What next? “Adopting one additional healthy behaviour

To delay onset or prevent disease by….

The need for large studies: CHD versus SBP in the Prospective Studies

Collaboration (PSC)

Usual SBP (mmHg)

120 140 160 180

1

2

4

8

16

32

64

128

256 Age at risk:

80-89

70-79

60-69

50-59

40-49

500,000 people

Usual SBP (mmHg)

120 140 160 180

1

2

4

8

16

32

64

128

256 Age at risk:

80-89

70-79

60-69

50-59

40-49

50,000 people

Usual SBP (mmHg)

120 140 160 180

1

2

4

8

16

32

64

128

256

Age at risk: 80-89

70-79

60-69

50-59

40-49

5000 people

UK Biobank is a major national health resource designed to improve the prevention, diagnosis

and treatment of a wide range of illnesses

Why is Biobank special?

• Very large size (n=503,000)

–1000s of disease cases for adequately powered case-

control and case-cohort studies

• Extensive and detailed exposure measures

• Comprehensive follow-up

linkage to a wide range of health-related records

questionnaires

detailed phenotyping of outcomes

• Open access resource: see www.ukbiobank.ac.uk

Gene-environment interaction

High throughput, low-cost methods

Automated sample archive

• Blood

whole blood

serum

plasma

red cells

buffy coat

• Urine

• Saliva

Total > 15 million aliquots

Enhancements • Web-based questionnaires for additional exposures and

outcomes (cognition, mental health, occupation..)

• Repeat of baseline assessment every few years in a

subsample of 20-25,000

• Wrist-worn accelerometers mailed to 100,000 participants to

measure physical activity

• Standard assay panel on samples from all participants

• Multimodal imaging in 100,000 - brain, cardiac and body fat

MRI; bone & joint DEXA; 3D carotid ultrasound

• Genotyping of all participants (820,000 SNPs)

• Continuous monitoring of cardiac rhythm

Enhancements

Neurodegenerative conditions

Condition Self-report

at baseline

(n)

Incident outcomes* (n)

by the end of:

2012 2017 2022 2027

Stroke

Alzheimer’s

Parkinson’s

7,000

100

900

2,000

800

1,000

5,000

3,000

3,000

9,000

9,000

6,000

20,000

30,000

14,000

*Estimates based on UK age- and sex-specific rates, adjusted for potential healthy cohort

effects and losses to follow-up, rounded to nearest 1000 (or nearest 100 if < 1000)

Age

Preclinical

Prodromal

Dementia

60 75 90 45

Cognitive Health

The Challenge

Identify early determinants

Identify early treatments to delay onset

Identify treatments to: 1. slow progression 2. relieve symptoms

Prevention Delay Slow / Relieve

The Step-change

• Dementia dedicated ‘big data’ platform

• Triangulation between multiple independent datasets

• Closer synergy between scientific specialties

• Closer partnership between academics and industry

• More targeted analytic questions

• Reducing transaction costs………

Methods Development

Dementia Resources

Readiness Cohort

Amyloid Cohort

Genetics Discovery

Cohort

Omics Discovery

Cohort

Biostatistics

Dementia Outcomes

Cognitive Assessment

Trials Recruitment

ELSI

Brain & iPSC Donation

Deep & Freq. Phenotyping

Experimental Medicine

Synaptic Function

Immunity

Vascular Determinants

Metabolic Determinants

Early Phase Trials

Research Networks

Imaging

Stem cell (iPSC)

Informatics

DPUK

Analytics

Portal Informatics Platform

22 Cohorts

Cohort Integration

The Infrastructure

The Cohorts

Mature Population Cohorts

Familial Disease Cohorts

Prodromal Population Cohorts

The Wider Context