By Megan Scudellari / June 19, 2014 1:10 PM EDT
Rows of small white bungalows, once the property of workers at the local textile mill, still line the streets of Kannapolis, North Carolina. A larger-than-life bronze statue of town hero and NASCAR icon Dale Earnhardt Sr. looms over the town square, and the single-screen Gem Theater just off Main Street shows the latest movie releases on weekends. It is, on the surface, a traditional Southern town.
But a short walk from the center of Kannapolis, just down the street from the local Baptist church and across from a tractor supply store, stands a blocky, nondescript gray building with a small parking lot and manicured landscaping. Inside is a huge warehouse, the length of two football fields. The space hums with the whirr of high-powered fans in the ceiling, which cool rows of tall gray freezers, each marked with an orange biohazard sticker. A technician opens a freezer and cold white mist pours out, revealing small metal boxes full of plastic vials—vials containing human blood and urine.
These are the bodily fluids of the locals. Since 2009, scientists have been collecting and storing biological samples from Kannapolis-area residents as part of a grand experiment. The project is big and bold: collect large amounts of physical and biochemical information from 50,000 townspeople, store that information in computer databases, then sift through it for molecular signals of disease. The goal is to rewrite the textbook of medicine.
It’s something we’ve needed for a while. Even in the 21st century, with the advent of anesthesia, vaccines, antibiotics and more, medicine remains a sophisticated guessing game. For example: An individual develops pancreatic cancer. As there is no reliable test for early detection of pancreatic cancer, the tumor is almost surely large by the time it’s discovered. Our imaginary patient, newly diagnosed, is prescribed the top-of-the-line chemotherapy. The treatment is difficult; he loses his hair, can’t get out of bed and vomits daily. If that drug cocktail doesn’t work, he is prescribed the second-best therapy on the market. If that therapy doesn’t work, it’s on to the third-best—fingers crossed that this one shrinks the tumor. His medical treatment is not tailored to him; his doctors do the best with what they have, but what they have is a one-size-fits-all approach.
A growing contingent of researchers and doctors advocate overhauling contemporary medicine by creating a medical system tailored to individuals. Also called molecular medicine, personalized medicine aims to tailor treatment based on molecular markers found in a patient’s blood, spit, urine, muscle tissue or pretty much any other part of the body. These molecular signals or “biomarkers,” such as a mutated gene or an overabundant protein, might eventually be used to more accurately predict disease risk, make diagnoses and identify the best treatment options for individuals. This new paradigm of medicine has been heralded since the sequencing of the human genome, but has yet to come to fruition. In fact, no one knows if it is going to work. But the residents of Kannapolis have signed up to try to find out.
Kannapolis isn’t the first place scientists have built a biobank of human samples. The Department of Veterans Affairs’ Million Veteran Program, launched in 2011, has collected blood samples and clinical information for over 200,000 veterans. Health care provider Kaiser Permanente in California is gathering genetic and medical data on 500,000 of its members. These are just two examples, and there are many more.
But the Kannapolis study is unique and important because of its community-based approach. In an established community, scientists can compare sick patients with healthy individuals who are not only the same age and gender but also live in the same neighborhood, helping to remove environmental and socioeconomic factors from the equation. Also, by ingraining the study into the culture and families of the town, scientists can better keep track of participants and follow them over long periods of time with a low risk of dropouts—a common pitfall in long-term studies.
Pastor Andy Langford of the Central United Methodist Church was one of the first volunteers to pee in a cup and have his blood drawn. “It only took 30 minutes. It wasn’t that big a thing,” he says in a gravelly Southern drawl. Langford pauses when asked why he participated. “It has potential to improve the health of everyone. Not just in this community, but everywhere. Why wouldn’t I do it?”
Murdock and the Mill
The MURDOCK Study (Measurement to Understand the Reclassification of Disease of Cabarrus and Kannapolis) is named after its founder and funder, David H. Murdock, the billionaire owner of the Dole Food Co. In 1985, Murdock lost the love of his life and wife of 18 years, Gabriele Murdock, to ovarian cancer. After her death, he became obsessed with longevity, devouring scientific articles on nutrition and health, seeking out experts on the topics, and in 2003 founding the Dole Nutrition Institute to support nutrition research.
Eventually the local economy improved—thanks in part to jobs created by the NCRC, which employs many residents in administrative, maintenance and even biotechnology positions—but some residents still declined to join the study. People can be scared off by the blood draw, says Leah Bouk, the clinical research coordinator for the study, but the most common reason for declining is privacy concerns, specifically whether the government can access participants’ samples and identities (it can’t).
To gain trust and alleviate fears, the MURDOCK team members embedded themselves in the community. Organizing health fairs, they offered free blood pressure screenings and Dole bananas. They went door to door, describing the study, and distributed “I Support the MURDOCK study” yard signs. Though Murdock doesn’t live in Kannapolis, when he visits, he joins in the effort. Last year, for example, he attended an enrollment drive at a primary care practice, where he gave a short presentation, then answered questions from local doctors.
Today, enrollment proceeds at a steady clip, with about 28 enrollees per week. “The community has really begun to rally,” says Perry. Langford enrolled, then persuaded 150 members of his flock to join the effort. Marie Dockery, director of a free health clinic in Concord, a town south of Kannapolis that is included in the study, enrolled. “We have seen the effects of not being informed about health in our parents and grandparents,” she says. “I think there’s an altruistic appeal for people to do this for the betterment of our community.”
Each participant is asked to donate three tablespoons of blood and three tablespoons of urine, and signs an eight-page consent form that gives researchers access to the samples. Participants receive a $10 gift card, but most, like Dockery, cite noble motives for joining.
The MURDOCK team already has enough samples to go to work. Duke researchers are using the biobank to study aging and cognitive decline, severe acne, physical performance and multiple sclerosis.
Simon Gregory, a Duke geneticist who identified one of the first genes associated with multiple sclerosis in 2007, is searching for biomarkers that signal progression of that incurable disease. MS is an inflammatory disease in which the body’s own immune system cells attack protective sheaths around nerves, leading to irreversible nerve damage. Currently, MS is diagnosed through an MRI scan that detects scarred neural tissue. “But what we’d like to develop is a biomarker that could either tell an MS patient if they’re going to have a relapse ahead of time or be an early marker for diagnosis,” says Gregory.
Gregory’s team has collected all the data and is now in the process of analyzing it, looking for signs that might indicate disease progression.
“The tremendous thing about the MURDOCK study is that its collection protocol is so good. They collect the samples in all the same way,” says Gregory. Standardized samples, plus the NCRC’s cutting-edge instrumentation, create the “perfect storm” for biomarker research, he adds. “The MURDOCK study [unites] all of the things we need to find these answers.”
Yet for all the potential, Kannapolis locals are aware that the study is unlikely to directly affect their health in the near future. But it has already begun to affect them in other ways. “Kannapolis is once again on the map,” says Perry. “We’re proud of the fact that we’re doing our part to personalize medicine.”