BIOPRESERVATION AND BIOBANKING

Volume 00, Number 00, 2020

ª Mary Ann Liebert, Inc.
DOI: 10.1089/bio.2019.0114

A Pilot Cancer-Phenome Biobanking System

in a Low-Resource Southeast Asian Setting:
The Philippine General Hospital Biobank Experience

Ma. Easter Joy V. Sajo,1 Joji Marie Y. Teves,1 Allen Joy M. Corachea,1 Leomir A. Diaz,1 Alison Faye O. Chan,1
Apple P. Valparaiso,2 Ana Victoria V. Dy Echo,3 Shiela S. Macalindong,2 Gemma Leonora B. Uy,2
Rodney B. Dofitas,2 Ma. Antonia E. Habana,3 Roy R. Gerona,4 Juan C. Irwin,4
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

Linda C. Giudice,4 and Michael C. Velarde1

Biobanking has become an indispensable tool for translational research and health innovations. While the field
of biobanking has progressed and evolved globally, biobanking in developing Association of Southeast Asian
Nations (ASEAN) countries such as the Philippines remains underrepresented because of several challenges
often encountered in these low- and middle-income countries. Recently, the Philippine government has un-
dertaken enormous efforts to advancing research and development in the country, and one of the current
research pursuits is the establishment of biobanks, with the hope of attaining more discoveries and innovations
in the future. Given that cancer remains a leading cause of death in the Philippines, the Philippine government
supported the establishment of a cancer biobank at the Philippine General Hospital (PGH). In this study, we
present a specific use case of biobanking activity at the PGH Biobank, to build a cohort of biospecimens from
Filipino patients with breast, endometrial, and ovarian cancer. This initiative is part of a biomonitoring study (1)
to assess environmental exposures and possible risk factors in the Philippine population and (2) to develop a
system of culturing human cells from Filipino patients for subsequent in vitro studies. We discuss issues faced
and the solutions developed during the implementation of the biobank. Strong research collaboration, a funding
source, basic infrastructure, and appropriate technology helped initiate this pilot biobank in the Philippines.
Overall, the experiences of establishing the PGH Biobank may help other institutions in low-resource countries
to set up cancer biobanks.

Keywords: tissue bank, cell repository, tumor collection, low-middle income country, Southeast Asia,
developing country

Introduction accelerate medical advances,6 the concept of biobanking in

developing Association of Southeast Asian Nations (ASEAN)

B iobanks serve as repositories for tissues, cells, blood,

and other human-derived samples collected from a
large number of individuals and stored anonymously along
with their protected associated information.1 These facilities
have become hubs, connecting investigators to resources that
eventually contributed to pioneering medical advances, such
as precision medicine.2–4 Hence, biobanking progressed rap-
idly to become an indispensable tool for translational research
and health innovations.5,6 While biobanks are envisioned to
countries such as the Philippines is still in its infancy. This is
reflected in the scarcity of large population-based studies in
the region, which is also underrepresented in the vast network
of Asian biobanks, mostly represented by China, Japan, and
Korea.7 Biobanks in the Philippines are typically owned by
prestigious private hospitals, which can afford a budget to
cover the cost for maintenance and upkeep of a small biobank.
But because most low-income patients have poor access to
health care,8 sample collection in this type of biobank may

1
Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines.
2
Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
3
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
4
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

1
 2 SAJO ET AL.
mostly involve upper to middle class populations, which may
not inclusively reflect the health and exposure status of the
broader Philippine demographics.
Over the past 50 years, the Philippines has experienced
major economic growth and socioeconomic improvements.
However, cancer mortality remains high in the Philippines
and the number continues to steadily increase.9 In 2011, the
Philippine government issued the Administrative Order No.
2011-0003, also called the National Policy on Strengthening
the Prevention and Control of Chronic Lifestyle Related
Non-communicable Disease, to institute programs to address
noncommunicable diseases in the Philippines. The govern-
ment has thus been giving more attention to research related
to noncommunicable diseases, including cancer. However,
as researchers have limited access to human specimens and
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.
paired, well-annotated clinical phenotyping, studies are re-
stricted to basic research and translating this research into
medical practice remains a challenge. Hence, the Philippine
government supported the establishment of a cancer biobank
at the University of the Philippines Manila (UPM) Philippine
General Hospital (PGH), a national university hospital and
the largest government health care facility in the Philippines.
In this study, we highlighted the experiences we encoun-
tered in establishing a small public hospital-based cancer
biobank in the Philippines, particularly focusing on a specific
biobanking activity of collecting biological samples from
patients with breast, endometrial, and ovarian cancer. This
initiative is part of a biomonitoring study (1) to assess envi-
ronmental exposures and possible risk factors in Filipinos and
(2) to develop a system of culturing patient-derived primary
cells for subsequent in vitro studies, especially those related to
environmental effects on human cells. We discuss some of the
unique challenges faced in establishing this cancer biobank in
a developing country such as the Philippines.
Materials and Methods
Patient recruitment
All procedures in this study were approved by the UPM
Research Ethics Board (REB), approval number: RGAO-
2017-0747. Written informed consent was obtained from all
participants before enrollment. Patient data collection was
compliant with the Philippine Data Privacy Act of 2012.
A total of 75 breast, 25 endometrial, 25 ovarian cancer pa-
tients, and 75 healthy female volunteers were recruited from
January 2018 to January 2019. Participants were women aged
18–59 years who are of Filipino descent from up to the third
generation ancestry. All cancer patients are new cancer pa-
tients without a prior cancer and current comorbidities.
Healthy individuals without a prior or current diagnosis of
cancer were screened by the attending physician to ensure
their good general health condition. All participants were
recruited randomly, regardless of their socioeconomic status
through the clinics of PGH, personal recommendations from
doctors, family, and friends, and advertisements from flyers
and social media.
Data collection
Clinical information was collected through the Depart-
ment of General Surgery 1 (GS1) for breast cancer and
healthy subjects, and the Department of Obstetrics and Gy-
necology (OB-GYN) for endometrial and ovarian cancer
patients. An exposure questionnaire was administered di-
rectly through an interview by a clinical research associate
(CRA) before the patient’s scheduled surgery or on a spec-
ified date for healthy subjects. Collected clinical information
was deidentified by the CRA and transferred to a biobank
encoder for storage in an encrypted database (Fig. 1).
Sample collection
Urine was collected by the CRA using a polypropylene-
based urine cup and transferred to five tubes of 5 mL
cryovials. Whole blood was obtained by the phlebotomist
of the Pathology Department using one 7 mL EDTA-
containing tubes for serum extraction. After centrifugation,
samples were transferred to two 2 mL cryovials. Plasma
samples were collected using two red top tubes and then
centrifuged at 3000 rpm for 10 minutes. Two 1 mL aliquots
were placed in 2 mL cryotubes. All samples were stored in
an ultralow freezer. Tumor tissues and normal adjacent tis-
sues were collected during surgery. About 1 · 1 cm samples
from primary tumors were provided to the PGH Biobank and
the remainder was given to the Pathology Department for
histopathological examination. A Material Transfer Agree-
ment was generated between the PGH Biobank and the re-
ceiving institution. For international distribution, transport
permits were secured from the Philippine Bureau of Quar-
antine, which required submission of the study protocol,
consent form, application form, and associated fees.
Cell culture
Tissues were collected in MACS Tissue Storage Solution
(Miltenyi Biotec, Bergisch Gladbach, Germany) and trans-
ported to the Institute of Biology (IB) at the University of the
Philippines Diliman (UPD) on ice. Samples were washed with
PBS (Life Technologies) with 1 · antibiotic-antimycotic solu-
tion (Gibco; Thermo Fisher Scientific), and minced into
1 mm3 before dissociation with MACS Human Tumor Dis-
sociation Kit in Gentle MACS Dissociator (Miltenyi Biotec).
Cells were filtered through MACS Smart Strainer (Miltenyi
Biotec) and centrifuged at 300 g for 7 minutes. Cell pellets
were cultured in different growth media supplemented with the
antibiotic-antimycotic solution and 0.5 mg/mL of gentamicin
(Gibco). DMEM/F12 media with 10% FBS and 1· Mammary
Epithelial Growth Supplement (MEGS) (Gibco) was used as
growth media for fibroblasts. Serum-free Medium 171 (Gibco)
with MEGS was used for epithelial-like breast and ovarian
cancer cells, while the defined keratinocyte-SFM (KSFM) was
used for epithelial-like endometrial cells. Flasks were incu-
bated at 37C with 5% CO2 and media changed every 3 days.
Results and Discussion
Challenges in biobank infrastructure
Challenges and hurdles in establishing a biobank are in-
evitable, especially in low-resource countries such as the
Philippines. Physical and technical infrastructures are not yet
in place and access to resources are often limited. Indeed,
setting up a physical infrastructure, which includes an area
designed for biobanking, dedicated freezers with backup
generators, and a reliable cost-economical database system,
to store sensitive patient information is the initial obstacle
that needed to be overcome by the PGH Biobank. In the
 UP PGH BIOBANK 3
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

FIG. 1. Biobank Workflow of the PGH Biobank. Establishing PGH Biobank include Patient Recruitment, Collection,
Sample Acquisition, and Distribution. The total duration of patient involvement in the study is 285–345 minutes for surgical
participants and 105 minutes for nonsurgical participants. CRA, clinical research associate; MOA, memorandum of
agreement; MTA, material transfer agreement; PGH, Philippine General Hospital.

Philippines, government institutions such as PGH strictly
follow a procurement and bidding system stipulated in the
Government Procurement Reform Act.10 As a consequence,
purchasing of large equipment may often take up to a year.
Equipment may also cost twice as much as in other countries
due to the need of a middleman or local distributor to process
acquisition documents.
Guidelines and standard operating procedures for es-
tablishing a biobank may also not be available for the
country or institution. While a section for biobanking is
mentioned in the Philippine National Ethical Guidelines
for health-related research,11 this guideline is very broad
and was still new at the time when the PGH Biobank was
being reviewed. Hence, the proponents of the PGH Bio-
bank worked closely with its Institutional Ethics Com-
mittee to create guidelines for biobanking by following an
international guideline.12 An organizational team was then
formed, which comprised (1) the governance committee
which sets implementing guidelines for the biobank and
(2) the management team which works together with
biobank recipients, to obtain ethics approval of research
protocols (Fig. 2). The UPD IB Cell Repository, which
aims to use primary cells for subsequent in vitro studies,
acted as one of the initial recipients of the PGH biobank.
Challenges in patient recruitment
The success in recruiting research participants may de-
pend on the number of patients seen by the hospital. This
may be challenging in some private institutions with pre-
mium medical costs, as many individuals in the ASEAN
countries do not have proper health care coverage.13 Ter-
tiary care centers are also thought to have a positive influ-
ence on recruitment due to the inclination of patients to trust
a medical specialist.14 PGH is the only national referral
center for tertiary care and is known to be the largest
 4 SAJO ET AL.
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

FIG. 2. Organizational Framework of the PGH Biobank and UPD IB Cell Repository. The PGH Biobank includes
governance and management to support researchers, including the UPD IB Cell Repository. Each of these components is
being regulated by the UPM REB, ensuring the protection of the patient’s right and confidentiality. UPD IB, University of
the Philippines Diliman Institute of Biology; UPM REB, University of the Philippines Manila Research Ethics Board.

hospital in the Philippines. It has highly trained physicians having only one specific vendor throughout the lifetime of the
and surgeons who offer government-subsidized medical biobank becomes very challenging.
services at low or no cost. Hence, this allowed for the ease Data collection from multiple departments also adds
of patient recruitment during the study, with a majority complexity to the database design. For this biobanking ac-
(83.0%) of participants coming from the 40–59-year-old tivity, data were obtained from two different departments,
bracket and a mean age of 48 years (Table 1). Most par-
ticipants (58.0%) reported a below-average monthly income
with only a quarter (24%) of them being employed. Table 1. Sociodemographic Characteristics
Nonsurgical participants were easier to recruit than sur- of Philippine General Hospital
gical cancer patients (Fig. 3). However, most nonsurgical Biobank Participants
participants came from the National Capital Region or
within the location of the biobank (*2 km), while several Characteristics N %
of the surgical participants came from farther places (as far
as >1000 km), with a median distance of *30 km from the Age group
20–29 7 3.50
biobank (Fig. 4). This suggests that finding a matching 30–39 27 13.50
control who lives in the same vicinity as the cancer patient 40–49 84 42.00
may pose a challenge if the patient had traveled a long 50–59 82 41.00
distance from PGH to receive treatment. Hence, estab- Community type
lishing satellite biobanks in other hospitals >30 km from Urban 126 67.02
the PGH Biobank should also be considered to ensure Suburban 28 14.89
maximum coverage of the population, especially when Rural 24 12.77
creating a biobank to study environmental exposures Unknown 10 5.32
across the country. Job
Student/trainee 0 0
Challenges in data collection and storage Paid employee 45 23.94
Self-employed/business owner 5 2.66
Data management systems for human biobanks are im- Housewife 1 0.53
portant to ensure proper storage and protection of clinical in- Retired 0 0.00
formation. While there are several commercially available Unemployed 86 45.74
laboratory management information systems (LIMS) for None of the above 19 10.11
biobanks, purchasing and maintaining a system can be very No answer 22 11.70
expensive. Most of these LIMS also have proprietary soft- Household monthly income
ware technologies with high subscription costs and require Below average income (<10k) 109 57.98
regular upkeep by the same vendor. Because the Philippine Average income (10k–30k)* 37 19.68
Above average income (>30k) 14 7.45
government procurement system follows a meticulous bid- No answer 18 9.57
ding process when contracting with commercial entities,
 UP PGH BIOBANK 5

fines the user profile and allows to create a database backup.

The biobank module contains the agreement forms, consent
forms, and specimen information. The medical records
module details patient information such as case number and
medical reports, but personal information, including name
and addresses, was not uploaded in the database to ensure
maximum protection of patient data privacy.
It is worth noting that PGH lacks a centralized, interoperable
patient registry system. Hence, the collection of patient infor-
mation required direct communication with patients and their
corresponding medical practitioners following a written in-
formed consent. All laboratory and pathology reports were also
acquired through direct communication with the corresponding
departments, adding burden to data collection. However, with
the push of the Philippine government to implement a National
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

FIG. 3. PGH Biobank Cumulative Patient Recruitment
Rate. Surgical cancer participants (breast, endometrial, and
ovarian cancer patients) and nonsurgical participants (nor-
mal) were recruited in a year. Recruitment rate was calcu-
lated from the total number of participants who consented
and met the inclusion/exclusion requirements. Color images
are available online.
which required a unique set of medical information as part of
their point-of-care. The GS1 team preferred more in-depth
information on the tumor characteristics, while the OB-GYN
team focused on patient history (Tables 2 and 3). As it was
difficult to harmonize the content of clinical information
collected from each department, the PGH Biobank devel-
oped a simple in-house database, designed to be dynamic
and customizable by the end-user to minimize the cost for
maintaining the system, while accommodating the differences
in clinical information collected between departments. The
database is composed of three modules: administration, bio-
bank, and medical records. The administration module de-
eHealth System to support the Republic Act 11223 (the Uni-
versal Health Care Act), it is hoped that this unified electronic
medical record system will accelerate data collection for PGH
biobank in succeeding studies.
Challenges in administering survey questionnaires
The PGH biobank administered exposure questionnaires
as part of the biomonitoring study. These questions included
a survey on living conditions, food source, food preparation,
food intake habits, personal care product use, household
product and furniture exposures, and other lifestyle activities.
Several participants had trouble answering some items in the
questionnaire, particularly those related to exposure frequency
and last exposure to a substance not related to food. Several
participants (60%) opted not to answer 23 out of 37 (62.2%)
questions not related to food (Supplementary Tables S1 and
S2) versus only 2 out of the 26 (7.7%) for questions related to
food intake habits (Supplementary Table S3) and 0 out of 6
(0%) for questions related to food source (Supplementary
Table S4). All participants also answered all questions related

FIG. 4. Distribution of Location of PGH Biobank Participants. (A) The overall number of participants residing in different
regions shown in the map of the Philippines. Darker green color indicates maximum number of participants (n = 107) and
the white color indicates the minimum number of participants (n = 0) per region. (B) The heatmap indicates total number of
surgical and nonsurgical patients per region in the Philippines. Asterisk (*) indicates the location of the biobank. (C) Min–
Max distance (km) with the median line distance of the participant’s residence from the hospital (PGH). CA, cancer; NCR,
National Capital Region. Color images are available online.
 6 SAJO ET AL.

Table 2. Clinical Information of Philippine to ownership of cookware, although most of them do not
General Hospital Biobank Participants own these items, resulting in time and frequency of use to
in the Department of Surgery be mostly not applicable (Supplementary Table S5). The
inclination to not answer questions is often due to the in-
n %
ability of participants to remember the time and frequency
Clinical stage of exposures. However, it is interesting that most partic-
I 1 1.33 ipants answered questions related to food. Because food is
IIA 63 84.00 thought to be an integral part of the sociocultural aspect
IIB 8 10.67 of Filipinos,15 it will be worth conducting future studies
IIIA 1 1.33 on the contribution of Filipino culture to the behavior of
No answer/data 2 2.67 answering questions.
Pathologic stage
I 1 1.33
IIA 23 30.67 Challenges in sample transport
IIB 16 21.33 The efficiency of sample distribution locally and interna-
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

IIIA 12 16.00
tionally is another issue that the PGH biobank had to eval-
IIB 6 8.00
IIIC 11 14.67 uate. As a proof of concept, the IB Cell Repository served as
No answer/data 6 8.00 an initial site for local distribution. While the PGH Biobank
and IB Cell repository are only about 18 km apart, the slow
Laterality
Right 34 45.33 traffic in Metro Manila required a travel time of about 1.5
Left 38 50.67 hours by car between the two institutions, although this was
Both 0 0.00 significantly improved when using a motorcycle courier
No answer/data 3 4.00 (Table 4). Hence, local transport of biospecimens did not
Tumor diameter become a major problem, as evidenced by the ability of the IB
1–10 cm 65 86.67 Cell Repository to successfully process fresh tissue samples
>10 cm 4 5.33 for cell culture (Fig. 5).
No answer/data 6 8.00 For international distribution, serum and urine samples were
Histology sent to the University of California San Francisco (UCSF) to
Apocrine carcinoma with pleomorphic 1 1.33 evaluate the mode of transportation. Because the Philippines
features experience an average of 19.4 tropical cyclones per year,16
Ductal carcinoma in situ comedo pattern 1 1.33 shipping of biological samples by air may often be challeng-
with areas suspicious of microinvasion ing, as shipments are often delayed and rerouted to multiple
Favor metaplastic carcinoma 1 1.33 locations during tropical storms. Indeed, some samples from
Invasive mammary carcinoma 64 85.33 the PGH Biobank intended for an overnight shipment arrived
Mucinous carcinoma 6 8.00
at the destination a week later, resulting in these samples
No answer/data 2 2.67
thawing and becoming no longer suited for research. Hence,
No. of positive nodes for international distribution, a specialized courier for sending
0 node 25 33.33
1–24 nodes 44 58.67 biological samples was the most guaranteed mode of inter-
No answer/data 6 8.00 national distribution (Table 4), as this type of courier ensured
fast delivery and maintained the low temperature requirement.
Total No. of nodes collected
1–10 5 6.67
11–38 64 85.33 Challenges in financial support
Prefer not to answer 3 4.00
LV or pleural invasion Another obstacle encountered during the establishment of
LV (-) 29 38.67 the PGH Biobank was the ability to obtain continuous finan-
LV (+) 32 42.67 cial support from the local government. In France and the
LV (+) PI (+) 6 8.00 Netherlands, biobanks can incur annual operational expendi-
LV (+) PI (-) 1 1.33 tures from USD 220,000 to USD 880,000 a year, excluding
PI (+) 1 1.33 research-related expenses.17 While the PGH Biobank requires
No answer/data 6 8.00 a significantly lower amount of funding than international
Margins biobanks, continuous financial support with minimal delays in
Negative 66 88.00 fund transfers remains critical for ensuring the maintenance of
<1 mm from basal margin 3 4.00 sample integrity and data storage. The lack of awareness re-
No answer/data 6 8.00 garding the importance of biobanking also adds to the reluc-
Molecular subtype tance of legislators to support such activities. Hence, public
Luminal-type 46 61.33 awareness through local media and symposia became one of
HER2/Neu+ 14 18.67 the key components of the PGH Biobank. In addition, gaining
Basal cell-like 4 5.33 the support of well-recognized officials and institutions helped
No answer/data 11 14.67 in pushing the biobank platform forward. This model was also
LV, lymphovascular. observed in China, where the Chinese biobank of immortalized
cell lines was able to attract the development of legislation
through the initiatives of the Chinese Academy of Medical
Sciences.18 As the Philippine government begins to recognize
 UP PGH BIOBANK 7

Table 3. Clinical Information of Philippine Table 3. (Continued)

General Hospital Biobank Participants
in the Department of Obstetrics and Gynecology Description n (%)
Description n (%) Use of OCP for 12 months
Yes 0 (0.00)
Marital status No 35 (89.74)
Single 5 (12.82) No answer 4 (10.26)
Married 25 (64.10)
Widowed 2 (5.13) Use of fertility drugs for 12 months
No answer 7 (17.95) Yes 3 (7.69)
No 31 (79.49)
Gravidity No answer 5 (12.82)
0 pregnancy 13 (34.21)
1–12 pregnancies 24 (63.15) Use of HRT
No answer 1 (2.63) Yes 0 (0.00)
No 35 (89.74)
Parity
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

No answer 4 (10.26)
0 viable offspring 14 (36.84)
1–9 viable offspring 23 (60.83) Use of tamoxifen within the last 2 years
No answer 1 (2.63) Yes 0 (0.00)
No 35 (89.74)
BMI No answer 4 (10.26)
Less than 18.5 kg/m2 8 (20.51)
18.5 to 24.9 kg/m2 12 (30.77) Histologic type
25.0 to 29.9 kg/m2 4 (10.26) Endometrioid carcinoma 13 (33.33)
30.0 or higher kg/m2 4 (10.26) Clear cell carcinoma 3 (7.69)
No answer 10 (25.64) Mucinous carcinoma 3 (7.69)
High grade carcinoma 1 (2.56)
Menarche Mixed (endometrioid+others, MMMT) 4 (10.26)
<12 years old 6 (15.38) Serous carcinoma 6 (15.38)
12–35 35 (89.74) Others (adenocarcinoma, adult granulosa 3 (7.69)
No answer 4 (10.26) cell tumor, liposarcoma, etc.)
Menopause No answer 7 (17.95)
<45 years old 3 (7.69) Stage
45–55 years old 16 (41.03) I 16 (41.03)
N/A 16 (41.03) II 3 (7.69)
No answer 4 (10.26) III 9 (23.08)
Smoking history IV 4 (10.26)
Yes 19 (48.72) No answer 7 (17.95)
No 16 (41.03) Grade
No answer 4 (10.26) 1 5 (12.82)
Diabetes mellitus 2 8 (20.51)
Yes 1 (2.56) 3 14 (35.90)
No 33 (84.62) No answer 12 (30.77)
No answer 5 (12.82) Laterality
Hypertension Bilateral 5 (12.82)
Yes 4 (10.26) Left 5 (12.82)
No 31 (79.49) Right 6 (15.38)
No answer 4 (10.26) N/A 16 (41.03)
History of endometriosis No answer 7 (17.95)
Yes 10 (25.64) Tumor volume
No 25 (64.10) 2.5–900 cm3 25 (64.10)
No answer 4 (10.26) 960–18,000 cm3 12 (30.77)
History of PCOS No answer 2 (5.13)
Yes 0 (0.00)
No 35 (89.74)
No answer 4 (10.26) the importance of biobanks and as it continues to provide its
History of infertility financial support to medical research, the PGH Biobank plans
Yes 3 (7.69) to expand into other research studies. It is envisioned that the
No 32 (82.05) PGH biobank will turn into a core facility to help support
No answer 4 (10.26) biobanking needs of other clinicians and researchers.
History of PID
Yes 5 (12.82)
No 30 (76.92) Importance of research collaborations
No answer 4 (10.26)
The success of the PGH Biobank was made possible
(continued) through the collaboration with UCSF. Establishing a bio-
bank de novo is very difficult. Setting up a biobank through
collaborations with a more developed institution with
 8 SAJO ET AL.

Table 4. Optimization of Different Sample Transport Mode for Local

and International Distribution of Biospecimens
Local distribution International distribution
Type or classification Type A Type B Type C Courier A Courier B
Mode of transportation Car service Railway transit Motor-cycle Airplane (wait for Airplane (next flight
bulk deliveries) available)
Distance 18 km 18 km 18 km *11,228 km *11,228 km
Total time required *1.5 hours *1 hour 45 minutes 5–10 days 2–3 days
Price PhP 1000 PhP 100 PhP 180 X 2 · the price of Courier
A
Remarks Extended travel Security concerns Saves time With long Without layovers
time due to in the train and money layovers guaranteed samples
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.

slow-moving compromised
traffic samples

similar interests helps in establishing a successful biobank,
as observed in the Human Heredity and Health in Africa
consortium, where the African Society for Human Genetics
partnered with the United Kingdom’s Wellcome Trust and
the United States’ National Institutes of Health to support the
establishment of biobanking activities in Africa, primarily in
support of health-related genomic research.19 The impact of
biobank networking is further emphasized by the European,
Middle Eastern, and African Society for Biobanking and
Biopreservation working group and the Bridging Biobank-
ing and Biomedical Research Across Europe and Africa
consortium.20

FIG. 5. Representative im-

ages of primary cells col-
lected, cultivated, and banked
by the Institute of Biology
UPD Cell Repository. Phase
contrast images of estab-
lished primary cells isolated
from breast (A), endometrial
(B), and ovarian (C) cells.
Normal cells (first column)
were isolated from the adja-
cent, cancer-unaffected, and
contralateral area of breast,
endometrium, and ovary, re-
spectively. Primary cancer
cells were cultured in differ-
ent media to produce differ-
ent cell types with different
cell morphologies: fibroblas-
tic (second column) and
epithelial-like (third column).
 UP PGH BIOBANK
Conclusion
As the PGH Biobank is currently the only government-
based tumor biobank in the country that mainly caters to
low- and middle-income patients in the Greater Manila
Area, there is still a need to create satellite biobanks in
other parts of the country and to collaborate with other
private biobanks, as sharing of samples and associated data
and biobanking consolidation may provide cost-reduction
solutions and avoid unnecessary redundancies in sample
collections.17 Overall, the experience of PGH Biobank
demonstrates the feasibility of establishing a government-
supported cancer biobank in the Philippines. Hence, the
PGH Biobank can now help facilitate cancer-related studies
in the Philippines and provide a means of collaboration
Downloaded by CHALMERS UNIVERSITY OF TECHNOLOGY from www.liebertpub.com at 04/18/20. For personal use only.
with other countries to study cancer-related health dis-
parities among the ASEAN population.
Acknowledgments
We express our gratitude to the PGH Biobank Personnel,
Susan Valibia, who coordinated all the necessary documents
and information needed for this study, and also our devel-
opers, Philip John Sales, Angelo Mycar Chu, and Khristian
Tiu for their efforts in developing the PGH Biobank elec-
tronic database.
Author Disclosure Statement
No conflicting financial interests exist.
Funding Information
This study was supported by the Philippine Commission
on Higher Education—Philippine California Advanced Re-
search Institute (CHED-PCARI, IHITM 2016–13, MCV).
Supplementary Material
Supplementary Table S1
Supplementary Table S2
Supplementary Table S3
Supplementary Table S4
Supplementary Table S5
References
1. Elger BS, Caplan AL. Consent and anonymization in re-
search involving biobanks: Differing terms and norms present
serious barriers to an international framework. EMBO Rep
2006;7:661–666.
2. Kaufman S, Rosset S. Exploiting population samples to
enhance genome-wide association studies of disease. Ge-
netics 2014;197:337–349.
3. Bingham S, Riboli E. Diet and cancer—The European
prospective investigation into cancer and nutrition. Nat Rev
Cancer 2004;4:206–215.
4. Riboli E, Hunt K, Slimani N, et al. European Prospective
Investigation into Cancer and Nutrition (EPIC): Study
populations and data collection. Public Health Nutr 2002;5:
1113–1124.
9
5. Murtagh MJ, Demir I, Harris JR, et al. Realizing the
promise of population biobanks: A new model for trans-
lation. Hum Genet 2011;130:333–345.
6. Coppola L, Cianflone A, Grimaldi AM, et al. Biobanking in
health care: Evolution and future directions. J Transl Med
2019;17:172.
7. Lee S, Jung PE, Lee Y. Publicly-funded biobanks and
networks in East Asia. Springerplus 2016;5:1080.
8. Umeh CA, Feeley FG. Inequitable access to health care by
the poor in community-based health insurance programs: A
review of studies from low-and middle-income countries.
Glob Health Sci Pract 2017;5:299–314.
9. Torre LA, Siegel RL, Ward EM, et al. Global cancer in-
cidence and mortality rates and trends—An update. Cancer
Epidemiol Biomarkers Prev 2016;25:16–27.
10. Saloma C. Procurement in the Philippine scientific enter-
prise system. Philipp J Sci 2016;145:5–6.
11. Philippine Health Research Ethics Board. Ethical guidelines
for research using human data and samples from biobanks,
registries, and databases. In: De Castro L (ed). National
Ethical Guidelines for Health Research. Taguig City: De-
partment of Science and Technology—Philippine Council
for Health Research and Development; 2017: 167–169.
12. International Ethical Guidelines for Health-related Research
Involving Humans, 4th ed. Geneva. Council for International
Organizations of Medical Sciences (CIOMS); 2016.
13. Van Minh H, Pocock NS, Chaiyakunapruk N, et al. Pro-
gress toward universal health coverage in ASEAN. Glob
Health Action 2014;7:25856.
14. Newington L, Metcalfe A. Factors influencing recruitment to
research: Qualitative study of the experiences and perceptions
of research teams. BMC Med Res Methodol 2014;14:10.
15. Becker G. Cultural expressions of bodily awareness among
chronically ill Filipino Americans. Ann Fam Med 2003;1:
113–118.
16. Allen N, Sudlow C, Downey P, et al. UK Biobank: Current
status and what it means for epidemiology. Health Policy
Technol 2012;1:123–126.
17. Doucet M, Yuille M, Georghiou L, et al. Biobank sustain-
ability: Current status and future prospects. J Biorepository
Sci Appl Med 2017;5:1–7.
18. Soo CC, Mukomana F, Hazelhurst S, et al. Establishing an
academic biobank in a resource-challenged environment.
South African Med J 2017;107:486–492.
19. Lassalle S, Hofman V, Ilie M, et al. Setting up a prospec-
tive thyroid biobank for translational research: Practical
approach of a single institution (2004–2009, Pasteur Hos-
pital, Nice, France). Biopreserv Biobank 2011;9:9–19.
20. Klingstrom T, Mendy M, Meunier D, et al. Supporting
the development of biobanks in low and medium income
countries. In: 2016 IST-Africa Conference, IST-Africa 2016.
Durban: IEEE; 2016: 1–10.
Address correspondence to:
Michael C. Velarde, PhD
Institute of Biology
College of Science
University of the Philippines Diliman
Quezon City 1101
Philippines
E-mail: mcvelarde@up.edu.ph