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Published on: Wednesday, June 12th, 2013 View all Articles
Panna Sharma, CEO of Rutherford, N.J.-based Cancer Genetics, Inc. (OTCQB: CGIX), talks with the Opportunist's Managing Editor Leslie Stone about his company's role in DNA-based cancer diagnostics and its mission to improve the success rate in cancer treatment.
It has been a decade since scientists completed the Human Genome Project and sequenced the entire genetic code of a human being to an accuracy of 99.999%. The discovery accelerated biomedical research and led to brand-new insights in the diagnosis and treatment of diseases such as cancer. By pinpointing common DNA letter codes, physicians could now predict not only if someone would develop a disease but also determine the best treatment for the disease based on the individual's genetic code.
Companies such as Cancer Genetics, Inc. (CGI), founded in 1999 by Dr. Raju Chaganti, an internationally recognized leader in cancer cytogenetics (a branch of genetics focused on the study of the structure and function of the cell) and molecular genetics, were at the forefront of understanding what all these genomic data points meant in terms of impact on cancer, explains CGI's CEO, Panna Sharma. "Dr. Chaganti is the chair at the Memorial Sloan-Kettering Cancer Center, where he is on the faculty of the Department of Medicine and Cell Biology Program, so we had a real advantage in the formation of the company. Our focus is on translational oncology rather than simply being another genetic technology company being driven by gene jockeys. When you are translating research insight into something that is clinically meaningful, one of the challenges in the whole endeavor is managing human disease and oncology by better understanding the biomarkers that take you from research insights to the practical day-to-day impact on patients and improved treatment. That is the key to building and scaling the next billion-dollar company in personalized medicine."
Opportunist: When did you join the company?
Panna Sharma: In the first quarter of 2010, I started as a consultant with CGI when they hired my prior firm, TSG Partners. At the request of one of the company's largest investors and Board member, John Pappajohn, who had taken 43 companies public—now 44 with CGI—I agreed to analyze and review the company and identify any deficiencies and make recommendations about how to improve those and put the company on a growth plan. After the assignment, John took me aside and asked me to run the company. He went through a whole laundry list of the specs he had in mind for the CEO and said I was ideal for the job. The company did a couple of external interviews, another few months passed, and he said, 'We really think you should do it.' Of course I'd already come to realize the interesting opportunity that CGI represented from my earlier analysis of the company. So we went to lunch and talked about what I wanted to do, what the company could be one day, and as they say, the rest is history. [Laughs]
Opportunist: What are your goals as CEO?
Panna Sharma: The general blueprint, ever since I came on board, was to fix the company in terms of structure and management, and start preserving and growing the customer base, rapidly launching the proprietary oncology microarrays and driving the scale through greater access to community hospitals. Strategically, that is where the company is today. We have increased our revenue exposure to community hospitals and centers from 12% in 2010 to nearly 48% today, and we have successfully launched five compelling, next-generation genomic products into the marketplace. Our revenues have grown from roughly $1.5 million in 2010 to over $4.8 million for the last 12 months, and we have more appropriately capitalized the company since the IPO. In April, we took the company public and raised an additional $6.9 million, which we see as the first step in becoming a global player in next-generation cancer diagnosis. In order to prepare for our growth, we have also made strategic additions to our management team and focused increasingly on partnering with other industry leaders that can help us achieve our focus on translational oncology.
Opportunist: Can you define that for us?
Panna Sharma: We are duly focused on cutting-edge research but also on the practical elements of developing diagnostic products and services that have a clinical impact on patients. Clinicians today are faced with so many questions, such as what is the subtype of cancer? Is it aggressive or indolent (i.e., will it sit there for a long time before becoming active)? Will the cancer respond to treatment? For the patient, there is a potentially good outcome or a bad outcome, which is typically measured by five-year death or survival rate. We have to change the success rate of initial cancer treatment, because so much money and healthcare resources are spent today on trying out different treatment plans. Often, these treatment plans have marginal or limited success or they have unwanted toxic effects on the patient. Changing the success rate of treatment through genomically guided diagnosis and theranosis is critical to improving treatment, improving access to proper treatment, and reducing wasteful use of healthcare resources. This is the promise of translational oncology: to translate the genomic insights from leading-edge research into the practical and economically impactful change needed in oncology diagnostics and treatment.
Opportunist: What makes CGI unique in the field of DNA-based cancer diagnostics?
Panna Sharma: Our focus and approach supports the entire cancer care continuum: diagnosis, prognosis and theranosis (selection of therapy). It's a snapshot that up until now was missing in cancer treatment. In other words, we use genomics to provide an accurate and definitive typing of the cancer. Does the patient have cancer and, if so, what type? Then we assist in patient outcome and disease management and assess their survival prospects. And finally, we develop a personal therapeutic plan that includes recommendations for which drugs to give, how much and when. The result is that patients receive faster and more accurate diagnoses and personalized oncology care. Physicians gain newer, more accurate tools to assess a patient's cancer and develop an informed treatment plan. Insurance companies save money, because everything can be done with one test.
Opportunist: We understand you recently entered a joint venture with The Mayo Clinic. What are your expectations for this alliance?
Panna Sharma: Our joint venture with The Mayo Clinic allows us to continue our innovations in the frontier of understanding the genomics of cancer and, very importantly, gives us a great partner that will really help move the needle in both the discovery and adoption of the next-generation sequencing based panels. They have a vested interest in the success of the research and in the operational success of the joint venture, OncoSpire Genomics. For our shareholders, it's great because it allows them to participate in the next, next thing in personalized medicine without all the associated startup costs, since we are leveraging Mayo's vast infrastructure in sequencing and bioinformatics. This, coupled with their clinical insights and biobank, will help accelerate the work at OncoSpire Genomics.
The joint venture will be based in Rochester, Minnesota, and I believe it will facilitate the focused development of these projects into innovative genomic products that can continue to impact patients and healthcare. Because of this relationship with Mayo, we have a significant advantage over companies like Foundation Medicine and Invitae. This advantage allows us to keep our current company, Cancer Genetics, on an aggressive growth roadmap, one focused on achieving global scale, while still allowing us to access and invest in innovation so that we ensure future growth, which is a great model for building long-term shareholder value.
Opportunist: What is the basis of each of your products?
Panna Sharma: We have validated hundreds of sites on the genome that are associated with very specific blood-borne or urogenital cancers, and our products look for those and provide the information about subtype of cancer, probable patient outcome, and the most appropriate or likely treatment option. We developed the research internally and validated it with our global partners such as Sloan-Kettering, The Mayo Clinic and the University of Iowa.
Opportunist: Who else are you partnering with?
Panna Sharma: We have a partnership with Gilead, the second largest biopharmaceutical company in the world, who chose us to do all their patient stratification and testing for international and national clinical trials for their blood-borne cancer drugs. That's very important for Gilead, because it helps reduce the costs of their clinical trials. This has also helped us to grow and scale the company, which should propel us for years to come.
We're also partnered with Roche, one of the premier names in cancer diagnostics globally. They chose us to help them scale their inroads into the emerging Central and Latin American market. They wanted to have a cancer-focused lab to bring in state-of-the-art testing, and they wanted the kind of culture focused on getting answers for every patient sample. We have been instrumental in helping them gain market share and deliver to patients who need these therapeutics. They are now servicing 15 countries in Central Latin America and have impacted patients' lives and grown their own market share in that category.
Opportunist: What are CGI's strengths and competitive advantages?
Panna Sharma: We are well positioned with a strong intellectual property portfolio, which we deliver in the form of compelling service. That is the key to our continued success, because many labs, hospitals, and cancer centers can't really say they have both unique products and services. Our hybrid business model is one of the reasons we have been able to attract some extraordinary partnerships and collaborators and, because of that, I see us being a real global leader in personalized cancer care.
In any M&A strategy, it's imperative that companies have great products, but if they lack business acumen or the right marketing philosophy, they will lose their value proposition despite having good technology. We have clinically validated genomic products that were built with some of the biggest names in cancer diagnosis and treatment: The Cleveland Clinic, Memorial Sloan-Kettering, the University of Iowa and the National Cancer Institute. We are focused on partnering with healthcare systems to help drive down costs and improve the care focus on very specific disease states, and we focus on delivering these in a very partner-specific way.
Opportunist: Who are your competitors?
Panna Sharma: There are of course new companies such as Foundation Medicine, but I like to think we have a very unique value proposition because of our business model and proprietary technology. That's not to say there aren't other companies out there making a lot of noise. Of course, there are the traditional big labs like Quest and LabCorp. Now, too, increasingly some of the bigger players are acquiring successful smaller companies—General Electric acquired Clarient, and Novartis acquired Genoptix—but I still believe there is a lot of opportunity for growth. Approximately $15 billion is spent globally on testing for blood-borne and urogenital cancers, and more and more of this testing is genomically based. That's a big space to fill, and I believe it offers a potential upside for us to capture a major share. By focusing on execution, we expect to accomplish our milestones and create substantial value for our shareholders as we grow. Compared with others in the industry, I believe we are tremendously undervalued.
Opportunist: What has been your most rewarding experience with CGI?
Panna Sharma: Two things stand out for me. Every spring, we have a Laboratorian of the Year award ceremony that is usually held during Lab Week in April. The award itself is a culmination of an entire week of lunches and activities that we hold to ensure our lab staff feels valued and enthusiastic about their work. It's always an exciting time, and people look forward to it every year. I usually present the award, and I invite last year's winner up to give the award to this year's winner. Another memorable moment for me was when we recently launched an event where everyone in the company met in a large conference room to discuss what they've accomplished over the past year and what they expect to accomplish in the next six months—not just clinical milestones but the type of work, the volume of work, and the teamwork they experienced. Knowing the company had such a momentous 2012, in which several of our departments focused on preparing to go public, the clinical lab grew, and our sales department expanded, it's interesting to see what everyone as a group was doing. The whole first half of the day, people were buzzing about how much we had accomplished as a company, and everyone walked away excited. We have decided to hold these discussions twice a year—once in January and once in July, so we have another one coming up in about a month.
We strive to incent everyone at the company, regardless of their role. In the biotech and life science industry, it is usually the top four or five people who have all the equity.
Everyone has equity and is an owner in CGI, whether they are in an administrative position or a scientist.
Opportunist: How many employees does CGI have?
Panna Sharma: We currently have 57 employees. Everyone is based in Rutherford, except for the salespeople, who are obviously out in the field. One of the local New Jersey trade magazines named us 'one of the most interesting companies to work for,' and Scientist Magazine named us one of the Top 20 companies to work for. Those achievements are important in helping us to attract top talent long term.
Opportunist: What are your expectations for the stock?
Panna Sharma: I'm primarily focused on driving value and building a great company that will become a leader in the space. In the long term, as more people become aware of our accomplishments and begin following the stock, I believe the valuation will follow and guide itself upward. That said, I sincerely believe we are tremendously undervalued today.
Opportunist: Where do you see the company in five to six years?
Panna Sharma: Today, several thousand cases come into our lab every quarter. Within five years we will have a national footprint, and we will be able to process several thousand cases every week. I expect our international profile to increase as well. In the last year, 8% of our revenue came from outside the United States. We have strong partnerships with regional cancer facilities, which will be a key ingredient in managing patient costs and patient care. I see our revenues growing from $5 million to $250 million over the next five or six years.
As we grow commercially, we obviously haven't forgotten the importance of continuing to invest in innovation. One important aspect of our category is the impact that next-generation sequencing will have. We believe it will really impact the understanding and management of disease, specifically cancer. We are several years away from impact—there is still a lot of regulatory and economic review and development to accomplish—but when it does impact, we want our shareholders to participate in that upside.


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Some of what UPS delivered today.
Along with the double album from The National, several other new recordings and expansive reissues arrived this morning, including: Tombeaux by master musician Paul Metzger, the latest collaboration between The Ex and Brass Unbound, the deluxe 20th anniversary edition of Come's 11:11 album, Time Lags' hand assembled version of the very rare Ellie Daniels Both Sides LP, a new 12" by Om, the soundtrack to the new Father Yod documentary The Source, a repress of Los Saicos' ¡Demolición! anthology, Lee Perry at Wirl Records; a limited edition reissue of the Wipers' classic Youth of America, Anatolian rocker Baris Manco's Sakla Samani Gelir Zamani, Spider John by the great Spider John Koerner, a vinyl LP version of one of my favorite Sublime Frequencies releases - Brokenhearted Dragonflies: Insect Electronica from Southeast Asia, and Kranky represses of Schöner Flußengel and Antithesis, both originally released in 2004 by the amazing Keith Fullerton Whitman. Stop by, there are more brand new records I didn't get to, as well as the never ending additions to the used LP stock.
Posted by Willimantic Records

subset: commoncrawl


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The first batch of Haj pilgrims from the State this year is all set to leave for Mecca on Tuesday morning.
To ensure they are healthy and fit to travel, the health department along with the Tamil Nadu Haj Committee has screened the pilgrims and has also given them a list of precautionary measures in view of the spread of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
MERS is a viral respiratory illness caused by a coronavirus. Coronaviruses are large families of viruses that cause illness in human and animals. Saudi Arabia and a number of other countries have reported cases of MERS-CoV since last year.
Officials said a total of 3,650 pilgrims from Tamil Nadu will visit Mecca in batches starting Tuesday. This includes nearly 700 pilgrims from Chennai. The majority of the pilgrims are in the age group of 50 to 70 years, and there are infants too, making health checks vital.
Pilgrims from other districts too, have started to arrive in the city.
"A total of 275 persons will leave for Jeddah by an 8 a.m. flight on Tuesday. The pilgrims will leave in batches till September 30. There are 12 flights scheduled," an official said.
The Central government has informed the Haj committee about the spread of MERS-CoV in Saudi Arabia he said, adding, "The pilgrims are being screened thoroughly and issued fitness/medical certificates before leaving. All of them are in good health. We have asked them to avoid close contact with people who have respiratory infections."
Public health department officials said the situation in Saudi Arabia was not alarming and that the Central government has issued a travel advisory. "We have screened the pilgrims for fever and respiratory infections. We have told them to cough or sneeze using a handkerchief to cover their faces. As usual, we have given them meningococcal meningitis vaccine," an official said.
"We will screen them when they return from Mecca. There is no need for screening at airports now," he added. Officials said the pilgrims will return in batches from November 7 to 14.
A few months earlier, the World Health Organisation said countries should advise pilgrims that pre-existing major medical conditions such as diabetes and chronic lung disease could increase the likelihood of contracting illnesses including MERS-CoV. Pilgrims were asked to consult a healthcare provider before travelling to review their risks.


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What steps must I take to get involved?
1) Complete the application.
Download and complete the CASA application located in the forms section
of the website under the volunteer tab.
2) Participate in an interview conducted by a CASA staff member.
Once you complete the application, a member of the CASA staff will contact you to schedule a 60 minute interview. Initial acceptance into the program will be determined during the interview.
3) Successfully complete background checks.
A background check will be initiated by the CASA staff upon your acceptance into the program.
4) Attend and successfully complete CASA training.
Training occurs over a five-week time span. Each week, CASA trainees complete 3 hours of online training prior to attending a 3 hour classroom session. Accommodations may be made at the discretion of CASA staff members for individuals who would like to serve as
a CASA but cannot attend the classroom sessions due to scheduling conflicts.
5) Participate in a swearing-in ceremony at the Sarpy County Juvenile Court.
Once you complete training, a Juvenile Court judge will swear you in as a CASA volunteer.
6) Choose your CASA child.
Upon your appointment as a CASA, you will choose a case with your staff supervisor. You will have the opportunity to review all available cases and pick the child or sibling group that you feel most suited to assist. Once your case is chosen, you will be appointed to that child or sibling group by the judge.
7) Start Advocating!
You're now ready to meet your CASA child or children and start making a difference!


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looking awesome!!!
No way! You rock!
I love beadboard...looking so good. You needed that for your busy little family.Oh, and I found the spinning organizer at michaels. They have a lot of neat functional office things.
Thank You for Your Lovely Comments. I enjoy every single one of them! <3


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Leeds South & East Foodbank
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Get Help
Find out how to get help from our foodbank.
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Donations Urgently Needed
We urgently need donations of toiletries, soap, toothpaste, toothbrushes, feminine hygiene items, and deodorants


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I've heard a lot of people saying a serious problem with the Libyan intervention is the cost, which could balloon to well over a billion dollars if the mission lasts for many more months. There's a consistent effort among those who are ambivalent about or opposed to the war to make the cost a major topic of conversation. And I've seen a number of people who are outraged that Obama made little attempt to reckon with the fiscal cost of intervention in his speech tonight. In particular, there's a real sense of confusion about why, in the middle of an acrimonious debate over whether and how to cut the budget, the administration is freely engaging in a war that will undoubtedly cost taxpayers millions.
Now, there's no doubt that president and others should account for the cost of the war when weighing the pros and cons of military action. But it's unreasonable to expect any good to come out of some sort of national conversation about fiscal priorities, particularly in this context.
You have to keep in mind that the president and the Democrats -- correctly, in my view -- believe that small adjustments to the discretionary budget have a negligible impact on the nation's long-term finances, which are basically threatened by the growth of entitlement spending and little else. But that's not a point that many Americans intuitively grasp. Indeed, the reason the GOP's cut-cut-cut politics have taken hold is that Americans generally don't understand the dynamics of long-term budgeting. They most certainly don't understand the scale of America's finances; a billion dollars sounds like a lot of money to most people, but it is, of course, an absolutely minuscule fraction of what the national government spends every year. With that in mind, it would be completely irrational and utterly self-sabotaging for the president to somehow explicitly prorate the cost of intervention in his speech or elsewhere, because A. that's a dramatic oversimplification of spending issues that unduly emphasizes inaction, and B. there's no chance that anyone else in the political universe would dream of similarly explaining the consequences of the initiatives they support, making it impossible for Americans to choose between, say, a $50 billion tax cut for the wealthy and the lives of tens of thousand of Libyan rebels. Why should the president endorse exactly the sort of penny-wise, pound-foolish thinking that he believes motivates his opposition?
It goes beyond that. In all honesty, I'm pretty furious at the amount of attention being paid on Capitol Hill to the fiscal cost of Libyan intervention. In the scheme of things, the amount of money being spent on Libya is minute. Virtually every political actor involved has farmed tens of billions of dollars into vastly less-deserving causes, be they tax cuts or agricultural subsidies or any number of other interest-group driven payouts. It's laughable for these same people to decide NOW is the time to start fussing over a billion here and a billion there. There's a thousand places they could find the money if they were so disposed; as such, it's very telling that none of these fiscal hawks seems to be reckoning with the value of, say, corporate tax breaks vis-à-vis the lives of Libyans. It'd be one thing if they were saying that our current spending priorities trump the value of intervention in Libya, but that's not a determination anyone seems to be making.
And that's because none of them actually care about the national finances in this context at all, they just know that the specter of US bankruptcy scares Americans, and therefore makes a useful political bludgeon against the president. It's concern trolling, through and through. Cost is always a consideration, but it's safe to say that anyone who treats cost as dispositive in the Libya debate is either seriously innumerate or seriously dishonest.
So yeah, frankly, I think the president is making the right decision to not publicly engage on the topic. The result would invariably be distorting and play directly into the hands of the self-serving political interests of his Congressional opposition.
EDIT: I was challenged on this point by someone who said that you can't gloss over the price of intervention because nonetheless, "all the little bits [of the deficit] add up to the whole." To which I would respond that, yes, this is true. But no one wants to talk about the other, much larger bits. That puts the relatively cheap Libyan intervention at a major political disadvantage compared to them.
(Full disclosure: this is an edited version of a comment I made on another blog.)


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One of 2010's joint recipients of the Citizen of the Year award, Ann Barnacoat is a tireless contributor to our community. She has been a volunteer for Willoughby Meals on Wheels for the past 14 years and has been active in the Chatswood Red Cross as the Trauma Teddy convenor. She has been on the Committee for Australian Support Dogs since 2002 and in her role as puppy raiser has trained many guide dogs and dogs which provide support for frail and disabled people. She and her dogs have made early morning TV appearances to promote community awareness and fundraising initiatives for guide dogs.
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Neil is a tiny but beautiful island located 37 Kms. to the south of the Andaman Islands. With unexplored coral reefs, brilliant bio-diversity, white sandy beaches and tropical forest and vegetation, it is one of the hot tourist spots in the Andamans. Neil Island is known as the 'vegetable bowl' of the Andamans. The settlers named the beaches after mythical characters of the epic Ramayana (Bharatpur, Laxmanpur, Sitapur, Ramnagar etc.) The island, with its very relaxed vibes and long, deserted beaches is a place to chill out after the "bustle" of Havelock. The widest part of the island is about 5 km in length. You can walk the whole island in about two hours.
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Jogos De PoolMais Jogados Melhor Avaliado O mais novo
Olympics Water PoloOlympics Water Polo
Multiplayer Pool SharksMultiplayer Pool Sharks
Penthouse Pool 3DPenthouse Pool 3D
9 Ball Quick Fire Pool9 Ball Quick Fire Pool
Billiard Blitz HustlerBilliard Blitz Hustler
Pandemonium PoolPandemonium Pool
Billiards Master ProBilliards Master Pro
Real 3D PoolReal 3D Pool
Crazy Pool 2Crazy Pool 2
Real PoolReal Pool
Balst BiliardsBalst Biliards
Beauty PoolBeauty Pool
Verti PoolVerti Pool
Quick Shooting PoolQuick Shooting Pool
Pool JamPool Jam
3D Quick Pool3D Quick Pool
Deluxe PoolDeluxe Pool
Thunder PoolThunder Pool
Pool ManiaPool Mania
Jogos De Pool - Jogos online Grátis
Pool, also more formally known as pocket billiards is the family of cue sports and games played on a pool table having six receptacles called pockets along the rails, into which balls are deposited as the main goal of play. An obsolete term for pool is six-pocket. There are hundreds of pool games. Some of the more well known include eight-ball (and the variant blackball), nine-ball (with variants ten-ball and seven-ball), straight pool, one-pocket, and bank pool. There are also hybrid games combining aspects of both pool and carom billiards, such as American four-ball billiards, cowboy pool, and bottle pool. So, you have a variety of pool games you can choose from. Which one it's gonna be? Are you so talented to try each one of them? Let's see you in action here on VitalityGames.com and we'll see what hidden talent you've got. For these pool game you must have a good strategy and you have to think a little bit like a physicist, because you have to think precise where the ball will hit. A great challenge is waiting you after the corner. Try and see what happens.
Check out this Jogos De Pool list on page 1. We have a total of 19 Jogos De Pool and the most popular are: Olympics Water Polo, Multiplayer Pool Sharks, Penthouse Pool 3D and many more free games. This page lists the games from 1 to 19. This list of Jogos De Pool received a rating of 3,43 / 5.00 from 157 votes.


text: Sea Sky Resort offers you the opportunity to relax and enjoy a wonderful beachside ocean vacation with a beautiful excotic garden and swimming pool with view at the beach. Start the day relaxing by the ocean , as you enjoy our complimentary welcome drink. Also be sure to enjoy a nice swim in our salt water swimmimg pool or walk on our expansive beach. Sea Sky Resort is the premier Resort for Wedding parties and birthday parties , a dream you will never forget.


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What's Your Style - Inspired at Davids — dog fabric
What's Your Style No. 3? Design for Dog Lovers
Posted by Gracie Willoughby on
We design the spaces of our home for family and friends. And for some clients that includes the four-legged members of our families. How fun to add great furniture pieces, wallcoverings, and fabrics to our room design that feature our love of dogs! The placement of these adornments should follow the same consideration as any other choices in your design plan. Keeping in mind lifestyle and product expectations, especially with fabric choice. It is wise to consider Sunbrella indoor and Crypton fabrics for upholstery. These performance fabrics are woven like indoor fabrics, with finishing techniques that create softness and draping. ...
- Tags: console with dogs, Davids Furniture, design blog, design for dog lovers, designing with pets in mind, dog accent table, dog fabric, dog wallpaper, end table with dog, interior designer harrisburg pa, interior designer hershey pa, interior designer in lancaster pa, interior designer mechanicsburg pa, interior designer reading pa, room design for dog lovers, working with an interior designer


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More channels. More palettes.
Check out all of our new online videos and workbooks
Everything in sync
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Product Portfolio update v3.5 available
Long-awaited Relevé Spot now shipping
National historic landmark gets upgrade with ETC gear
Prodigy FlyPipe gives purpose to the unused corners of your world
Cincinnati Music Hall modernizes with ETC while preserving history
ETC brings light to Tree of Codes
New options for ArcSystem now shipping
ETC Mosaic breathes life into Art on theMART
University of Cincinnati CCM transitions to LED with ETC
Museum of the Bible creates immersive experience with ETC


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DNS Cache – FortiBalancer
Chapter 9 DNS Cache
9.1 Overview
The DNS SLB mechanism used by FortiBalancer appliance supports DNS cache feature. Upon receiving any type "A" or "AAAA" DNS responses, which are mapping of host names to IP addresses, FortiBalancer will save them in SLB DNS cache. Then, when the FortiBalancer appliance receives any DNS requests for the cached "A" or "AAAA" records from clients, the appliance will directly send back the "A" or "AAAA" responses to the clients. If there is no records in cache that hit the requests, the FortiBalancer appliance will communicate with the remote DNS server(s) directly, and then save the server responses in cache for responding to the coming requests.
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