Pots of Gold at the End of Laboratory Benches and in Freezers

Whether one is a paleopathologist probing ancient civilizations, a modern-day epidemiologist searching for clues about the natural history of a specific disease process, or even a research entomologist studying the evolution and differences among hundreds of beetle species identified through centuries,1 the study of previously collected biological specimens repeatedly has proven enlightening. As stated by Baker in her recent comprehensive discussion of biobanks, “High quality data-rich samples are essential for future research.”2 Often, as the result of investigator initiation or sometimes even by accident, discoveries from unique specimens continue to result in important scientific advances. There is no more appropriate example than the discovery and recovery of the 1918 Spanish influenza virus from human remains preserved in the Alaskan permafrost.3 Employing such concepts, the U.S. Military for centuries has made (and continues to make) numerous medical/scientific contributions. Not only has the Armed Forces Institute of Pathology itself contributed to scientific knowledge, but the collaboration of this renowned institute with civilian investigators has been a model for joint efforts. Noteworthy is the postmortem evaluation of casualties from the Korean War to uncover enlightening clues toward understanding the then-underappreciated early onset of human atherosclerosis.4 A common thread throughout such investigations has been the discovery and utilization of technological advances, such as modern molecular biology and imaging methods, to further mine these collected treasures. Laboratory methodology and other scientific inquiry have become more ingenious than were ever imagined by investigators during the original periods of study design and specimen collection decades previously. Because of the frequently unpredictable future value of such gathered specimens, careful oversight and long-term care of such repositories are required. This supplement to Military Medicine contains descriptions of several current instances of such stewardship. The specimen repositories directly or indirectly originated from military-related populations, and are representative of “pots of gold” at the end of laboratory benches from past and present clinical and epidemiologic studies. Individually and collectively these Military Medicine articles emphasize not only the opportunities for innovative biologic and technological approaches to long recognized enigmatic diseases, but the articles also allude to contemporaneous issues inherent in addressing ethical and quality assurance hurdles facing those who make use of these often unexplored treasures. However, the important food for thought discussed in this supplement demands enhanced proactive attention, not only for military-associated investigations, but also by colleagues in the academic and industrial scientific communities who find themselves as custodians/guardians for nonmilitary-associated repositories of sera, of microorganisms, and of pathological specimens. The included articles describe continuing specific efforts by the Department of Defense (DoD) to create and maintain repositories. Perdue and colleagues' description of the DoD gigantic serum repository and their discussion of maximizing present and future use of the millions of serum specimens now stored and comprehensively cataloged in this unique collection provide an excellent overview of what is required to create and efficiently maintain potentially usable resources.5 The description of the United States Air Force Ranch Hand Collection of biological specimens, collected from Vietnam veterans for study of the consequences of herbicide exposure, has important implications for future operations.6 Of considerable importance is the DoD's collaboration with the Institute of Medicine (IOM), which has been granted considerable responsibility for this collection. The IOM has prepared to open The Ranch Hand collection to qualified investigators, including those not directly connected to the military as well as to projects of potential importance to current military members and veterans. Similar joint collaboration by the Medical Follow-up Agency of the IOM and the DoD (Air Force) has been initiated for the collection of slightly less than 45,000 sera obtained from Air Force recruits at Warren Air Force Base (AFB), Wyoming, during the Korean conflict.7 These sera resulted from studies of group A streptococcal infections and prevention of rheumatic fever. Those sentinel studies resulted in the 1954 awarding of a prestigious Lasker Award to the Warren Air Force Base Streptococcal Laboratory, another joint military–civilian effort. Although never foreseen by the civilian–military investigators at the time, study of the Warren serum collection (not described in this supplement) half a century later enhanced understanding of infection with hepatitis C virus (undiscovered at the time of the original studies in 1949–1954) as well as genomic studies of patients with celiac disease (using laboratory techniques not available in the 1940s and 1950s).8,9 Opportunities to use evolving technology to prospectively study historical biospecimens are a major thrust of the purpose of this supplement. Advantageous civilian—military collaboration is further documented by Eickhoff's description of the important studies by Meiklejohn and colleagues at the University of Colorado Medical Center—funded in large part by the military —studying influenza in nearby military facilities.10 The important takeaway lessons from those studies include the unfortunate tragedy that the valuable collection had to be discarded during the 1990s because of lack of funding for its preservation. As a result, newer laboratory and epidemiologic approaches could not be applied to the collection's specimens. In this author's experience, this is not an uncommon happening in the scientific community, even among government-supervised collections. Investigators and administrators with experience in collecting, maintaining, and cataloging repository samples fully realize that those duties can prove to be an expensive administrative task. Because the primary purpose of military-sponsored collections is to promote understanding of medical/public health issues with potentially adverse effects on military personnel, support for study of medical and public health issues among civilian populations using military-collected and -supported repositories should be given special consideration. The articles included in this supplement not only offer insight into the potential value of such specimen repositories for the military, but also clearly reinforce the concept2 that scientific specimen collections, regardless of their source(s), should be made known and accessible for meritorious, peer-reviewed proposals for study by governmental, academic, and industrial scientific communities. Clearly defined and accepted ethical standards are also required when studying specimens from repositories. Although there are complex ramifications, especially when both living and deceased subjects are represented, attempts must be made to achieve carefully considered, consensus standards.11 This supplement's articles emphasize the importance of military-sponsored repositories and repositories representing collaboration between the DoD and academic institutions and industry and should encourage heightened interest by the scientific community as well as those with oversight responsibility. Perhaps a representative working group with appropriate expertise and drawn from the appropriate government and civilian scientific communities can be convened and can collaborate to produce guidelines for acquisition, maintenance, and effective utilization of biologic specimen repositories for scientific/medical advancement. The creation of an open register for existing and new repositories would facilitate studies by present and future scientists and investigators. Is it too far-fetched to speculate about a collaborative international effort?12