'Heroes deserve to go home': The need for genetics in wartime Ukraine

I'm standing in a modern office building in Kyiv, Ukraine, in a room with pale yellow walls, a large dark wooden desk and cabinets, and – in front of me – two windows that have each been shattered.

'The building you see right in front of us was hit by twelve drones in one night during the summer,' says Oleksandr Vlasyshen, director and owner of the Genecode Diagnostics testing lab.

'What do you think they were trying to hit?' I ask him.

'That building used to be a factory of some sort, I think.'

'But it isn't any more?'

'There hasn't been anything there for years,' he says. 'At least, I don't think so.'

'So, why did they hit it?'

'Oh someone must have given them a tip-off. Probably wrong. I don't know. The power of the blast blew our windows. They're still holding together, just about, but let me know if you get cold.'

When the full-scale invasion started in 2022, Vlasyshen was running a medical centre that covered the full remit of patient care, from diagnosis to treatment and operations. It did everything apart from eye operations and brain surgery. He realised that genetics was going to be critical in a country at war, and so together with his friend and colleague Dr Andrei Semikhodskii, he created Genecode.

Since the start of the war more than ten years ago and the full-scale invasion in 2022, the need for genotyping has acquired a very specific and morbid angle. There's a law in Ukraine that requires all members of the military to be genotyped during wartime, so that if a soldier is killed, he can easily be identified. With this in mind, Vlasyshen and Dr Semikhodskii came up with a scheme that would allow the government to quickly and anonymously genotype everyone in the military.

Vlasyshen explains that it requires two envelopes, two test tubes and four QR codes to ensure that only the soldier's military unit has the ability to decode the identity of the genetic material, and only in the event that something has happened.

'So, you have a database with the genetic material of every person in the army?' I ask.

'Well, no,' he says. 'When it came to it, everything happened so quickly that the government didn't have the funding or the time to make it happen. So now we are working out how to deal with the situation.'

Because of the intensity of the war, many fallen soldiers are buried near the field of battle, without being formally identified or sent back to their families. 'But the majority are genotyped,' Vlasyshen continues. 'We are the leading genotyping lab in Ukraine, and we do around 400 human identification tests every month. But we were built for a capacity of 1300-1500 every day, so we have a lot going spare.'

Matching the genetic material and returning bodies to their families can take months or years. Normally, families come looking for their loved ones. If it's a blood relative, the lab can take a DNA test from the mother, father or child.

'But of course, now instead of having an existing database, we have to do one or more additional tests for the matches to be found. It works out to be much more expensive.'

Vlasyshen has come across all sorts of situations in this line of work. A mother once received the remains of her son, which mistakenly contained three hands. The wife and mother of a soldier both had the same dream that the body returned to them was not that of their loved one, and they wanted to have a genetic test to verify. Sometimes, there are financial considerations. A soldier may have been married, but then also had a child with someone else, in which case both women are able to claim government benefits. Given how long soldiers are away for, and the stress they are under, there are instances where they want to prove the paternity of their wife's child for their own peace of mind.

'Our tests can help to resolve all sorts of situations,' says Vlasyshen. 'They've helped to save families, and they've been used in a number of court decisions.'

According to official databases, around five to ten percent of the children born at the start of the full-scale invasion do not have a father's name recorded. Vlasyshen reckons that since the start of the war, this number has increased to around 30 percent. Relationships are built and disintegrate far too quickly for things to go on record.

The spare capacity at Genecode is being used for three major other areas of activity. They perform around 200 to 300 non-invasive prenatal tests (NIPTs) every month, a similar number of embryo tests, and around 100 oncological genomic profiling tests. They also conduct a handful of genetic ancestry tests.

Vlasyshen has seen an increase in Down's syndrome results. In 2014, the numbers across Ukraine were around one in every 1450 births. In 2023, he was seeing one in every 760. This isn't necessarily outside the expected global statistics, and it could be to do with an increase in testing and awareness, but Vlasyshen thinks that the war has led to an increase in the age at which people have children.

'In every 48 NIPTs, we see about two to three with mutations. In the 2000 or so NIPTs that we have done since we started these a year ago, we have already seen blood tests positive for Edwards' and Patau syndrome.'

These are severe genetic conditions with a survival rate of around ten percent beyond the first year. They are known to appear globally no more frequently than in one out of every five or ten thousand live births.

'Ukrainian medicine currently has a very poor understanding of prenatal risk factors, and we test very few pregnant women,' says Vlasyshen. 'Every child has the right to be born, but the families also have the right to know and prepare themselves for what might happen. Our major issue in Ukraine is that we need to teach our doctors to be able to communicate this to the mothers. We just don't have good training in this.'

In Belgium and the Netherlands, the majority of pregnant women receive NIPT as standard. In the USA, around 50 percent of pregnant women receive NIPT, depending on insurance. In the UK, five to ten percent of pregnant women receive NIPT, but all women who are at high risk of a trisomy pregnancy are offered the test. Vlasyshen indicates that fewer than five percent of pregnant women receive NIPT in Ukraine.

Preimplantation genetic tests are used to select IVF embryos for transfer. In order to promote an increase in birth rate, the government in Ukraine funds one round of IVF for all couples struggling to get pregnant. 'After the age of 40, around 65 percent of the embryos are not recommended for use,' Vlasyshen says. 'Again, we are just wasting money and the psychological wellbeing of the couple if we don't screen in advance.'

Yaroslava, a scientist working at Genecode, shows me around the lab. I am asked to put on shoe protectors, a gown, hair covering and a face mask. 'All the employees at our lab have been genotyped, so it is less serious if some of our genetic material somehow accidentally gets mixed up with those being tested. We can check and separate it out,' Yaroslava explains.

I am shown into the room where they receive all the analyses and categorise them. Then, I am shown into the room where they prepare for genotyping. Then, I am shown into 'the most exciting room', where they have around a dozen machines and screens that perform the actual analysis (including both next-generation sequencing and polymerase chain reaction).

'They aren't the very very latest machines we've seen at conferences, but they're pretty modern and they're extremely efficient,' she explains.

The war has thrown up a number of challenges for the laboratory. First, there is the fact that many of the reagents used there need to be stored at a temperature of between –20 and –80 degrees Celcius. While it's possible to get most of the reagents to Poland by plane, the journey into and across Ukraine has its logistical challenges – it involves transporting reagents by train or car, which takes a long time.

Another issue is that a lot of people have left the country since the start of the full-scale invasion. 'Many experts have left us... and nobody comes here to teach us the new methodologies, so how do we learn?'

But Genecode's main goal is to help return the thousands of fallen soldiers to their families.

'We have the capacity, but we need the funding to be able to match them,' says Vlasyshen. 'Heroes deserve to go home.'