Perhaps you're one of the 12 million people who has spit into a tube in recent years to learn the secrets in your genetic code, like your ancestry, your health risks, or your carrier status for certain diseases. If you haven't participated in direct-to-consumer genetic testing, you may know someone who has.
It's for people who want more control over their genetic data--plus a share of the proceeds when and if that data is used.
Mountains of genomic data have been piling up steeply over the last several years, but according to some experts, not enough research and drug discovery is being done with the data collected, and customers rarely have a say in how their data is used. Now, a slew of ambitious startup companies are bringing together the best of blockchain technology and human genomics to help solve these problems.
But First, Why Is Your Genome So Valuable?
Access to genetic information is an obvious boon to scientific and medical progress. In the right hands, it has the potential to save lives and reduce suffering — by facilitating the development of better, safer, more targeted treatments and by shedding light on the role of genetics in countless diseases and medical conditions.
Research requiring access to direct-to-consumer (DTC) genomic data is already well underway. For example, 23andMe, the popular California-based DTC genetic testing company, has published 107 research articles so far, as of this May, using data from their five million-plus customers around the world. Their website states that, on average, of the 80 percent of their customers who have opted to share their genomic data for research purposes, each "individual contributes to 200 different research studies."
And this July, a new collaboration was announced between 23andMe and GlaxoSmithKline, the London-based pharmaceutical company. GlaxoSmithKline will be using data from 23andMe customers to develop new medical treatments, while 23andMe will receive $300 million from the four-year deal. Both companies are poised to profit significantly from their union.
Should 23andMe's customers share in the gains? Peter Pitts, president of the Center for Medicine in the Public Interest, believes they should. "Are they going to offer rebates to people who opt in, so their customers aren't paying for the privilege of 23andMe working with a for-profit company in a for-profit research project?" Pitts told NBC. So far, 23andMe has not announced any plans to share profits with their customers.
But outside of such major partnerships, many researchers are frustrated by the missed opportunities to dig deeper into the correlations between genetics and disease. That's because people's de-identified genomic information is "essentially lying fallow," siloed behind significant security blockades in the interest of preserving their anonymity. So how can both researchers and consumers come out ahead?
Putting Consumers Back in Control
For people who want more control over their genetic data -- plus a share of the proceeds when and if that data is used -- a few companies have paired consumer genomics with blockchain technology to form a new field called "blockchain genomics." Blockchain is a data storage technology that relies on a network of computers, or peer-to-peer setup, making it incredibly difficult to hack. "It's a closed loop of transactions that gets protected and encrypted, and it cannot be changed," says Tanya Woods, a blockchain thought leader and founder of Kind Village, a social impact technology platform.
The vision is to incentivize consumers to share their genomic data and empower researchers to make new breakthroughs.
"So if I agree to give you something and you agree to accept it, we make that exchange, and then that basic framework is captured in a block. … Anything that can be exchanged can be ledgered on blockchain. Anything. It could be real estate, it could be the transfer of artwork, it could be the purchase of a song or any digital content, it could be recognition of a certification," and so on.
The blockchain genomics companies' vision is to incentivize consumers to share their genomic data and empower researchers to make new breakthroughs, all while keeping the data secure and the identities of consumers anonymous.
Consumers, or "partners" as these companies call them, will have a direct say regarding which individuals or organizations can "rent" their data, and will be able to negotiate the amount they receive in exchange. But instead of fiat currency (aka "regular money") as payment, partners will either be remunerated in cryptocurrency unique to the specific company or they will be provided with individual shares of ownership in the database for contributing DNA data and other medical information.
Luna DNA, one of the blockchain genomics companies, "will allow any credible researcher or non-profit to access the databases for a nominal fee," says its president and co-founder, Dawn Barry. Luna DNA's infrastructure was designed to embrace certain conceptions of privacy and privacy law "in which individuals are in total control of their data, including the ability to have their data be 'forgotten' at any time," she said. This is nearly impossible to implement in pre-existing systems that were not designed with full control by the individual in mind.
One of the legal instruments to which Barry referred was the European Union's General Data Protection Regulation, which "states that the data collected on an individual is owned and should be controlled by that individual," she explained. Another is the California Privacy Act that echoes similar principles. "There is a global trend towards more control by the individual that has very deep implications to companies and sites that collect and aggregate data."
David Koepsell, CEO and co-founder of EncrypGen, told Forbes that "Most people are not aware that your DNA contains information about your life expectancy, your proclivity to depression or schizophrenia, your complete ethnic ancestry, your expected intelligence, maybe even your political inclinations" — information that could be misused by insurance companies and employers. And though DTC customers have been assured that their data will stay anonymous, some data can be linked back to consumers' identities. Blockchain may be the answer to these concerns.
Both blockchain technology and the DTC genetic testing arena have a glaring diversity problem.
"The security that's provided by blockchain is tremendous," Woods says. "It's a significant improvement … and as we move toward more digitized economies around the world, these kinds of solutions that are providing security, validity, trust — they're very important."
In the case of blockchain genomics companies like EncrypGen, Luna DNA, Longenesis, and Zenome, each partner who joins would bring a digital copy of their genetic readout from DTC testing companies (like 23andMe or AncestryDNA). The blockchain technology would then be used to record how and for what purposes researchers interact with it. (To learn more about blockchain, check out this helpful visual guide by Reuters.)
Obstacles in the Path to Success
The cryptocurrency approach as a method of payment could be an unattractive lure to consumers if only a limited number of people make transactions in a given currency's network. And the decade-old technology underlying it -- blockchain -- is not yet widely supported, or even well-understood, by the public at large.
"People conflate blockchain with cryptocurrency and bitcoin and all of the concerns and uncertainty thereof," Barry told us. "One can think of cryptocurrency as a single expression of the vast possibilities of the blockchain technology. Blockchain is straightforward in concept and arcane in its implementation."
But blockchain, with its Gini coefficient of 0.98, is one of the most unequal "playing fields" around. The Gini coefficient is a measure of economic inequality, where 0 represents perfect equality and 1 represents perfect inequality. Around 90 percent of bitcoin users, for example, are male, white or Asian, between the ages of 18 and 34, straight, and from middle and upper class families.
The DTC genetic testing arena, too, has a glaring diversity problem. Most DTC genetic test consumers, just like most genetic study participants, are of European descent. In the case of genetic studies, this disparity is largely explained by the fact that most research is done in Europe and North America. In addition to being over 85 percent white, individuals who purchase DTC genetic testing kits are highly educated (about half have more than a college degree), well off (43 percent have a household income of $100,000 or more per year), and are politically liberal (almost 65 percent). Only 14.5 percent of DTC genetic test consumers are non-white, and a mere 5 percent are Hispanic.
Since risk of genetic diseases often varies greatly between ethnic groups, results from DTC tests can be less accurate and less specific for those of non-European ancestry — simply due to a lack of diverse data. The bigger the genetic database, wrote Sarah Zhang for The Atlantic, the more insights 23andMe and other DTC companies "can glean from DNA. That, in turn, means the more [they] can tell customers about their ancestry and health…" Though efforts at recruiting non-white participants have been ongoing, and some successes have been made at improving ancestry tools for people of color, the benefits of genomic gathering in North America are still largely reaped by Caucasians.
So far, it's not yet clear who or how many people will choose to partake in the offerings of blockchain genomics companies.
So one chief hurdle for the blockchain genomics companies is getting the technology into the hands of those who are under-represented in both blockchain and genetic testing research. Women, in particular, may be difficult to bring on board the blockchain genomics bandwagon — though not from lack of interest. Although women make up a significant portion of DTC genetic testing customers (between 50 and 60 percent), their presence is lacking in blockchain and the biotech industry in general.
At the North American Bitcoin Conference in Miami earlier this year, only three women were on stage, compared to 84 men. And the after-party was held in a strip club.
"I was at that conference," Woods told us. "I don't know what happened at the strip club, I didn't observe it. That's not to say it didn't happen … but I enjoyed being at the conference and I enjoyed learning from people who are experimenting in the space and developing in it. Generally, would I have loved to see more women visible? Of course. In tech generally I want to see more women visible, but there's a whole ecosystem shifting that has to happen to make that possible."
Luna's goal is to achieve equal access to a technology (blockchain genomics) that could potentially improve health and quality of life for all involved. But in the merging of two fields that have been unequal since their inception, achieving equal access is one tall order indeed. So far, it's not yet clear who or how many people will choose to participate. LunaDNA's platform has not yet launched; EncrypGen released their beta version just last month.
Sharon Terry, president and CEO of Genetic Alliance — a nonprofit organization that advocates for access to quality genetic services — recently shared a message that reflects the zeitgeist for all those entering the blockchain genomics space: "Be authentic. Tell the truth, even about motives and profits. Be transparent. Engage us. Don't leave us out. Make this real collaboration. Be bold. Take risks. People are dying. It's time to march forward and make a difference."
Sarah Watts is a health and science writer based in Chicago. Follow her on Twitter at @swattswrites.
Even with groundbreaking advances in cancer treatment and research over the past two centuries, the problem remains that some cancer does not respond to treatment. A subset of patients experience recurrence or metastasis, even when the original tumor is detected at an early stage.
"Why do some tumors evolve into metastatic disease that is then capable of spreading, while other tumors do not?"
Moreover, doctors are not able to tell in advance which patients will respond to treatment and which will not. This means that many patients endure conventional cancer therapies, like countless rounds of chemo and radiation, that do not ultimately increase their likelihood of survival.
Researchers are beginning to understand why some tumors respond to treatment and others do not. The answer appears to lie in the strange connection between human life at its earliest stages — and retroviruses. A retrovirus is different than a regular virus in that its RNA is reverse-transcribed into DNA, which makes it possible for its genetic material to be integrated into a host's genome, and passed on to subsequent generations.
Researchers have shown that reactivation of retroviral sequences is associated with the survival of developing embryos. Certain retroviral sequences must be expressed around the 8-cell stage for successful embryonic development. Active expression of retroviral sequences is required for proper functioning of human embryonic stem cells. These sequences must then shut down at the later state, or the embryo will fail to develop. And here's where things get really interesting: If specific stem cell-associated retroviral sequences become activated again later in life, they seem to play a role in some cancers becoming lethal.
"Eight to 10 million years ago, at the time when we became primates, the population was infected with a virus."
While some retroviral sequences in our genome contribute to the restriction of viral infection and appear to have contributed to the development of the placenta, they can also, if expressed at the wrong time, drive the development of cancer stem cells. Described as the "beating hearts" of treatment-resistant tumors, cancer stem cells are robust and long-living, and they can maintain the ability to proliferate indefinitely.
This apparent connection has inspired Gennadi V. Glinsky, a research scientist at the Institute of Engineering in Medicine at UC San Diego, to find better ways to diagnose and treat metastatic cancer. Glinsky specializes in the development of new technologies, methods, and system integration approaches for personalized genomics-guided prevention and precision therapy of cancer and other common human disorders. We spoke with him about his work and the exciting possibilities it may open up for cancer patients. This interview has been edited and condensed for clarity.
What key questions have driven your research in this area?
I was thinking for years that the major mysteries are: Why do some tumors evolve into metastatic disease that is then capable of spreading, while other tumors do not? What explains some cancer cells' ability to get into the blood or lymph nodes and be able to survive in this very foreign, hostile environment of circulatory channels, and then be able to escape and take root elsewhere in the body?
"If you detect conventional cancer early, and treat it early, it will be cured. But with cancer involving stem cells, even if you diagnose it early, it will come back."
When we were able to do genomic analysis on enough early stage cancers, we arrived at an alternative concept of cancer that starts in the stem cells. Stem cells exist throughout our bodies, so in the case of cancer starting in stem cells you will have metastatic properties … because that's what stem cells do. They can travel throughout the body, they can make any other type of cell or resemble them.
So there are basically two types of cancer: conventional non-stem cell cancer and stem cell-like cancer. If you detect conventional cancer early, and treat it early, it will be cured. But with cancer involving stem cells, even if you diagnose it early, it will come back.
What causes some cancer to originate in stem cells?
Cancer stem cells possess stemness [or the ability to self-renew, differentiate, and survive chemical and physical insults]. Stemness is driven by the reactivation of retroviral sequences that have been integrated into the human genome.
Tell me about these retroviral sequences.
Eight to 10 million years ago, at the time when we became primates, the population was infected with a virus. Part of the population survived and the virus was integrated into our primate ancestors' genome. These are known as human endogenous retroviruses, or HERVs. The DNA of the host cells became carriers of these retroviral sequences, and whenever the host cells multiply, they carry the sequences in them and pass them on to future generations.
This pattern of infection and integration of retroviral sequences has happened thousands of times during our evolutionary history. As a result, eight percent of the human genome is derived from these different retroviral sequences.
We've found that some HERVs are expressed in some cancers. For example, 10-15 percent of prostate cancer is stem cell-like. But at first it was not understood what this HERV expression meant.
Gennadi V. Glinsky, a research scientist at the Institute of Engineering in Medicine at UC San Diego.
How have you endeavored to solve this in your lab?
We were trying to track down metastatic prostate cancer. We found a molecular signature of prostate cancer that made the prostate tumors look like stem cells. And those were the ones likely to fail cancer therapy. Then we applied this signature to other types of cancers and we found that uniformly, tumors that exhibit stemness fail therapy.
Then in 2014, several breakthrough papers came out that linked the activation of the retroviral sequences in human embryonic stem cells and in human embryo development. When I read these papers, it occurred to me that if these retroviral sequences are required for pluripotency in human embryonic stem cells, they must be involved in stem cell-resembling human cancer that's likely to fail therapy.
What was one of the biggest aha moments in your cancer research?
Several major labs around the U.S. took advantage of The Cancer Genome Anatomy Project, which made it possible to have access to about 12,000 individual human tumors across a spectrum of 30 or so cancer types. This is the largest set of tumors that's ever been made available in a comprehensive and state of the art way. So we now know all there is to know about the genetics of these tumors, including the long-term clinical outcome.
"When we cross-referenced these 10,713 human cancer survival genes to see how many are part of the retroviral network in human cells, we found that the answer was 97 percent!"
These labs identified 10,713 human genes that were associated with the likelihood of patients surviving or dying after [cancer] treatment. I call them the human cancer survival genes, and there are two classes of them: one whose high expression in tumors correlates with an increased likelihood of survival and one whose high expression in tumors correlates with a decreased likelihood of survival.
When we cross-referenced these 10,713 human cancer survival genes to see how many are part of the retroviral network in human cells, we found that the answer was 97 percent!
How will all of this new knowledge change how cancer is treated?
To make cancer stem cells vulnerable to treatment, you need to interfere with stemness and the stemness network. And to do this, you would need to identify the retroviral component of the network, and interfere with this component therapeutically.
The real breakthrough will come when we start to treat these early stage stem cell-like cancers with stem cell-targeting therapy that we are trying to develop. And with our ability to detect the retroviral genome activation, we will be able to detect stem cell-like cancer very early on.
How far away are we from being able to apply this information clinically?
We have two molecule [treatment] candidates. We know that they efficiently interfere with the stemness program in the cells. The road to clinical trials is typically a long one, but since we're clear about our targets, it's a shorter road. We would like to say it's two to three years until we can start a human trial.