- Bien-être & santé -
Dr Goranka TANACKOVIC
A PERSON’S AUTHENTICITY IS NOT CONFINED
TO THEIR GENETIC HERITAGE
Knowing one’s genome used to be the stuff of science fiction. Progress has been spectacular, and one can well imagine that in the near future, everyone will have access to all or part of their personal information. A geneticist and biologist who graduated from the universities of Zagreb and Geneva, Dr Goranka Tanackovic is an EXPERT in genetic analysis and heads Gene Predictis, a pioneering start-up in the field of personalized preventive medicine, currently housed in the Innovation Park at the Federal Institute of Technology Lausanne (EPFL).
On what are the Gene Predictis genetic tests based?
Genetically speaking, human beings are 99.9% the same. We are interested in the rest, the genetic differences that make us unique, the ‘genetic variants’. The tests we conduct are aimed at ascertaining the specific individual characteristics which mean that we have unequal chances with respect to certain risks, or that show different reactions to certain products or foods.
What type of genetic tests does Gene Predictis currently offer?
Most of our activities at this time are focused on optimizing drug therapies. Our Cypass® test enables an evaluation of individual responses in terms of the effectiveness of various drugs, the risks of side-effects as well as the means by which they are eliminated. In order to produce effects, most drugs are transformed by our body via various metabolic paths that one might compare to roads. Even though these roads follow the same path, they may feature varying degrees of speed and be more or less crowded. Some reach their destination faster than others and with less undesirable effects. By studying almost 100 personal genetic variants, we can evaluate how an individual metabolizes a drug, which path is the fastest and safest for that particular person and therefore which type of treatment is most suitable. We thus draw up a kind of personal identity card. Based on this information, physicians can direct their prescriptions towards drugs to which a given organism is liable to respond better, while minimizing side-effects and taking account of potential interaction with other existing treatments. Based on a similar approach, our Pill Protect® test evaluates the individual risk of thrombosis for a woman taking the pill. This condition represents the major contraception risk, but can also be related to menopausal treatments and the post-partum period. This test is the first specifically developed to measure the risk of thrombosis linked to the contraceptive pill. It has been validated by a clinical study involving 1,600 women. It acts as a scientific complement to the classic gynecologist’s questionnaire at the time of prescribing the pill. The clinical study showed that it detects six times more women at risk than the traditional questionnaire.
How are tests conducted and are they exclusively prescribed by doctors, or can individuals get direct access to them?
For ethical reasons, we work exclusively with professionals, physicians, hospitals and clinics. We regard ourselves as a partner providing additional insight, but they are the key contacts for patients, with the global vision cultivated by each one. It is important at this point to recall that Swiss legislation prohibits offering medical genetic tests to patients directly. Our genetic tests have lifelong validity and are conducted on DNA taken from blood or extracted from mouth lining scrapings. The results are detailed in a comprehensive report sent to the prescribing physician who explains them to the patient. The results of the Cypass® test are also summed up on an anonymous and confidential credit card-format document that the patient can keep with them, in the same way as their blood group card, and use during medical visits or future prescriptions.
What are the concrete objectives of these tests?
Here again, we follow a strict code of ethics. Our analyses focus on pathologies for which there is a response strategy, whether in terms of prevention or treatment. We are deliberately geared towards solutions. By way of example, we know how to measure an individual’s predisposition to certain diseases, such as exfoliative glaucoma or age-related macular degeneration (AMD), before the first symptoms appear. In the case of glaucoma, there is a preventive surgical treatment that can prevent the pathology being triggered. For cardiovascular diseases, our nutrigenetic tests can serve as a basis for a lifestyle change in case of a known risk.
What do nutrigenetic tests involve?
They enable people to adopt a diet suited to their genetic makeup. They evaluate the risk of developing a food intolerance or the capacity to metabolize certain nutriments, such as gluten, lactose, as well as caffeine and alcohol. For example, the genetic test evaluating the risk of developing a gluten intolerance is an excellent means of confirming the diagnosis. One can definitively exclude this intolerance if results are negative, something that cannot be achieved by a serological test alone. On the other hand, if the gluten test pinpoints a predisposition to intolerance, a subsequent intestinal biopsy will potentially serve to confirm celiac disease. It is therefore the first stage of the diagnosis. Nutrigenetic tests help the physician or the nutritionist to create a tailored diet pattern, without pointless deprivation, whether in terms of hypercholesteremia, folates or a deficiency in vitamin D or B12. In case of chronic insomnia or tachycardia, the manner of metabolizing coffee can provide scientific confirmation. In the field of lifestyle habits, our genetic tests can show whether someone is more suited to endurance sport or intense effort, such as measuring their risk of ligament injury… All of which is useful information to optimize training. From better-aging to osteoporosis, the field of applications is truly vast.
These advances can change everything in the treatment of serious pathologies such as cancer. Can you explain how?
Certain genetic mutations lead to certain cancers. In a family-based risk context, genetic tests can confirm the presence or absence of a specific mutation within an individual and thus enable a preventive treatment or stricter monitoring. Let’s take the example of breast cancer with the mutation of one of the BRCA genes that was widely discussed in relation to Angelina Jolie. Mutations of these genes are relatively rare within the population as a whole, and yet they are present among 10% of women who have a familial or inherited type of breast cancer. So for families at risk, the test is extremely worthwhile and can be used after concertation with physicians. In other cases, an isolated test is of extremely limited value.
Each individual is free to decide if they want to know the results of their genetic tests or not. If the patent does not wish to know, the results can be passed on exclusively to his or her physician, who will take an informed medical decision, without revealing the genetic results. I think it is extremely important to respect personal choices, particularly in the case of families with certain genetic risks. Some family members may not be keen to have that information, but globally speaking it is worthwhile knowing the risks if one can change things…
At the end of the day, might one say that a knowledge of our genetic predispositions makes us responsible for managing this initial capital to the best of our ability, and thus gives us a certain degree of freedom?
Yes. I personally consider a genetic profile as a joker; it is up to each person to handle their initial data by taking the right decisions in terms of diet, exercise… Not everything is predetermined and we all have the possibility of enriching and turning our capital to good account by adjusting our lifestyle. Indeed, experience proves that people who know their conditions tend to follow their physician’s guidance more faithfully.
Is there a risk of abusive use? How can one decide to analyze certain genetic aspects only when it is possible to see all the rest? Do you think these tests will remain confined to prevention without ever leading to the temptation to optimize human beings?
Here at Gene Predictis, we operate an ethical code of conduct: we perform the analysis requested by the physician and nothing else. Once again, there is no point in detecting something for which we currently have no solution. Gene therapies are moving ahead but are still far from highly effective, as we are facing a number of technological challenges. By way of example, gene therapy trials on Duchenne muscular dystrophy and cystic fibrosis raise a number of unresolved issues. Whatever the case, I am convinced that society can play an essential role in defining a legal framework for these activities as of now. Safeguards are absolutely necessary in order to guarantee individual freedom. We must work on international ethical codes in order to determine what we want to do with our health.
How would you define the link between genetic heritage and an individual’s authenticity?
A person’s authenticity is not confined to their genetic heritage. It also encompasses the influence of our environment, our social relations, our personal history, our life experiences and our values. I agree with the idea put forward by Professor Proust who estimates that innate characteristics account for one-third of who we are, and our lifestyle for two-thirds. Human beings are in a state of flux within a huge overall dynamic; they progress and are shaped by their adventures, and this aspect is the most fascinating of all.
Based on an interview by Anne-Marie Clerc