February 12, 2025 • 18 mins
This week on Biotech Nation, Dr. Lincoln Nadauld shares how Culmination Bio is using 9 million preserved tissue samples and decades of patient data to improve how we understand and treat diseases. From discovering patterns in cancer treatments to exploring breakthroughs in heart and autoimmune diseases, this unique approach is changing medicine.
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Episode Transcript
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Dr. Moira Gunn (00:11):
As excited as we are at being able to read our
DNA and measure the status ofall things biological, data is
only valuable when we understandwhat it means. Today, we visit
the frontier of figuring it allout. Doctor Lincoln Nadauld is
the president and CEO ofCulmination Bio in Salt Lake
(00:35):
City. Doctor Nadauld, welcome tothe program.
Dr. Lincoln Nadauld (00:38):
Thank you for having me. It's my pleasure.
Dr. Moira Gunn (00:40):
We're talking about Culmination Bio today, but
I wanna start by talking about adifferent organization,
Intermountain Health. And that'sbecause Culmination Bio is an
outgrowth of IntermountainHealth, which itself is a big
story to my mind. So tell usabout the geographic extent, the
(01:00):
services Intermountain Healthprovides, and how that is a
basis for Culmination Bio tocome about.
Dr. Lincoln Nadauld (01:08):
Well, Intermountain Health is a large
not for profit health deliverynetwork headquartered in Salt
Lake City, and it operates 33hospitals and approximately 400
physician clinics. And is spreadacross seven primary states and
cares for approximately9,000,000 lives. Beginning in
1983, it implemented one of thevery first electronic medical
(01:31):
record systems in The UnitedStates and in the world. What
that allowed then is thesubsequent capturing of health
outcomes, the the results andthe journey of patients over the
subsequent forty years. So thatwas the first unusual thing
about Intermountain Health.
And the second unusual thingregarding culmination is
(01:51):
Intermountain has not discardedor thrown away any of the
tissues or specimens collectedfrom patients in its existence.
And what that means is anytissue biopsy, any kind of
surgical resection, anythingcollected from a patient, for
the most part, has been saved,stored, and preserved, which
(02:11):
represents a remarkable andunique data asset.
Dr. Moira Gunn (02:15):
Now let me ask you this. How many biospecimens
do you have?
Dr. Lincoln Nadauld (02:21):
Well, you can probably appreciate that if
you never threw anything away,you would collect quite a store.
And now Intermountain has over9,000,000 unique individual
biospecimens and over 20,000,000histopathology slide images. So
it's a very extraordinary anddeep dataset.
Dr. Moira Gunn (02:40):
Listeners might say, well, so what? Well, the so
what is now today with today'stechnology, we can take those
specimens and we can convertthat into data. We can analyze
what's there and compare it tothe treatment outcomes. Isn't
that right?
Dr. Lincoln Nadauld (02:59):
You've got it. And what's amazing is when
the health system began storingand saving all of these samples
and collecting this data, theydid not know what their ultimate
purpose was. They weren'tcollecting these saying, oh, we
wanna do this big study in fortyyears. They just had an
intuition that these would bevaluable down the line. And now
here we are forty plus yearslater and technologies are
(03:22):
available that we can liberateDNA, RNA, and these other
molecules from these storedsamples and analyze them in very
high throughput, verysophisticated ways.
And when you combine that kindof biological data with health
outcomes data, you can now makevery powerful statistical
conclusions and inferences. Forexample, you can say, here are
(03:46):
the set of biological factorsor, you know, biomarkers is one
of the words we love to use thatwould have predicted or been
prognostic for this patient'ssubsequent outcome. And that's
exactly how we're using thisdataset.
Dr. Moira Gunn (04:01):
I just wanna get sort of a comparison for people
to understand what's out thereand just how big this is. I
mean, if we consider twentythree and Me, to date, it has
sold some 12,000,000 kits. Okay.That's more than your 9,000,000.
And they've done partial DNAanalysis, but they have very
(04:21):
little treatment history oroutcome data.
Now this breadth and depth ofsource data is on a much smaller
scale than what's the potentialhere with the Intermountain
Health biospecimens?
Dr. Lincoln Nadauld (04:36):
Yeah. I think there are two different
scales that are useful forcomparing datasets. One is just
the raw number of availablebiospecimens, blood or tissue
that can yield, biologicalinformation. And so here we are
with 9,000,000. There are othersout there that have less.
There aren't very many that havemore, but the other spectrum
(04:59):
that can be used for comparisonis the depth of clinical data or
outcomes data, and that's wherethis is really extraordinary. On
average, across our 9,000,000biospecimens, we have twenty two
years of clinical history, andit's continuous, unfragmented,
and comprehensive acrosslaboratory, imaging,
(05:21):
medications, other diagnoses. Imean, it's a little bit
overwhelming, honestly.
Dr. Moira Gunn (05:26):
When you go back in anyone's life and they've had
some tissue removed forsomething, you know, whatever
the problem may be, they alsohad other treatments with it. In
the case of cancer, they mighthave had radiation, one
chemotherapy or another. How didit work? Did it work well?
Didn't it?
We know a lot more about thattoday. So we can analyze that to
(05:49):
see what worked and didn't workin a way that we we couldn't
predict whenever that happenedyears ago.
Dr. Lincoln Nadauld (05:55):
That's exactly right. So we can do that
in cancer, like the example youused, where we find patients
with breast cancer, coloncancer, and lung cancer, and
say, here are the therapies theyreceived, and now let's analyze
the biological data from theirsamples and say, could we pick
out the one or two or threemarkers that would have
(06:16):
successfully predicted theirtheir outcome? Now that's just
cancer. And this is what's sofascinating about this data is
it spans the whole spectrum ofhuman diseases. So there are
entire companies that are verysuccessfully built and have
become very big just in thecancer space.
Well, we have hundreds ofthousands of cancer cases and
(06:40):
cancer journeys, but we alsohave hundreds of thousands of
cardiovascular disease cases andhundreds of thousands of
neurosciences and hundreds ofthousands of autoimmune disorder
cases and on and on the listgoes across the whole spectrum
of human diseases with hundredsof thousands or more patients in
each one of those. So you couldenvision conducting these
(07:01):
analyses, performing thesestudies, doing these
investigations with any diseasethat you can that that interests
you.
Dr. Moira Gunn (07:09):
In general, you probably have an example of that
disease somewhere in thesebiospecimens. Whatever disease
you're talking about, ninetynine percent chance you're gonna
get there.
Dr. Lincoln Nadauld (07:19):
Well, of everybody that I've talked to so
far that has had an inquiry, Ihave not yet returned an answer
of zero. We've always had somenumber of cases in their disease
of interest.
Dr. Moira Gunn (07:32):
Now I'm also reminded of the UK Biobank, a
tremendous effort ongoing effortheaded by sir Rory Collins who's
been on the program. It hashealth records and outcomes
because there is a nationalhealth service.
Dr. Lincoln Nadauld (07:46):
I have a lot of respect for the UK
Biobank and what they'veaccomplished. It's an
extraordinary dataset. And, youknow, I think they have
acknowledged that they haveabout 500,000 participants. What
they've done a very nice job ofis analyzing the genomes of all
of those. So they know thehealth histories and they also
know the genomes, and that'svery powerful.
(08:08):
You know, in by way ofcomparison, at Culmination Bio,
we have 9,000,000, you know,contributing disease journeys
and biospecimens. We haven'tanalyzed all of those. In fact,
we've only analyzed about thefirst two hundred and fifty
thousand. So we have madeprogress, but, you know, 250,000
out of 9,000,000, and and by theway, there are more pouring in
(08:29):
every year, you know, we we haveplenty of runway ahead of us.
Dr. Moira Gunn (08:34):
So now let's get to culmination bio, and you're
relatively new. Where do youstart? You didn't just say,
well, we'll just take the firstone in order. I mean, did you
have a a plan here?
Dr. Lincoln Nadauld (08:45):
Well, I I just have to acknowledge there
are two individuals that areworth commenting on here. The
first is a person named HomerWarner, and he had this, you
know, crazy idea that computersshould be used in health care.
He was right, of course, as weall now know. But in 1983, he's
the one who developed this firstEMR, this electronic medical
record, and that is whatgenerated all of these
(09:07):
electronic outcomes for us tonow use. You know?
And I'm glad he did it in 1983because now forty years later,
we get all of that data. Thesecond person worth commenting
on is doctor Elizabeth Hammond,a a very well respected and now
retired pathologist. And she'sthe one who fought like crazy to
not just, quote, unquote, throwaway all of these biospecimens.
(09:29):
She made sure that they werepreserved and cataloged. And to
answer your question, how do youapproach this?
Well, we have fought thetemptation to just start at the
beginning, so to speak, and andplow through it as a brute force
effort. Instead, we've beenthoughtful or we we're trying to
be thoughtful in our ownestimation and work in two ways.
(09:51):
The first is we have curated allof this data according to human
diseases. So we look, we wethink about it and catalog it in
terms of oncology andautoimmunity and so forth. And
then the second thing we do isask interesting clinical
questions.
Could we predict or diagnosedisease earlier than it's
(10:11):
currently being diagnosed bytaking advantage of this data.
And because we know we don'thave a corner on all of the
great questions in the world, wework very closely with partners
and make this data available tothem knowing that we may
accelerate some of theirdiscovery efforts, which we're
fine with because there's somuch data here. We need as many
(10:32):
bright minds as possible to workwith us on it.
Dr. Moira Gunn (10:36):
Let's put a pin in the fact that Homer Werner
wanted to have electronicmedical records. And when he got
everybody to say yes, I guess,he couldn't go down and say,
well, let's let's put a arequest for proposal out, and
all of the people withelectronic medical record system
will give us their best. No.They didn't exist. Forty years
(10:58):
later, you've got the sameproblem Homer did.
Dr. Lincoln Nadauld (11:01):
You've got it. And our big challenge is how
do we analyze all of it? Well,we have now also had to go and
build some of our own technologyto query this data. We, first of
all, have pulled it off of, youknow, hard drives and landed it
in a cloud based data lake. Andthis data lake is exactly as it
(11:25):
sounds.
It is a vast pool, an enormousreservoir of data, but that's
not enough just to have a bigreservoir of data. You have to
have a way to sift through itand survey and query it and
interrogate it. It. So we've hadto do this second thing, which
is build technology capable ofdiving into that data lake,
(11:47):
organizing the data, querying itin real time, and delivering
information back that is usableto anybody that that needs
access. So the technology thatwe have built that allows us to
query the data lake is Apex.
And Apex is the name of our dataplatform, and it's what we use,
(12:07):
and it's what we allow ourpartners and customers to use to
query this vast data lake.
Dr. Moira Gunn (12:13):
So the hundred million dollar question, and I
don't know why I said hundredmillion, I just picked a number
out of the air, is how do youput all this data together to
get some new answer? What canyou do with this data that
couldn't be done before?
Dr. Lincoln Nadauld (12:28):
Well, the big trick is to take all of the
data and and not just analyze itwholesale, but to analyze it
with a rational question behindit. And so you, you know,
there's so much data that if youjust take millions of patient
journeys and all of theirbiological data, you end up with
trillions of data points. Andthe key we believe is to ask
(12:51):
questions of the data. And sothese can be clinical questions
and these are questions that wehaven't historically been able
to ask. Things like patientswith condition X, you know, use
inflammatory bowel disease as anexample.
Patients with Crohn's orulcerative colitis. What are the
biological factors or markersthat would predict for people
(13:11):
who are going to respond to thefirst available treatment
compared to patients who won'trespond to anything and will end
up having to have, you know,significant surgeries throughout
their life. That would behelpful to know. So when we ask
questions of the data that areinformed by clinical scenarios,
that's when this data becomes sopowerful. And we know that we
(13:33):
don't have all of the bestquestions in mind, and that's
why we have worked on it withpartners.
We have other customers andpartners who come with very
specific questions of their own,and they're looking similarly as
we are for markers or underlyingdata that would be associated
with certain outcomes. We haveother partners who wanna use it
to validate new technologies andstill others who wanna use this
(13:56):
data to train some of their ownmodels.
Dr. Moira Gunn (13:59):
I know you've already gotten some results. I
know there was at least onepublication in Nature Genetics.
Dr. Lincoln Nadauld (14:04):
Yeah. We have found working with one of
our partners, Amgen. In fact,they were one of our very
earliest partners. And togetherwith Amgen, we launched a study
where we were looking athundreds of thousands of
participants and analyzing theirgenomes and using that genome
information combined with theirhealth outcomes information to
(14:25):
make discoveries, and we'vepublished many of those
together. And, really, it'sthrough the, arm of Amgen called
DecoGenetics in Reykjavik,Iceland who are so good at this.
They're they're, I believe, oneof the best in the world at
taking large scale, populationscale, genome, and clinical data
information and makingdiscoveries. And together with
(14:46):
them, we've have found andpublished, for example, the 17
genetic variants that contributeto fatty liver disease. That's
something that scientists havelooked for for for decades. So
to now understand the geneticunderpinnings for a common and
rapidly growing disease likefatty liver disease is very
helpful. And and now nowcompanies and and scientists can
(15:09):
begin to look for medicines thatwill help those patients or
develop new tests that candiagnose these patients earlier
when their disease can betreated more easily.
That's exactly what we hope toaccomplish.
Dr. Moira Gunn (15:21):
So I know you're working not just with Amgen, but
with Merck and others. But whatis Culmination Bio doing on its
own?
Dr. Lincoln Nadauld (15:28):
Well, we certainly work in those specific
disease areas with our partners,but something that we're frankly
getting quite good at is theability to diagnose disease just
off of digital information.Meaning, we can develop new
diagnostics that don't require anew blood test. So wouldn't it
be nice to know that your healthcare provider is using some of
(15:51):
your previously capturedinformation to look for diseases
that historically we didn't havea diagnosis we didn't have
diagnostic tests for. And thatso that's what we're doing.
We're enabling that, and it'svery powerful.
Dr. Moira Gunn (16:02):
And I'm assuming that you're open to working with
others.
Dr. Lincoln Nadauld (16:05):
We're very open to working with others. In
fact, in developing some ofthese tests that work off of
digital data, We've workedclosely and are continuing to
work closely with partners whohave their own experience here.
And by putting our mindstogether and even by testing our
algorithms against each other'sdatasets, we can refine our
(16:26):
approach, and and we can befaster.
Dr. Moira Gunn (16:28):
Well, talking about faster, you started here
with 9,000,000 biospecimens andtheir health records. How many
of the 9,000,000 biospecimenshave you analyzed, and how long
will it take to analyze themall?
Dr. Lincoln Nadauld (16:42):
I'm kind of chuckling because, you know, we
have analyzed, as I referencedbefore, a a few hundred
thousand, but we have 9,000,000.And what's kind of startling is
we have 450,000 new, fresh,unique biospecimens that come
into our repository each year,which means I am not utilizing
(17:04):
or analyzing each year more thanare coming I'm not exhausting
faster than it's coming in. So,we're we're getting behind.
Dr. Moira Gunn (17:12):
This reminds me when when, astrophysicist talk
about the the the universe andhow it's getting bigger and
bigger. It's going further awayall the time. It's like, to ask
you when it's gonna be done is,like, never at the rate we're
going now. So, we're gonna hopefor more partners, better
technology, and better ideas,you know, about how we how we're
(17:33):
gonna ask these questions andget the answers. Well, doctor
Nadauld, thank you so much forfor seeing us, and, I hope you
come and talk to us again.
Dr. Lincoln Nadauld (17:42):
I would love to. It's been a thrill. I
really, really appreciate thetime.
Dr. Moira Gunn (17:46):
Doctor Lincoln Nadauld is the president and CEO
of Culmination Bio in Salt LakeCity. More information is
available on the web atculmination.com.
As excited as we are at being able to read our
DNA and measure the status ofall things biological, data is
only valuable when we understandwhat it means. Today, we visit
the frontier of figuring it allout. Doctor Lincoln Nadauld is
the president and CEO ofCulmination Bio in Salt Lake
(00:35):
City. Doctor Nadauld, welcome tothe program.
Dr. Lincoln Nadauld (00:38):
Thank you for having me. It's my pleasure.
Dr. Moira Gunn (00:40):
We're talking about Culmination Bio today, but
I wanna start by talking about adifferent organization,
Intermountain Health. And that'sbecause Culmination Bio is an
outgrowth of IntermountainHealth, which itself is a big
story to my mind. So tell usabout the geographic extent, the
(01:00):
services Intermountain Healthprovides, and how that is a
basis for Culmination Bio tocome about.
Dr. Lincoln Nadauld (01:08):
Well, Intermountain Health is a large
not for profit health deliverynetwork headquartered in Salt
Lake City, and it operates 33hospitals and approximately 400
physician clinics. And is spreadacross seven primary states and
cares for approximately9,000,000 lives. Beginning in
1983, it implemented one of thevery first electronic medical
(01:31):
record systems in The UnitedStates and in the world. What
that allowed then is thesubsequent capturing of health
outcomes, the the results andthe journey of patients over the
subsequent forty years. So thatwas the first unusual thing
about Intermountain Health.
And the second unusual thingregarding culmination is
(01:51):
Intermountain has not discardedor thrown away any of the
tissues or specimens collectedfrom patients in its existence.
And what that means is anytissue biopsy, any kind of
surgical resection, anythingcollected from a patient, for
the most part, has been saved,stored, and preserved, which
(02:11):
represents a remarkable andunique data asset.
Dr. Moira Gunn (02:15):
Now let me ask you this. How many biospecimens
do you have?
Dr. Lincoln Nadauld (02:21):
Well, you can probably appreciate that if
you never threw anything away,you would collect quite a store.
And now Intermountain has over9,000,000 unique individual
biospecimens and over 20,000,000histopathology slide images. So
it's a very extraordinary anddeep dataset.
Dr. Moira Gunn (02:40):
Listeners might say, well, so what? Well, the so
what is now today with today'stechnology, we can take those
specimens and we can convertthat into data. We can analyze
what's there and compare it tothe treatment outcomes. Isn't
that right?
Dr. Lincoln Nadauld (02:59):
You've got it. And what's amazing is when
the health system began storingand saving all of these samples
and collecting this data, theydid not know what their ultimate
purpose was. They weren'tcollecting these saying, oh, we
wanna do this big study in fortyyears. They just had an
intuition that these would bevaluable down the line. And now
here we are forty plus yearslater and technologies are
(03:22):
available that we can liberateDNA, RNA, and these other
molecules from these storedsamples and analyze them in very
high throughput, verysophisticated ways.
And when you combine that kindof biological data with health
outcomes data, you can now makevery powerful statistical
conclusions and inferences. Forexample, you can say, here are
(03:46):
the set of biological factorsor, you know, biomarkers is one
of the words we love to use thatwould have predicted or been
prognostic for this patient'ssubsequent outcome. And that's
exactly how we're using thisdataset.
Dr. Moira Gunn (04:01):
I just wanna get sort of a comparison for people
to understand what's out thereand just how big this is. I
mean, if we consider twentythree and Me, to date, it has
sold some 12,000,000 kits. Okay.That's more than your 9,000,000.
And they've done partial DNAanalysis, but they have very
(04:21):
little treatment history oroutcome data.
Now this breadth and depth ofsource data is on a much smaller
scale than what's the potentialhere with the Intermountain
Health biospecimens?
Dr. Lincoln Nadauld (04:36):
Yeah. I think there are two different
scales that are useful forcomparing datasets. One is just
the raw number of availablebiospecimens, blood or tissue
that can yield, biologicalinformation. And so here we are
with 9,000,000. There are othersout there that have less.
There aren't very many that havemore, but the other spectrum
(04:59):
that can be used for comparisonis the depth of clinical data or
outcomes data, and that's wherethis is really extraordinary. On
average, across our 9,000,000biospecimens, we have twenty two
years of clinical history, andit's continuous, unfragmented,
and comprehensive acrosslaboratory, imaging,
(05:21):
medications, other diagnoses. Imean, it's a little bit
overwhelming, honestly.
Dr. Moira Gunn (05:26):
When you go back in anyone's life and they've had
some tissue removed forsomething, you know, whatever
the problem may be, they alsohad other treatments with it. In
the case of cancer, they mighthave had radiation, one
chemotherapy or another. How didit work? Did it work well?
Didn't it?
We know a lot more about thattoday. So we can analyze that to
(05:49):
see what worked and didn't workin a way that we we couldn't
predict whenever that happenedyears ago.
Dr. Lincoln Nadauld (05:55):
That's exactly right. So we can do that
in cancer, like the example youused, where we find patients
with breast cancer, coloncancer, and lung cancer, and
say, here are the therapies theyreceived, and now let's analyze
the biological data from theirsamples and say, could we pick
out the one or two or threemarkers that would have
(06:16):
successfully predicted theirtheir outcome? Now that's just
cancer. And this is what's sofascinating about this data is
it spans the whole spectrum ofhuman diseases. So there are
entire companies that are verysuccessfully built and have
become very big just in thecancer space.
Well, we have hundreds ofthousands of cancer cases and
(06:40):
cancer journeys, but we alsohave hundreds of thousands of
cardiovascular disease cases andhundreds of thousands of
neurosciences and hundreds ofthousands of autoimmune disorder
cases and on and on the listgoes across the whole spectrum
of human diseases with hundredsof thousands or more patients in
each one of those. So you couldenvision conducting these
(07:01):
analyses, performing thesestudies, doing these
investigations with any diseasethat you can that that interests
you.
Dr. Moira Gunn (07:09):
In general, you probably have an example of that
disease somewhere in thesebiospecimens. Whatever disease
you're talking about, ninetynine percent chance you're gonna
get there.
Dr. Lincoln Nadauld (07:19):
Well, of everybody that I've talked to so
far that has had an inquiry, Ihave not yet returned an answer
of zero. We've always had somenumber of cases in their disease
of interest.
Dr. Moira Gunn (07:32):
Now I'm also reminded of the UK Biobank, a
tremendous effort ongoing effortheaded by sir Rory Collins who's
been on the program. It hashealth records and outcomes
because there is a nationalhealth service.
Dr. Lincoln Nadauld (07:46):
I have a lot of respect for the UK
Biobank and what they'veaccomplished. It's an
extraordinary dataset. And, youknow, I think they have
acknowledged that they haveabout 500,000 participants. What
they've done a very nice job ofis analyzing the genomes of all
of those. So they know thehealth histories and they also
know the genomes, and that'svery powerful.
(08:08):
You know, in by way ofcomparison, at Culmination Bio,
we have 9,000,000, you know,contributing disease journeys
and biospecimens. We haven'tanalyzed all of those. In fact,
we've only analyzed about thefirst two hundred and fifty
thousand. So we have madeprogress, but, you know, 250,000
out of 9,000,000, and and by theway, there are more pouring in
(08:29):
every year, you know, we we haveplenty of runway ahead of us.
Dr. Moira Gunn (08:34):
So now let's get to culmination bio, and you're
relatively new. Where do youstart? You didn't just say,
well, we'll just take the firstone in order. I mean, did you
have a a plan here?
Dr. Lincoln Nadauld (08:45):
Well, I I just have to acknowledge there
are two individuals that areworth commenting on here. The
first is a person named HomerWarner, and he had this, you
know, crazy idea that computersshould be used in health care.
He was right, of course, as weall now know. But in 1983, he's
the one who developed this firstEMR, this electronic medical
record, and that is whatgenerated all of these
(09:07):
electronic outcomes for us tonow use. You know?
And I'm glad he did it in 1983because now forty years later,
we get all of that data. Thesecond person worth commenting
on is doctor Elizabeth Hammond,a a very well respected and now
retired pathologist. And she'sthe one who fought like crazy to
not just, quote, unquote, throwaway all of these biospecimens.
(09:29):
She made sure that they werepreserved and cataloged. And to
answer your question, how do youapproach this?
Well, we have fought thetemptation to just start at the
beginning, so to speak, and andplow through it as a brute force
effort. Instead, we've beenthoughtful or we we're trying to
be thoughtful in our ownestimation and work in two ways.
(09:51):
The first is we have curated allof this data according to human
diseases. So we look, we wethink about it and catalog it in
terms of oncology andautoimmunity and so forth. And
then the second thing we do isask interesting clinical
questions.
Could we predict or diagnosedisease earlier than it's
(10:11):
currently being diagnosed bytaking advantage of this data.
And because we know we don'thave a corner on all of the
great questions in the world, wework very closely with partners
and make this data available tothem knowing that we may
accelerate some of theirdiscovery efforts, which we're
fine with because there's somuch data here. We need as many
(10:32):
bright minds as possible to workwith us on it.
Dr. Moira Gunn (10:36):
Let's put a pin in the fact that Homer Werner
wanted to have electronicmedical records. And when he got
everybody to say yes, I guess,he couldn't go down and say,
well, let's let's put a arequest for proposal out, and
all of the people withelectronic medical record system
will give us their best. No.They didn't exist. Forty years
(10:58):
later, you've got the sameproblem Homer did.
Dr. Lincoln Nadauld (11:01):
You've got it. And our big challenge is how
do we analyze all of it? Well,we have now also had to go and
build some of our own technologyto query this data. We, first of
all, have pulled it off of, youknow, hard drives and landed it
in a cloud based data lake. Andthis data lake is exactly as it
(11:25):
sounds.
It is a vast pool, an enormousreservoir of data, but that's
not enough just to have a bigreservoir of data. You have to
have a way to sift through itand survey and query it and
interrogate it. It. So we've hadto do this second thing, which
is build technology capable ofdiving into that data lake,
(11:47):
organizing the data, querying itin real time, and delivering
information back that is usableto anybody that that needs
access. So the technology thatwe have built that allows us to
query the data lake is Apex.
And Apex is the name of our dataplatform, and it's what we use,
(12:07):
and it's what we allow ourpartners and customers to use to
query this vast data lake.
Dr. Moira Gunn (12:13):
So the hundred million dollar question, and I
don't know why I said hundredmillion, I just picked a number
out of the air, is how do youput all this data together to
get some new answer? What canyou do with this data that
couldn't be done before?
Dr. Lincoln Nadauld (12:28):
Well, the big trick is to take all of the
data and and not just analyze itwholesale, but to analyze it
with a rational question behindit. And so you, you know,
there's so much data that if youjust take millions of patient
journeys and all of theirbiological data, you end up with
trillions of data points. Andthe key we believe is to ask
(12:51):
questions of the data. And sothese can be clinical questions
and these are questions that wehaven't historically been able
to ask. Things like patientswith condition X, you know, use
inflammatory bowel disease as anexample.
Patients with Crohn's orulcerative colitis. What are the
biological factors or markersthat would predict for people
(13:11):
who are going to respond to thefirst available treatment
compared to patients who won'trespond to anything and will end
up having to have, you know,significant surgeries throughout
their life. That would behelpful to know. So when we ask
questions of the data that areinformed by clinical scenarios,
that's when this data becomes sopowerful. And we know that we
(13:33):
don't have all of the bestquestions in mind, and that's
why we have worked on it withpartners.
We have other customers andpartners who come with very
specific questions of their own,and they're looking similarly as
we are for markers or underlyingdata that would be associated
with certain outcomes. We haveother partners who wanna use it
to validate new technologies andstill others who wanna use this
(13:56):
data to train some of their ownmodels.
Dr. Moira Gunn (13:59):
I know you've already gotten some results. I
know there was at least onepublication in Nature Genetics.
Dr. Lincoln Nadauld (14:04):
Yeah. We have found working with one of
our partners, Amgen. In fact,they were one of our very
earliest partners. And togetherwith Amgen, we launched a study
where we were looking athundreds of thousands of
participants and analyzing theirgenomes and using that genome
information combined with theirhealth outcomes information to
(14:25):
make discoveries, and we'vepublished many of those
together. And, really, it'sthrough the, arm of Amgen called
DecoGenetics in Reykjavik,Iceland who are so good at this.
They're they're, I believe, oneof the best in the world at
taking large scale, populationscale, genome, and clinical data
information and makingdiscoveries. And together with
(14:46):
them, we've have found andpublished, for example, the 17
genetic variants that contributeto fatty liver disease. That's
something that scientists havelooked for for for decades. So
to now understand the geneticunderpinnings for a common and
rapidly growing disease likefatty liver disease is very
helpful. And and now nowcompanies and and scientists can
(15:09):
begin to look for medicines thatwill help those patients or
develop new tests that candiagnose these patients earlier
when their disease can betreated more easily.
That's exactly what we hope toaccomplish.
Dr. Moira Gunn (15:21):
So I know you're working not just with Amgen, but
with Merck and others. But whatis Culmination Bio doing on its
own?
Dr. Lincoln Nadauld (15:28):
Well, we certainly work in those specific
disease areas with our partners,but something that we're frankly
getting quite good at is theability to diagnose disease just
off of digital information.Meaning, we can develop new
diagnostics that don't require anew blood test. So wouldn't it
be nice to know that your healthcare provider is using some of
(15:51):
your previously capturedinformation to look for diseases
that historically we didn't havea diagnosis we didn't have
diagnostic tests for. And thatso that's what we're doing.
We're enabling that, and it'svery powerful.
Dr. Moira Gunn (16:02):
And I'm assuming that you're open to working with
others.
Dr. Lincoln Nadauld (16:05):
We're very open to working with others. In
fact, in developing some ofthese tests that work off of
digital data, We've workedclosely and are continuing to
work closely with partners whohave their own experience here.
And by putting our mindstogether and even by testing our
algorithms against each other'sdatasets, we can refine our
(16:26):
approach, and and we can befaster.
Dr. Moira Gunn (16:28):
Well, talking about faster, you started here
with 9,000,000 biospecimens andtheir health records. How many
of the 9,000,000 biospecimenshave you analyzed, and how long
will it take to analyze themall?
Dr. Lincoln Nadauld (16:42):
I'm kind of chuckling because, you know, we
have analyzed, as I referencedbefore, a a few hundred
thousand, but we have 9,000,000.And what's kind of startling is
we have 450,000 new, fresh,unique biospecimens that come
into our repository each year,which means I am not utilizing
(17:04):
or analyzing each year more thanare coming I'm not exhausting
faster than it's coming in. So,we're we're getting behind.
Dr. Moira Gunn (17:12):
This reminds me when when, astrophysicist talk
about the the the universe andhow it's getting bigger and
bigger. It's going further awayall the time. It's like, to ask
you when it's gonna be done is,like, never at the rate we're
going now. So, we're gonna hopefor more partners, better
technology, and better ideas,you know, about how we how we're
(17:33):
gonna ask these questions andget the answers. Well, doctor
Nadauld, thank you so much forfor seeing us, and, I hope you
come and talk to us again.
Dr. Lincoln Nadauld (17:42):
I would love to. It's been a thrill. I
really, really appreciate thetime.
Dr. Moira Gunn (17:46):
Doctor Lincoln Nadauld is the president and CEO
of Culmination Bio in Salt LakeCity. More information is
available on the web atculmination.com.
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