“We stay abreast of the developments in genomics on a regular basis by incorporating the most recent published research in this domain”

Dr Abdur Rub,
Co-founder, Xcode Life Sciences,
With exper tise in precision medicine and personalized preventive Health, Xcode believes that the era of “one size fits all” in medicine is over. Competing with other global players , Xcode is working closely with professional practitioners across domains to enable truly personalized solutions across the spectrum of human needs. Dr Abdur Rub, Co-founder, Xcode Life Sciences, in an interview with Mahesh Kallayil discusses the evolving role of genomics and personalized medicine in Indian pharma industry and much more.

How would you summarize Xcode Life Sciences' vision & mission and accomplishments to date?
Our vision is to play a key role in the genetics-led transformation that is currently underway in curative and preventive Healthcare. From our modest beginnings, we have grown quite a bit in terms of our product portfolio and product reach, and currently are one of the leading companies in India in preventive genetic testing.

What sets Xcode Life Sciences apart from companies with similar offering?
Xcode is one of the few companies that is established and run by scientists. Xcode is run primarily as a scientific research organization with a commercial arm. We work extensively with physicians and wellness professionals on research projects that are of high relevance in specialized practices and work on creating high health impact and low cost products that can make a meaningful difference in health outcomes for people.

Could you please explain to us the evolving role of clinical genomics and personalized medicine in Indian pharma industry?
In the USA, 50 per cent of all drugs currently under clinical trial collect DNA information as part of the trial. Currently, Indian biopharma does not carry out much of independent drug development, but we expect this to change in the future, and for India to become a leader in Biopharma innovation. In the future, all drug development will involve clinical genomic aspects.

What are the competitiveness of Indian genomics market against the markets of other countries?
Just as India was able to dominate in the IT sector, we believe India will dominate the genomics sector as well, since much of genomics is what can be considered as Bio-IT. The wet laboratory part of it will be commoditized and the value will reside in big data genomic analysis. We anticipate that India will play a key role as a global hub for genomics.

How is the company positioned in the Indian and global market in the field of clinical genomics?
We are positioned well to benefit from the emerging trends of precision medicine through pharmacogenetics, nutritional genetics and predisposition genetics. We currently have partners in four countries outside of India and the number is growing.

Over the past several years, what are some of the changes that you've noticed in genomic arena, and how has Xcode Life Sciences responded to these changes?
In the early days of genetics, the focus of most companies was on vending broad genetic information, including aspects of ancestry, disease, etc. The market for such information-centric genetic services is limited. Our learning was that the end user is seeking not information, rather, they are seeking specific solutions. So, we turned our focus towards developing solutions for specific health issues in which genetics plays a key role. On the other side, there are companies which sell very high cost genetic tests for critical conditions such as oncology which are struggling to gain traction. It's becoming clear that genetic services need to be high impact and cost-effective. We have incorporated these aspects in our product development and costing.

Please share your thoughts on Nutrigenetics?
Nutrigenetics, in our opinion, is a game changer for the health of the population. At some point in time in the near future, we will look back and feel like our nutritional practice was archaic, in a similar way to how we feel about computers; twenty years ago, they were considered slow, expensive , clunky and archaic. To give you a simple example, more than 70 percent of India is lactose intolerant and the vast majority of it consumes milk and milkderived products in large quantities. You would not do that if you had knowledge of Nutrigenetics. Milk is a wonderful food for those who can metabolize lactose, for others it could be the main reason for their gastrointestinal problems and other chronic conditions. There are many such examples to cite, such as the individual's capacity to convert folate which is based on which version of the MTHFR gene one carries, or the capacity to synthesise DHA from omega's which is based on which version of the FADS1 gene is present. There is a vast disconnect between how nutrition is practiced today (one size fits all) to how it should be practised (personalized and customized), given that we now have affordable and effective tools to learn about our genetic metabolism of different constituents in our food. This brings to mind an old maxim which goes along the lines of - with proper food, medicine is of no need; without it, medicine is of no use, which is true today as much as it was thousands of years ago. Thankfully, we have the tools to implement this maxim.

What new opportunities does pharmacogenetics offer in disease treatment and drug discovery?
Genetics can account for 20-95 percent of the variability in an individual's response to drugs. 2.2 million severe Adverse Drug Events (ADEs) occur in the U.S. every year and ADEs are the 4th leading cause of death. As many as 33 percent of all potentially clinically significant drug interactions, one of the possible causes of ADEs, are caused by drug-gene and drug-drug-gene interactions and may be missed by drug-drug interaction analysis alone. Currently, there are 137 FDA-approved drugs which have pharmacogenomic information on their labelling. And 50 percent of all clinical trials have genetic data collection as part of the trial. In future, it's hard to imagine any clinical trial and drug prescription without a genetic component to it.

May we have your perspective on ethics of personalized medicines ?
Medicine should be personalized to the best possibility using all tools available as long as the cost-benefit is justified, that would constitute the most ethical medical practice. In that sense, personalized medicine is the best practice. Today, clinicians practice this with the tools that are available to them and genetics is one more tool in their arsenal to deliver the best outcome for the patients.

Clinical genomics field is expected to reap the benefits in near future. In what ways are you competing for the same?
Our goal is to deliver the best value proposition at a competitive price, which is our product development goal at Xcode. We have demonstrated the same in many areas. In fact, you will find that almost all of our products today offer the highest amount of genomic information content relative to a competing product of a comparable price.

Currently, what are the major challenges you are facing and how are you gearing up?
Consumer and professional practitioner education is a major challenge. We have stepped up to it and doing a lot of work in that area. We conduct courses and workshops to educate the professionals through certifications and CME events on how to integrate genetics into their practice.

Please appraise us on your recent collaborations. How you think these deals going to help Xcode Life Sciences to strengthen its market presence and R & D realm?
We have ties with several partner agencies such as HealthSpring, Medall, NM Medical, QUA Nutrition among other national and international partners. Our partners are a foundation of the healthcare ecosystem and are key influencers in people's healthcare decision making process. They are key innovation partners who help determine the core needs of customer segments and help design products and services to fulfill those needs.

What, in your opinion, are the challenges in regulation that need to be addressed?
The challenges are not specific to genetic tests. It will come under the purview of general testing services.

How do you plan to leverage on GOI's Make in India initiative ?
We are looking to develop and manufacture technologies of our own. So far, we have developed our own saliva collection kit end to end, which costs the lowest in the world, while offering comparable functionality. Many of the assays will be homegrown, eventually. We founded Xcode in India with the vision of making it a global genomics hub. There is a real opportunity for that as India offers a huge pool of trainable talent which is key to genomics and informatics. In the future, much of bioinformatics will happen in India.

How does the company keep abreast with the ever-changing trends ?
We stay abreast of the developments in genomics on a regular basis by incorporating the most recent published research in this domain. We also carry out research projects of our own with our partners. One key advantage we offer to our partners and customers is that we keep our tests current by updating them on a regular basis. We also change the technology platforms frequently to the ones that offer superior accuracy and cost advantage. To stay competitive, it's important for us to be nimble and stay abreast of the changes in the technology and research landscape and be the change makers wherever possible.

Kindly apprise us of Xcode Life Sciences, future plans?
The last couple of years have been great for us in terms of technological and commercial progress. We hope to outdo ourselves in the coming years. We are happy about the tone and culture we have set for the company in terms of being a research and science-driven organization, rather than a marketing organization. You will continue to see more and more scientific output from our team in the years ahead, which of course, will feed into our commercial success as well.