need to recreate an equitable, efficient system for accessing and sharing specimens for each new outbreak or epidemic, the VBS must be sustainable. In addition to developing a business plan, one way to encourage participation is to ensure that VBS member sites will derive a benefit from taking part in the VBS. For the 10x10 members, one of the benefits will be expanding laboratory capabilities by introducing new laboratory tests and an option to participate in External Quality Assurance (EQA), which will strengthen their laboratory capabilities. This reciprocal benefit model encourages participation, contributes to overall global health infrastructure development, and offers additional sites for quality testing during the next pandemic.
Our experience working with the 10 x 10 partners to create a collaborative approach for decision making and solving common problems has been very valuable for the future success of the VBS. The participatory approach, used to harmonize terminology for biorepository and biobank (10) or define the population for control specimens, has been successful for building a 10x10 team and will be our way of working with future partners. We aim to build a VBS based on cooperation, trust, and mutual respect for differences.
5.2 Impact and future vision
The 10x10 project is the first step designed to test the feasibility of implementing the VBS to improve access to needed specimens during epidemics. The VBS will address currently known barriers to access and sample needs and will learn from the pilot any unanticipated challenges to sharing. The focus on LMIC and inclusion of different populations will ensure that more representative specimens will be available for the development of diagnostic tests and evaluation of vaccines, with more predictable performance across the globe (7). Solutions developed by the VBS to some of the current challenges will contribute to more timely and more equitable access to quality specimens. The VBS will contribute also to global infectious diseases biobanking capacity and quality, which will enable LMIC sites to participate in regional and local research and development and will enhance overall biosecurity (14).
Our timeline for development of the VBS is shown in Figure 2. Future plans include continued development of the VBS model, as illustrated: we will expand and accrue new contributing sites through: 1) the “buddy system” where our founding sites will recruit new members and new members recruit more in multiple rounds, or 2) by inviting other qualifying networks and biorepositories interested in sharing specimens to join our effort. A coordinating center or secretariat will oversee and facilitate sharing of specimens, and the co-technical leads will oversee sample characterization. The VBS is envisioned as an evolving system applying lessons learned and adapting to the needs of its stakeholders. Based on experience with the 10x10 adjustments to the planned governance structure or sample characterization will be evaluated. Accomplishing the 10x10 pilot’s goal of characterizing and sharing specimens is vital for building confidence in the VBS model and proving practical utility. Our current focus is on human serum/plasma to mainly show a VBS system can function. In the future, additional specimen and data types may also be considered.
6 Conclusions
Based on the results and progress to date, there is a high probability of success for both the 10x10 pilot and the broader VBS. We identified 10 highly motivated and willing partners, who were selected to meet the criteria of broad geographic distribution and availability of infrastructure and experience needed to initiate collection and sharing of a required set of serum and plasma specimens. A plan has been developed for characterization of the specimens, coordinated by expert managing institutions, and collaborations are planned for data management, with support from the umbrella CONTAGIO program and other partners. Three working groups have been established, and are in the process of completing the governance framework, including ethical and data protection requirements, mapping regulations that impact sharing, and shipping and benefits for participation at each site. Most encouraging is progress with the 10x10 team towards creating a collaborative process for decision-making that has built trust and equity. The initial success of the 10x10 project demonstrates feasibility and the demand for a sustainable global biobanking system.
The VBS, informed by 10x10 experience, will help solve some of the hurdles that currently impede access to specimens and enhance capabilities and responses to future disease outbreaks. By bridging borders and fostering collaboration in biobanking, the VBS will be an invaluable asset in protecting global public health.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Author contributions
JG: Conceptualization, Resources, Project administration, Writing – review & editing, Writing – original draft, Methodology. AP: Writing – original draft, Methodology, Writing – review & editing, Conceptualization. ZS: Writing – review & editing, Project administration, Writing – original draft. TJ: Methodology, Conceptualization, Writing – review & editing, Resources, Funding acquisition. MC: Writing – original draft, Writing – review & editing, Resources, Conceptualization, Methodology.
Funding
The author(s) declare financial support was received for the research and/or publication of this article. This work is supported by the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 101137283 (CONTAGIO).
Acknowledgments
We are grateful for our 10X10 members in providing their information for this manuscript: Anyela Lozano-Parra, Gustavo Adolfo Gómez Gómez, Van-Mai Cao-Lormeau, MD Moyeen Chowdhury, Ibrahim Swaray, Ecaterina Noroc, Elena Romancenco, Inèz Vigan-Womas, Ousaman Noël Diallo, Kareen Arias, David Perera, Mong How Ooi, Jajah Fachiroh, Ruba Alsmadi, and Laura Pezzi.
Conflict of interest
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.
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Abbreviations
CGH, Center for Global Health, Colorado School of Public Health at the University of Colorado-Anschutz; CONTAGIO, Cohort Network to be Activated in Outbreaks; EQA, External quality assurance; EVA-G, European Virus Archive-Global, Aix Marseille University; FUNSALUD, Fundación para la Salud Integral de los Guatemaltecos; LMIC, low and middle income countries; SOP, standard operating procedures; VBS, Virtual Biorepository System; WP4, Work Package 4.
Footnotes
- ^ Price A, Abdulbaki L, Poje J, Giri J, Winstanley G, Steinberg Z, et al. An Open Access Collaborative Global Virtual Biorepository System (VBS): A Delphi Consensus. (2025), in publication.
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Keywords: biorepository, specimen sharing, epidemic preparedness, pilot study, LMIC
Citation: Giri J, Price A, Steinberg Z, Jaenisch T and Chu M (2025) Bridging borders: the virtual biorepository system, a sustainable global biobanking system for epidemic threats preparedness. Front. Trop. Dis. 6:1656222. doi: 10.3389/fitd.2025.1656222
Received: 29 June 2025; Accepted: 29 September 2025;
Published: 28 October 2025.
Edited by:
Ana Paula Arez, New University of Lisbon, PortugalReviewed by:
Judita Kinkorova, University Hospital in Pilsen, CzechiaCarmen Swanepoel, University of Stellenbosch, South Africa
Copyright © 2025 Giri, Price, Steinberg, Jaenisch and Chu. 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.
*Correspondence: Judith Giri, anVkaXRoLmdpcmlAY3VhbnNjaHV0ei5lZHU=