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Skip to 0 minutes and 12 seconds The example you have put, I remember, the classical book of human genetics by Vogel and Motulsky. They put that example of the cars. To tell the difference between cars is extremely difficult, to tell the difference between an operating and a non-operating car is much easy, and this is the interesting point. The genome, the transcriptome, and we have to talk on another point

Skip to 0 minutes and 41 seconds that you have also been working: it’s the environment, what now it seems that we should call the exposome I don’t know whether the word is accepted, widely accepted or not. The point is, the exposome no doubt is important for health, why we are working so much in genetics and maybe there is no much effort on the exposures we have? Technology… is because we can, I guess is the answer. I mean, is this genetics, this revolution has happened because of the conjunction of computational power, statistical know-how, and just flat out technology, that can let us measure half a million genotypes for 50 euros, per person.

Skip to 1 minute and 28 seconds So we are not there, -with the protein for sure- and the metabolome which is really what’s critical for the exposures; again, that technology is great for looking at about 200 things but doing a genome wide to look at 50.000 metabolites it’s not possible yet. But I think that’s a little bit more fundamental on that too, it’s a little bit theoretical. So as geneticists, we partition or we divide the sources of the variation into genetic and environmental, and we allow a few interactions between them. But the genetic, we can study now, and it’s fabulous, and we will soon have millions of sequenced genomes. What’s the equivalent on the environmental side, okay? Well let’s think about the partition in the environment.

Skip to 2 minutes and 12 seconds You’ve got things you can measure like how warm it is, how much daylight there is, what elevation you are, what your social economic status is… There are broad measures. And then there’s a compound of stochastic. How do we measure that? How do we measure whether you had a trauma when you were three years old? How do we measure whether you’ve been exposed to some toxin that you got through sitting in a rainstorm, from a cement factory? We don’t know how to measure those things, or what to measure yet, so right now, I think environmental exposome stuff it is done one component at a time, and it’s expensive. The beauty of the genetics is it’s everything uncomprehensive.

Skip to 2 minutes and 52 seconds Of course if we can study that, in the exposome, we would do it, but… hopefully we will get there but I think that’s a reason why. It’s not because it’s not important, it’s critical, but we can’t do it.

Skip to 3 minutes and 4 seconds A close friend of mine used to pose in the following terms: The genome is huge but it’s finite. The environment, we don’t know how big it is. At the very end… precision medicine, how all that is going to be used into the health? How can we put that? And the promises that genomics has been doing into health, are there going to be fulfilled? So actually, the reason I’m being here in Barcelona this three months is to think about this issues. I think there’s a lot of hype around personalized medicine.

Skip to 3 minutes and 44 seconds That you’re going to be able to say to somebody: you will die on your 73th birthday of kidney failure. That’s garbage. That’s not going to happen. But what we can do is… I think two areas that I’m really intrigued by. So one is risk classification.

Skip to 4 minutes and 1 second So we can’t say: look you’ve got an average risk of cardiovascular disease, or average risk of depression. Now what you do with that? So one thing you can imagine is saying okay if your blood pressure is extremely high you have high hypertension. And yeah, your genetics says that you shouldn’t. Then maybe that’s a point too. That says look, there’s something in your lifestyle that’s addressable. Or the other way around, maybe you say “Look, my genetics of type 2 diabetes says that I’m very high risk metabolically, and I’m absolutely fine right now” but then you’ll be more vigilant about that.

Skip to 4 minutes and 33 seconds So I think that’s a level of we could engage people, not everybody is kind to become engaged, so some people respond to that, others won’t. But I think that that’s potential useful; or even something more pragmatic, such as a variant that says I’ve got a high risk of deep end thrombosis might change how you fly, I think. So that’s usable, perhaps whether or not people adopt it, will have to see.

Skip to 4 minutes and 56 seconds The area that I’m much more interested right now, though, is in therapeutics; and I think what’s behind the whole precision medicine an issue… Certainly, president Obama proposed this one million person “All of us” project is that… you know, medical usage, medicines right now are killing us in a couple of ways. The costs of the health systems are too high and they are making you sick a lot of the time. So if we can target the right medications to the right people, we’ll be ahead of the game. And so if you take something like statins and blood pressure medications… or anti-TNF for inflammatory disease… You know, not everybody is benefiting from those, okay?

Skip to 5 minutes and 37 seconds So what’s called the number of people to treat is really high, the number of people taking your drug to benefit just a few is really enormous. And if we can use genomics to say, who’s at risk, or who is going to respond, or who is going to have an adverse response, which I think, are totally achievable in the next five or ten years for the most common diseases. Then we can really reduce those expenses for the system, and we can really make sure that the medications are benefiting those who need them the most. And I personally, I think, that’s the way that genomics is really going to take us in the next five years.

Skip to 6 minutes and 9 seconds So we have seen that there are lots of things that genetics, genomics still do not understand but, meanwhile, we have lots of possibilities of using our knowledge.

Conversation with Greg Gibson. Part 3

Greg Gibson, Professor and Director, Center for Integrative Genomics, School of Medicine, Emory University, Atlanta, Georgia, USA.

His research focuses on three broad areas: quantitative evolutionary genetics, focusing on disease susceptibility; transcriptomics, with emphasis on how the different cells and tissues have a specific gene expression profile, in some cases clearly related to disease; and predictive health genomics.

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