November 2017 IPA

16 APAC / November 2017 , Since 1995, we have established multiple prospective cohorts with ongoing evaluation to discover, evaluate and validate biomarkers for predicting diabetes and its complications, including but not limited to heart disease, kidney failure, cancer, stroke and all- cause death. These cohorts, databases and biobanks included 20,000 patients enrolled into the Hong Kong Diabetes Registry, 4500 adults and adolescents as control subjects and 1000 first degree relatives of families of young onset diabetes. Also, we are part of the Asian Genetic Epidemiology Network and Global Diabetes Consortium, the latter supported by the United States National Institute of Health, which are our key collaborators for validating our discoveries, along with other universities in China, Europe, Australia, Singapore, Korea, Japan and USA. Using family-based linkage analysis, investigations of candidate genes and genome wide association studies, we have discovered rare and common genetic variants predictive of diabetes and its complications with replication in other cohorts or supported by independent meta-analysis. Validation: Based on the genetic markers discovered in our Chinese cohorts, with validation in other Asian populations or independent analysis, we have developed proprietary risk algorithms combining these genetic markers with highly modifiable risk factors to predict probabilities of diabetes or its complications over time. Given the subtle inter-ethnic differences in genomic architectures as well as distribution, frequency and effect size of these genetic variants within the same loci, these genetic markers and algorithms are highly applicable to Asian populations which account for 60% of the global population with diabetes. Despite the modest effect size of these individual risk factors, whether genetic or non- genetic, their joint effects can be amplified to increase the odds to 3-10 folds in complex diseases due to multiple causes. Based on these premises, we have used similar strategies to develop a large number of risk equations for predicting multiple diabetic complications, with personalized reports and decision support. All of which were proven to change practice and health care behaviours with positive clinical outcomes. Differentiation between GemVCare and others: Unlike other diabetes gene tests offered by other companies, GemVCare tests are specific for Asians as most of the genetic markers used in the test are discovered in our Chinese cohorts and validated in other Asian populations. Rather than just showing your inherited risk of getting diabetes or its complications, environmental factors and your health status such as sex, weight, height, blood glucose level and blood lipid reading, etc are also taken into account in our algorithms. Therefore, the report and suggestions given are very personal. With the big data accumulated over years, our algorithm is able to predict your future risks of getting diabetes or its complications, as well as provide you an updated figure after changing your lifestyle or body health status. Future plans/business model Our business model is mainly a B2B model. At the moment, we work with different channels for services, these channels are mainly clinics and hospitals, where doctors can issue our tests to patients they find are at high risk and would like to go through a screening for better disease management. Other B2B channels include insurance companies, corporates, pharmaceutical companies, etc. These companies concern about the health and potential risk of getting illnesses in their clients and staff, our tests provide good solutions in knowing their future risks and help formulate a personalized health plan for effective health management. Follow-up services by our partnered clinics/ companies will be provided, which developed a beneficial cooperation between companies without direct competition. With more and more research and development done in the university and validation in Asian populations, we foresee our product and services are beneficial to other Asian counties. Currently we are seeking opportunities to expand our services to Asian countries, with the successful business model adopted in Hong Kong. Challenges ahead: An effective disease management is the key to chronic illness, traditional approach to diabetes treatment only involves medication but not specific enough for individual. With genetic tests, medical professions can re-classify clients and patients into different risk groups for personalised care plans. However, not every healthcare professionals are well trained for that and it takes time to introduce such new concepts to both doctors and patients. We believe our research work and clinical validation would be useful for education and give informed decisions. By providing adequate training and promotion through seminars and exhibitions, we hope more doctors and patients would be empowered by our services. The era of advance technology and big data is a double-edged sword: on one hand, we have more information and resources for research and development; while on the other hand, we foresee there will be more and more genetic testing companies emerging in the coming years. However, we do believe with our strong research and development team and continual clinical validation, we would provide the best product and service to our clients.