Toward Precision Medicine:
Building a patient centric information commons on common and
rare diseases with I2b2/tranSMART
Application to Autism and Phelan McDermid Syndrome
Paul Avillach, MD, PhD Assistant Professor -‐ Harvard Medical School Center of Biomedical Informa:cs Research Connec:on – CHIP-‐ Boston Children’s Hospital Toward Precision Medicine: Building a Knowledge Network for
Biomedical Research and a New Taxonomy of Disease
Report from National academy of science, USA, 2011
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PI: Isaac Kohane – Harvard - CBMI
Health care
Clinical Research
Health Information System
Browser tools
available
for Researchers
DRG
Imaging
Pathology
Rx
2) Structured
data from
research
studies
ETL
Biology
ETL
EHR reports
ETL once a week
EHR forms
1) Analysis tools 3) ‘omics data
Phenotypic ‘omics
+’omics
•  Integrated platform to support translational research
•  Initiated by Johnson & Johnson et Recombinant 7 years ago
•  Open-source since January 24th , 2012
•  Installed at HEGP Hospital, Paris since May, 2012
•  Today, driven and maintained by the tranSMART
http://transmartfoundation.org
Objectives :
1.  Integration of clinical, biological and ‘omics
data in one place – hypothesis free –
2.  Generation of hypothesis by Clinicians /
Researchers
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Autism cohorts
Phenotype data
•  Simons Simplex Collection (SSC)
•  AGRE
•  Autism Consortium (AC)
•  BCH i2b2 HER data
2,760
3,300
525
16,587
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BIG data
RESEARCH ARTICLE
[Bioinformatics & Integrative Genomics]
TCGA
a
Ref. 25
HGS-OvCa
489 tumours GBM
b
Tumour/gene groups
Gene expression
Low
1p36.33
10–5.5 10–10
10–20
1p34.2
1q21.2
1,000 genes
Differentiated
Immunoreactive
Mesenchymal
Proliferative
245 tumours
0.
25
a
4q13.3
5p15.33
5p13.2
High
6p22.3
Deletion
Known rela:onships between genes Neutral
TCGA
set
c 0.25training
10
10
10
b
Sequence varia:on (Batches Copy 9–15; 215
tumors)
number Death event (red)
varia:on –20
–40
–60
10–80
Amplification
TCGA test set
(BatchesGene 17–24;e255
tumors)
xpression 8p11.21
DEPTOR
Poor prognosis
genes (107)
12q13.2
12q15
14q11.2 (METTL17)
14q32.33
Good prognosis
genes (85)
Prognostic
gene score
10
0
–10
+ many more Lower risk
Higher risk
Lower risk
9
Higher risk
inc
of
10–40
BR
an
of
BR
lat
BR
viv
for
ep
wi
41
sec
ina
an
Ge
mi
(Su
SSC (928)
Raw data
RNA Blood (Kunkel-Kohane)
–  Affymetrix Gene ST 1.0
–  Affymetrix U133+2
–  Illumina HiSeq
316
19
154
LCL (Geschwind)
- Illumina REF-8 3.0
AC (166)
439
Blood (Kunkel-Kohane)
–  Affymetrix Gene ST 1.0
–  Affymetrix U133+2
–  Illumina HiSeq
BCH (386)
117
21
28
Blood (Kunkel-Kohane)
–  Affymetrix Gene ST 1.0
–  Affymetrix U133+2
–  Illumina HiSeq
AGRE (1,048)
186
168
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LCL (Geschwind)
- Illumina REF-8 3.0
1,048
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DNA •  Static genomic predisposition
–  Goal: enable streamlined analysis of genomic
variation at any functional unit resolution
•  Single variant / variant type
•  Single gene
•  Gene set / pathway
•  Regulatory module
•  Cellular system
•  Genomic location / context
…
•  Measurement types
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Raw genotyping array data by cohort
•  SSC (3,184)
–  Ilumina Infinium1M
–  Illumina 1M Duo
DNA •  AC (60)
- Affymetrix SNP 6.0
•  AGRE (3,832)
- 
- 
- 
- 
Affymetrix 10K
Affymetrix 500K
Illumina HumanHap550
Illumina Infinium 1M
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WHOLE EXOME SEQUENCE data by cohort
•  SSC (2,963)
–  State
914
•  Illumina GAIIx
•  Illumina HiSeq
–  Eichler
DNA 676
•  Illumina GAIIx
•  Illumina HiSeq
–  Wigler
1373
•  Illumina HiSeq
•  AC (381)
–  Daly
381
•  Illumina HiSeq
•  AGRE (1672)
–  Walsh
750
•  Illumina HiSeq
–  BI-BCM
•  Illumina HiSeq
922
ABI SOLiD
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Exome sequence
data processing
>
Variant calling
>
Variant annotation > tranSMART input
Physical location
e.g. Chr:start-end
Cytoband
…
Gene
e.g. Gene name
Variant function
…
Gene set
e.g. Pathway
Molecular process
…
Predicted variant impact
e.g. SIFT
PolyPhen
…
Conservation
e.g. GERP
PhyloP
…
Population frequency
e.g. 1000 Genomes
ESP 6500
…
Clinical significance
e.g. ClinVar
OMIM
…
Expression patterns
e.g. GTEx
BrainSpan
…
Transcriptional regulation
e.g. ENCODE TFBS
Histone modifications
…
Comprehensively
annotated variants
Individual genotypes
ANNOVAR
SNPs,
indels
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Live DEMO hIps://www.youtube.com/watch?v=rUFH697a2n4 16
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PCORnet $105 million Start date Jan 2014 18 months 11 CDRN $7M 18 PPRN $1M 21
PCORI PPRN Grant
•  Phelan-McDermid Syndrome Data Network
–  PI: Megan O’Boyle, Mother of PMS patient
–  Co-PI: Paul Avillach, MD, PhD
•  Total: $1M
•  18 months
•  To collect all available patient data from PhelanMcDermid Syndrome (PMS) patients to make meaningful,
well-annotated clinical data available to researchers and to
share insights with members of the PCORI network
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Peter B. Jensen, Lars J. Jensen and Søren Brunak, Nat Rev Genet. 2012 24
Kohane I, Nature Review Gen. 2011
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Live Demo PMS_DN
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PaHent Centric InformaHon Commons (PIC) PI: Isaac Kohane RESTful API 27
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P50: Centers of Excellence in Genomic Science Neuropsychiatric Genome-‐Scale and RDOC Individualized Domains (N-‐GRID) PI: Isaac Kohane 500 subjects will use the same i2b2/tranSMART infrastructure to store and access all the following
datatypes:
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• 
• 
• 
• 
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• 
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• 
Results of 4h of self-report measures, clinician interview, and neuropsych testing.
EMR notes and codes
RDoC-parsing (NLP) of EMR notes
Whole-genome (not just exome) sequencing
GWAS (illumina psych chip - ~250k SNPs + CNV's) for at least a subset
RNA-seq (baseline and possibly additional experimental conditions)
L1000 (expression) data for up to 400+ conditions x multiple cell lines
illumina expression data x multiple lines (fibroblast, NPC, differentiated neurons)
nanostring (expression) data x multiple lines (iPS, NPC, differentiated neurons)
ATAC-seq data x multiple lines
Additional data from Greenberg lab (electrophys etc)
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PCORI PMS_DN team
• 
• 
• 
Megan O’Boyle, PI & Mom of Shannon
Paul Avillach, MD, PhD , Co-PI, Harvard
Medical School
Liz Horn, PhD, Co-PI, Network Director
PMSF Research director
•  Geraldine Bliss, MSc & Mom of
Project Manager
•  Andria Cornell Mann
LGC Data Network Specialist
•  Rebecca Davis
Family Engagement Specialist
•  Jackie Malasky
Harvard Medical School : CBMI
•  Sushma Hanawal
•  Michael McDuffie, MSc
•  Isaac Kohane, MD, PhD
•  Eric Perakslis, PhD
Boston Children’s Hospital: cTAKES NLP
•  Guergana Savova, PhD
•  Pei Chen
Harvard Medical School : IT Infrastructure
Support
•  Christopher Botka
•  David Hummel
•  Daniel Lewis
Avillach Lab
hIp://avillach-‐lab.hms.harvard.edu Developers
•  Michael McDuffie, MSc
•  Sushma Hanawal
•  Pei Chen
Research Associates
•  Antoine Neuraz, MD, MSc
•  Cartik Saravana, PhD
Graduate students
•  Maxime Wack, MD
•  Claire Hassen-Kodja, MD, MSc
•  Samuel Finlayson
Previous members
•  Ephi Sachs, MD
•  Heike Lehmann
We are hiring now
•  Senior Software Developer *2
•  Senior Database Developer *2
•  Postdocs *2
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P50: Centers of Excellence in Genomic Science Neuropsychiatric Genome-‐Scale and RDOC Individualized Domains (N-‐GRID) PI: Isaac Kohane 34
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