Implementing Personalized Health(care): the need to bridge fields Professor of Personalized Healthcare Head Radboud Center for Proteomics, Glycomics and Metabolomics Coordinator Radboud Technology Centers Head Biomarkers in Personalized Healthcare Prof Alain van Gool NanoNextNL Medicine Theme Day 3 July 2015, Amsterdam
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Implementing Personalized Health(care): the need to bridge fields
Professor of Personalized Healthcare Head Radboud Center for Proteomics, Glycomics and Metabolomics Coordinator Radboud Technology Centers
Head Biomarkers in Personalized Healthcare
Prof Alain van Gool
NanoNextNL Medicine Theme Day 3 July 2015, Amsterdam
My mixed perspectives in personalized health(care)
Personalized health(care), more than pathways only
Source: Barabási 2007 NEJM 357; 4}
• People are different • Different networks and influences • Different risk factors • Different preferences
10
10 Alain van Gool, NanoNext.NL, 3 July 2015
Personalized health(care) in a systems view
11
11 Alain van Gool, NanoNext.NL, 3 July 2015
A changing world: Personalized Medicine@ USA
“The term "personalized medicine" is often described as providing "the
right patient with the right drug at the right dose at the right time."
More broadly, "personalized
medicine" may be thought of as the tailoring of medical treatment to the individual characteristics, needs, and
preferences of a patient during all stages of care, including prevention,
diagnosis, treatment, and follow-up.”
(FDA, October 2013)
12
12 Alain van Gool, NanoNext.NL, 3 July 2015
A changing world: Personalized Medicine @Europe
European Science Foundation 30 Nov 2012
Innovative Medicine Initiative 2 8 July 2013
EC Horizon2020 10 Dec 2013
13
13 Alain van Gool, NanoNext.NL, 3 July 2015
Personalized Healthcare @ Radboudumc
People are different Stratification by multilevel diagnosis
+ Patient’s preference of treatment
Exchange experiences in care communities Select personalized therapy
Population
Man
Molecule
14
14 Alain van Gool, NanoNext.NL, 3 July 2015
Societal goal of personalized health(care)
15
Source: prof Jan Kremer
15 Alain van Gool, NanoNext.NL, 3 July 2015
Partners in personalized health(care)
16 Alain van Gool, NanoNext.NL, 3 July 2015
Key aspects of personalized health(care)
1. What to measure?
2. How much can it change?
3. What should be the follow-up for me?
17 Alain van Gool, NanoNext.NL, 3 July 2015
Exponential technologies
“The only constant is change, and the rate of change is
increasing”
We are at the knee of the exponential curve
18 Alain van Gool, NanoNext.NL, 3 July 2015
19
19 Alain van Gool, NanoNext.NL, 3 July 2015
Demo room
20 Alain van Gool, NanoNext.NL, 3 July 2015
Exponential developments in biomarker technologies
• Next generation sequencing • DNA, RNA • Risk analysis and therapy selection
• Mass spectrometry
• Proteins, metabolites
• Monitoring of disease and treatment effects
• Imaging • Non invasive images, real time • Spatial view of intact organs and organisms
21 Alain van Gool, NanoNext.NL, 3 July 2015
Next Generation Sequencing
{Nature, July 17 2014, 511: 344-}
22
22 Alain van Gool, NanoNext.NL, 3 July 2015
Mass spectrometry • Example: Glycoproteomics in plasma • Detection of ~12.000 unique deconvoluted monoisotopic masses
per single analysis (> 50% are glycopeptides)
500
1000
1500
2000
m/z
5 10 15 20 25 30 35 40 Time [min]
Proof of principle study:
Monique van Scherpenzeel, Dirk Lefeber, Hans Wessels, Alain van Gool Translational Metabolic Laboratory, Radboudumc, unpublished data 23 Alain van Gool, NanoNext.NL, 3 July 2015
Imaging
Slide courtesy of Maroeska Rovers, Peter Friedl, Otto Boerman, Radboudumc
Example: Image-guided surgery: • Use (auto)fluorescence to highlight tumor cells • Specific removal of tumor tissue
• Extend to other imaging modalities in operation room (eg MRI)
24 Alain van Gool, NanoNext.NL, 3 July 2015
The epigenome
25 Alain van Gool, NanoNext.NL, 3 July 2015
The microbiome
26 Alain van Gool, NanoNext.NL, 3 July 2015
‘New’ data
27
27 Alain van Gool, NanoNext.NL, 3 July 2015
28
Personalized advice
Action
Selfmonitor Cloud
Lifestyle Nutrition Pharma
DIY monitoring of vital signs
28 Alain van Gool, NanoNext.NL, 3 July 2015
• DIY sequence your genome and/or your microbiome genome • at a provider, at a pharmacy, at home
• Take your genome to the doctor • Have a personalized healthcare advice
DIY sequencing
29 Alain van Gool, NanoNext.NL, 3 July 2015
30
• Measure your brain waves (EEG)
• Recognize conditions for maximal concentration or relaxation.
• Use device to train.
DIY brainwave monitoring
30 Alain van Gool, NanoNext.NL, 3 July 2015
DIY blood biomarker analysis
• Measure key biomarkers in one drop of blood at few $ per test panel
• Download data to your smartphone to monitor your own trend
31 Alain van Gool, NanoNext.NL, 3 July 2015
‘insideables’
‘wearables’
32 Alain van Gool, NanoNext.NL, 3 July 2015
33 Alain van Gool, NanoNext.NL, 3 July 2015
Try-outs at REshape Center of Health(care) Innovation
Lucien Engelen
34 Alain van Gool, NanoNext.NL, 3 July 2015
37
37 Alain van Gool, NanoNext.NL, 3 July 2015
But …
Knowledge and Innovation gap:
1. What to measure?
2. How much can it change?
3. What should be the follow-up for me?
38 Alain van Gool, NanoNext.NL, 3 July 2015
Biomarker innovation gaps
39
Discovery Clinical
validation/confirmation
Diagnostic
test
Number of
biomarkers
Gap 1
Gap 2
Gap 3
1. Imbalance between biomarker discovery, validation and application
2. Many more biomarkers discovered than available as diagnostic test
3. Limited translation to point-of-care devices
39 Alain van Gool, NanoNext.NL, 3 July 2015
Biomarker innovation gaps: some numbers
40
5 biomarkers/ working day
1 biomarker/ 1-3 years
1 biomarker/ 3-10 years
?
Eg Biomarkers in time: Prostate cancer May 2011: n= 2,231 biomarkers Nov 2012: n= 6,562 biomarkers Oct 2013: n= 8,358 biomarkers Nov 2014: n= 10,350 biomarkers