Medical Design Briefs - March 2024 - 18

The Role of Phenotypes
priate approach. In oncology, for example,
research institutions have observed
variation among different types of cancers
and treatments and are beginning
to get to the root cause of why cancers
are different. They've been successful
in using that knowledge to customize
treatments, bring new treatments, and
identify patients who would benefit from
different types of treatment.
One thing that has been clear about
obesity for a while - and has been clear
to obesity practitioners - is that there's
variability in response. This variation
suggests that precision medicine is needed
in obesity, much like it is needed in
oncology.
In 2013, the AMA categorized obesity
as a disease, which opened the door to
treating it with multi-modalities of treatment
to include medicine and surgery.
As the obesity rates rise, it becomes ever
more critical to quickly identify who will
respond to specific diets, medications, or
procedures based on their unique characteristics
or phenotype.
MDB: Why do phenotypes aid in the
treatment of obesity?
MB: Phenotyping enables us to understand
the type of obesity disease people
have and tailor treatments that address it
specifically, for the first time ever. Beyond
that, it changes the conversation around
obesity and explains to patients that they
have a genetic predisposition to obesity
resulting in their lifelong struggle - and
it's not a moral failing. In addition to
scientifically treating the disease, phenotypes
also address the emotional side of
obesity and debunk the shame that these
patients have felt for decades.
MDB: What are the primary goals of a
product like the MyPhenome test?
MB: We believe knowledge is power,
and the ability to diagnose and treat patients
with the right diet, the right medication,
or the right procedure will be a
major step forward for curing obesity.
Obesity treatment is not a one-size-fits-all
approach, and phenotyping is the only
way to personalize treatment by arming
doctors with information that allows them
to feel confident in the treatment plan.
The primary goal for physicians and patients
is for the patient to receive the best
possible treatment as soon as possible in
their treatment cycle. For the healthcare
system as a whole, the goal is for the patient
to be treated as quickly as possible with the
right intervention so time and money aren't
wasted on wrong interventions.
MDB: How does the test work?
MB: We have launched our first two saliva-based
genetic tests, MyPhenome Hungry
Gut and MyPhenome Hungry Brain,
to identify an individual's phenotype. This
test is a simple cheek swab that can be performed
in a provider's office and sent off
to a lab to look at about 6,000 gene variants
to determine the patient's phenotype.
From there, the provider receives a report
that identifies the patient's phenotype, and
provides recommended treatment options
that can include medications, surgical approaches,
and/or lifestyle interventions.
MDB: Do you have forward-looking
plans to extend phenotyping to other
diseases?
MB: Eventually, yes. We expect the
field of obesity to remain our focus for
quite some time. We believe that similar
to oncology, obesity will have various subtypes
and levels, and we're not even close
to the end of the road to discovery.
That being said, when dealing with a
chronic disease such as obesity, accompanied
by numerous comorbidities, it's
intriguing to explore whether specific
phenotypes are predisposed to certain
associated health complications. For
example, if you have been identified as
having a Hungry Gut phenotype, we will
begin to see what other disease states
are commonly seen with a Hungry Gut
phenotype - like type 2 diabetes, heart
disease, or hypertension. We will be able
to evaluate all of these different diseases
related to obesity with our algorithm.
MDB: Can you provide a brief overview
of the research that led to the development
of the test?
The company's first two saliva-based genetic tests, MyPhenome Hungry Gut and MyPhenome Hungry Brain, identify
an individual's phenotype. (Credit: Phenomix Sciences)
18
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MB: Phenomix's founders have spent
decades researching obesity through a
number of clinical trials and nearly 800
patients. Before patients were treated
with a specific obesity intervention, they
went through a series of tests to measure
quantifiable traits of obesity (like calories
to fullness and how fast food goes
through the intestines). These patients'
genes were then measured, and nearly
two million gene variants were observed.
The key to Phenomix's discoveries is
the three-way association of measurable
traits, biomarkers, and clinical outcomes.
Phenomix's founders found that obesity
is not a single disease with a single
treatment type, but a constellation of diseases
(or phenotypes). Understanding a
person's obesity phenotype - the combination
of genes with environmental and
behavioral factors - can help pinpoint
the cause of weight gain. Phenomix's
technology is based on research from
its physician founders, Drs. Acosta and
Camilleri of Mayo Clinic. Their research
Medical Design Briefs, March 2024

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Medical Design Briefs - March 2024

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