Veterans (and the VA) are playing a key role in the war against cancer
Veterans are likely to play a significant part in what has been called "the Moon shot" in cancer research -- the plan announced by President Barack Obama last week for a cancer fight effort to equal the country's determination to put a man on the moon during the 1960s.
Fittingly, the veterans' role in the cancer Moon shot, as well as in scores of other research projects into illnesses that impact vets and non-vets alike, will be doing something they were prepared to do back in their active duty days: shed some blood.
"When they realize that this could help other veterans most of them volunteer right away" when asked, VA Secretary Bob McDonald said during a visit to the VA Medical Center in Boston on Friday, when he toured the lab and growing biorepository.
The VA project, called the Million Veterans Program, predates the cancer Moon shot by six years. Its goal is to collect blood samples -- and with it the DNA -- of at least a million veterans, and use it to research illnesses, including at the genetic level.
"This is fascinating what they're doing here," McDonald said. "The whole role of genomics will be huge in, and that's one of the reasons we wanted you to see this, because I think the work of the Million Veteran Project underscores the importance of genomics in the Moon Shot in eradicating cancer."
It is veteran-centric, for sure, and already is being used in alpha and beta projects that focus on veteran issues, according to the VA.
The veterans' blood samples, informed by medical health records that, depending on the veteran, may go back 20 or more years, could hold the key to understanding causes and discovering treatments and cures for myriad illnesses. The VA is looking at some 750,000 genetic markers that medical researchers believe could be linked to illnesses that plague veterans, ranging from cancers to heart disease, kidney disease to post-traumatic stress disorder.
To date, the effort has collected close to 445,000 vials of blood, each one spun in a centrifuge prior to storing to divide red cells, white cells and plasma. The vials are kept in an oversized refrigeration unit within a lab at the hospital.
Although the project name suggests it will store a million samples, it will continue to grow the biorepository as long as there is funding support and vets who volunteer. There is storage space for several million samples. During a tour of the lab, McDonald climbed a ladder to look into the storage site, where a robotic arm, kept at minus 20 degrees Celsius, plucked newly deposited vials one at a time from small containers and moved them into trays that were then automatically transferred into the unit and stored at minus 80 degrees Celsius.
"When I do my recruiting speech to try to attract people to VA, this is exactly the issue -- come be on the cutting edge, the tip of the spear [in medical research] that can make a difference in so many people's lives," McDonald said.
The department has spent about $130 million on the program since it began laying the foundation for it in 2010. Its nearly 445,000 samples have come from nearly 245,000 veterans. It currently is getting in about 100,000 samples per year, which means it will hit the million mark around 2022.
They hope the speed that up by opening the program to active-duty personnel. The VA estimates that would add an additional 25,000 samples a year to the collection and perhaps allow them to reach one million by 2020, said Dr. Mary Brophy, director of the biorepository.
Because the donations are for research purposes, neither the VA nor the Defense Department can simply request use of a veteran's or service member's blood for the project.
Donors -- strictly veterans right now -- may volunteer for the project at a number of VA sites across the country. In signing up, they are told their blood and medical information will be shared with researchers and that they may not benefit directly or immediately from any of the research.
But their identities are masked on the samples, so that researchers do not know whose blood or DNA they are working with. For its part, the VA does retain a link between the sample code and the veteran so that changes in health or long-term effects of drugs and medications can be incorporated into the veteran's research profile.
While Britain began building its own biorepository before the U.S. and currently has more samples --about 500,000 -- the VA is quickly catching up and will pass that number.
It's not only because the veterans have volunteered in such large numbers, but because VA has been able to build the computing capacity to handle the data.
"It's not just the samples, it's the informatics platform. The reason VA can do that better than anyone … is that we have an electronic health record," she said. "We have the health record already in a data base, and it's been around for 20-30 years."
The British Health System -- it does not have a separate system for veterans – is largely decentralized, with many medical records still in paper form and residing in doctor's offices across the country.
Not only has an existing data base of electronic records and a willing veteran population allowed VA to rapidly build its biorepository, it has already provided the VA enough samples and data to launch several research studies of benefit to veterans.
The projects include cardiovascular risk factors among African American and Hispanic Americans, to determine how genes influence obesity and lipid levels affect the heart; an examination of genetic risk from chronic use of alcohol, tobacco and opioids; and a study into how genes affect the risk and progression of kidney disease -- a major risk factor for veterans, according to researchers.
The biorepository is essentially one-stop shopping for a specific patient cohort and control group for any research institution wanting to investigate an illness or try out a new drug, according to Brophy.
"If I want to do a study in Gulf War Illness, before I would have to go out and find all these patients with Gulf War Illness, do it myself, Then get the samples, store it and send it out" to research lab, she said. The biorepository eliminates those time-consuming steps, she said, by making VA the go-to place for medical researchers.
Now, she said, if a research lab needs 5,000 patients with Gulf War Illness, it can get that cohort from the VA, as well as a control group without Gulf War Illness.
"The infrastructure is there to do key PTSD research, Gulf War Illness research. The hard work of getting people together, knowing who has Gulf War Illness [is done]," she said.