Monday, August 25, 2014

Personal genomics in India

Personal genomics - where a consumer directly gets his or her DNA sequenced through a private company to learn about their predispositions to various diseases as well as other lifestyle conditions - has been on the rise in the West, with companies springing up to offer direct-to-consumer genetic testing, and a McKinsey report anointing it as one of the 12 disruptive technologies of the future, with an estimated market value of around 1 trillion dollars in a decade from now.

In India, however, personal genomics is very much a nascent industry. Three years ago, I wrote about Acton Biotech, a company that at the time was planning to introduce India's first commercial genome scanning service. While that doesn't seem to have happened, I recently had a chance to speak with Anu Acharya, the CEO of Hyderabad-based Mapmygenome, which started offering large-scale genome tests to customers last year under the brand Genomepatri.

In the three years since I last wrote about the Indian personal genomics market, Mapmygenome is one of a clutch of companies that have emerged in this space - Xcode and Nutragene are some of the others. However, the tests offered by these companies are smaller in scale and cheaper, and often focus on a particular condition - cardiac disease, for example. In comparison, Genomepatri (which has been used by over 2000 customers so far), tests a few thousand genes that are linked to 110 different conditions, such as metabolic disease and oesophageal cancer, chosen for their relevance to the Indian population. Mapmygenome does offer some targeted panels as well, of which the cardiac and oncology platforms are fairly popular.

Mapmygenome couples its testing platform with genetic counseling for each consumer, so that people can better understand the implications of their genomic data and how to use it to make informed decisions about their health and lifestyle. In doing so, the company manages to avoid a major loophole that has snagged other DTC companies like 23andMe - that of leaving data interpretation to consumers, who quite often don't have much of an idea what to do next with information that may or may not be clinically valid. 23andMe was in fact sued by a customer, and have since shut down their DTC genetic testing service altogether after getting hit by an injunction from the FDA.

There's another problem that Mapmygenome has had to tackle, which is the fact that there isn't a comprehensive genetic database created using the DNA of the Indian population they can draw upon (Some academic efforts to do so are the Indian Genetic Disease Database and the Indian Genome Variation initiative). Populations in the West are genetically different from those in India, and data obtained from Western genetic studies may not always translate easily. They currently use a platform that had been previously developed, while also working to expand their database in collaboration with physicians to clinically validate their findings. Mapmygenome has also tied up with 40 hospitals and chains to offer their services to customers, usually as part of a health checkup.

I think it's fair to say that the full benefits of personal genomics and personalized medicine won't be felt immediately. Right now, the pricing on these tests is still quite high in the Indian context, but given the dramatic speed at which sequencing costs have been falling, this shouldn't be an issue for long. Acharya claims that her company's services have gotten a good market response. But in general, genetic tests still remain a niche product, and will do so until the Indian public is better educated about their value.

We've already seen the emergence of targeted drugs in oncology - Herceptin is the classic example - that prove the value of genetic testing as a diagnostic device. However, there aren't similar targeted interventions that can act as preventive therapy; the advice given by most genetic counselors still remains in the realm of "Eat healthy and exercise". Allow me to get a little fanciful and speculate that what can make preventive testing more meaningful is if we can develop epigenome sequencing platforms as well, which take environmental factors (diet, lifestyle) into account, and may provide a more tailored dataset for a single individual.

Nonetheless, the possibilities for personal genomics in India remain vast, and can potentially spur much-needed innovation in healthcare and targeted therapies. Let's hope that companies like Mapmygenome and their ilk are able to deliver on their exciting promises.

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