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Persoonsgericht onderzoek en
behandeling
Prof Alain van Gool
Professor Personalized Healthcare
Head Translational Metabolic Laboratory
Coordinator Radboudumc Technology Centers
PERSOONSGERICHTE ZORG VAN ALLE KANTEN
Van patiëntnummer 9839839 naar Ferdi de Graaf
Nijmegen, 12 maart 2019
Persoonsgericht onderzoek en behandeling
Persoonsgerichte
diagnose
Persoonsgerichte
therapie
= Persoonsgerichte zorg
+Patient participatie
Therapie monitoring
2 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Onderzoek
Persoonsgericht onderzoek in klinische laboratoria
Persoonsgerichte diagnose
Persoonsgerichte
therapie
= Persoonsgerichte zorg
+Patient participatie
X-Omics
Therapie monitoring
3 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Crash course in moleculaire en cellulaire biology
4 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Persoonsgerichte zorg in zeldzaam metabole ziekten
Normale Nederlandse ouders
Zoon Brian 2002, laag geboortegewicht, hoog lactaat, laag bloedsuiker
Mentale retardatie, bewegingsstoornis, epilepsie
† leeftijd 3,5 jr (ademhalingsfalen)
Zoon Joël 2009, hetzelfde klinisch beeld
† leeftijd 1,5 jr (epilepsie aanvallen)
Vermoeden van defect in mitochondriële functie
{Wortmann et al, Human Biology 2017}
Case studie
5 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Lab testen • Hoog lactaat
• ATP produktie ↓, Creatine fosfate produktie ↓
• Maar OXPHOS enzym complex I-V normaal
• Kandidaat genen gesequenced: geen variant
• Onderliggend ziekte mechanisme?
• Later: Whole Exome Sequencing - WARS2 mutaties{medicalxpress.com}
{Rodenburg, Biochim
Biophys Acta, 2016}
Nieuw ziekte mechanisme
• WARS2 is mtDNA-gecodeerd
tryptophanyl-tRNA synthases
• Nieuwe mutaties leiden tot
instabiliteit van WARS2 eiwit
• Minder Trp-tRNATrp
• Minder eiwit produktie
• New prenatal genetic test
{Wortmann et al, Human Biology 2017}
7 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Meet & greet @ Translationeel Metabool Laboratorium
De kracht van omics in diagnostiek
Genomics
Test van 3.000.000.000 DNA basen
in 1 keer
500
1000
1500
2000
m/z
5 10 15 20 25 30 35 40 Time [min]
Proteomics, glycomics, metabolomics
Test van 10.000-50.000 eiwitten, glycanen
of metabolieten in 1 keer
9 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
De kracht van omics in diagnostiek
Enkele
biomarker
Omics
panel
Patient 1
Patient 2
• Grotere kans op positieve
diagnostiek
• Context van de verandering
↑ toename
↓ afname
10 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
11 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Precision medicine in genetisch-metabole ziekten – nu
Persoonsgerichte diagnose
Genomics
(WES)
Metabolomics
Nieuwe ziekte
mechanismen
Persoonsgerichte therapien
Nature Genetics 2018
NEJM 2014
Nature 2016
NEJM 2014
Genet Med 2017
Translational Metabolic Laboratory
Glycomics
Precision medicine in genetisch-metabole ziekten – toekomst
Genomics
(WGS)
Metabolomics
Glycomics
Glycoproteomics
Deep Learning
Artificial Intelligence
System biology
Nature Genetics 2016 Pilot 2017
Translational Metabolic Laboratory
Persoonsgerichte diagnose Nieuwe ziekte
mechanismen
Persoonsgerichte therapie
12 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
www.radboudumc.nl
• Snelle vertaling moleculair onderzoek naar diagnostiek
• Technologie innovatie is cruciaal voor impact in
personalized healthcare
• X-omics is de toekomst van moleculaire diagnostiek
13 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
Acknowledgements
Translational Metabolic Laboratory
Hans Wessels
Dirk Lefeber
Karlien Coene
Leo Kluijtmans
Richard Rodenburg
Jolein Gloerich
Anouk Suppers
Purva Kulkarni
Roel Tans
Esther Willems
Ron Wevers
and others
Edwin Cuppen
Albert Heck
Thomas Hankemeier
Peter Bram ‘t Hoen
Daniella Kasteel
and others
Collaborators/funders
Human Genetics Nijmegen
Marcel Nelen
Alexander Hoischen
Lisenka Vissers
Christian Gillisen
Han Brunner
and others
alain.vangool@radboudumc.nl
www.radboudumc.nl/en/people/alain-van-gool
www.slideshare.net/alainvangool
CarTarDis
Daphna Habets
Arthur van den Wijngaard
and others
Rainer Bischoff
Theo Luider
and others

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2019 03-12 Symposium Persoonsgerichte Zorg, Radboudumc, Nijmegen, Alain van Gool

  • 1. Persoonsgericht onderzoek en behandeling Prof Alain van Gool Professor Personalized Healthcare Head Translational Metabolic Laboratory Coordinator Radboudumc Technology Centers PERSOONSGERICHTE ZORG VAN ALLE KANTEN Van patiëntnummer 9839839 naar Ferdi de Graaf Nijmegen, 12 maart 2019
  • 2. Persoonsgericht onderzoek en behandeling Persoonsgerichte diagnose Persoonsgerichte therapie = Persoonsgerichte zorg +Patient participatie Therapie monitoring 2 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019 Onderzoek
  • 3. Persoonsgericht onderzoek in klinische laboratoria Persoonsgerichte diagnose Persoonsgerichte therapie = Persoonsgerichte zorg +Patient participatie X-Omics Therapie monitoring 3 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 4. Crash course in moleculaire en cellulaire biology 4 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 5. Persoonsgerichte zorg in zeldzaam metabole ziekten Normale Nederlandse ouders Zoon Brian 2002, laag geboortegewicht, hoog lactaat, laag bloedsuiker Mentale retardatie, bewegingsstoornis, epilepsie † leeftijd 3,5 jr (ademhalingsfalen) Zoon Joël 2009, hetzelfde klinisch beeld † leeftijd 1,5 jr (epilepsie aanvallen) Vermoeden van defect in mitochondriële functie {Wortmann et al, Human Biology 2017} Case studie 5 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 6. Lab testen • Hoog lactaat • ATP produktie ↓, Creatine fosfate produktie ↓ • Maar OXPHOS enzym complex I-V normaal • Kandidaat genen gesequenced: geen variant • Onderliggend ziekte mechanisme? • Later: Whole Exome Sequencing - WARS2 mutaties{medicalxpress.com} {Rodenburg, Biochim Biophys Acta, 2016}
  • 7. Nieuw ziekte mechanisme • WARS2 is mtDNA-gecodeerd tryptophanyl-tRNA synthases • Nieuwe mutaties leiden tot instabiliteit van WARS2 eiwit • Minder Trp-tRNATrp • Minder eiwit produktie • New prenatal genetic test {Wortmann et al, Human Biology 2017} 7 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 8. Meet & greet @ Translationeel Metabool Laboratorium
  • 9. De kracht van omics in diagnostiek Genomics Test van 3.000.000.000 DNA basen in 1 keer 500 1000 1500 2000 m/z 5 10 15 20 25 30 35 40 Time [min] Proteomics, glycomics, metabolomics Test van 10.000-50.000 eiwitten, glycanen of metabolieten in 1 keer 9 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 10. De kracht van omics in diagnostiek Enkele biomarker Omics panel Patient 1 Patient 2 • Grotere kans op positieve diagnostiek • Context van de verandering ↑ toename ↓ afname 10 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 11. 11 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019 Precision medicine in genetisch-metabole ziekten – nu Persoonsgerichte diagnose Genomics (WES) Metabolomics Nieuwe ziekte mechanismen Persoonsgerichte therapien Nature Genetics 2018 NEJM 2014 Nature 2016 NEJM 2014 Genet Med 2017 Translational Metabolic Laboratory Glycomics
  • 12. Precision medicine in genetisch-metabole ziekten – toekomst Genomics (WGS) Metabolomics Glycomics Glycoproteomics Deep Learning Artificial Intelligence System biology Nature Genetics 2016 Pilot 2017 Translational Metabolic Laboratory Persoonsgerichte diagnose Nieuwe ziekte mechanismen Persoonsgerichte therapie 12 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 13. www.radboudumc.nl • Snelle vertaling moleculair onderzoek naar diagnostiek • Technologie innovatie is cruciaal voor impact in personalized healthcare • X-omics is de toekomst van moleculaire diagnostiek 13 Alain van Gool, Symposium Persoonsgerichte Zorg, Nijmegen, 12 maart 2019
  • 14. Acknowledgements Translational Metabolic Laboratory Hans Wessels Dirk Lefeber Karlien Coene Leo Kluijtmans Richard Rodenburg Jolein Gloerich Anouk Suppers Purva Kulkarni Roel Tans Esther Willems Ron Wevers and others Edwin Cuppen Albert Heck Thomas Hankemeier Peter Bram ‘t Hoen Daniella Kasteel and others Collaborators/funders Human Genetics Nijmegen Marcel Nelen Alexander Hoischen Lisenka Vissers Christian Gillisen Han Brunner and others alain.vangool@radboudumc.nl www.radboudumc.nl/en/people/alain-van-gool www.slideshare.net/alainvangool CarTarDis Daphna Habets Arthur van den Wijngaard and others Rainer Bischoff Theo Luider and others

Hinweis der Redaktion

  1. I like to show two examples why we think so. Example my lab at Radboudumc (I recently became head of the Translational Metabolic Laboratory in Radboudumc where we do research and diagostics to the functional genome). Close interaction with genetics colleagues. Since 5 years we sequence patients that we cannot diagnose easily, last year 8000 exomes sequences, diagnostic reimbursement In quite some cases still 10-20 variants left that may cause the disease We now add metabolomics as functional screen to contextualize the genomic analysis Identified 10 new mechanisms of disease in metabolic disorders Based on insights identified new therapies for metabolic disorders, often nutrition supplements
  2. Example Radboudumc. Points to make: However, we feel we have just begun and can further extend these innovations WES will become WGS, also other sequencing modalities (RNA Chip-Seq, epigenetics) New metabolomics panels, also + glycomics, glycoprotemics Add new data analysis methods (deep learning, AI) Expect to identify more new disease mechanisms and translation to new therapies