According to the National Human Genome Research Institute, humans are 99.9% identical. All our small variations in hair color, height, and our susceptibility to disease resides in just that 0.1% difference. An emerging field of medicine looks to dig into the small difference to make medications more effective and side effects less severe.
Pharmacogenomics is the hybrid field between pharmacology and genetics. Pharmacology looks at how medicines interact with each other and inside the human body. Most medications are processed, activated, or broken down by enzymes in our livers.
“The genomics side of it is we inherit DNA from Mom and Dad one copy from each. We look at how our body inherited that information and what’s the resultant activity in those enzymes. And different medications have to processed to make them active or make them leave the body- to be excreted from the body. Trying to look at and help match up the best suited medications for you. Whether that’s to give you good pain relief or help break down a medication to leave the body," explained Krista Bohlen, the director of Personalized Pharmaceutical Medicine at Avera.
The more medications you take, the more ways different medicines can interact with each other and with your body. It’s why some medications you can’t take with others, or they warn of increased side effects when taken in tandem. Pharmacogenomics aims to look at those interactions based on your genetic build up and minimize your harm or risk for severe side effects.
Not ever drug and medications is being tested for yet.
“There are certain medications we can look at how they are being processed and we know the genetics and enzymes and we have good clinical guidelines for how to do that," said Bohlen. The field, still being relatively young is still developing and growing the number of medications it can test for.
"A big portion of the medications that we look at are for mental health so depression anxiety, stimulants, and anti-psychotics and things. Certain pain medications, some of our cholesterol medications and certain cardiovascular medications. We just recently added a couple genes for oncology to prevent some of those serious toxicology’s that can happen," Bohlen added.
Since it’s just select medications, doctors aren’t always testing your genetics prior to prescribing medications.
“What we’d like to see eventually in the field is what we call pre-emptive or proactive pharmacogenomics, where we test everybody and we have the results before we even need it. What we are doing currently is reactive pharmacogenomics we are testing reactively or for cause," Bohlen explained. "I think a lot of that is driven because of insurance and the state of reimbursement. But what we’d like to get to is that pre-emptive where we have it done on everyone and we have it done each time it’s applicable or for each new prescription.”
If you are interested in pharmacogenomics- you can talk to your doctor. Since it’s DNA that’s being tested, you’ll only need to be tested once, and retested as new medications are sequenced. Bohlen says that most patients just receive a blood draw, but for rural patients, a clean saliva sample is also functional for the sequencing.
Bohlen said the field is still developing and research is ongoing. She said as the field discovers more, the targeted treatments for each individual and disease will become more precise.
As more medications and diseases are sequenced, and more things can be matched to DNA markers, she foresees one day where pharmacogenomics is just standard practice.
