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Wearables and PrecisonHealth
Michael Snyder
March 13th, 2019
Conflicts: Personalis, Genapsys, SensOmics, Qbio, January, Filtricine, Akna
• Focused on Health• Proactive• Measure many things• Frequent?• Individual based
• Focus on Illness• Reactive• Measure very few things• Infrequent• Population based
MedicinePresently Should be
Precision Health
Health
Genome
Food
Health Is a Product of Genome, Exposome, Lifestyle
Environmental Exposures
ExerciseLifestyle
Stress
Genome
Transcriptome
Proteome
MetabolomeLipidomics
Autoantibody-ome
Longitudinal Personal Omics Profiling
Cytokines
Epigenome
Billions of Measurements!
Microbiome (Gut, Urine, Nasal, Tongue, Skin)
OmicsMeasurements
4
Year 2 …Year 1 Viral infection
Biosensors
Clinical TestsQuestionaires
Stress EchosGlucose Control
107 Individuals 5.5 yrs
Metabolic
Infectious
Other Heme/Onc
Cardiovascular
7 Oncologic Risk Genes(Thyroid Cancer in 1)
1 Lymphoma (Imaging)1 MGUS (IgM) 1 Smoldering Myeloma (IgM)1 α Thalassemia (Clinical) 1 β Thalassemia (Gene/Clinical)1 Pros1 Mutation (gene)
1 Lyme Disease (wearable)
6 Carotid Plaques (imaging)1 Atrial Fib. (wearable)1 RMB20 mutation (gene)1 Reduced LVEF/GLS (imaging)3 Dilated L. Atrium (imaging) 1 Pharmagenomic (gene)
1 Sleep Apnea (wearable)1 SLC7A9 mutation (cystinuria risk)2 Macroalbuminuria
1 MODY mutation (gene)1 ABCC8 Mutation (gene)14 New Diabetes
49 Major Health Discoveries
Rose, Contrepois et al. Nat. Medicine, in press
Discovery of B-Cell Lymphoma
Rose, Contrepois et al. Nat. Medicine, in press
Transitions in DM status
Rose, Contrepois et al. Nat. Medicine, in press
−20
0
20
40
−60 −40 −20 0 20 40MDS1
MDS2
−5.0
−2.5
0.0
2.5
5.0
−8 −4 0 4MDS1
MDS2
Cytokines
ClinicLabs
−1000
0
1000
−1000 0 1000MDS1
MDS2
−4000
0
4000
8000
−20000 −10000 0 10000MDS1
MDS2
Metabolome
Transcriptome
Strong Personal CharacteristicsMultiDimensional Scaling for 12 subjects with at least 10 healthy baseline visits
Basis B1Basis
Peak
Apple Watch
Dexcom Constant Glucose Monitor
Withthings Smart Scale
Qardio Blood Pressure Cuff
ScanaduScout
Autographer – Life Logger
iHealth Pulse Oximeter
Athos – Smart Shorts
RadtargeRadiation
Sensors: Over 900 Devices
Li, Dunn et al. PloS Biol 2017
Δ Sk
in T
emp
(Nig
ht –
Day
)Δ
HR
(Nig
ht –
Day
)
43 People: All are different
SpO2 Levels Drop During Airline Flights
SpO2Measurements
Associated With Fatigue
Li, Dunn et al. PloS Biol 2017
Early detection of Lyme disease
% o
f out
lier (
HR
)%
of o
utlie
r (Sk
in te
mp.
)
Day 458 470 474462 466 478 482 486 490 494
Detects All Days of Illness
Li, Dunn et al. PloS Biol 2017
Change-of-Heart Algorithm
Continuous Glucose Monitoring: Lots of Spikers
24 hours
2-4 weeks
Dexcom G415
Classification of People into Glucotypes Based on CGM Profiles
Segment CGM profiles into windows and cluster
Glucotypes
The same meal triggers different glycemic responses in different people
Bread + Peanut Butter
Protein Bar
Cornflakes + Milk
Glucotype classification may help find diabetes risk
18Clustering based n clinical and glucose data
Latest Wearable: Human Exposome
Biotics Abiotics
Asthma & allergies strike
1 out of 5Americans
Carcinogens,Pollutants,Smoke
Identify Personal Exposomes:Track individuals up to 890 days
Flow rate: 0.5L/min
Average human breathes in 11L/min
CartridgesFilters
P1 n=201P2 n=33P3 n=12P4 n=4P5 n=4P6 n=2P7 n=3P8 n=7
Others n=17
Total N=283
2014−072014−1
02015−0
12015−0
42015−0
72015−1
02016−0
12016−0
42016−0
72016−1
02017−0
1
Date
Ind
ivid
ua
l
Season spring summer fall winter
Timelines
−50
−25
0
25
50
−100 0 100Longitude
Latitude
37.3
37.5
37.7
37.9
−122.4 −122.2 −122.0 −121.8Longitude
Latitude
P1P2P3
What can we capture?(Minus human reads)
>2500 species~300/sample
>70 billion reads>10 Trillion base pairs> 7 million assembled contigs
Empty filter Pine Pollen
Brochosomes“Stem rust” spores Inorganic materials
(water repellent coating on
insects)
Puccinia graminis
Eucalyptus Pollen
Dynamic exposome specific to individuals
Timeline
P1
P2
P3
Kingdom level
890 days
429 days
301 days
P1 P2 P3Plant
FungiBacteria Mixed
Season and location matterP1 Samples: Location
P1 Samples: Season
Forward-selected variables from a collection of 64 meta-variables
Location, location, locationDifferent persons, same month
San FranciscoAlkanindiges: Sludge bacteriaKlebsiella: pneumonia pathogen
Seasonal influence on the genera
Pine tree sheds millions of pollens
“False Turkey Tail”, spore season starts around fall
season spring summer fall winter
*
***
*Kruskal−Wallis, p = 0.00016
0
5
10
15
Ster
eum
hirs
utum
0
5
10
3 4 5 6 7 8 9 10 11 12 1 2
Chemicals are influenced by locationLocation Bethesda−MD
Boston−MACampusDavis−CA
East_Lansing−MIHouston−TX
MontanaSF−CA
−2
0
2
Phth
alat
e
−2
0
2
Geo
smin
−2
0
2
Capr
ylic
acid
−2
0
2
SF−CA
Campu
s
Campu
s
Campu
s
Montan
a
Housto
n−TX
Campu
s
Campu
s
Campu
s
Boston−M
A
Campu
s
East_L
ansin
g−MI
Davis−
CA
Boston−M
A
Bethes
da−M
D
Om
etho
ate
“Earthy” smell
Pesticide
Plastic components
Body Scent
Chemicals are correlated with biologicalsLocation Bethesda−MDBoston−MA
CampusDavis−CA
East_Lansing−MIHouston−TX
MontanaSF−CA
−2
0
2
Phlebiopsis
−2
0
2
Gym
nopus
−2
0
2
Lentinus
−2
0
2Coniosporium
−202
SF−CA
Campus
Campus
Campus
Montana
Houston−TX
Campus
Campus
Campus
Boston−MA
Campus
East_Lansing−MI
Davis−CA
Boston−MA
Bethesda−MD
PyridineOrganic
solvent, used in paint
Common Fungal genera
The Exposome Cloud – connections between detected species
Smart Phone = Control Center
Acknowledgements
31
Snyder LabWenyu ZhouBrian PieningKevin ContrepoisTejaswini MishraKim KukurbaShannon RegoJessica SibalHannes RostVarsha RaoLiang LiangTejas MishraChristine YehHassan ChaibEric WeiMonica Avina
WearablesXiao LiJessie DunnDenis SalinsSophia Miryam …Heather Hall
Weinstock LabGeorge WeinstockErica SodergrenYanjiao ZhouShana LeopoldDaniel SpakowiczBlake HansonEddy BautistaLauren PetersenLei ChenBenjamin LeopoldSai LekPurva Vats
Jon Bernstein
NIHLita ProctorSalvatore SechiJon LoTempioAnd other
McLaughlin LabTracy McLaughlinColleen CraigCandice AllisterDalia PerelmanElizabeth Colbert
ExposomeChao JiangXin WangJingga InloraTing WangXiyan Li
32
The Future?Genomic Sequencing
1. Predict risk2. Early Diagnose3. Monitor4. Treat
GGTTCCAAAAGTTTATTGGATGCCGTTTCAGTACATTTATCGTTTGCTTTGGATGCCCTAATTAAAAGTGACCCTTTCAAACTGAAATTCATGATACACCAATGGATATCCTTAGTCGATAAAATTTGCGAGTACTTTCAAAGCCAAATGAAATTATCTATGGTAGACAAAACATTGACCAATTTCATATCGATCCTCCTGAATTTATTGGCGTTAGACACAGTTGGTATATTTA….
Amanda Mills
Omes & Sensors: Personal Devices
SpO2Measurements
Can Adapt on Flights >7hrs
Share Information With Physician
Importance in Individual Variation from “Normal”
Sund-Levander M. Scand J Caring Sci 2002;122-8. & Souissi N. Chronobio Int 2007;24:739 -48
Oral temp in 2749 healthy individuals
100.8F
99.1F
97.5F
94.6F
92.0F
Sequences related to pathogens: rare
Species level
6 people with Carotid Plaque
MGUS PreCancer: High IgM
Rose, Contrepois et al. Nat. Medicine, in press
Circadian and diurnal patterns
Li, Dunn et al. PloS Biol 2017
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