So, I've searched the database.
And you can search on, on whether, you can search on the gene name.
You can search on the disease.
>> Okay
>> And, and when I put that information into the website, it pulls
up a number of different tests and a number of different testing labs.
>> Yes, yes that's a bunch.
>> Right.
And, and you can filter.
>> Mm-hm.
>> To, on a number of different factors.
One thing that's not shown on our screen here, is
that you can filter, based on where the testing lab is.
Right?
So, so the location might be important for you.
You might want to test in the, in a laboratory in the U.S., for example.
>> Mm-hm.
>> But like I said, there are a number of different tests, that come up here.
Some of them are for multiple genes.
So, do you think you'd be interested in looking
at bunch of different genes or just a APOE gene.
>> I, I'm, I mean I just learned about this,
so I'm going to stick with the APOE for now.
>> Okay.
>> But I'm interested to know what the genes are doing
in these, these gene panels and how they help or don't help.
>> Right.
So, we, we can certainly explore what these
other genes do and if you might be interested.
But, but for this scenario where you >> Mm-hm.
>> He expressed an interest in this one particular gene
>> Mm-hm.
>> Let's just focus on that one.
>> Sounds good.
>> So the APOE gene alone, you have another couple of choices to make.
You have APOE gene alone where you do targeted variance analysis.
And then you have another test here, for the
APOE gene, where you could sequence the whole gene.
>> Okay.
So it's not just the gene, there's more detail, beyond that.
I have to know the gene and what I want to test for in the gene.
>> Well, in some cases, yes.
In this specific example, you probably want to focus on targeted
variant detection because, there are specific locations in the genes.
Specific polymorphisms.
>> Mm-hm.
>> This APOE-4 allele for which we know that a
person who has that has an increased risk of Alzheimer's Disease.
If you do sequence analysis of the whole gene.
You have the ability to detect any new variant in that
gene, but you're not necessarily know what to make of that information.
>> Okay, okay.
>> Right?
So you find a new genetic variant, so what, how are you
going to know if it increases his risk of Alzheimer's disease or not?
>> Okay.
>> So, in this case.
>> So this one just tests for the one snip that tells me that it's APOE-4.
>> That's right.
Well, technically speaking APOE-4 is defined by the combination of two snips.
>> Two snips, okay.
>> But that's irrelevant.
>> Okay.
>> But, the point is that.
>> That the report will only look at that.
>> It will only look at that.
>> Okay.
And it will give me extra information that I won't know.
>> That's right.
>> How to interpret.
Okay.
>> No extra information.
>> Okay.
>> Okay?
>> Okay.
>> Anything else you want to know?
>> well, I had a few questions, about, what happens after we get those test done?
You said that it's not guaranteed that he'll get Alzheimer's disease
if he has these alleles, but his risk will be higher.
In my practice, I actually, you know, he's an
older gentleman I take care of his middle aged son.
It's going to be kind of weird knowing that, that he has these risk alleles.
And his son could've inherited them.
I guess I'm not supposed to this, I just had a sort of odd situation.
Is there any guidance you can give me in that, in that context?
>> Yeah, well, so there are a couple of things that I want to tell you.
One, with respect to the son, you've
got to be really careful with genetic information.
Because, for this gene in particular, a lot
of people don't want to know their results.
And you really have to respect a persons right to not know a genetic result.
So, if you go through with these testing for this gentleman.
He needs to be very conscious of the fact that if
he tests positive, that information, he might not want to share that.
Or he might want to check with his offspring to
see if they would also want to be tested or not.
So, that's one thing.
And the other is you know, you mentioned earlier about
how there was nothing you can really do about Alzheimer's disease.
>> Mm-hm.
>> If you were tested, if you test positive
>> Yeah.
>> So what?
What, what information am I going to get from this?
And the point is that, you have to consider the personal utility
>> Mm-hm.
>> Of tests like this as well.
You have a patient who, who knows that, if he tests positive.
He may get Alzheimer's disease and that there's nothing he can do about it.
But for him he may get some great relief knowing that you
know, there's a genetic basis and, and that he might be at risk.
He may be able to do some planning for, for the future.
Get his affairs in order something that if he chooses to do that.
So you know, that's the other side here is
that even though there might be any clinical utility.
That personal utility is increasingly being
recognized as something of value to patients.
>> Sounds like there needs to be a pretty significant
conversation before I send this test, and probably afterwards as well.
>> Absolutely.
Absolutely, you should you should talk to him about
this, make sure he knows all of the risks.
The psychological risks, the economic risks, things
like that, as well as the potential benefits.
>> Okay, okay.
Well thank you so much.
>> Great.
>> I'll let you know what comes of this.
And how, how how this goes forward with him.
>> Good luck.
>> Thank you.