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Biology subjects

Christensen, B.

Publications and source records attributed to Christensen, B..

At least 19 recordsLinked to original sources

Inferring absolute counts from proportions by constraining multivariate normal distributions

Biological measurements often result in proportional data, which derive from underlying biological counts. Proportion data are lacking a dimension of information as compared to counts, restricting available analysis methods and separating the data from the biology. We demonstrate a mathematical technique that estimates absolute counts corresponding to proportion data, which we refer to as Mahalanobis Count Inference (MCI). MCI uses information from a population-representative multivariate normal (MVN) distribution of component counts and ultimately outputs an estimated count and a confidence interval per observation proportion vector. We apply MCI to the imputation of white blood cell (WBC) counts, and of total mRNA within single cells. The method performs very well on total mRNA recapitulation (log-space Pearsons R = 0.81), and well enough on WBC counts to outperform proportions at multiple classification tasks. MCI operates with minimal assumptions, and is applicable to many compositional omics.

systems biology↗

Continuous DNA Methylation Deconvolution-Based Surrogate for B-Cell Differentiation State in CLL

Chronic Lymphocytic Leukemia (CLL) is clinically divided into IGHV mutated (M-CLL) and IGHV unmutated (U-CLL) subtypes, which are thought to arise from distinct cells of origin along the B-cell differentiation pathway. We measured genome-scale DNA methylation in purified CLL samples (n = 89) and utilized reference-based cell deconvolution techniques to develop a continuous metric of epigenetic similarity across a B-naive-like to B-memory-like scale (B-Index). B-Index accurately classifies CLL into clinical subtypes (98.8%), has a stronger epigenetic signal than IGHV gene percent identity, and demonstrates additional epigenetic signal within the M-CLL subgroup. We demonstrate that U-CLL is epigenetically more similar to B-memory than B-naive cells and reconcile previous reports of a B-naive-like epigenetic signal. The B-memory-like program of U-CLL is enriched for binding sites of transcription factors related to the germinal center activation pathway. Our findings provide epigenetic evidence for discerning CLL mechanisms of initiation and cell of origin. We also identified an epigenetic signal associated with tumor burden, which may have some relation to viral infections such as Epstein-Barr-Virus. Our cell-type deconvolution-based approach to developing a continuous metric for CLL epigenetic differentiation state can be applied to other tumors with multiple subtypes across differentiation stages.

cancer biology↗

Endothelial cell-specific DNA methylation alterations identified in breast cancer with epigenetic deconvolution

DNA methylation alterations are epigenetic modifications that regulate gene expression and contribute to carcinogenesis. Technical challenges and high costs limit the use of single-cell sequencing approaches to measure and understand cell-specific DNA methylation alterations in the tumor microenvironment (TME). Using cell type deconvolution (HiTIMED) and an interaction testing framework (CellDMC), we identified DNA methylation alterations in tumor endothelial cells (TECs) from measures in bulk biospecimens. Alterations in TECs contribute to abnormal angiogenesis, resulting in disorganized, leaky blood vessels that can hinder drug delivery and immune access. We hypothesize that TECs in the TME exhibit distinct DNA methylation patterns compared to normal endothelial cells, driving phenotypic changes that support tumor growth and vascular dysfunction. We used genome-scale DNA methylation data and a testing and validation set design (tumor, n=1,080; nontumor, n=415) to identify TEC-specific DNA methylation alterations in breast cancer. Between cohorts, we validated 4,562 TEC-specific CpGs (4,163 hypermethylated and 399 hypomethylated), and found that many map to genes regulating angiogenesis and endothelial function. Integration with mRNA data from tumor samples in both discovery and validation sets revealed genes whose expression correlates with TEC-specific DNA methylation patterns and endothelial cell proportions, highlighting potentially novel therapeutic targets. This study demonstrates the utility of cellular deconvolution to uncover cell lineage-specific epigenetic changes in cancer using bulk specimen, and identifies TEC-specific methylation alterations as novel potential targets for therapeutic intervention.

cancer biology↗

Sufficient levels of BECLIN1 are required for intestinal epithelial cell homeostasis and protection against unwanted intestinal inflammation

The prototypical autophagy regulator BECLIN1, orchestrates both autophagic and endocytic trafficking, and its homozygous deletion in the intestinal epithelium leads to intestinal disruption bearing similarities to inflammatory bowel disease (IBD). However, complete loss of BECLIN1 is rare in human disease. To model the effects of a partial reduction in BECLIN1, we examined mice with a monoallelic deletion of Becn1 in the intestinal epithelium, which decreased BECLIN1 protein levels by approximately 50%. Unlike the fatal phenotype following homozygous Becn1 deletion, the heterozygous mice were grossly normal, though they presented with significantly shorter small intestines. Gastrointestinal organoids derived from the mice also displayed disrupted endocytic trafficking and altered cytoskeletal dynamics resulting in mislocalisation of junctional proteins such as E-CADHERIN. In the mice, these changes were associated with impaired goblet cell function and maturation accompanied by abnormal mucin production, composition and secretion, resulting in compromised mucus barrier integrity. The mice also exhibited heightened susceptibility to dextran sulfate sodium (DSS)-induced colitis, emphasising the critical role of BECLIN1 in mediating protection against unregulated inflammation. Investigation of BECLIN1 levels in biopsies from patients with inflammatory bowel disease (IBD) revealed changes in its expression across distinct states of inflammation with reduced levels observed in highly inflamed regions in some patients, consistent with the gastrointestinal defects seen in mice with reduced BECLIN1. Hence, this study provides crucial insights into the multifaceted importance of BECLIN1 sufficiency in the intestinal epithelium to prevent pathophysiology. This highlights the potential of BECLIN1 as a biomarker and therapeutic target for IBD management.

cell biology↗

Optimizing Protocols for MicroRNA Profiling of Infant and Toddler Stool

BackgroundMicroRNAs (miRNAs) are increasingly being investigated as potential biomarkers for child development and disease. Although a growing number of studies are utilizing infant and toddler stool for transcriptomic analyses, no studies have compared protocols for preserving and extracting miRNAs from this specimen type, despite unique challenges, including abundant levels of RNAses and microbial RNA. MethodsTo address this, we first compared three commercially available kits and four preservation methods for their ability to yield high quality RNA from infant and toddler stool (Phase 1). RNA quality was determined by fragment analyzer. ResultsOf the three RNA extraction kits compared, Zymo BIOMICs yielded the highest overall RNA Quality Number (RQN) (median (range) RQN 9.4 (5.7-10.0)). Of the four preservation methods tested, stool collected in RNAlater and Zymo DNA/RNA Shield Fecal Collection Tubes yielded the highest two RQNs (median (range) RQN 9.8 (5.7-10.0) and 9.4 (5.4-10.0), respectively), which did not differ significantly from each other (p = 0.47). Second, using miRNA-seq we directly compared miRNA profiles for RNA extracted using the Zymo BIOMICs kit from paired aliquots of the same stool sample from four infants collected into RNAlater and Zymo DNA/RNA Shield Fecal Collection Tubes (Phase 2). Given that microbial sequences greatly outnumber human miRNAs in stool, reads were first classified as human versus microbial prior to aligning human-classified reads to miRBase v22.1. The percentage of reads classified as human and the percentage of human reads aligning to miRBase did not differ for samples collected in RNAlater versus Zymo Shield (p = 0.12 and p = 0.86, respectively). Furthermore, after multiple testing correction, normalized miRNA counts did not differ significantly between the two preservatives for any of the 42 human miRNAs detected across the eight samples. ConclusionsCollecting infant and toddler stool in either RNAlater or Zymo DNA/RNA Shield Fecal Collection Tubes, when paired with RNA extraction using the Zymo BIOMICs extraction kit, yielded high-quality RNA with similar human miRNA profiles. Moreover, of the 42 miRNAs that were detected, several (i.e., miR-194a-3p, miR-200c-3p, miR-26a-5p) are thought to contribute to overall gut homeostasis. These findings may inform protocols for future studies that aim to profile miRNAs in infant and toddler stool to evaluate their potential utility as biomarkers for childrens health.

developmental biology↗

Increased contact between lipid droplets and mitochondria in skeletal muscles of male elite endurance athletes

Endurance athletes exhibit higher skeletal muscle mitochondrial and lipid droplet (LD) content compared to recreationally active individuals, along with greater whole-body oxygen uptake and maximal fat oxidation rates. In this study, we investigated if these differences manifest in a greater LD-mitochondria contact and how this may relate to the organelles size, shape, and numerical densities. We obtained skeletal muscle biopsies from 17 male elite triathletes and road cyclists and 7 recreationally active men. Using quantitative transmission electron microscopy, we found that the endurance athletes had 2-3-fold greater LD-mitochondria contact length than the recreationally active individuals. This was related to higher numerical densities of both mitochondria and LDs in the intermyofibrillar space. Adding data from untrained individuals with equally high intermyofibrillar LD density as the endurance athletes revealed a 24% greater LD-mitochondria contact length in the endurance athletes. We observed small trivial differences in the shape of both organelles between populations. However, large mitochondrial profiles were more elongated and irregular in shape compared to small mitochondrial profiles, while large LD profiles were more circular and less irregular than small LD profiles. Within the group of athletes, large intermyofibrillar LD profiles correlated with a high fraction of PLIN5-positive LDs and their maximal fat oxidation rate was positively associated with an interaction between the profile size of both intermyofibrillar LDs and mitochondria. In conclusion, male endurance athletes have a greater LD-mitochondria contact than recreationally active and untrained individuals. This muscular phenotype is restricted to the intermyofibrillar space and to fibres rich in mitochondria.

physiology↗

A necroptotic-to-apoptotic signaling axis underlies inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic condition caused by altered cytokine signaling, maladaptive immunity, dysbiosis, and intestinal barrier dysfunction. Patients with IBD receive therapy to correct these imbalances and achieve remission. However, most patients relapse, suggesting that pathological mechanisms persist during remission. Here, we show that excess epithelial cell death is an underlying feature of IBD that arises in patients in remission and on advanced therapy. Mechanistically, nascent inflammation reprograms epithelial cells into a macrophage-like state that promotes RIPK1-independent necroptotic signaling, then triggers iNOS-mediated mitochondrial apoptosis of absorptive epithelial cells and PUMA-mediated intestinal stem cell death. These findings reveal aberrant epithelial cell death signaling as a hallmark of IBD that occurs early in mucosal lesion development and persists despite current therapeutic approaches. One-Sentence SummaryEpithelial cell death is dysregulated in patients with inflammatory bowel disease.

cell biology↗

An immunohistochemical atlas of necroptotic pathway expression

Necroptosis is a lytic form of regulated cell death reported to contribute to inflammatory diseases of the gut, skin and lung, as well as ischemic-reperfusion injuries of the kidney, heart and brain. However, precise identification of the cells and tissues that undergo necroptotic cell death in vivo has proven challenging in the absence of robust protocols for immunohistochemical detection. Here, we provide automated immunohistochemistry protocols to detect core necroptosis regulators - Caspase-8, RIPK1, RIPK3 and MLKL - in formalin-fixed mouse and human tissues. We observed surprising heterogeneity in protein expression within tissues, whereby short-lived immune barrier cells were replete with necroptotic effectors, whereas long-lived cells lacked RIPK3 or MLKL expression. Local changes in the expression of necroptotic effectors occurred in response to insults such as inflammation, dysbiosis or immune challenge, consistent with necroptosis being dysregulated in disease contexts. These methods will facilitate the precise localisation and evaluation of necroptotic signaling in vivo. HighlightsO_LI13 automated immunohistochemistry protocols for detecting the necroptotic pathway C_LIO_LINecroptotic pathway expression is confined to fast-cycling immune barriers C_LIO_LINecroptotic pathway expression changes at sites of immunoinflammatory challenge C_LIO_LIImmunodetection of necrosomes in IBD patients is a putative new diagnostic tool C_LI

cell biology↗

DeltaAI: Semi-Autonomous Tissue Grossing Measurements and Recommendations using Neural Radiance Fields for Rapid, Complete Intraoperative Histological Assessment of Tumor Margins

Mohs Micrographic Surgery (MMS) aims to excise cutaneous cancer with real-time margin analysis. However, manual tissue grossing and analysis can be inefficient, so we propose DeltaAI, a novel workflow that utilizes Neural Radiance Fields (NeRF) to enable rapid tissue grossing and generate a 3D model in an augmented reality (AR) environment. In our study, we captured 30-second videos of 17 MMS specimens using a photogrammetry turntable and cellphone camera. Preprocessing the tissues with segmentation models, we created a dataset of 923, 360-degree-view, images per video (17 videos). Using COLMAP, we estimated poses for sparse tissue reconstructions and trained the NeRF model for 3D volumetric tissue renderings. The results demonstrated that DeltaAI generated more accurate and complete 360-degree, 3D tissue renderings compared to previous models, while also achieving significantly faster runtimes. Our proposed semi-autonomous NeRF-based workflow has the potential to enhance the speed of MMS specimen processing, measurement, report generation, and margin assessment. It can inform real-time grossing decisions, automate the export of electronic health record data, and facilitate time-efficient and complete cancer excisions. Moreover, DeltaAI can contribute to the wider adoption of AI technology in clinical settings by improving tissue modeling for manual grossing.

pathology↗

An Aurora kinase A-BOD1L1-PP2A B56 Axis promotes chromosome segregation fidelity

Cancer cells are often aneuploid and frequently display elevated rates of chromosome mis-segregation in a phenomenon called chromosomal instability (CIN). CIN is commonly caused by hyperstable kinetochore-microtubule (K-MT) attachments that reduces the efficiency of correction of erroneous K-MT attachments. We recently showed that UMK57, a chemical agonist of MCAK (alias KIF2C) improves chromosome segregation fidelity in CIN cancer cells although cells rapidly develop adaptive resistance. To determine the mechanism of resistance we performed unbiased proteomic screens which revealed increased phosphorylation in cells adapted to UMK57 at two Aurora kinase A phosphoacceptor sites on BOD1L1 (alias FAM44A). BOD1L1 depletion or Aurora kinase A inhibition eliminated resistance to UMK57 in CIN cancer cells. BOD1L1 localizes to spindles/kinetochores during mitosis, interacts with the PP2A phosphatase, and regulates phosphorylation levels of kinetochore proteins, chromosome alignment, mitotic progression and fidelity. Moreover, the BOD1L1 gene is mutated in a subset of human cancers, and BOD1L1 depletion reduces cell growth in combination with clinically relevant doses of taxol or Aurora kinase A inhibitor. Thus, an Aurora kinase A-BOD1L1-PP2A axis promotes faithful chromosome segregation during mitosis. (175 words)

cell biology↗

Potential to Enhance Large Scale Molecular Assessments of Skin Photoaging through Virtual Inference of Spatial Transcriptomics from Routine Staining

The advent of spatial transcriptomics technologies has heralded a renaissance in research to advance our understanding of the spatial cellular and transcriptional heterogeneity within tissues. Spatial transcriptomics allows investigation of the interplay between cells, molecular pathways and the surrounding tissue architecture and can help elucidate developmental trajectories, disease pathogenesis, and various niches in the tumor microenvironment. Photoaging is the histological and molecular skin damage resulting from chronic/acute sun exposure and is a major risk factor for skin cancer. Spatial transcriptomics technologies hold promise for improving the reliability of evaluating photoaging and developing new therapeutics. Current challenges, including limited focus on dermal elastosis variations and reliance on self-reported measures, can introduce subjectivity and inconsistency. Spatial transcriptomics offer an opportunity to assess photoaging objectively and reproducibly in studies of carcinogenesis and discern the effectiveness of therapies that intervene on photoaging and prevent cancer. Evaluation of distinct histological architectures using highly-multiplexed spatial technologies can identify specific cell lineages that have been understudied due to their location beyond the depth of UV penetration. However, the cost and inter-patient variability using state-of-the-art assays such as the 10x Genomics Spatial Transcriptomics assays limits the scope and scale of large-scale molecular epidemiologic studies. Here, we investigate the inference of spatial transcriptomics information from routine hematoxylin and eosin-stained (H&E) tissue slides. We employed the Visium CytAssist spatial transcriptomics assay to analyze over 18,000 genes at a 50-micron resolution for four patients from a cohort of 261 skin specimens collected adjacent to surgical resection sites for basal and squamous keratinocyte tumors. The spatial transcriptomics data was co-registered with 40x resolution whole slide imaging (WSI) information. We developed machine learning models that achieved a macro-averaged median AUC and F1 score of 0.80 and 0.61 and Spearman coefficient of 0.60 in inferring transcriptomic profiles across the slides, and accurately captured biological pathways across various tissue architectures.

pathology↗

Spatial Omics Driven Crossmodal Pretraining Applied to Graph-based Deep Learning for Cancer Pathology Analysis

Graph-based deep learning has shown great promise in cancer histopathology image analysis by contextualizing complex morphology and structure across whole slide images to make high quality downstream outcome predictions (ex: prognostication). These methods rely on informative representations (i.e., embeddings) of image patches comprising larger slides, which are used as node attributes in slide graphs. Spatial omics data, including spatial transcriptomics, is a novel paradigm offering a wealth of detailed information. Pairing this data with corresponding histological imaging localized at 50-micron resolution, may facilitate the development of algorithms which better appreciate the morphological and molecular underpinnings of carcinogenesis. Here, we explore the utility of leveraging spatial transcriptomics data with a contrastive crossmodal pretraining mechanism to generate deep learning models that can extract molecular and histological information for graph-based learning tasks. Performance on cancer staging, lymph node metastasis prediction, survival prediction, and tissue clustering analyses indicate that the proposed methods bring improvement to graph based deep learning models for histopathological slides compared to leveraging histological information from existing schemes, demonstrating the promise of mining spatial omics data to enhance deep learning for pathology workflows.

pathology↗

Increased mitochondrial surface area and cristae density in the skeletal muscle of strength athletes

Mitochondria are the cellular organelles responsible for resynthesising the majority of ATP. In skeletal muscle, there is an increased ATP turnover during resistance exercise to sustain the energetic demands of muscle contraction. Despite this, little is known regarding the mitochondrial characteristics of chronically strength-trained individuals and any potential pathways regulating the strength-specific mitochondrial remodelling. Here, we investigated the mitochondrial structural characteristics in skeletal muscle of strength athletes and age-matched untrained controls. The mitochondrial pool in strength athletes was characterised by increased mitochondrial cristae density, decreased mitochondrial size, and increased surface-to-volume ratio, despite similar mitochondrial volume density. We also provide a fibre-type and compartment specific assessment of mitochondria morphology in human skeletal muscle, which reveals across groups a compartment-specific influence on mitochondrial morphology that is largely independent of fibre-type. Furthermore, we show that resistance exercise leads to signs of mild mitochondrial stress, without an increase in the number of damaged mitochondria. Using publicly available transcriptomic data we show that acute resistance exercise increases the expression of markers of mitochondrial biogenesis, fission, and mitochondrial unfolded protein responses (UPRmt). Further, we observed an enrichment of the UPRmt in the basal transcriptome of strength-trained individuals. Together, these findings show that strength athletes possess a unique mitochondrial remodelling, which minimises the space required for mitochondria. We propose that the concurrent activation of markers of mitochondrial biogenesis and mitochondrial remodelling pathways (fission and UPRmt) with resistance exercise may be partially responsible for the observed mitochondrial phenotype of strength athletes.

physiology↗

Inferring Spatially Resolved Transcriptomics Data from Whole Slide Images for the Assessment of Colorectal Tumor Metastasis: A Feasibility Study

Over 150,000 Americans are diagnosed with colorectal cancer (CRC) every year, and annually over 50,000 individuals will die from CRC, necessitating improvements in screening, prognostication, disease management, and therapeutic options. Tumor metastasis is the primary factor related to the risk of recurrence and mortality. Yet, screening for nodal and distant metastasis is costly, and invasive and incomplete resection may hamper adequate assessment. Signatures of the tumor-immune microenvironment (TIME) at the primary site can provide valuable insights into the aggressiveness of the tumor and the effectiveness of various treatment options. Spatially-resolved transcriptomics technologies offer an unprecedented characterization of TIME through high multiplexing, yet their scope is constrained by cost. Meanwhile, it has long been suspected that histological, cytological and macroarchitectural tissue characteristics correlate well with molecular information (e.g., gene expression). Thus, a method for predicting transcriptomics data through inference of RNA patterns from whole slide images (WSI) is a key step in studying metastasis at scale. In this work, we collected and preprocessed Visium spatial transcriptomics data (17,943 genes at up to 5,000 spots per patient sampled in a honeycomb pattern) from tissue across four stage-III matched colorectal cancer patients. We compare and prototype several convolutional, Transformer, and graph convolutional neural networks to predict spatial RNA patterns under the hypothesis that the transformer and graph-based approaches better capture relevant spatial tissue architecture. We further analyzed the models ability to recapitulate spatial autocorrelation statistics using SPARK and SpatialDE. Overall, results indicate that the transformer and graph-based approaches were unable to outperform the convolutional neural network architecture, though they exhibited optimal performance for relevant disease-associated genes. Initial findings suggest that different neural networks that operate on different scales are relevant for capturing distinct disease pathways (e.g., epithelial to mesenchymal transition). We add further evidence that deep learning models can accurately predict gene expression in whole slide images and comment on understudied factors which may increase its external applicability (e.g., tissue context). Our preliminary work will motivate further investigation of inference for molecular patterns from whole slide images as metastasis predictors and in other applications.

pathology↗

Assessment of Emerging Pretraining Strategies in Interpretable Multimodal Deep Learning for Cancer Prognostication

Deep learning models have demonstrated the remarkable ability to infer cancer patient prognosis from molecular and anatomic pathology information. Studies in recent years have demonstrated that leveraging information from complementary multimodal data can improve prognostication, further illustrating the potential utility of such methods. Model interpretation is crucial for facilitating the clinical adoption of deep learning methods by fostering practitioner understanding and trust in the technology. However, while prior works have presented novel multimodal neural network architectures as means to improve prognostication performance, these approaches: 1) do not comprehensively leverage biological and histomorphological relationships and 2) make use of emerging strategies to "pretrain" models (i.e., train models on a slightly orthogonal dataset/modeling objective) which may aid prognostication by reducing the amount of information required for achieving optimal performance. Here, we develop an interpretable multimodal modeling framework that combines DNA methylation, gene expression, and histopathology (i.e., tissue slides) data, and we compare the performances of crossmodal pretraining, contrastive learning, and transfer learning versus the standard procedure in this context. Our models outperform the existing state-of-the-art method (average 11.54% C-index increase), and baseline clinically driven models. Our results demonstrate that the selection of pretraining strategies is crucial for obtaining highly accurate prognostication models, even more so than devising an innovative model architecture, and further emphasize the all-important role of the tumor microenvironment on disease progression.

pathology↗

Graph neural networks ameliorate potential impacts of imprecise large-scale autonomous immunofluorescence labeling of immune cells on whole slide images

The characteristics of tumor-infiltrating lymphocytes (TIL) are essential in cancer prognostication and treatment through the ability to indicate the tumors capacity to evade the immune system (e.g., as evidenced by nodal involvement). Machine learning technologies have demonstrated remarkable success for localizing TILs, though these methods require extensive curation of manual annotations or restaining procedures that can degrade tissue quality, resulting in imprecise annotation. In this study, we co-registered tissue slides stained for both hematoxylin and eosin (H&E) and immunofluorescence (IF) as means to rapidly perform large-scale annotation of nuclei. We integrated the following approaches to improve the prediction of TILs: 1) minimized tissue degradation on same-section tissue restaining, 2) developed a scoring algorithm to improve the selection of patches for machine learning modeling and 3) utilized a graph neural network deep learning approach to identify relevant contextual features for lymphocyte prediction. Our graph neural network approach accounts for surrounding contextual micro/macro-architecture tissue features to facilitate interpretation of registered IF. The graph neural network compares favorably (F1-score=0.9235, AUROC=0.9462) to two alternative modeling approaches. This study brings insight to the importance of contextual information leveraged from within and around neighboring cells in a nuclei classification workflow, as well as elucidate approaches which enable the rapid generation of large-scale annotations of lymphocytes for machine learning approaches for immune phenotyping. Such approaches can help further interrogate the spatial biology of colorectal cancer tumors and tumor metastasis.

pathology↗

Video-Based Deep Learning to Detect Dyssynergic Defecation with 3D High-Definition Anorectal Manometry

BACKGROUND AND AIMSEvaluation for dyssynergia is the most common reason that gastroenterologists refer patients for anorectal manometry, because dyssynergia is amenable to biofeedback by physical therapists. High-definition anorectal manometry (3D-HDAM) is a promising technology to evaluate anorectal physiology, but adoption remains limited by its sheer complexity. We developed a 3D-HDAM deep learning algorithm to evaluate for dyssynergia. METHODSSpatial-temporal data were extracted from consecutive 3D-HDAM studies performed between 2018-2020 at a tertiary institution. The technical procedure and gold standard definition of dyssynergia were based on the London consensus, adapted to the needs of 3D-HDAM technology. Three machine learning models were generated: (1) traditional machine learning informed by conventional anorectal function metrics, (2) deep learning, and (3) a hybrid approach. Diagnostic accuracy was evaluated using bootstrap sampling to calculate area-under-the-curve (AUC). To evaluate overfitting, models were validated by adding 502 simulated defecation maneuvers with diagnostic ambiguity. RESULTS302 3D-HDAM studies representing 1,208 simulated defecation maneuvers were included (average age 55.2 years; 80.5% women). The deep learning model had comparable diagnostic accuracy (AUC=0.91 [95% confidence interval 0.89-0.93]) to traditional (AUC=0.93[0.92-0.95]) and hybrid (AUC=0.96[0.94-0.97]) predictive models in training cohorts. However, the deep learning model handled ambiguous tests more cautiously than other models; the deep learning model was more likely to designate an ambiguous test as inconclusive (odds ratio=4.21[2.78-6.38]) versus traditional/hybrid approaches. CONCLUSIONSBy considering complex spatial-temporal information beyond conventional anorectal function metrics, deep learning on 3D-HDAM technology may enable gastroenterologists to reliably identify and manage dyssynergia in broader practice.

bioinformatics↗

Development of Biologically Interpretable Multimodal Deep Learning Model for Cancer Prognosis Prediction

Robust cancer prognostication can enable more effective patient care and management, which may potentially improve health outcomes. Deep learning has proven to be a powerful tool to extract meaningful information from cancer patient data. In recent years it has displayed promise in quantifying prognostication by predicting patient risk. However, most current deep learning-based cancer prognosis prediction methods use only a single data source and miss out on learning from potentially rich relationships across modalities. Existing multimodal approaches are challenging to interpret in a biological or medical context, limiting real-world clinical integration as a trustworthy prognostic decision aid. Here, we developed a multimodal modeling approach that can integrate information from the central modalities of gene expression, DNA methylation, and histopathological imaging with clinical information for cancer prognosis prediction. Our multimodal modeling approach combines pathway and gene-based sparsely coded layers with patch-based graph convolutional networks to facilitate biological interpretation of the model results. We present a preliminary analysis that compares the potential applicability of combining all modalities to uni- or bi-modal approaches. Leveraging data from four cancer subtypes from the Cancer Genome Atlas, results demonstrate the encouraging performance of our multimodal approach (C-index=0.660 without clinical features; C-index=0.665 with clinical features) across four cancer subtypes versus unimodal approaches and existing state-of-the-art approaches. This work brings insight to the development of interpretable multimodal methods of applying AI to biomedical data and can potentially serve as a foundation for clinical implementations of such software. We plan to follow up this preliminary analysis with an in-depth exploration of factors to improve multimodal modeling approaches on an in-house dataset.

pathology↗