Funding reductions threaten pioneering Nurses Health Studies

We all recognize that smoking harms heart health. Doctors advise postmenopausal women to focus on sustaining a healthy weight to reduce breast cancer risk. Trans fats have almost vanished from our diets.

All of these revolutionary public health measures trace their origins to the Nurses’ Health Studies, which have consistently monitored data on lives and lifestyles — and collected biological samples — from thousands of participating nurses for decades. Presently, recent federal funding reductions are jeopardizing these initiatives.

The biological samples from the studies are stored in a system of high-capacity freezers, which must sustain temperatures as low as 170 degrees Celsius. These freezers are filled with liquid nitrogen and overseen by a small team of research assistants and managers at the T.H. Chan School of Public Health and Brigham and Women’s Hospital. Funding to maintain the biorepository has been cut.

“These women have contributed everything they can for us,” stated biobank manager Janine Neville-Golden regarding the volunteers whose blood and tissue are preserved in the repository and who have devoted their time over years to complete surveys and undergo observation during life changes such as illness and pregnancy. “We’ve got to safeguard these right now. They’re essential for future health.”

The Nurses’ Health Study, initiated in 1976 and continued through a second cohort, referred to as Nurses’ Health Study II, in the late ’80s, has facilitated breakthroughs in dietary research, cancer studies, and the understanding of hormones in women’s health. The Nurses’ Health Study 3, introduced in 2010, includes a diverse range of health professionals and, for the first time, male nurses.

“This is a singular, irreplaceable asset, in many aspects. There are other biobanks, but this one is incomparable in scale and related data.”

Jorge Chavarro

In 2010, HSPH researchers Jorge Chavarro, Walter Willett, Janet Rich-Edwards, and Stacey Missmer initiated the third study in partnership with investigators at the Channing Division of Network Medicine at Brigham and Women’s Hospital and Harvard Medical School to advance the discoveries enabled through examining nurses’ health.

This study commenced in conjunction with the Growing Up Today Study (GUTS), which recruits children of Nurses’ Health II participants and aims to build upon insights obtained from previous studies.

However, in light of the funding reductions, the collection of samples for both studies has halted.

“This is a singular, irreplaceable asset, in many aspects,” remarked Chavarro, principal investigator for both Nurses Health III and GUTS. “Other biobanks exist, but this one is distinctive in scale and associated data.”

Chavarro indicated that while biological samples are relatively simple to collect, “What makes a biobank valuable is the ability to connect information from those samples to details about individuals’ health.”

Many of the participants from Nurses Health I and II — numbering in the hundreds of thousands — have provided multiple biological samples, including urine, cheek swabs, and blood. They’ve participated in various surveys and have been monitored through significant life events like illness and childbirth.

Chavarro was in the process of gathering biological samples, including stool, for his research.

“These samples were initially collected when individuals were young and healthy and contain decades of information about their lifestyles, and follow-ups,” Chavarro explained.

He mentions that HSPH is diligently seeking funding to replace the lost federal grants. However, without a long-term funding strategy, the essential liquid nitrogen cannot be acquired, and millions of samples will deteriorate.

“If there isn’t a sustainable approach to continue financing the ongoing operations of the biorepositories, we are going to lose samples,” he said. “It may not happen this week, but it’s not something that can be delayed indefinitely.”

In addition to the liquid nitrogen, Chavarro noted that there is also a genuine risk of losing the team that enables specimen research like his to be feasible.

“Operating a biorepository involves more than just storing samples in a freezer. It necessitates a lot of specific technical knowledge,” he said. “You must understand how to store samples under what conditions, and you need someone to fix a freezer failure — you need people who know how to react.”

Neville-Golden, who has been with the biorepository for 16 years, supervises a small team responsible for maintaining and retrieving samples for research. If issues arise with a freezer late at night, she’s the one who gets called. For her, the project is very much a human endeavor.

“I’ve learned a great deal,” she stated, from freezer maintenance to the ambitious objectives of the researchers she collaborates with to test hypotheses against the samples. “It’s not about the money, it’s about service and the greater good.”

Neville-Golden affirmed that her team — consisting of a handful of research assistants and a committed project manager, Nicole Romero — receives around 200 external requests each year to utilize data from the cohorts.

“There’s a long queue to gain access to these samples, simply because there’s insufficient manpower to extract the samples that people request,” she explained.

Their team selectively picks samples from tens of thousands stored in each freezer, thaws them, and prepares them for research. It’s demanding work, but Neville-Golden stated she tries to remember the individuals who provided the samples, and what they aspired to achieve by contributing.

“A few of them we’ve engaged with over the years said when we are at work and we see individuals who are severely ill and enduring everything they’re facing, we want to do whatever we can to alleviate that, to improve situations, to eradicate pain and suffering,” she reflected. “So it has truly been a labor of love for them.”

Chavarro reiterated that there is bridge funding in progress to address the immediate costs of the repository, and Neville-Golden noted that samples might last up to a month without new liquid nitrogen being supplied to the freezers.