Dr. Noura Abul-Husn, MD, PhD, leads the program as vice president of genomic health at 23andMe. A trained internist, medical geneticist and physician-scientist, Dr. Abul-Husn has spent most of her career spearheading large-scale genomic medicine initiatives with an education, clinical and research lens. For the past two years at 23andMe, her focus has been on the expansion of access to helpful genetic information for health promotion and disease prevention. Prior to joining the company, she was the founding chief of genomic medicine in the department of medicine and clinical director of the Institute for Genomic Health at Mount Sinai.
In this interview with NutraIngredients-USA, Dr. Abul-Husn discusses how 23andMe makes complex genomic data accessible to consumers so that it may take health-promoting actions based on that information. She also talks about 23andMe’s role in recommending vitamins, additional lab assessments and biological age tests to gauge longevity of organs. These tools usher in a new era for the company, she said.
NutraIngredients-USA: What are your primary responsibilities at 23andMe? Since you began at the company, what new programs have you spearheaded?
Noura Abul-Husn: I am the vice president of genomic health at 23andMe, and I lead a team of health and scientific experts who are prioritizing bringing health-related genetic information into the hands of consumers. We think about how we connect valuable genetic information that’s helping people focused on prevention and longevity to bridge the gap between that knowledge and healthcare itself.
What we heard time and time again was that people now needed help navigating their next steps. What consumers really need next is to know what to do with that information. What are the recommendations that we could help people navigate to ensure that they are leveraging that knowledge to the best extent possible? And that’s where I came in and started to think about how we make the results you receive through genetic testing actionable. How do you empower people with that knowledge to take on the right next steps? What we wanted to do is to make awareness about the power of prevention and how genetics tie into that. We’re becoming that partner for the consumer in that journey toward prevention and longevity.
NIU: What do you think is the biggest challenge in translating the raw data that you get from people into promoting actionable insight? How do you connect all that information in a seamless way?
NAH: Genetic information is relatively complex, and one of the things that I think 23andMe is excellent at is simplifying that science and ultimately what you want to know from your genetics. Does your genetic information tell you that there is a potential health risk in your future that should be focused on? What are the opportunities that are available to you if you want to act around that knowledge? When you think of it that way, then you can create the necessary tools to simplify the science in the right way. If we’re thinking about genetic health risks, there are a couple of different ways that those can manifest. For example, one is having a variant in a gene, which is a change in a gene. And we all have many, many of these variants.
If someone has a variant that is known to be disease-associated, we have great technology to assess variants. The caveat there is that the science does evolve. So, part of our job is staying on top of that science and understanding that evolution and how we interpret those variants correctly. There are uncertainties that I hope a decade from now we won’t have. That’s why we must always stay up to date with how you interpret variants.
NIU: Does that evolving science maybe confuse a consumer who is not a scientist, not a doctor, and who isn’t constantly following the literature? How do you frame the conversation in a way that makes 23andMe relevant now and 10 years from now?
NAH: I love that question because it’s something that we think about internally quite a bit. We want to avoid confusion. We must be very transparent in how we’re relaying information that’s based on knowledge that we have today. This knowledge could change over time, and we will update you if that is the case. And with genetics, more than probably other types of biomarkers or lab tests, we know that this is a science that is evolving over time and getting more precise. There is a way to communicate that.
NIU: What are the disease prevention and management strategies at 23andMe? How has the company moved forward on these disease mitigation programs?
NAH: One of the big advances that we’ve had is the ability to use someone’s genetic information across the entirety of their genome to create something called a polygenic risk score that aggregates all of that information into a single score, and can tell you whether or not you’re at a higher likelihood of a common condition, like heart disease or diabetes or high blood pressure, compared to the general population. And what we’ve been able to do is generate and validate many of these polygenic risk scores for several common conditions. What that means is a customer who decides to use 23andMe today could get access to a host of different types of genetic health reports that are giving predisposition information about a variety of health conditions, many of which are well known. The genetic information offers an opportunity for intervention. With every one of these types of genetic health risk reports or polygenic risk scores, we tie them with recommendations for next steps. We created something called a health action plan, which offers the consumer clear next steps on what they should do with the information they’ve learned, whether there’s a recommended lab test that they may need to understand, for example. Should they talk to a clinician? Should they consider other surveillance screening?
We can then give guidance on what are the lifestyle recommendations that are well known. We use whatever information is available that’s evidence-based from the literature.
NIU: What does that look like? If I’m a consumer of 23andMe, which I am, and I open my profile, what am I going to potentially see?
NAH: If you open your profile and you’re a 23andMe+ premium member, you now have access to all of the polygenic risk score reports that we have developed and validated and are surfacing to consumers. Let’s say that you’re someone who finds out that you have an elevated likelihood for high blood pressure and you’re somebody in your 20s or 30s. Maybe you’ve had your blood pressure checked, maybe you haven’t. You’ll get a host of reports, and then the ones where you have an elevated risk, you’re also going to get an action. 23andMe prioritizes the next steps that you should be taking. We may tell you to input your blood pressure if you have had that done recently. We’ll give you an interpretation of those numbers when you give your blood pressure. If your blood pressure is elevated, then we guide you for what next steps you want to take. Is it borderline or is it elevated enough that you should really be speaking to a clinician to be on medication? Are there lifestyle interventions that would benefit you?
NIU: Is 23andMe making any recommendations regarding supplements in their disease prevention strategies?
NAH: I think there are some specific health conditions where some vitamins and supplements might be recommended. For example, I’m thinking age-related macular degeneration. People who are high risk for that type of eye condition are recommended a certain type of vitamin combination. You wouldn’t know if you have elevated risk of that condition unless you knew you had a family history. These are very concrete next steps that someone would really benefit from taking this type of vitamin combination to avoid having problems with eyesight later.
NIU: 23andMe is venturing into the longevity space, correct?
NAH: Correct, this is the Total Health platform, which is a product we launched also about a year ago. It brings together all that 23andMe genetic health risk information, tying that to recommendations and clinical supports, labs and biological age. This means that a customer who purchases Total Health will have an additional layer of genetic testing that the program offers by exome sequencing, a comprehensive screening for a set of genes that we know to be medically actionable. We know that those are genes related to disease risks, for which there are interventions that could be undertaken to reduce the risk, to prevent the disease, to catch it as early as possible. In addition to those polygenic risk scores and everything we talked about earlier on, consumers will have access to lab testing, which will tell the status of your body and organs as well as offer cardiometabolic testing that most people aren’t getting routinely in their doctor’s office.
Those lab tests will surface something called biological age, and biological age is really a way of assessing your overall organ age. This age can be different from your chronological age. What’s really interesting about it is that it can point to specific areas where those organs may require more attention.
If your biological age is elevated—let’s say you’re 35 years old chronologically but your biological age is showing that you’re 40 years old—is it because your liver health is not optimal? Then what can you do to optimize your liver health? The next time you check your labs, six months from now, will you see a difference?
The key thing is that people who undergo Total Health and testing for advanced biological age and biomarker testing are getting a consultation with an expert clinician who has been trained to understand how to bring genetics to interpret all these different advances in genetics and testing, giving people a personalized recommendation plan focused on prevention. Most clinicians are not trained in traditional health care to bring genetics into the picture to focus on prevention in this way.
