All In The Genes

Precision medicine could reveal the secrets of Asia’s collective DNA without carrying the risks of consumer genetic testing. Here’s how.

Going behind the genes

In Asia, the crown for the most mature genetic testing market belongs to Japan. Given that a third of its population is projected to be 65 or older by 2035, more and more people in Japan are seeking insights into potential health risks they may face as they age.

Locally, the sector is dominated by two companies—Genequest and Genesis Healthcare—with the latter formed in 2004, predating American personal genomics company 23AndMe by two years.

Through its flagship GeneLife test kits, Genesis Healthcare has almost a million customers across Asia, and offers a glimpse into the likelihood of developing various cancers and conditions like cardiovascular disease.

Intriguingly, GeneLife kits also assess qualities that seemingly lack genetic links, including caffeine-induced anxiety, the ability to communicate in relationships and your romantic success rate.

Meanwhile, in China, 23Mofang analyzes all these things and more, with a uniquely Chinese twist. For the affordable price of 449 yuan (US$69), customers can discover if they are related to ancient royalty like Emperor Gaozu, the founder of the centuries-long Han dynasty. Along with GeseDNA, 23Mofang is just another example of around 100 companies in the genetic testing space, with the local industry expected to see around US$405 million in sales by 2022.

Despite the buzz, few are familiar with how these tests actually work. On the surface, they appear to be pain-free and—let’s face it—pretty fun affairs; all you have to do is order the kit online and provide a saliva sample in the designated tube. After shipping it to the test provider, sit back, relax and wait for the results to be revealed.

Behind the scenes, DTC companies use a quick and inexpensive technique known as genotyping to analyze genetic material. By looking at variations at specific portions of DNA, genotyping can identify potential disease-causing mutations, but it requires a pre-defined list of variants to watch out for. As a result, genotyping is unable to pick up variants outside this list, making it prone to false negatives, even more so in Asia, given the region’s lack of genetic representation.

“Cancer and Alzheimer’s are considered complex genetic diseases, where certain variations increase the risk of developing the disease in an individual,” explained Dr. Saumya Jamuar, a senior consultant of the Genetics Services, Department of Pediatrics at Singapore’s KK Women’s and Children’s Hospital. “Yet, many of the genetic risk factors remain unknown, especially in the Asian context.”

Given these limitations, users like Singapore-based research assistant Mr. Sean Ou, who tried the test kit CircleDNA from Hong Kong DTC company Prenetics, believe that fellow consumers should approach results from genetic tests with caution.

“[In my experience], CircleDNA presented the genes associated to the target phenotype or genotype, together with a concise description of the results with citations,” shared Ou. “However, some genetic results are largely based off scientific associations, so users may need to apply a little discernment while interpreting the results.”

As it turns out, Ou’s concerns aren’t exactly unfounded. Given the lack of industry standards for DTC testing in China, it means that companies can use different testing procedures and databases, with the same sample potentially yielding multiple interpretations of questionable accuracy.

“If [DNA testing companies] have the proprietary data of locals, the accuracy may be better,” said Jamuar. “However, it is difficult to prove or disprove as the data is proprietary and the companies involved may not be willing to share them for review.”

A molecular biologist by training, Kami Navarro left the sterile walls of the laboratory to pursue a Master of Science Communication from the Australian National University. Kami is the former science editor at Asian Scientist Magazine.

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