Andrea Evers

Health Valley March 13, 2013

Radboud Personalized Healthcare
Prof.dr. Andrea W.M. Evers &
Prof.dr. Alain J. van Gool

on behalf of the

Taskforce Personalized Healthcare
Radboud University Medical Centre
Nijmegen, The Netherlands

Major shift to
Personalized Healthcare concepts

One-size-fits-all

Healthcare tailored to needs
and characteristics of the
individual

Reactive medicine

Pro-active, pre-emptive, and
preventive healthcare

European Science Foundation

Need for Personalized Healthcare tools
Mechanism ? Prognosis ?
Patient classification ?

Diagnosis ?
Other (latent) diseases ?

Treatment Disease Disease state

Drug exposure ?
Cross-species differences ?
Target engagement ?
Off-target drug effects ?
Modulation of mechanism ?

High need for (molecular) tools
to improve disease management

4

Working in complex human biological systems
requires a system biology approach

Radboud University Medical Centre

Excelling in research,
patient care and education
for personalized healthcare

9500 employees
3500 students
950 beds
3000 scientific publications
150 dissertations each year

Our mission
To have a significant
impact on healthcare

Our vision
 Distinctive quality
 Personalized healthcare
 Operational excellence
 Sustainable networks

Our mission
To have a significant impact
on healthcare

Our principles
 Patient as Partner
& Participatory Healthcare
 Translational research
 Implementation in
Care, Research & Education

Following ESF Recommendations

1. Generation of datasets to
develop, refine, and apply
new disease taxonomy
2. Revised models and decision-
making processes focused on
the individual
3. Interdisciplinary, participative,
and translational research
4. Infrastructure and resources
(funding and support)


Investments in preconditions for
implementation

Infrastructure
Cross-disciplinary working
Interdisciplinary structures
Biobanks
Access to core technologies
Promotion of health (literacy)
Education & training programs



Interdisciplinary taskforce (2012)
fundamental, clinical, and methodological
researchers
in Personalized Healthcare
a patient representative
communication experts
valorization expert
Laboratory Anthropo-
Communicatio Medicine genetics
n Oncology
Radboud
Valorization
Personalized
Neurology
Healthcare
Task Force
Health care
Patient
innovation
Medical Health
Psychology Evidence


fundamental, clinical, and
methodological researchers
n Oncology
Radboud
Valorization
Personalized
Neurology
Healthcare
Task Force
Health care
Patient
innovation
Medical Health
Psychology Evidence


fundamental, clinical, and
methodological researchers
n Oncology
Radboud
Valorization
Personalized
Neurology
Healthcare
Task Force
Gynae-
Patient
cology
Medical Health
Psychology Evidence


fundamental, clinical, and methodological
researchers
Medicine genetics
Communicatio
n Oncology
Radboud
Valorization
Personalized
Neurology
Healthcare
Task Force
Health care
Patient
innovation
Medical Health
Psychology Evidence


Definition Radboud Personalized Healthcare

• Translational and interdisciplinary research
(From molecule to men to population back to men)

• Connection to Patient as Partner “It’s far more important
(Education and Health care) to know what person
the disease has than
what disease the
person has.”

Hippocrates, 400 B.C

“We enable personalized and participatory patient care
through interdisciplinary research”


•Majority of (current and future) RUMC research represents
research on Personalized Healthcare

•Personalized Healthcare research is about equally
represented in all research institutes
e.g. Oncology, Rare diseases, Inflammation, Neurology

“Personalized Healthcare builds onto the
historic roots of the university and the Radboud
University Medical Center.”
Interview research director

Personalized Healthcare @ Radboud UMC

Various best practice examples
Malaria treatment
Macula degeneration
Rare metabolic diseases
Genome sequencing
Parkinson care
Participatory E-health care

Best-Practice Examples

Radboud
Personalized Healthcare

Malaria control

Molecule

Molecular evaluation of
hotspot interventions on
parasite populations
Identification of
malaria proteins that
are recognized by
malaria-exposed
populations
Personalized interventions
1. households next to a swamp: larve control
2. households with few nets: additional nets
3. households with parasite carriers:
prophylactic treatment
Mapping immune
responses to this
protein to find malaria
hotspots

,
olds
seh T. Bousema et al., Radboud
re hou
ts a gnition UMC,
a
: do
map A-1 rec
o Population Health Valley 2013, Pecha
Are r AM
u Kucha
colo

Age-related
Macula degeneration
Patient
Neovascular AMD can be
treated with anti-VEGF
injections, but 10% of patients
do not respond to these
expensive and invasive
therapy

Treatment
Genes
Patients with a low genetic load can
effectively be treated with anti-VEGF
therapy
The genetic load of risk
alleles in CHF and ARMS2
can help predict the response
to anti-VEFG treatment Complement activity Genetic studies
(exome sequencing)
may reveal new
pathogenic pathways
in AMD that can be
targeted with new
therapies

Patients with a high genetic load and
high complement activation may benefit A. Den Hollander & C.
from a combination therapy of anti- Hojing, Radboud UMC
VEGF and complement inhibitors

Prostate cancer
PSA screening: 30% Patient
reduction in prostate
cancer mortality.
However, also about
40% over treatment of
insignificant tumors

Molecule
Personalized interventions
Molecular profiling
leads to non-invasive
urine test

Only men with significant tumors will be
treated (i.e., 40% less operations). Focal
surgical treatment will be possible:
1. Cryo surgery
Person 2. Laser surgery
3.HIFU and/or
4. Brachy

Multi-parametric MRI and
MRI-guided biopsies lead to
J. Barentsz, J. Schalken et
improved localization of
al., Radboud UMC
significant tumors

Participatory E-health care
for chronic somatic conditions
E-health screening
for disease-related
physical,
psychological or
social adjustment About 1/3 of Personalized E-health treatment modules

problems patients with
Physical Psychological Social
chronic somatic functioning functioning functioning
conditions suffer
from adjustments
problems

Patient not at risk:
Standard care

Personalized E-health self-management
E-health risk profile treatments personalized to
Patient at risk: disease- and patient-specific
Personalized E-health self- problems and risk and
management treatments resilience factors

A. Evers, P vd Kerkhof et al.,
Radboud UMC

Planning 2013

• Proactive stimulation of Personalized Healthcare research
within Radboud UMC

• Incorporate Personalized Healthcare in core tasks: Health
Care, Research, Education

• Strengthen technological and methodological infrastructure

• Join forces with external partners (NL,EU) to implement
Personalized Healthcare in translational networks

Investments and networks with industrial
and university partners

29

Personalized Healthcare Stakeholders

Investments and networks with industrial
and university partners

Infrastructure
Cross-disciplinary working
Interdisciplinary structures
Biobanks
Access to core technologies
Promotion of health (literacy)
Education & training programs

Radboud Biobank
for biomarkers and other data collection

TopSectorplan Life Science & Health
{www.rijksoverheid.nl} {http://www.zonmw.nl/nl/roadmaps-lsh/}

Roadmap Molecular Diagnostics:

•Build an efficient biomarker development pipeline in the Netherlands
•Bring all stakeholders together in a functional open innovation network based
on public-private-partnerships
•Have end-users (patients) direct biomarker discovery in beginning
•Improve progress of biomarkers from discovery to clinical implementation

Biomarkers and self-diagnosis …

Participatory E-health UMC St Radboud:
Digital outpatient clinics and communities

Mijn Radboud
Dossier

Mijn Zorgnet

Participatory E-health UMC St Radboud:
Digital personalized selfmanagement

Personalized selfmanagement care
• Flexible choice treatment modules,
depending from the risk profile of patients
Mijn E-coach
• Stepped care

European networks

European Science
Foundation (2013)

Radboud University Medical Center
as field lab to implement Forward Look
‘Personalised Medicine
for the European Citizen’

European networks
Personalized Healthcare & Self-management

European Centre
and Self-management

Initiative of TNO and CBO
with Radboud University Medical Center (A. Evers)
& other industrial, university and care partners

EU-Horizon 2020 topics
and Radboud Personalized Healthcare
Understanding the Developing effective
determinants of health, screening programmes and Improving surveillance and
imrpoving health Understanding disease Developing better vaccines
improving the assessment preparedness
promotion and disease of disease susceptibility
prevention

Optimising the efficiency
Improving diagnosis Personalised and effectiveness of
healthcare systems and
reducing inequalities
Brain & Cancer through evidence based
Cognition decision making and
dissemination of best
practices and innovative
Using in-silico medicine for technologies
Immunity & Rare
improving disease
management and Infection Diseases
prediction

Regenerative Quality
Promoting integrated care
Medicine of Care

Treating disease Medicine

Improving scientific tools
Transferring knowledge to Individual empowerment
and methods to support Active ageing, independent
clinical practice and Better use of health data for self-management of
policy making and and assisted living
scalable innovation actions health
regulatory needs


Speakers I.Norstedt, ERC Coordinator Personalized Medicine

Plenary Session
Health Valley

Radboud
with
Paul Smits (dean)

Thank you
for your
attention!

Andrea Evers

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Editor's Notes