Our DNA holds critical and unique information about us, our traits, and how we interact with medications. DNALabs testing kits are designed to help healthcare practitioners as well as individuals to personalize the treatment options that are best suited for their unique DNA. In this interview, DNALabs Chief Science Officer Aaron Goldman explains how pharmacogenetics can save lives and why it should be incorporated into our healthcare systems.
Please describe the story behind the company: What sparked the idea, and how has it evolved so far?
DNALabs was founded around pharmacogenetics testing, which I always saw as the low-hanging fruit of personalized medicine or genetics, because the variants are so well-characterized, and there are published guidelines for physicians, so it’s clear what prescription adjustments should be made when a patient has a certain genetic variant.
We do most of our business B2B. We sell most of our tests through health care providers like medical clinics, naturopaths, dietitians, pharmacists, chiropractors, GP’s, and hospitals.
We’re also working on a bunch of different research projects where we’re supporting some clinical trials. We’re working with several Toronto hospitals as well as the University of Toronto and the Canadian military.
What kind of DNA tests do you offer at DNALabs?
We have three classes of tests: (1) ‘pharmacogenetics,’ or drug compatibility testing; (2) nutrition and lifestyle testing; and (3) cannabis sensitivity testing.
We launched our drug compatibility test three years ago. As we were doing our outreach and giving talks to doctors, we realized that drugs just don’t work the way they’re supposed to – many types of drugs (especially those used for pain, cardiovascular disease, and anxiety and depression) often require a lengthy ‘trial-and-error’ process where different medications and different dosages are tried until they find one that works. Pharmacogenetics can help minimize this trial-and-error and get patients on the right drug sooner, but there are also many preventative measures you can take to avoid needing drugs in the first place.
Here’s a quick introduction to DNALabs’ MatchMyMeds kit:
That led us to the development of our nutrition & lifestyle test, which has been our biggest seller. There are other companies out there that do similar tests, but what we’ve done is we made it very easy for patients to understand. At the same time, we provide enough information that healthcare practitioners can use to help their patients take their health to the next level. Many companies sell vitamin tests, fitness tests, cardio tests, but we’ve combined all of those into one very comprehensive test.
Canada has legalized cannabis for recreational use two years ago and for that event, we launched a cannabis sensitivity test, which is designed to help pharmacists and doctors prescribe cannabis more effectively, and help people feel more comfortable using it. For example, if someone is a slow metabolizer of THC, and they also carry genetic variants that put them at risk of cannabis-induced psychosis, they should either avoid THC or use low levels of it.
What are the current considerations that doctors take when prescribing medication, and how does your solution impact them?
Many factors go into whether a particular medicine is going to work or not: Age, gender, weight, comorbidities of other diseases, what other drugs the patient might be taking, and so on.
Arguably, genetics is the most predictive of all of those factors. One study showed that up to 95% of drug variability can be explained by genetics. The way it works is that everyone metabolizes drugs at different rates, and that’s usually done by our liver enzymes.
If you metabolize a drug too quickly, it can flow through your body so fast that it never accumulates to effective levels and it just doesn’t work;
If you metabolize too slowly, your body doesn’t clear it away quickly enough and it builds up, leading to adverse drug reactions or unwanted side effects;
If you have an enzyme that metabolizes a drug, and you’re taking another drug that blocks that enzyme, that’s called a drug-drug interaction. Pharmacists and doctors are very well aware of that, but in some cases, you might not even be taking another drug, and the enzyme still wouldn’t work because of a genetic reason. That’s called a gene-drug interaction.
Even though the two last scenarios I mentioned are very similar and lead to the same outcome, gene-drug interactions are not still not getting the attention they deserve.
That being said, DNALabs is working to support clinical drug trials. Most if not all new drugs that are coming to the market these days take pharmacogenomics into account.
What other traits can you uncover with a DNA test, and how can that information help individuals lead a healthier lifestyle?
A DNA test report can help figure out deficiencies and supplementation by looking at a whole broad array of outcomes:
We look at the risk of nutrient deficiencies and nutrient overload. Someone might have a risk of hemochromatosis, which is a rare condition of iron overload. If that person decides to take an iron supplement, because they read somewhere that it was healthy, they could be in danger.
Another example is the physical fitness component of our nutrition and lifestyle test where we identify markers of inflammation. Everyone has inflammation when they exercise, but some people can clear that away quicker than others. If you know your body is slow at clearing inflammation, you can take longer breaks between sets in the gym, or you can take natural products, like antioxidants, NAC, or Omega 3 to help with that inflammation.
We also look at mental health markers. If you know that you’re slow at clearing dopamine out of your brain and as a result, you have more anxiety and stress, you can take vitamins that act as cofactors for the enzymes that clear that up, or lifestyle changes that you can make to reduce the amount of stress and anxiety.
Hormonal health is another big area, especially with women’s health and estrogen metabolism. For example, there are harmful estrogen metabolites that, if not cleared away, retain estrogenic activity and can cause free radical and DNA damage that can lead to chronic illnesses like cancer down the road.
It’s really about making the lifestyle, dietary, and sometimes supplementation and medical changes, and hopefully seeing improvements.
Which trends or technologies do you find to be particularly interesting these days around your field of work?
That’s a great question because it’s a very fast-moving field and there’s so much amazing innovation. The technologies that we’re looking at are obviously around genetics, genotyping, and sequencing. All of these technologies have been around for a while, but they just keep getting better, cheaper, and faster.
We’re always looking to be on the cutting edge. All of our tests look at variations in DNA, but I think the future is going to take a whole ‘OMICS’ approach. We won’t be looking at DNA only, but also at other biomarkers, such as RNA, protein, and the microbiome.
The microbiome looks at the bacteria in our gut – we have more bacteria cells in our bodies than human cells, and we’re now learning that the makeup of bacteria in our gut has big implications for our health.
Epigenetics is another big trend, where we can look at things like DNA methylation that change the DNA and how it’s expressed. These changes can be inherited from generation to generation but are not encoded in the DNA sequence itself. I find that fascinating and I think that’s going to be another area of interest in the future. I don’t think we’re there yet in terms of understanding how to clinically implement epigenetics, but I know that with big data analysis, we’re going to make discoveries and figure those things out.
How can Pharmacogenetics be standardized into our health care systems?
Primarily, our tests were designed to be taken at birth. Your DNA doesn’t change throughout your lifetime, so you can have the report in your health record and it will always be relevant.
Standardizing pharmacogenetics is challenging. In Canada, every province manages its own health care system. They’re always looking to cut costs, so it’s very challenging to get a DNA test, especially nutrition and lifestyle tests, which are often seen as less important than the medical tests.
Private insurance companies are looking to cover a lot of these tests now because they understand that getting their clients’ employees to live a healthy lifestyle will make them more productive at work and these tests can also help to get employees back to work more quickly when they get sick.
Public services on the other hand are very slow to act. They’ve been looking at pharmacogenetics, but they still haven’t included it in their coverage. In the US, they started covering some pharmacogenetics for very specific cases. I believe solving this challenge comes down to education.
Another big challenge here is that we have term limit policies where the government is only in power for four years at a time, so they’re unlikely going to invest in a test today that might save someone from having a heart attack 20 years from now. The return on the investment is not within the government’s four-year term, so there has to be a more long term approach or a vision to implement pharmacogenetics in public healthcare systems. Again, it all comes back to education.
Because of these term limit policies, a lot of the studies have been focused on mental health. Pharmacogenetics is very well established for the biggest impact areas of mental health, like anti-anxiety and antidepressants, because those are always hard to get right.
We know that cardiovascular disease is a huge case for pharmacogenomics. We’ve been doing a few cardiovascular studies with hospitals in Toronto, looking at blood-thinning agents, and we found that the help could be very quick. But if, for example, you’re doing a population study for cardiovascular disease and the impact of pharmacogenetics, you typically have to wait years to understand that the case is better than the control, and that testing is better than not testing.
Anyone doing a clinical trial should be collecting DNA, if not the whole DNA analysis or pharmacogenetic analysis along with it. It doesn’t make sense to do a clinical trial and not take at least a swab because it costs very little compared to the cost of a clinical trial. Take a swab, put the cells in the freezer, or even make DNA and put in the freezer. That doesn’t cost a lot, but it could end up being super valuable down the road.
Imagine doing a clinical trial with a drug that helps people with certain genetics, but kills people with a very rare genetic variant disorder. If a couple of people die in a trial, you can figure out why and come up with a companion diagnostic that would rule out risk factors before prescribing the drug.
We are doing studies in that area and hopefully, we can contribute and convince the government to cover pharmacogenetics sometime in the future.
How do you envision the future of your industry?
I think we’ll have real-time biofeedback that doesn’t just look at DNA but at multiple types of biomarkers. As mentioned above, it’s going to be a whole ‘OMICS’ approach. We might have a watch with sensors that reads protein and RNA biomarkers in real-time and gives feedback on what’s happening in the body. Going back to the iron example, your watch might check your iron levels, either once a day or constantly in real-time, and send you notifications about things you should be eating or doing to keep the levels in check. This might be far in the future, but I think we’ll all have our DNA known.