Becoming a Quantified Self

Becoming a Quantified Self Invited Speaker Technology, Media and Telecom (TMT) Summit Deloitte University Dallas, TX April 26, 2012 Dr. Larry SmarrDirector, California Institute for Telecommunications and Information Technology Harry E. Gruber Professor, Dept. of Computer Science and Engineering Jacobs School of Engineering, UCSD 1 http://lsmarr.calit2.net

Calit2 Has Been Had a Vision of “the Digital Transformation of Health” for a Decade www.bodymedia.com• Next Step—Putting You On-Line! – Wireless Internet Transmission – Key Metabolic and Physical Variables – Model -- Dozens of Processors and 60 Sensors / Actuators Inside of our Cars• Post-Genomic Individualized Medicine – Combine – Genetic Code – Body Data Flow – Use Powerful AI Data Mining Techniques The Content of This Slide from 2001 Larry Smarr Calit2 Talk on Digitally Enabled Genomic Medicine

The Calit2 Vision of Digitally Enabled Genomic Medicine is an Emerging Reality 3 July/August 2011 February 2012

Lifechips--Merging Two Major Industries: Microelectronic Chips & Life Sciences LifeChips: the merging of two major industries, the microelectronic chip industry with the life science industry65 UCI Faculty LifeChips medical devices

From One to a Billion Data Points Defining Me:The Exponential Rise in Body Data in Just One Decade! Billion: MyFull Genome Full DNA, MRI/CT Images SNPs Million: My DNA SNPs, Zeo, FitBit Blood Variables One: Hundred: My Blood Variables Weight Weight My

During the 2000s, The Fraction of the Population That is Obese Has Greatly Increased2000 35% of Adults 17% of Children No State Reduced its % Obese In 2010 2009 Source: Behavioral Risk Factor Surveillance System, CDC

I Arrived in La Jolla in 2000 After 20 Years in the Midwest and Decided to Move Against the National Trend 1999 2010 2000 Age Age 51 61 I Reversed My Body’s Decline By Altering My Nutrition and Exercise See the full story at: http://lsmarr.calit2.net/repository/092811_Special_Letter,_Smarr.final.pdf

I Lost Weight by Changing What & How Much I Eat,While Increasing Aerobic and Weight Bearing Exercise Exercise is Elliptical and Walking Gradually Moving to Zone Diet and 182±4 lbs. Regular Exercise Current Weight 180 Average Blood Pressure 134/73, Pulse 55 Resting Pulse Lowered to 45

I Quantify My Food Intake So I Can “Tune” My Glucose/Insulin System and Lower Inflammation Computed Average Over 12 Days When at Home for Maximum Accuracy Measure All Food and Drink Components, Then Use USDA Lookup to Compute Each Item Measuring Daily Food Intake• Quality of Food Needs More “LifeChips”! – All Organic and Mostly Locally Grown – Carbs are Low Glycemic Index – No Added Sugar or Refined Flour – Mostly Fruits and Vegetables – Proteins are Lean – Meat is Grass Fed – No Corn or Antibiotics – Fish is Wild, Often Locally Caught – Fats are Omega-3 Rich – Supplemented by 7g Daily Pharmaceutically Purified Fish Oil Pills For my recommendations on nutrition, exercise, sleep and stress, see: http://lsmarr.calit2.net/repository/LS_reading_recommendations_FiRe_2011.pdf

Wireless MonitoringHelps Drive Exercise Goals My Average is 7,000 Steps/ Day Over Last 10 Months

Quantifying My Sleep Pattern Using a Zeo -Surprisingly About Half My Sleep is REM! REM is Normally 20% of Sleep An Infant Typically Mine is Between 45-65% of Sleep Has 50% REM

On the Road Zeo Solution:Link Headband to Android Smartphone

CitiSense –New NSF Grant for Fine-GrainedEnvironmental Sensing Using Cell Phones Seacoast Sci. 4oz 30 compounds Intel MSP contribute e W rett re ns se riie re CitiSense ve ve L C/A S EPA r ve “d “d iisp co sp di s F lla ayy” CitiSense Team ” distribute PI: Bill Griswold Ingolf Krueger Tajana Simunic Rosing Sanjoy Dasgupta Hovav Shacham Kevin Patrick Integrate Into a “LifeChip”

From Measuring Macro-Variablesto Measuring Your Internal Variables www.technologyreview.com/biomedicine/39636

Where I Believe We are Headed: Predictive, Personalized, Preventive, & Participatory Medicine I am Leroy Hood’s Lab Rat! Using a “LifeChip” Quantify ~2500 Blood Proteins,50 Each from 50 Organs or Cell Types from a Single Drop of Blood To Create a Time Series www.newsweek.com/2009/06/26/a-doctor-s-vision-of-the-future-of-medicine.html

Tracking and Reducing Inflammation is Critical to Your Health 2004

I Have Greatly Lowered My Body’s Inflammation From Food By Increasing Omega-3s Ratio of AA/EPA “Silent Inflammation” Chronically Ill I take 6 Fish Oil American Pills Per Day Average “Healthy” American Ideal Range My Range Range Source: Barry Sears My Tests by www.yourfuturehealth.com

Most Blood Variables Stay Within Normal Range:Fraction of Normal Upper Range For Three Variables Occasional Brief Excursions Above Normal Upper Range

My Quarterly Blood Tests In Addition to Lipids: Only One Was Far Beyond Normal Limits• Electrolytes • Liver – Sodium, Potassium, Calcium, – GGTP, SGOT, SGPT, LDH, Total Magnesium, Phosphorus, Boron, Direct Bilirubin, Chlorine, CO2 Alkaline Phosphatase• Micronutrients • Thyroid – Arsenic, Chromium, Cobalt, – T3 Uptake, T4, Free Thyroxine Copper, Iron, Manganese, Index, FT4, 2nd Gen TSH Molybdenum, Selenium, Zinc • Blood Cells• Blood Sugar Cycle – Complete Blood Cell Count – Glucose, Insulin, A1C Hemoglobin – Red Blood Cell Subtypes• Cardio Risk – White Blood Cell Subtypes – Complex Reactive Protein (CRP) • Cancer Screen – Homocysteine – CEA, Total PSA, % Free PSA• Kidneys – CA-19-9 – Bun, Creatinine, Uric Acid • Vitamins & Antioxidant Screen• Protein – Vit D, E; Selenium, ALA, coQ10, – Total Protein, Albumin, Globulin Glutathione, Total Antioxidant Fn. I Track Over 100 Blood Variables Over Time

Blood Measurements Reveal Chronic Inflammation Via Complex Reactive Protein Biomarker 15x Normal CRP from Symptom: Blood Tests Acute Diverticulitis “Come Back When You Have a Symptom” ?Inflammation 5x Normal Antibiotics CRP Good Range

Inflammation is Episodic and Growing: What Could be the Cause? 27x Much of the Inflammation Drop Is Spontaneous Previous Graph Size 15x Antibiotics5x Antibiotics Normal Range CRP < 1 Demonstrates Value of Fine-Grained Time Series

CRP and LDL Cholesterol Co-Create Arterial Plaque High CRP Arterial Plaque FormationCRP > 4.2, 5x Risk of Future Heart Disease http://sjog.org.au/pathology/pathology_wa/doctor_resources/clinical_articles/high_sensitivity_crp.aspx

Frequent Stool Analysis Reveals Lactoferrin Spike to Active Crohn’s Disease (CD) Level Colonoscopy Typical May 2011 Normal Lactoferrin Level < 7 Lactoferrin Value for Active Crohn’s Colonoscopy May 2006 Colonoscopy Jan 2012 Colonoscopy December 2010 Colonoscopy and Biopsies Support CD Diagnosis

Confirming the Crohn’s Hypothesis: Finding the “Smoking Gun” with MRI ImagingLiver I Obtained the MRI Slices Transverse Colon From UCSD Medical Services and Converted to Interactive 3D Working With Small Intestine Calit2 Staff & DeskVOX Software Descending Colon Diseased Sigmoid Colon Major Kink Sigmoid Colon Threading Iliac Arteries

LS Sigmoid Colon Cross Sections Showing Inflamed Wall Jan 2012 MRI Enterography report: “long segment wall thickening in the proximal and mid portions of the sigmoid colon, extending over a segment of approximately 16 cm, with suggestion of intramural sinus tracts. Ulcerative Colitis isRestricted tothe Mucosa, while Crohns Disease Note Affects the Thickness Whole of Wall -Bowel Wall Normal is 3mm (like a Balloon) Source: L Smarr Using Calit2’s Jurgen Schultz Software

Exploring My Internal Organs in the Calit2Virtual Reality CAVE Using DeskVOX Software Photo & DeskVOX Software Courtesy of Jurgen Schulze, Calit2

Autoimmune Diseases Effect 5-8% of Americans• Crohn’s Disease Despite decades of research, the etiology of Crohns disease• Ulcerative Colitis remains unknown.• Rheumatoid Arthritis Its pathogenesis may involve a complex interplay between• Multiple Sclerosis host genetics,• Psoriasis immune dysfunction,• Type 1 Diabetes, and microbial or environmental factors.• Ankylosing Spondylitis --The Role of Microbes in Crohns Disease Paul B. Eckburg & David A. Relman• Lupus Erythematosus Clin Infect Dis. 44:256-262 (2007)• Plus Over 70 Others The National Institute of Allergy and Infectious Diseases (NIAID)

The Cost of Sequencing a Human GenomeHas Fallen Over 10,000x in the Last Ten Years! This Has Enabled Sequencing of Both Human and Microbial Genomes

Single Nucleotide Polymorphisms (SNPs) Make Up About 90% of All Human Genetic VariationPerson A SNPs Occur Every 100 to 300 Bases Along Human DNAPerson B www.23andme.com Tracks One Million SNPs

I Wondered if Crohn’s is an Autoimmune Disease, Did I Have a Personal Genomic Polymorphism? From www.23andme.com Polymorphism in Interleukin-23 Receptor Gene — 80% Higher Risk ATG16L1 of Pro-inflammatory Immune Response IRGM NOD2 SNPs Associated with CD

You are a Superorganism:Your Body Has Ten Microbes for Every Human Cell! Firmicutes Are the Dominant Phyla in the Human Microbiome Science v.330, p. 1619 (2010)

The Gut Microbiome Has Been Mapped in the Last Five Years Using Genome Sequencing“A majority of the bacterial sequences corresponded to uncultivated species and novel microorganisms.” 395 Phylotypes Firmicutes Bacteroidetes “Diversity of the Human Intestinal Microbial Flora” Paul B. Eckburg, et al Science 308, 1635-8 (2005)

Crohn’s Disease Patients Have Number of Firmicute Gut Microbe Species Reduced by Over 2/3! Healthy Gut MicrobesActinobacteria 7 Bacteroidetes Proteobacteria Firmicutes 33 5 43 IBD Gut MicrobesActinobacteria 7 Bacteroidetes Proteobacteria Firmicutes 33 5 13 The Missing Firmicutes Inhibit Pro-Inflammation Manichanh, et al, Gut 2006;55:205–211

Next Step: Use Microarray to Measure Time Series of Microbial Diversity www.secondgenome.com “Second Genome has developed a sensitive, flexible and robust platform for the identification of microbiome-based signatures for the rapid identification of microbial gut health biomarkers.” DNA microarray that can identify, within hours, over 50,000 different microbesLBL’s Gary Andersenand his PhyloChip

Microbial MetagenomicsCan Diagnose Disease StatesFrom www.23andme.com Mutation in Interleukin-23 Receptor Gene—80% Higher Risk of Pro-inflammatory Immune Response IBD Patients Harbored, on Average, 25% Fewer SNPs Associated with CD Microbial Genes than the Individuals Not Suffering from IBD. 2009

Finding Out if I Have Missing Microbes:Metagenomic Sequencing of My Gut Microbiome I Received a Disk Drive Last Week With 35 GB FASTQ Files Weizhong Li, UCSD NGS Pipeline: 230M Reads Only 0.2% Human Next: 100,000 cpu-hrs Gel Image of Extract from Smarr Sample-Next is Library Construction Manny Torralba, Project Lead - Human Genomic Medicine J Craig Venter Institute January 25, 2012

100,000 People Like MeAre Uploading Their Genomes and Medical Records I Have Been Accepted by PGP and Spoke at GET 2012: "N=1: Pioneers of self-tracking" GET Held at the Harvard Medical School

Integrative Personal Omics Profiling: 1000x the Data I Have Taken Cell 148, 1293–1307, March 16, 2012 • Michael Snyder, Chair of Genomics Stanford Univ. • Genome 140x Coverage • Blood Tests 20 Times in 14 Months – tracked nearly 20,000 distinct transcripts coding for 12,000 genes – measured the relative levels of more than 6,000 proteins and 1,000 metabolites in Snyders blood

Integrating Systems Biology Data: Cytoscape • OPEN SOURCE Java Platform for Integration of Systems Biology Data • Layout and Query of Interaction Networks (Physical And Genetic) • Visual and Programmatic Integration of Molecular State Data (Attributes) 39 www.cytoscape.org

With the Explosion in Biomedical Data,What is the Required Cyberinfrastructure? Report 2009 http://rci.ucsd.edu

Source: Lucila Ohno-Machado, UCSD SOM iDASH Outcome of NIH Botstein-Smarr Report (1999) 41http://acd.od.nih.gov/agendas/060399_Biomed_Computing_WG_RPT.htm

New NCBC: integrating Data for Analysis, Anonymization, and SHaring (iDASH) Private Cloud at SD Supercomputer Center Medical Center Data Hosting HIPAA certified facility 42 Source: Lucila Ohno-Machado, UCSD SOM funded by NIH U54HL108460

UCSD Next Generation Sequencer Example: Professor Trey IdekarLeichtag/Sequencer Storage Skaggs/Users Next Gen Sequencers Generate ~1TB/Run Calit2/Storage SDSC/Triton Source: Chris Misleh, Calit2/SOM

Calit2 Community Cyberinfrastructure for AdvancedMicrobial Ecology Research and Analysis (CAMERA) Source: Phil Papadopoulos, SDSC, Calit2 512 Processors ~200TB ~5 Teraflops Sun X4500 ~ 200 Terabytes Storage 1GbE and Storage 10GbE Switched/ 10GbE Routed Core 5000 Users 90 Countries

Access to Computing Resources Tailored by User’s Requirements and Resources Advanced HPC Platforms CAMERA Core HPC Resource NSF/DOE TeraScale Resources Source: Jeff Grethe, CAMERA

NSF Funds a Data-Intensive Track 2 Supercomputer: SDSC’s Gordon-Coming Summer 2011• Data-Intensive Supercomputer Based on SSD Flash Memory and Virtual Shared Memory SW – Emphasizes MEM and IOPS over FLOPS – Supernode has Virtual Shared Memory: – 2 TB RAM Aggregate – 8 TB SSD Aggregate – Total Machine = 32 Supernodes – 4 PB Disk Parallel File System >100 GB/s I/O• System Designed to Accelerate Access to Massive Data Bases being Generated in Many Fields of Science, Engineering, Medicine, and Social Science Source: Mike Norman, Allan Snavely SDSC

Rapid Evolution of 10GbE Port Prices Makes Campus-Scale 10Gbps CI Affordable • Port Pricing is Falling • Density is Rising – Dramatically • Cost of 10GbE Approaching Cluster HPC Interconnects$80K/portChiaro(60 Max) $ 5K Force 10 (40 max) ~$1000 (300+ Max) $ 500 Arista $ 400 48 ports Arista 48 ports2005 2007 2009 2010 Source: Philip Papadopoulos, SDSC/Calit2

10G Switched Data Analysis Resource: SDSC’s Data Oasis – Scaled Performance10Gbps OptIPuter UCSD RCI Radical Change Enabled by Co-Lo Arista 7508 10G Switch 5 384 10G Capable 8 CENIC/ 2 32 NLR Triton 4 Existing 8 Commodity Trestles 32 2 Storage 100 TF 12 1/3 PB 40128 8 Dash 2000 TB Oasis Procurement (RFP) > 50 GB/s 128 • Phase0: > 8GB/s Sustained Today Gordon • Phase I: > 50 GB/sec for Lustre (May 2011) :Phase II: >100 GB/s (Feb 2012) Source: Philip Papadopoulos, SDSC/Calit2

From “How Do You Feel?”,to “What Are Your Numbers?” Where’s There’s Data There’s Hope

For Further Information Visit My Portal http://lsmarr.calit2.net/

Becoming a Quantified Self

by Larry Smarr

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