Friday, January 21, 2011

One size does not fit all

On January 11th of this year, 23andMe, one of several companies offering direct-to-consumer genotyping (or genetic testing), put out a press release entitled, "23andMe Presents Top Ten Most Interesting Genetic Findings of 2010."

I found number 5 on that list to be quite appealing. It reads, in part:

One size doesn’t fit all — personalizing treatment

The old adage, “take two aspirin and call me in the morning,” doesn’t work as well as we might think. It turns out that one size doesn’t fit all when it comes to drug response, and for some people, certain drugs might be more effective, not work at all, or even produce serious side effects. The growing body of pharmacogenomics research has helped us understand that, at least in part, genetics play a role in how well some drugs work for different people. The 23andMe Drug Response reports link customers’ genetics to the way they might respond to certain drugs and medications. The results range from whether you’re likely to benefit from a drug, need a different dose due to sensitivity, experience toxic or adverse effects, or even have increased risk for other conditions. 23andMe cautions that its Drug Response reports should not be used to independently establish, abolish, or adjust medical treatment and medications but should be discussed with your physician. Only a medical professional can determine whether a particular drug or dose is appropriate for you.

The piece goes on to describe, briefly, two genes, CYP2C9 and VKORC1 and the role of variants of these genes in warfarin dosing.

OK, so this is all neat but really only represents the tip of the tip of the iceberg. There are many more examples of one size not fitting all and reaching far beyond pharmaceuticals. We and many others have reported on many such interactions between certain genetic variants and diet which affect disease risk. On this blog, I have listed some examples pertaining to HDL-cholesterol. And those variants that show interactions with physical activity as modifiers of disease risk are really interesting. And not to forget other environmental factors or lifestyle choices of sleep, latitude and altitude of residence (how much seasonality you experience, oxygen tension), use of alcohol, use of tobacco, and so forth.

For scientists, medical professionals and the general public alike, clearly a greater understanding of elements at the basis of "one size does not fit all" would be welcome. Stay tuned, it's happening - more of these elements, the gene-environment interactors, are being described and collated into databases.