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Visual Exploration of 
Clinical and Genomic Data for 
Patient Stratification 
NILS GEHLENBORG 
! 
@nils_gehlenborg・http://www.gehlenborg.com 
Broad Institute of MIT and Harvard 
Cancer Program 
Harvard Medical School 
Center for Biomedical Informatics
Team 
Alexander Lex Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA 
Marc Streit Johannes Kepler University, Linz, Austria 
Christian Partl Graz University of Technology, Graz, Austria 
Sam Gratzl Johannes Kepler University, Linz, Austria 
Dieter Schmalstieg Graz University of Technology, Graz, Austria 
! 
Hanspeter Pfister Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA 
Peter J Park Harvard Medical School, Boston, MA, USA 
! 
Nils Gehlenborg Harvard Medical School, Boston, MA, USA & Broad Institute, Cambridge, MA 
!! 
! 
! 
Special thanks to 
Broad Institute TCGA Genome Data Analysis Center Team 
in particular Michael S Noble, Lynda Chin & Gaddy Getz
Funding 
Peter J Park NIH/NCI The Cancer Genome Atlas 
! 
Nils Gehlenborg NIH/NHGRI K99/R00 Pathway to Independence Award 
!!
?
TCGA 
The Cancer Genome Atlas
20+ cancer types 
× 
500 patients
10,000+ patients
mRNA expression 
microRNA expression 
DNA methylation 
protein expression 
copy number variants 
mutation calls 
clinical parameters
Stratome
Anthony92931 / Wikimedia Commons
Correlation with clusters based on other data types? 
Different outcomes? 
Mutations or copy number variants associated with clusters? 
Demographic differences?
Challenges 
How can we explore overlap of patient sets across stratifications? 
How can we compare properties of patient sets within a stratification? 
How can we discover “interesting” stratifications and pathways to consider 
How can we handle terabytes of clinical and genomic data in visualization tools?
Problem 1 
! 
Comparing Patient Sets 
across Stratifications
Patients 
Stratifications
mRNA Copy Number 
gene X 
Mutation 
gene Y 
del 
normal 
amp 
mut 
normal 
#1 
#2 
#3 
#4
mRNA Copy Number 
gene X 
Mutation 
gene Y 
del 
normal 
amp 
mut 
normal 
#1 
#2 
#3 
#4
mRNA Copy Number 
gene X 
Mutation 
gene Y 
del 
normal 
amp 
mut 
normal 
#1 
#2 
#3 
#4
mRNA Copy Number 
gene X 
Mutation 
gene Y 
del 
normal 
amp 
mut 
normal 
#1 
#2 
#3 
#4
StratomeX 
(short for Stratome Explorer)
mRNA Copy Number Mutation 
del 
normal 
amp 
mut 
normal 
#1 
#2 
#3 
#4
Select band
Select block
Compare clusterings: consensus NMF and hierarchical
Park columns
Compare clusterings: left cluster split
Compare clusterings: right cluster split
Compare clusterings: left cluster contained in right cluster
Problem 2 
! 
Comparing Patient Sets 
within Stratifications
Block Visualizations: Patient Properties 
Numerical Data 
Matrix 
Vector 
Matrix + (Pathway) Maps 
Categorical Data 
Scalar
Add KEGG glioma pathway and map mRNA transcript levels
Modify color mapping on the fly
View pathway detail (cluster 2)
Zoom into pathway detail (cluster 2): EGFR down-regulated
View pathway detail (cluster 3)
Zoom into pathway detail (cluster 3): EGFR up-regulated
Add copy number for EGFR
Add copy number for EGFR
Add survival stratified by TP53 mutation status
View detail of Kaplan-Meier plot based on TP53
?
Knowledge-driven Exploration 
Data-driven Exploration
Problem 3 
! 
Finding “Interesting” 
Stratifications and Pathways
Is there a mutation that overlaps with this mRNA cluster? 
Is there a mutually exclusive mutation? 
Is there a CNV that affects survival? 
Is there a pathway that is enriched in this cluster? 
Query 
Stratifications 
Clinical Params 
Pathways
Guided 
Exploration 
Query 
Retrieve 
Visualize 
Stratifications 
Clinical Params 
Pathways
LineUp 
S Gratzl, A Lex, N Gehlenborg, H Pfister and M Streit, “LineUp: Visual Analysis of Multi-Attribute 
Rankings“, IEEE Transactions on Visualization and Computer Graphics 19:2277-2286 (2013)
Example: Clear Cell Renal Carcinoma (KIRC) 
Main TCGA Paper published in Nature in 2013 
! 
First goal here: Characterize mRNA clusters
View TCGA mRNA subtypes
Add MutSig q-values for mutations
Invert q-value mapping
Add filter to inverted q-value as cut-off
Query mutated genes
Queries 
Retrieve Stratifications 
Sets with large overlap: Jaccard Index 
Similar stratifications: Adjusted Rand Index 
Survival: Log Rank Score (one vs rest) 
Retrieve Pathways 
Gene Set Enrichtment Score: original or PAGE (one vs rest)
Query mutated genes
Result of Jaccard Index query: preview PTEN
Query mutated genes
Query mutated genes
Query mutated genes with cluster m2
Result of Jaccard Index query: preview MTOR
Re-order columns
Add TCGA microRNA subtypes (direct insert mode)
Add TCGA microRNA subtypes (direct insert mode)
Observe large overlap between m1 and mi3
Observe large overlap between m3 and mi2
Query for copy number variation matching m3
Query only tumor suppressor genes (Vogelstein et al.)
Query only tumor suppressor genes (Vogelstein et al.)
Score only deletions
Score only deletions
Score only deletions
Score only deletions
Score only deletions
View CDKN2A copy number status and m3 and mi2 overlap
Add survival stratified by TCGA microRNA clusters
Find gene mutation that affects survival
Score only mutations
Score only mutations
Score only mutations
Score only mutations
View BAP1 mutation status and survival stratified by BAP1
View BAP1 mutation status and survival stratified by BAP1
View BAP1 mutation status and survival stratified by BAP1
Query for enriched pathway in TCGA mRNA cluster m4
Preview KEGG ribosome pathway overexpression in m4
Confirm selection
Change color mapping
View ribosome pathway detail for TCGA mRNA cluster m4
?
Problem 4 
! 
Dealing with Terabytes of 
Cancer Genomics Data
TCGA 
Data Coordination Center 
Broad Institute 
Genome Data Analysis Center 
Standardized Data Sets 
Standardized Analyses 
Analysis Reports 
MSKCC cBio Portal 
TCGA Working Groups 
StratomeX 
...
Standardized Data Sets Standardized Analyses Analysis Reports 
Data set versioning 
Format normalization 
Removal of redacted data 
. . . 
Mutation Analysis 
Copy Number Analysis 
Clustering 
Correlations 
Pathway Analysis 
. . .
102 
Standardized Data Sets Standardized Analyses Analysis Reports 
http://gdac.broadinstitute.org 
individual downloads and view reports 
firehose_get 
bulk download
102 
Standardized Data Sets Standardized Analyses Analysis Reports 
http://gdac.broadinstitute.org 
individual downloads and view reports 
firehose_get 
bulk download
Standardized Data Sets Standardized Analyses Analysis Reports 
+ = one per 
Data Matrices Stratifications 
mRNA (array & sequencing) 
microRNA (array & sequencing) 
methylation 
reverse phase protein array 
clinical parameters 
clustering (CNMF & hierarchical) 
gene mutation status (binary) 
gene copy number status (5 class) 
Data Package 
tumor type
up to 24 data and result files 
from 18 Firehose archives 
up to 500 MB (190 MB compressed) 
Data Packages
Schroeder et al. Genome Medicine 2013, 5:9
Challenges 
How can we explore overlap of patient sets across stratifications? 
How can we compare properties of patient sets within a stratification? 
How can we discover “interesting” stratifications and pathways to consider 
How can we handle terabytes of clinical and genomic data in visualization tools?
CALEYDO 
StratomeX is part of the Caleydo Visualization Framework 
Implemented in Java, uses OpenGL and 
Eclipse Rich Client Platform 
Binaries available for Linux, Windows, Mac OS X 
Requires Java 1.7 JRE or JDK (on Mac OS X) 
Open source licensed under BSD license 
Source code on GitHub
CALEYDO 
StratomeX 
http://stratomex.caleydo.org 
http://www.github.com/caleydo 
A Lex, M Streit, H-J Schulz, C Partl, D Schmalstieg, PJ Park, N 
Gehlenborg, “StratomeX: Visual Analysis of Large-Scale Heterogeneous 
Genomics Data for Cancer Subtype Characterization”, Computer Graphics 
Forum (EuroVis '12), 31:1175-1184 (2012) 
M Streit, A Lex, S Gratzl, C Partl, D Schmalstieg, H Pfister, PJ Park, N 
Gehlenborg, “Guided Visual Exploration of Genomic Stratifications in 
Cancer”, Nature Methods 11:884–885 (2014)
Plans 
! 
Where to go from here?
Domino 
S Gratzl, N Gehlenborg, A Lex, H Pfister and M Streit, “Domino: Extracting, Comparing, and 
Manipulating Subsets across Multiple Tabular Datasets“, IEEE Transactions on Visualization and Computer 
Graphics (2014)
INTEGRATION
INTEGRATION INTEGRATION
INTEGRATION 
Horizontal Integration across Data Types 
Biological Insight
Vertical Integration across Data Levels 
Confirmation & 
Troubleshooting 
INTEGRATION
Refinery Platform 
! 
! |
Refinery Platform 
! 
! | 
Data repository based on ISA-Tab for reproducible research 
Workflow execution in Galaxy 
Integrated visualization tools with access to provenance 
http://www.refinery-platform.org
CALEYDO 
StratomeX 
http://stratomex.caleydo.org 
http://www.github.com/caleydo 
A Lex, M Streit, H-J Schulz, C Partl, D Schmalstieg, PJ Park, N 
Gehlenborg, “StratomeX: Visual Analysis of Large-Scale Heterogeneous 
Genomics Data for Cancer Subtype Characterization”, Computer Graphics 
Forum (EuroVis '12), 31:1175-1184 (2012) 
M Streit, A Lex, S Gratzl, C Partl, D Schmalstieg, H Pfister, PJ Park, N 
Gehlenborg, “Guided Visual Exploration of Genomic Stratifications in 
Cancer”, Nature Methods 11:884–885 (2014)
Execute Logrank 
Test query 
Select displayed 
set 
Execute Jaccard 
Index query 
Select displayed 
Z[YH[PÄJH[PVU 
Execute Adjusted 
Rand Index query 
6WLU8LY`PaHYK 6WLU8LY`PaHYK 
Select pathway 
Select displayed 
set 
Add other data 
Execute GSEA 
query 
Select displayed 
Z[YH[PÄJH[PVU 
Select displayed 
Z[YH[PÄJH[PVU 
Select clinical param. 
in LineUp view 
Manually 
Execute Logrank 
Test query 
Execute PAGE 
query 
:LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU 
in LineUp view 
Select pathway Select pathway Select pathway Select clinical param. 
in LineUp view 
(KKZ[YH[PÄJH[PVU 
Based on Logrank 
Test score (survival) 
Based on similarity to 
KPZWSH`LKZ[YH[PÄJH[PVU 
Based on overlap 
with displayed set 
Add pathway 
Stratify with displayed 
Z[YH[PÄJH[PVU 
Find based on differential 
expression in displayed set 
Stratify with displayed 
Z[YH[PÄJH[PVU 
Display 
UZ[YH[PÄLK 
Add pathway 
Based on Logrank 
Test score (survival) 
Add other data 
Add independent 
column 
Add dependent 
column 
Add independent 
column to existing one 
Manually 
Based on GSEA Based on PAGE 
6WLU8LY`PaHYK 
Select clinical param. 
in LineUp view 
in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view

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Visual Exploration of Clinical and Genomic Data for Patient Stratification

  • 1. Visual Exploration of Clinical and Genomic Data for Patient Stratification NILS GEHLENBORG ! @nils_gehlenborg・http://www.gehlenborg.com Broad Institute of MIT and Harvard Cancer Program Harvard Medical School Center for Biomedical Informatics
  • 2. Team Alexander Lex Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA Marc Streit Johannes Kepler University, Linz, Austria Christian Partl Graz University of Technology, Graz, Austria Sam Gratzl Johannes Kepler University, Linz, Austria Dieter Schmalstieg Graz University of Technology, Graz, Austria ! Hanspeter Pfister Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA Peter J Park Harvard Medical School, Boston, MA, USA ! Nils Gehlenborg Harvard Medical School, Boston, MA, USA & Broad Institute, Cambridge, MA !! ! ! Special thanks to Broad Institute TCGA Genome Data Analysis Center Team in particular Michael S Noble, Lynda Chin & Gaddy Getz
  • 3. Funding Peter J Park NIH/NCI The Cancer Genome Atlas ! Nils Gehlenborg NIH/NHGRI K99/R00 Pathway to Independence Award !!
  • 4. ?
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. TCGA The Cancer Genome Atlas
  • 11. 20+ cancer types × 500 patients
  • 13.
  • 14. mRNA expression microRNA expression DNA methylation protein expression copy number variants mutation calls clinical parameters
  • 15.
  • 18.
  • 19.
  • 20. Correlation with clusters based on other data types? Different outcomes? Mutations or copy number variants associated with clusters? Demographic differences?
  • 21. Challenges How can we explore overlap of patient sets across stratifications? How can we compare properties of patient sets within a stratification? How can we discover “interesting” stratifications and pathways to consider How can we handle terabytes of clinical and genomic data in visualization tools?
  • 22. Problem 1 ! Comparing Patient Sets across Stratifications
  • 24. mRNA Copy Number gene X Mutation gene Y del normal amp mut normal #1 #2 #3 #4
  • 25. mRNA Copy Number gene X Mutation gene Y del normal amp mut normal #1 #2 #3 #4
  • 26. mRNA Copy Number gene X Mutation gene Y del normal amp mut normal #1 #2 #3 #4
  • 27. mRNA Copy Number gene X Mutation gene Y del normal amp mut normal #1 #2 #3 #4
  • 28. StratomeX (short for Stratome Explorer)
  • 29. mRNA Copy Number Mutation del normal amp mut normal #1 #2 #3 #4
  • 30.
  • 33. Compare clusterings: consensus NMF and hierarchical
  • 35. Compare clusterings: left cluster split
  • 36. Compare clusterings: right cluster split
  • 37. Compare clusterings: left cluster contained in right cluster
  • 38. Problem 2 ! Comparing Patient Sets within Stratifications
  • 39.
  • 40. Block Visualizations: Patient Properties Numerical Data Matrix Vector Matrix + (Pathway) Maps Categorical Data Scalar
  • 41. Add KEGG glioma pathway and map mRNA transcript levels
  • 42. Modify color mapping on the fly
  • 43. View pathway detail (cluster 2)
  • 44. Zoom into pathway detail (cluster 2): EGFR down-regulated
  • 45.
  • 46. View pathway detail (cluster 3)
  • 47. Zoom into pathway detail (cluster 3): EGFR up-regulated
  • 48.
  • 49. Add copy number for EGFR
  • 50. Add copy number for EGFR
  • 51. Add survival stratified by TP53 mutation status
  • 52. View detail of Kaplan-Meier plot based on TP53
  • 53.
  • 54. ?
  • 56. Problem 3 ! Finding “Interesting” Stratifications and Pathways
  • 57.
  • 58. Is there a mutation that overlaps with this mRNA cluster? Is there a mutually exclusive mutation? Is there a CNV that affects survival? Is there a pathway that is enriched in this cluster? Query Stratifications Clinical Params Pathways
  • 59. Guided Exploration Query Retrieve Visualize Stratifications Clinical Params Pathways
  • 60.
  • 61. LineUp S Gratzl, A Lex, N Gehlenborg, H Pfister and M Streit, “LineUp: Visual Analysis of Multi-Attribute Rankings“, IEEE Transactions on Visualization and Computer Graphics 19:2277-2286 (2013)
  • 62. Example: Clear Cell Renal Carcinoma (KIRC) Main TCGA Paper published in Nature in 2013 ! First goal here: Characterize mRNA clusters
  • 63. View TCGA mRNA subtypes
  • 64. Add MutSig q-values for mutations
  • 66. Add filter to inverted q-value as cut-off
  • 67.
  • 69. Queries Retrieve Stratifications Sets with large overlap: Jaccard Index Similar stratifications: Adjusted Rand Index Survival: Log Rank Score (one vs rest) Retrieve Pathways Gene Set Enrichtment Score: original or PAGE (one vs rest)
  • 71. Result of Jaccard Index query: preview PTEN
  • 74. Query mutated genes with cluster m2
  • 75. Result of Jaccard Index query: preview MTOR
  • 76.
  • 78. Add TCGA microRNA subtypes (direct insert mode)
  • 79. Add TCGA microRNA subtypes (direct insert mode)
  • 80. Observe large overlap between m1 and mi3
  • 81. Observe large overlap between m3 and mi2
  • 82. Query for copy number variation matching m3
  • 83. Query only tumor suppressor genes (Vogelstein et al.)
  • 84. Query only tumor suppressor genes (Vogelstein et al.)
  • 90. View CDKN2A copy number status and m3 and mi2 overlap
  • 91. Add survival stratified by TCGA microRNA clusters
  • 92. Find gene mutation that affects survival
  • 97. View BAP1 mutation status and survival stratified by BAP1
  • 98. View BAP1 mutation status and survival stratified by BAP1
  • 99. View BAP1 mutation status and survival stratified by BAP1
  • 100. Query for enriched pathway in TCGA mRNA cluster m4
  • 101. Preview KEGG ribosome pathway overexpression in m4
  • 104. View ribosome pathway detail for TCGA mRNA cluster m4
  • 105. ?
  • 106. Problem 4 ! Dealing with Terabytes of Cancer Genomics Data
  • 107. TCGA Data Coordination Center Broad Institute Genome Data Analysis Center Standardized Data Sets Standardized Analyses Analysis Reports MSKCC cBio Portal TCGA Working Groups StratomeX ...
  • 108. Standardized Data Sets Standardized Analyses Analysis Reports Data set versioning Format normalization Removal of redacted data . . . Mutation Analysis Copy Number Analysis Clustering Correlations Pathway Analysis . . .
  • 109. 102 Standardized Data Sets Standardized Analyses Analysis Reports http://gdac.broadinstitute.org individual downloads and view reports firehose_get bulk download
  • 110. 102 Standardized Data Sets Standardized Analyses Analysis Reports http://gdac.broadinstitute.org individual downloads and view reports firehose_get bulk download
  • 111. Standardized Data Sets Standardized Analyses Analysis Reports + = one per Data Matrices Stratifications mRNA (array & sequencing) microRNA (array & sequencing) methylation reverse phase protein array clinical parameters clustering (CNMF & hierarchical) gene mutation status (binary) gene copy number status (5 class) Data Package tumor type
  • 112.
  • 113.
  • 114. up to 24 data and result files from 18 Firehose archives up to 500 MB (190 MB compressed) Data Packages
  • 115. Schroeder et al. Genome Medicine 2013, 5:9
  • 116. Challenges How can we explore overlap of patient sets across stratifications? How can we compare properties of patient sets within a stratification? How can we discover “interesting” stratifications and pathways to consider How can we handle terabytes of clinical and genomic data in visualization tools?
  • 117. CALEYDO StratomeX is part of the Caleydo Visualization Framework Implemented in Java, uses OpenGL and Eclipse Rich Client Platform Binaries available for Linux, Windows, Mac OS X Requires Java 1.7 JRE or JDK (on Mac OS X) Open source licensed under BSD license Source code on GitHub
  • 118. CALEYDO StratomeX http://stratomex.caleydo.org http://www.github.com/caleydo A Lex, M Streit, H-J Schulz, C Partl, D Schmalstieg, PJ Park, N Gehlenborg, “StratomeX: Visual Analysis of Large-Scale Heterogeneous Genomics Data for Cancer Subtype Characterization”, Computer Graphics Forum (EuroVis '12), 31:1175-1184 (2012) M Streit, A Lex, S Gratzl, C Partl, D Schmalstieg, H Pfister, PJ Park, N Gehlenborg, “Guided Visual Exploration of Genomic Stratifications in Cancer”, Nature Methods 11:884–885 (2014)
  • 119. Plans ! Where to go from here?
  • 120. Domino S Gratzl, N Gehlenborg, A Lex, H Pfister and M Streit, “Domino: Extracting, Comparing, and Manipulating Subsets across Multiple Tabular Datasets“, IEEE Transactions on Visualization and Computer Graphics (2014)
  • 121.
  • 124. INTEGRATION Horizontal Integration across Data Types Biological Insight
  • 125. Vertical Integration across Data Levels Confirmation & Troubleshooting INTEGRATION
  • 126.
  • 127.
  • 129. Refinery Platform ! ! | Data repository based on ISA-Tab for reproducible research Workflow execution in Galaxy Integrated visualization tools with access to provenance http://www.refinery-platform.org
  • 130. CALEYDO StratomeX http://stratomex.caleydo.org http://www.github.com/caleydo A Lex, M Streit, H-J Schulz, C Partl, D Schmalstieg, PJ Park, N Gehlenborg, “StratomeX: Visual Analysis of Large-Scale Heterogeneous Genomics Data for Cancer Subtype Characterization”, Computer Graphics Forum (EuroVis '12), 31:1175-1184 (2012) M Streit, A Lex, S Gratzl, C Partl, D Schmalstieg, H Pfister, PJ Park, N Gehlenborg, “Guided Visual Exploration of Genomic Stratifications in Cancer”, Nature Methods 11:884–885 (2014)
  • 131. Execute Logrank Test query Select displayed set Execute Jaccard Index query Select displayed Z[YH[PÄJH[PVU Execute Adjusted Rand Index query 6WLU8LY`PaHYK 6WLU8LY`PaHYK Select pathway Select displayed set Add other data Execute GSEA query Select displayed Z[YH[PÄJH[PVU Select displayed Z[YH[PÄJH[PVU Select clinical param. in LineUp view Manually Execute Logrank Test query Execute PAGE query :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU :LSLJ[Z[YH[PÄJH[PVU in LineUp view Select pathway Select pathway Select pathway Select clinical param. in LineUp view (KKZ[YH[PÄJH[PVU Based on Logrank Test score (survival) Based on similarity to KPZWSH`LKZ[YH[PÄJH[PVU Based on overlap with displayed set Add pathway Stratify with displayed Z[YH[PÄJH[PVU Find based on differential expression in displayed set Stratify with displayed Z[YH[PÄJH[PVU Display UZ[YH[PÄLK Add pathway Based on Logrank Test score (survival) Add other data Add independent column Add dependent column Add independent column to existing one Manually Based on GSEA Based on PAGE 6WLU8LY`PaHYK Select clinical param. in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view in LineUp view