Interactive story outlining how pharma-focussed personalized medicine has matured into society-focussed personalized healthcare.

1. Personalized Health(care):
more than just targeted medicines
Professor of Personalized Healthcare
Head Radboud Center for Proteomics, Glycomics
and Metabolomics
Coordinator Radboud Technology Centers
Senior Scientist Integrator Biomarkers
Prof Alain van Gool
Symposium Neuroinformatics and personalized health care
Nijmegen, 26 Nov 2015

2. My background in personalized health(care)
8 years academia (NL, UK)
(molecular mechanisms of disease)
13 years pharma (EU, USA, Asia)
(biomarkers, Omics)
4 years med school (NL)
(personalized healthcare, Omics, biomarkers)
4 years applied research institute (NL, EU)
(biomarkers, personalized health, nutrition)
A person / citizen / family man
(adventures in EU, USA, Asia)
1991-1996
(PhD)
1996-1998
(post-doc)
2009-2012
(visiting prof)
1999-2007 2007-2009 2009-2011
2011-now
2011-now (prof)
2 Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 2015

3. Source: Chakma, Journal of Young Investigators, 16, 2009
Principle of Personalized/Precision/Targeted Medicine
3
3
Molecular biomarkers as key drivers to select right patient for right drug
at right dose at right time: Companion Diagnostics
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 2015

4. Example: Personalized Medicine in melanoma
Key biomarkers:
Stratification: BRAFV600E DNA mutation assay
Mechanism: P-ERK
Cyclin-D1
Efficacy: Ki-67
18FDG-PET, CT
Clinical endpoint: progression-free survival (%)
{Source: Flaherty et al, NEJM 2010}{Source: Chapman et al, NEJM 2011}
4 Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 2015

5. Emerging companion diagnostics
Good examples personalized medicine in Oncology:
• Cyp450, Her2/neu, BRCA, BRAF, EGFR, EML4/ALK, etc
• Issue with drug resistancy in several solid tumors
Emerging, also beyond the oncology field:
• Volker: Intestinal surgery → XIAP → Cord blood
• Beery twins: Cerebral palsy → SPR → Diet 5HTP
• Wartman: Leukemia → FLT3 → Sunitinib
• Gilbert: Healthy → BRCA → Mas/Ovarectomy
• Snyder: T2Diabetes → GCKR, KCNJ11 → Diet, exercise
• Lauerman: Scotoma, leg → JAK2 → Aspirin
• Bradfield: Healthy → CDH1 → Gastrectomy
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 20155

6. Companion diagnostics in current drug labels
Metabolism
Efficacy or
safety
Source: www.fda.gov (June 2013)
= molecular biomarker that indicates the right patient for right drug at
right dose at right time
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 20156

7. Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 20157
Rational selection of best targets and biomarkers works
The 5R’s assessment:
• Right Target
• Right Tissue
• Right Safety
• Right Patients
• Right Commercial Potential

8. 8
Optimal Personalized / Precision / Targeted Medicine

9. People are more than linear pathways

10. People are more than linear pathways
Source: Barabási 2007 NEJM 357; 4}
• People are different
• Different networks and influences
• Different risk factors
• Different preferences
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201510

11. Personalized health(care) in a systems view
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Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201511

12. Societal need in efficient personalized health(care)
Source: prof Jan Kremer
Towards cost effective care, less cure
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201512

13. Personal need in efficient personalized health(care)
It’s personal !
‘I want to stay healthy.’
‘If not, how do I get healthy?’
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201513

14. A changing world in 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)
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Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201514

15. 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
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201515

16. 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
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201516

17. 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
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201517

18. www.radboudumc.nl/research/technologycenters
Radboudumc Technology Centers
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19. 19
New data !
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201519

22. Key aspects of personalized health(care)
‘I want to stay healthy. If not, how do I get healthy?’
1. What to measure?
2. How much can it change?
3. What should be the follow-up for me?
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201522

23. Personalized Health(care) model
Personalized
Intervention
of patients-like-me
Risk profiles
of persons-like-me
Big
Biomarker
Data
Molecular
Non-molecular
Environment
…
HomeostasisAllostasisDisease
Time
Disease
Health
Selfmonitoring
Adapted from Jan van der Greef, TNO (2013)
Personal profile
Personalized
Participatory
Pre-emptive
Personalized health
Personalized medicine
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201523

24. The route to Personalized Health(care)
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201524

25. Analogy: TOMTOM
GPS to a location
Amsterdam
Traffic jam
Amsterdam
Route 1 Route 2
= Default Traffic jam near Utrecht Alternative route
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201525

26. Personalized Health(care) model
GPS to health
Health
Route 1 Route 2
= Default
First signs of
disease risk
Alternative route
Now
Disease risk
Health
Now
Health
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201526

27. Translation is key in Personalized Healthcare !
Personal profile data
Knowledge
Understanding
Decision
Action
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201527

28. Translation is key in Personalized Healthcare !
“I’m afraid you’re
suffering from an
increased IL-1β and
an aberrant miR843
expression”
Adapted from:
?
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201528

29. Shared decision making
Treatment options
Pro’sCon’s
Select personalized therapy
Example from Prostate cancer patient guide
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201529

30. Mind the Biomarker innovation gaps
Discovery Clinical
validation/confirmation
Diagnostic
test
Number of
biomarkers
Gap 1
Gap 2
Gap 3
• Too much biomarker discovery
• Too little development to application
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201530

31. Biomarker innovation gaps: some numbers
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
Oct 2015: n = 11,856 biomarkers
Discovery Clinical
validation/confirmation
Diagnostic
test
Number of
biomarkers
Gap 1
Gap 2
Gap 3
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201531

32. Most important in Personalized Health(care):
Focus on the end user: the patient / citizen
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Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201532

33. Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201533

34. Acknowledgements
Ron Wevers
Jolein Gloerich
Hans Wessels
Monique Scherpenzeel
Dirk Lefeber
Leo Kluijtmans
Lucien Engelen
Nathalie Bovy
Paul Smits
Maroeska Rovers
Bas Bloem
and many others
www.radboudumc.nl/personalizedhealthcare
www.radboudumc.nl/research/technologycenters
www.radboudresearchfacilities.nl
alain.vangool@tno.nl
alain.vangool@radboudumc.nl
www.linkedIn.com
www.slideshare.net/alainvangool
Many collaborators
Jan van der Greef
Ben van Ommen
Bas Kremer
Lars Verschuren
Ivana Bobeldijk
Marjan van Erk
Carina de Jongh
Peter van Dijken
Peter Wielinga
Robert Kleemann
Suzan Wopereis
and many others And funders
CarTarDis
Alain van Gool, Workshop Neuroinformatics and personalized health care , Nijmegen, 26 Nov 201534