Question 1

Can you clarify what you meant about liquid biopsy screening still being under research, and whether that applies to lung cancer too?

Dr. Shrinidhi Nathany · Accepted Answer

The cancer screening approach using liquid biopsy, which uses circulating tumour DNA in blood to catch early-stage disease, is still under research overall. In some cancers like lung cancer it has already been mandated and recommended by guidelines, but in other cancers it is still under research. For lung cancer specifically it is already recommended and proven; for other cancers it is still under research. And for any kind of inherited genetic disease, we can test the family and detect the genetic disease in other family members early.

Question 2

Can liquid biopsy also be done for other purposes, not just lung cancer screening?

Dr. Shrinidhi Nathany · Accepted Answer

Yes.

Question 3

What has caused the rise in cancer in the world today?

Dr. Shrinidhi Nathany · Accepted Answer

What has caused the rise in cancer is multifactorial. Number one is lifestyle. Number two is environmental insults like radiation and the kind of food we eat, and stress. But also underrated and underdiagnosed is genetics, and at least 30% of cancers are genetic, so we need to test to understand those cases.

Question 4

Can you clarify what CRISPR-Cas9 is?

Dr. Shrinidhi Nathany · Accepted Answer

CRISPR-Cas9 is a technology related to gene therapy that lets you edit the gene. CRISPR is gene editing, and the Cas9 technology is what lets us edit the gene, for example the gene causing type 1 diabetes mellitus, and deliver it back to the patient so the disease is cured. That is not yet available in all countries.

Question 5

What is the most common genetic cancer?

Dr. Shrinidhi Nathany · Accepted Answer

The most common genetic cancer, as it's the most commonly tested for, is breast cancer. Breast and ovarian cancer has a syndrome called hereditary breast and ovarian cancer syndrome, and that is the most common because it is right now the most tested for. However, there are many more cancers which can be inherited.

Question 6

Can molecular genomics help in preventing aging?

Dr. Shrinidhi Nathany · Accepted Answer

That is the most in-thing right now, which is longevity testing, which can tell you your actual biological age. Supposing you are 30 years of age by your date of birth, but because of stress your body may actually be 40 years old biologically. You can prevent that: we can first study why your body is aging faster, and then you can modify your lifestyle based on the genetics, what you should eat and what you should not eat and what kind of therapy you should take, and it gives you a lot of a personalised report.

Question 7

Can you clarify more about gene therapy?

Dr. Shrinidhi Nathany · Accepted Answer

For example, sickle cell anaemia is caused by a point mutation where only one letter in the genome is changing. So what we can do is if A is becoming B, we make the B back to A and edit that gene, and deliver it through an IV cannula in the form of a solution. That is what is going to get integrated into the patient, and the disease can be cured. That is what gene therapy is.

Question 8

Can we do genomic modifications to prevent cancer?

Dr. Shrinidhi Nathany · Accepted Answer

Well, not yet. What we can do is, supposing somebody in my family got cancer, I can get my genes tested so I know whether I am at risk of getting that cancer, and then I can try to catch it early, because once you're at a last stage it becomes difficult to cure. If you catch it early you can still cure the cancer.

Question 9

What are the common tumour marker genes tested for routinely?

Dr. Shrinidhi Nathany · Accepted Answer

The recommendation is to test at least 50 genes. If somebody is interested I can send the list across to the Jivo team and they can share it with everybody.

Question 10

Is it possible to combine genes from three people to get the desired characteristics of a baby?

Dr. Shrinidhi Nathany · Accepted Answer

Yes, that is what is called designer babies, which can be done. You cannot really extract only particular genes, but you can make designer babies now in the lab through clinical embryology.

Question 11

I didn't understand well the difference between genetics and genomics. Based on which examination or test can we know genetic and genomic compatibility?

Dr. Shrinidhi Nathany · Accepted Answer

The difference between genetics and genomics: you are a clinician, you are seeing the patient. What you see in the patient is genetics. What I do in the lab is genomics.

Question 12

What test is used for [pre-marital] compatibility genomics?

Dr. Shrinidhi Nathany · Accepted Answer

It is called genome sequencing.

Question 13

How did the robot help in the testing process?

Dr. Shrinidhi Nathany · Accepted Answer

The robot helps us prepare the sample inside the machine and helps us detect which gene is there.

Question 14

What about the cost and outcome? Is it relatable, and what about affordability for middle-income countries?

Dr. Shrinidhi Nathany · Accepted Answer

Yes, it is very much relatable. The cost is relatable to the outcome because you can get those therapies for much lesser cost in middle-income countries, and there are also patient access programmes where they reduce the cost of these medicines. I already said it can be between $300 to $1,000.

Question 15

How can you treat Alzheimer's disease using molecular genetics?

Dr. Shrinidhi Nathany · Accepted Answer

You can't really treat Alzheimer's disease based on molecular genetics, but you can at least know what is causing the Alzheimer's disease so that the other family members can be helped.

Question 16

What about chronic hepatitis and hepatic carcinomas, an infection causing cancer? Can genomics help here too?

Dr. Shrinidhi Nathany · Accepted Answer

That is an infection causing cancer. But in this case too we can test for hepatitis B virus DNA, and we can monitor the disease by checking how much of that DNA is in the patient's blood, to see whether the patient is responding to treatment or not.

Question 17

I'm interested to know what genomic sequencing is all about.

Dr. Shrinidhi Nathany · Accepted Answer

All the genes in the body which cause some genetic disease or some kind of cancer, that is what we look at in genomic sequencing. We try to know what the sequence of that gene is.

Question 18

How can genomics be applicable across medicine?

Dr. Shrinidhi Nathany · Accepted Answer

In all aspects of medicine, it can be applied to know the diagnosis, to know the risk of the disease in the family, to also know what kind of therapy will work or not, and also for prevention.

Genomics Revolution in Cancer

Questions Doctors Asked Dr. Shrinidhi Nathany