In 2016, Indonesian native Levana Sani met three senior scientists, Alexander Lezhava, Astrid Irwanto, and Jianjun Liu at the Genome Institute of Singapore. The scientists were working on pharmacogenetic research on a drug called Dapsone, a prescription medicine to treat the symptoms of leprosy.
They found that Dapsone could have life-threatening adverse reactions for some people. “The drug is usually nearly 100% effective, but it could be dangerous for some patients. While leprosy could lead to physical and psychological disabilities, the disease doesn’t actually kill people. Many patients die because of the side effects of the drug,” Levana Sani, CEO of genetic testing company Nalagenetics, told KrASIA.
With this finding, Sani and the team went to Papua, the easternmost province of Indonesia, where the government was struggling to combat high rates of leprosy. They partnered with the Indonesian health ministry to distribute 1,000 genetic test kits in five villages and discovered that 20% of leprosy patients carried the gene responsible for potentially fatal reactions to Dapsone. This finding helped doctors decide which patients could be safely treated with the drug.
“The success of this first program made us believe that genetic testing for drug response is important, and we can replicate the test with many other drugs as well,” Sani explained.
Pharmacogenetic testing can also save thousands of dollars in costly trial-and-error and healthcare treatments. Pharmacogenomics, or pharmacogenetics, is a research field that studies how an individual’s genes affect how he or she responds to medications. By conducting specific tests, clinicians can see patients’ genetic information, understand their risks of developing an adverse reaction, and predict the likelihood of efficacy. Clinicians use that information to personalize medicine prescriptions for patients.
Sani, together with Lezhava, Irwanto, and Liu decided to launch Nalagenetics in Singapore in 2016 to continue their research. The company aims to reduce adverse drug reactions and increase prescription efficacy by conducting genetic testing, while also providing more scientific and tailored information to doctors and patients.
The startup first received science grants from Singapore’s science and research agency A*STAR, and in 2018, it raised a seed investment round from East Ventures and Intudo Ventures.
Pharmacogenetics is not a new field, as it has been studied since the early 2000s. Yet, it has not been widely adopted in the medical world, according to Sani. “If you think of new medical technology, you have to think if is it really useful compared to the status quo. We have to calculate the cost benefits in the long run. If cost benefits are not good, people will not accept the new discovery,” she said.
“At Nalagenetics, we make inexpensive test kits and we generate data for people who take the test. We explain to them that based on the test, their bodies need certain medicines, and if their current medication doesn’t work, we’ll recommend a replacement drug that is more suitable for their genes.”
The firm has been collaborating with doctors and research hospitals in Singapore and in Jakarta, Indonesia. The Nalagenetics team matches patients interested in taking the test with genetic counselors for pre-test and post-test counseling at one of the startup’s hospital partners. If patients already have a regular doctor, the Nalagenetics team will approach the doctor to explain how to conduct the test, Sani explained. When performing the test, the doctor will take a sample by cotton-swabbing the patient’s inner cheek.
Patients can then read their test reports via the Nalagenetics’ mobile app within five days. The app also allows patients to check and learn more about their medication prescription, and report possible adverse reactions. Users can also consult 24/7 with genetic counselors and pharmacists through the app.
For doctors, the firm provides a “clinical decision” support software that helps them to manage test orders, analyze data, and create digital test reports of their patients. The big data collected can then be used by doctors for their prescriptions or as guidelines for research in pharmacogenetics.
The co-founders believe that genetics knowledge needs to be localized to be impactful. “Around 80% of all genetic discoveries are found in the Caucasian population, so there’s not enough science being done in non-caucasian or Asian groups, although we [Asian] make up the majority of the world’s population,” Sani said.
The COVID-19 response
Nalagenetics has been helping various hospitals in Indonesia to set up labs for conducting COVID-19 tests, and it has also provided medical training for staff at these labs.
“At the beginning of the outbreak, there were hospitals turning down patients because they were overwhelmed. So we approached these hospitals and said ‘we will help you to build a lab, implement all the right machines, and train your manpower so you can run these COVID-19 samples quickly.’ We also provide them with our clinical decision software,” said Sani.
The startup has also developed an independent screening tool named COVID-19 Likelihood Meter (CLM). Using machine learning, the CLM scores a patient’s risk of being positive for COVID-19, and eventually, also provides tailored recommendations for recovery.
“We partnered with Center for Indonesia’s strategic development initiatives (CISDI) to develop the COVID-19 meter. With this tool, we can find out the risk factors of one area, for example, a hospital, which is different from other places. We also work with some other hospitals and with the Indonesian medical association for the trial and the distribution of the COVID meter. This is important, especially since vaccines started to roll out, people would become careless and some of them might ignore the health protocol, so there’s a need for a cheaper, more effective way of screening.”
Going forward, Nalagenetics expects to work with more hospitals in Indonesia and Singapore to distribute genetic tests and further advance its scientific research.
“We’re fundraising to build more labs and develop new cases to predict many chronic medical conditions. We’re also in advance talks with a major pharma company in Malaysia, so we aim to expand to Malaysia this year,” said Sani.
This article is part of KrASIA’s “Startup Stories” series, where the writers of KrASIA speak with founders of tech companies in South and Southeast Asia.