Thursday, January 29, 2015

Can Patients Understand their Own Genome?

I just ran my 23andme SNP data (Single Nucleotide Polymorphism: basically, the distinct mutations that make my DNA unique) through, a website that puts the number and type of mutation in a handy table.  The website also provides nutritional recommendations based on the presumbed metabolic impact of my particular mutations.

However, after feverishly researching biochemistry I have some concerns with Dr. Yasko's conclusions cited on that site and others. These websites appear to make a number of biochemistry mistakes, and I'm not seeing a lot of citations to original research, just a lot of unpublished "physician observations".

A selection of results from G enetic Genie. There are two copies of most genes in our genomes (one from our father, one from our mother) and one or both may be mutated. The color-coded results show that I have two mutated copies of several important genes (colored red) involved in neurotransmitter metabolism and other core biochemical processes. I also have two genes with one bad copy (yellow),

Some of the statements about, for example, BH4, appear to be incorrect. Genetic Genie states that impaired BH4 production or increased BH4 utilization can impact ammonia detoxification in the urea cycle, but BH4 is not directly involved as a cofactor in ammonia to urea conversion. Instead, BH4 is involved in one of at least two pathways for generating citrulline. (Citrulline is regenerated in the urea cycle to turn ammonia into urea.)

Not to say they're not doing good work, but you have to interpret biochemistry in context. For example, I am homozygous for a mutation in CBS, which they say would upregulate CBS activity and lead to increased cystathione, cysteine, and eventually to increased taurine and sulfite. But I also have a heterozygous mutation in CTH, which would limit the amount of cystathione converted into cysteine, effectively stopping that cascade at the starting line.

I hope we're just a short ways off from a website or interface that can actually map all of our unique (SNP-dependent) metabolic pathways, but I think we're still in the dark ages when it comes to interpretting SNP genome results. Promethease is the online tool that has replaced 23andme's health-specific genetic information, but the website only summarizes Pubmed results:

The Promethease website is great, but is based on observational studies with tiny effect sizes. Trying to infer causation from those correlational studies is a textbook example of how not to interpret statistics.

Faced with the complexity of ~20,000 SNPs and less-than-user-friendly professional tools like ENSEMBL, I don't think it is possible for individuals to understand how SNPs influence protein function to the extent necessary to make informed decisions about our biochemsitry.

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