Feature Article: August 2023 – How to Effectively Use Genomics in a Clinical Age Management Practice

How to Effectively Use Genomics in a Clinical Age Management Practice

Jeff Morris

In a workshop at the October AMMG conference, participants will learn how to make genomics clinically actionable so that better brain, cardiac and overall health and longevity can be obtained for patients.

The workshop, How to Effectively Use Genomics in a Clinical Age Management Practice, is being led by Sharon Hausman-Cohen, M.D., the owner and co-founder of Resilient Health, a precision medicine practice in Austin, TX, and Chief Medical Officer of IntellxxDNA.

“I think the main thing is that a lot of people have thought that genomics, while very interesting, was not actionable,” Dr. Hausman-Cohen told the E-Journal. “One of our doctors has said that she played with genomics ten years ago and didn’t find it very useful. But genomics has become useful now.”

The point of the workshop, she said, is to help you understand how genomics can be actionable, so that you can use it in your practice if you choose to. But even if you don’t choose to use genomics in your practice, you will now have much more insight into the contributing factors that affect your patients’ health, and it will still give you a new set of tools as to how to address your patients.

“I think 10-to-15 years from now precision medicine will be the norm,” said Dr. Hausman-Cohen. “I think we’re still at the beginning of it.” But it has practical applications right now.

“What we find,” she said, “and the reason we’re offering the workshop, is that once somebody starts to use genomics—which is the ultimate precision tool especially for brain science—and they’re able to improve outcomes, solve those medical mysteries, get even better patient outcomes but also compliance—their attitude becomes, ‘I don’t even want to see patients without genomics, it’s like flying blind.’ Once you have the tool you don’t ever want to give it up, because it helps so much.”

It is particularly important, she said, for brain science.

“With the heart, you have blood markers; a lot of the markers that reflect what is going on in the heart are released into the blood,” said Dr. Hausman-Cohen. “But because of the blood-brain barrier, there are very few blood tests that are useful. You have completely different things going on in the brain that are not reflected in the blood, including vitamin levels, inflammatory marker levels, enzymes, receptors, etc. Brain science has been a lot of guesswork. Genomics is really helpful for everything to do with the brain.”

Dr. Hausman-Cohen was a co-author on a study published in The Journal of Alzheimer’s Disease in 2022, “Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project.” Its objective was to determine whether a precision medicine approach to Alzheimer’s disease and mild cognitive impairment is effective enough in a proof-of-concept trial to warrant a larger, randomized, controlled clinical trial. It found that all outcome measures revealed statistically significant improvement.

She points to one particular lecture during the AMMG workshop, “Sorting Out the Variable in the Role of Genomics in Optimizing Brain Health,” by Sandeep Kapoor, M.D. The session will present an interactive case to see how a genomic plan was developed to improve cognition in a 75-year-old diagnosed with early dementia. In one of her own sessions, Dr. Hausman-Cohen will discuss how understanding root causes of depression, stress and anxiety can help to improve your patients’ mental health and their quality adjusted healthspan.

In children, she said, “we use it for autism, ADHD, and those kinds of things. In adults we use it for memory, and for mental health, but even things like osteoporosis: every tissue has differential expression of the DNA, so unless you’re going to do a bone  biopsy, you cannot fully understand what are the contributing causes to any chronic disease that is not blood related by checking the blood. You can get a little bit of leakage of markers into the blood, but genomics provides a whole other level of information.”

Dr. Hausman-Cohen said genomics have been around for a while, but most of it has been pharmacogenomics, cancer genomics, or nutragenomics, meaning gene variants that relate to how you metabolize a certain drug. “What we’re teaching is kind of the next generation of genomics,” she said. “President Obama in 2015 said let’s start the precision medicine era, and he specifically called out pharmacogenomics and cancer genomics, and I think we’ve made great headway in that. But then, for disease state genomics, that’s where this is just now coming of age.”

She said it is still an area that is in its toddlerhood—not infancy anymore—but there’s still a lot of growth that’s going to happen.

What they are going to particularly focus on is working with gene variants. “Everybody has the same genes, but within each gene, everybody also has variations, that’s what makes us different from one another. Those variants, or SNPs—which are called single nucleotide polymorphisms, where one letter changes in the DNA which makes us unique—sometimes they work to our advantage, sometimes to our disadvantage.”

The big difference in the research she has been involved in, which she says is why she is leading the workshop, is she has been working with a research team to figure out “what each variant does, and how can we respond to each gene, based on what is in the literature. A better understanding of what genes contribute to what diseases, that are common chronic diseases of aging, is very important to us as age management physicians. How we can respond to them in a more precision way and improve how a patient feels, thinks, their longevity—all of that.”

The answer to “why do genomics?” says Dr. Hausman-Cohen, is because it addresses aging on the inside. “How you feel on the inside, how your heart and your brain works absolutely relates to healthy aging,” she says. “We always say to patients, ‘What’s the use of looking great if your brain doesn’t work? Enhancing your cognitive health can directly boost your attractiveness by improving your memory, attentiveness, and communication skills, making you stand out in any crowd.’  It can help clinicians hone in on which patients will benefit from hormone replacement, antioxidant support, detox support, targeted anti-inflammatories; neuronal regeneration, targeted vitamin support, etc.”

There are a number of tools out there, said Dr. Hausman-Cohen. At this particular workshop, all of the speakers are using IntellixDNA. “That’s one of the reasons we made it non-CME,” she said. “There really are not a lot of products for age management genomics. There’s another one, Amsterdam Genomics, that does a little bit of this, but not nearly as much.”

She said she thinks the focus will be to hear from age management physicians from offices across the country, and how they are making genomics actionable, whether they are specializing in cardio-metabolic disease and other classic age management issues, or brain optimization.

“I think that the beauty of this workshop—what I’m very excited about,” she said, “is we’re going to hear from five different speakers from across the country, that have very different styles of practices, that all involve health optimization and age management, and how they are using genomics to improve patient outcomes and patient satisfaction, and even patient retention.”

Dr. Hausman-Cohen said the one day, eight-hour workshop is an initial step in understanding how DNA can be used in your practice, and having a better idea of how to respond to patients’ health challenges. “I think of age management as the health care of people who want to remain healthy in the last third of their life,” she said. “This conference is not only for people who want to use genomics in your practice, but who want to understand what some of the factors are. We will give you tools that you can use even if you don’t offer genomics.” She said all participants who do choose to add genomics to their practice will get three one-on-one mentoring sessions.

The Genomics Workshop will be held on Thursday, October 19 from 8 a.m. to 5:30 p.m. Among the faculty, besides Dr. Hausman-Cohen and Dr. Kapoor, are David C. Socol, M.D. and Chris Cappicotto, M.D., along with Ashley Madsen, PA. For more information visit agemed.org.