deCODEme

I was watching part of the Martha Stewart show last week and caught an interesting segment on personalized medicine. She featured Kari Stefansson, MD, PhD, CEO and co-founder of deCODEme, a company in Iceland which detects risk factors for certain illnesses through your DNA. Their idea behind the genetic testing is to provide information to individuals for the ability to make preventative decisions about their health for the future.

The complete scan includes 35 illnesses covering various cancers, heart disease, diabetes, rheumatoid arthritis, crohn's disease, multiple sclerosis, restless leg syndrome, nicotine dependence, glaucoma, psoriasis, and others. The company says it is different from its competitors, because it gives better accuracy and information on ancestry. Of course, this testing is only capable if you have about $1,000 lying around.

This made me think about genetics and eating disorders. Hypothetically, (we all know how I love to ask these questions) if there was a specific "anorexia," "bulimia," or "beinge eating disorder" gene, would you have gotten tested?

Another question I thought about was from a statement Stefansson said. His thoughts were that within 5-10 years, every child would have this type of testing--that it would be a standard thing in infant care. If this were the case (and I doubt it could actually get to the point of being "standard" as some people would be opposed to it), would you get your child tested for an eating disorder gene or any of the illnesses they cover?

*Note: My own belief is that any eating disorder is not solely biological nor cultural, but a combination of both. The questions asked are just for hypothetical questions and to get discussion going. ;-)

Which genes drive metabolism?

Reuters reported an interesting article a few days ago about researchers finding 4 genes that drive metabolism. The four genes FADS1, LIPC, SCAD and MCAD affect the metabolism by determining the rate in which individuals burn up food. These genetic variations could lead to personalized treatment for those who have susceptibility to obesity or coronary artery disease which have genetic components.

So this made me wonder. If you knew you had these genes and that your body would never be the "thin" (in your terms) ideal that you wanted, would you continue to pursue your efforts in trying to obtain it? Would it actually give you a sense of peace, knowing that you didn't have control over what your body did or rather would it make you feel worse, like your body was betraying you by having these certain genes?

Pharmacogenetics and depression

A few weeks ago, the Mayo Clinic recently published a new study on phamacogenetics (the study of how people's genetic makeup affects their response to medication) and depression. Researchers genotyped DNA from 1,914 individuals from a sample of the Star-D study (Sequenced Treatment Alternatives to Relieve Depression Study), a seven year study that analyzed treatment of depression in adults. In this particular study, they looked at the serotonin receptor gene, SLC6A4, and the likelihood to respond to the anti-depressant, citalopram (celexa). The results showed that there are two variations in the gene which determine who may respond to this anti-depressant.

The researchers also investigated among racial populations of white, black, and hispanic individuals. They found only the white patients with the two distinct variations in gene were more likely to have remission of depression symptoms as compared to the other two groups.

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Personally, I find pharmacogenetics really fascinating. It's essentially an extension of personalized medicine. If you have read this blog before, you know I'm a big advocate of this. I talk about it in this post awhile back with rEEG and eating disorders. There's just so much out there that we don't know about the very nature of our own human genetic make-up--what works, what doesn't, etc., but we continue to learn everyday new discoveries for implications in a variety of disorders. The chairman of the Mayo Clinic, Dr. Mrazek, sums it up nicely in regards to this study.

He says, "Each step is a step toward greater accuracy in prescribing the right medication for each patient. "First, we started with trial and error - which feels like flipping a coin to select a medication. The Holy Grail would be to be able to consider the implications of variations in many genes. Ultimately, we hope to be able to determine with great accuracy which patients will respond to specific antidepressants and which patients will almost certainly not respond."

He also estimates that within two years there will be more extensive tests available which will focus on more than one gene. I guess this is a stay tuned for now to see what new research will emerge.

rEEG and eating disorders

A new study recently was presented about the use of rEEG (referenced-EEG) for the selection of medications in those with refractory eating disorders and comorbid depression. I'm never too keen on the word "refractory," but in this case, it means those who had multiple inpatient or partial hospitalizations and had tried medications without success for their symptoms.

So what is rEEG exactly? rEEG is a new system of image diagnostic testing which uses the standard EEG and quantitative EEG known as QEEG. The patient's report is then compared to a large normative database to assess which classes of medications would be useful for treatment. Essentially, these reports are telling physicians which medications will likely improve brain function.

This study consisted of 8 female patients with both anorexia or bulimia and depression. After the rEEG and establishing which medications(medication classes were antidepressant, stimulant, anticonvulsant, and combinations), psychiatrist followed the patients at 8 weeks, 6 month, and the two year mark. Questionnaires for depression and clinical symptomology were used.

The results showed that there was decreased depression and significant improvement in eating disorder symptoms and weight. Beyond that, after the rEEG medication recommendations, hospitalizations significantly decreased among the patients.

Although this is a very small study, I think it is very interesting. Personally, I'm not a medication fan, but I do think there is a place for them as well as natural methods too. I think when you can decrease the trial and error approach to finding which medication will work for you, the frustration level lessen. Besides, some people (even like me as I roll my eyes here) may be more apt to trying them.

In general, I think personalized medicine is the next wave of medicine. If you think about it, our body and brain chemistries are all different. What may work for one person won't necessarily work for another. While weight restoration and using food as medicine are highly important factors in recovery, medications can be helpful for combating some symptoms. Right now, other than fluoxetine for bulimia, there is no effective medication out there for eating disorders.

I hope there will be larger and longitudinal future studies using this treatment approach. Honestly, I would think the insurance companies would be jumping on this bandwagon as it would reduce health care costs which is something we all know they are about. Sad really.

Poster of study