3. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
The central dogma
4. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
What do all those variations do?
5. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Genomic Data
Algorithmic
Analysis
Traditional medical genomics pipeline
Patient:
Exomes/
Genome
Patient:
Exomes/
Genome
6. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
We have a common language
for sequence data….
ATCTTAGCACGTTAC…
….not so much for phenotypes
8. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Can we help machines understand
phenotypic features?
“Palmoplantar
hyperkeratosis”
Human phenotypic feature
I have absolutely
no idea what
that means
9. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Obstacles to phenome-based interpretation
Building a comprehensive phenomic database
requires multiple disparate sources:
Human Genes, Variants, etc. databases
Orthologous genes in model organisms
Phenotype Search and Matching
How do utilize phenotypes in a variant filtering pipeline?
How do we match phenotypes in different species?
How much difference does phenotyping make?
10. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
The Human Phenotype Ontology
Hyposmia
Abnormality of
globe location
eyeball of
camera-type eye
sensory
perception of smell
Abnormal eye
morphology
Motor neuron
atrophyDeeply set eyes
motor neuronCL
34571 annotations in
22 species
157534 phenotype
annotations
2150 phenotype
annotations
12. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
A disease is a collection of
phenotypic features
Patient
Disease X
Differential diagnosis with similar but non-matching phenotypes is difficult
Flat back of head Hypotonia
Abnormal skull morphology Decreased muscle mass
14. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Making OMIM and other disease resources computable
Free text -> ontology curation
enables interoperability
15. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Which phenotypic profile is most similar?
Model X
Patient
Disease Y
16. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Model X
Patient
Disease Y
Fuzzy phenotype feature matching
17. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Inferring phenotypic knowledge of the human
coding genome from model organisms
Other= rat, fly, worm, mouse, zebrafish
19. Combining genotype and phenotypic data for
variant prioritization
Remove off-target and
common variants
Variant score from allele
freq and pathogenicity
Phenotype score from phenotypic similarity
PHIVE score to give final candidates
Mendelian filters
tinyurl.com/exomiser
20. York platelet syndrome and STIM1
Markello T et al. Molecular Genetics and Metabolism 2015, 114: 474 Grosse J, J Clin Invest 2007 117: 3540-50
Impaired platelet aggregation
(HP:0003540)
Thromocytopenia (HP:0001873)
Abnormal platelet activation
(MP:0006298)
Thrombocytopenia (MP:0003179)
UDP_2542 Stim1Sax/Sax
http://www.nature.com/gim/journal/vaop/ncurrent/full/gim2015137a.html
21. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Disease diagnosis: using the interactome
22. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Image credit: Viljoen and Beighton, J Med Genet. 1992
Schwartz-Jampel Syndrome,
Type I
Hspg2 mutation, a
proteoglycan
~100 phenotype annotations
How much phenotyping is a enough?
24. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Each Case Report
associated with an HPO profile
Robinson, P. N., Mungall, C. J., &
Haendel, M. (2015). Capturing
phenotypes for precision medicine.
Molecular Case Studies, 1(1),
a000372. doi:10.1101/mcs.a000372
Capturing phenotypes for precision medicine
25. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
patientarchive.org:
Patient data and knowledge exchange
Automatic extraction of HPO
from clinical summaries
Intuitive visualization
Encrypted patient sensitive
data
Search over encrypted data
Collaborative diagnosis
Fine-grained patient data
sharing
26. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
HPO synonyms for the patient / layperson
Small
Lower Jaw
Hypoplasia
of the
mandible
Bat earsOtopastasis
HP:0000394
Pref Label: Otopastasis
Synonyms: lop ear, prominent ears
Suggested synonyms:
Bat ears; ears sticking out
HP:0009118
Pref Label: Aplasia/Hypoplasia of the mandible
Suggested Synonyms: Small Mandible; Small lower
Jaw; Little Lower Jaw; Mandibular micrognathia;
MicroMandible; Mandibular Deficiency; Mandibular
Retrognathia …
Small Head
Micro-
cephaly
HP:0000252
Pref Label: Microcephaly
Synonyms: Decreased Head Circumference; Reduced
Head Circumference; Small head circumference
Suggested Synonyms : Small Head; Little Head; Small
Skull; Little Skull; Small Cranium…
27. ACMG Annual Clinical Genetics Meeting
March 8 – 12, 2016 • Tampa, Florida
@monarchinit
Conclusions
Making phenotypic features computable is crucial for precision
medicine
• Variant interpretation needs more than genomic data
• Methods of incorporating phenotypic features are evolving
• We need all the organisms’ G2P data
The Monarch Portal integrates and organizes gene-phenotype data
• Ontologies make phenotypes computable
• Depth and breadth of structured phenotype data is growing
Future work
• Environmental/exposure
• Quantitative/imaging data
• Complex/common diseases and cancer
We understand central hypothesis DNA RNA Protein building blocks
We’ve found reliable methods to describe and move genetic information around with computers.
that we can see/ assess phenotype, but how do you computationally describe it ?
Massive amounts of genetic data must also be able to be aligned with a phenotype – in a way that a machine can reason and infer
an undiagnosed genetic patient having several phenotypes (asymmetry of face, temporal bulging, café au lait on neck, asymmetric smile/ facial animation, uneven eyes.
There is a lot we don’t know about the genome
Adding phenotype
Our approach is to try and get the machine to understand the terms so that it can assist us intelligently.
Represent organism as a biological subject
Represent diseases/genotypes as collections of nodes in the graph
3. Interoperable with other bioinformatics resources and leverage modern semantic standards
We can match in “fuzzy” ways by making semantic associations, and leveraging underlying logic, such as anatomy
OWLsim algorithm
About HPO 2: We want the vocabulary to be enable sophisticated phenotypic matching within and across species
Data from mouse, rat, zebrafish, worm, fruitfly
Gene-Phenotype Data
Genomic data
Gene functions
Disease/Phenotype vocabularies
This was the novel case we solved. The UDP patient had a number of signs and symptoms including various platelet abnormalities. The same heterozygous, missense mutation was seen in 2 patients and ranked top by Exomiser. It had never been seen in any of the SNP databases and was predicted maximally pathogenic. Finally a mouse curated by MGI involving a heterozygous, missense point mutation introduced by chemical mutagenesis exhibited strikingly similar platelet abnormalities.
Going through HPO and systematically adding synonyms; flagging those that are relevant to the layperson
Fully translational – from bench to bedside – group of stakeholders, contributors and partners