Michelle M. Li

Ruth Johnson, Michelle M. Li, Ayush Noori et al.

In clinical artificial intelligence (AI), graph representation learning, mainly through graph neural networks (GNNs), stands out for its capability to capture intricate relationships within structured clinical datasets. With diverse data -- from patient records to imaging -- GNNs process data holistically by viewing modalities as nodes interconnected by their relationships. Graph AI facilitates model transfer across clinical tasks, enabling models to generalize across patient populations without additional parameters or minimal re-training. However, the importance of human-centered design and model interpretability in clinical decision-making cannot be overstated. Since graph AI models capture information through localized neural transformations defined on graph relationships, they offer both an opportunity and a challenge in elucidating model rationale. Knowledge graphs can enhance interpretability by aligning model-driven insights with medical knowledge. Emerging graph models integrate diverse data modalities through pre-training, facilitate interactive feedback loops, and foster human-AI collaboration, paving the way to clinically meaningful predictions.

Xuefeng Liu, Songhao Jiang, Xiaotian Duan et al.

Protein-ligand binding is the process by which a small molecule (drug or inhibitor) attaches to a target protein. Binding affinity, which characterizes the strength of biomolecular interactions, is essential for tackling diverse challenges in life sciences, including therapeutic design, protein engineering, enzyme optimization, and elucidating biological mechanisms. Much work has been devoted to predicting binding affinity over the past decades. Here, we review recent significant works, with a focus on methods, evaluation strategies, and benchmark datasets. We note growing use of both traditional machine learning and deep learning models for predicting binding affinity, accompanied by an increasing amount of data on proteins and small drug-like molecules. With improved predictive performance and the FDA's phasing out of animal testing, AI-driven in silico models, such as AI virtual cells (AIVCs), are poised to advance binding affinity prediction; reciprocally, progress in building binding affinity predictors can refine AIVCs. Future efforts in binding affinity prediction and AI-driven in silico models can enhance the simulation of temporal dynamics, cell-type specificity, and multi-omics integration to support more accurate and personalized outcomes.

Aashna P. Shah, Michelle M. Li, Yash Lal et al.

Blood-based biomarkers underpin clinical diagnosis and management, yet their interpretation relies largely on fixed population reference intervals that ignore stable, intra-patient variability. As such, population-based interpretation can mask meaningful deviation from an individual's baseline, risking delayed disease detection. To remedy this, there have been increasing efforts to personalize blood biomarker interpretation using individual testing histories. However, these methods may overfit to sparse data, inflating false-positive rates and unnecessary follow-up, and can also unwittingly include unrecognized or subclinical disease. Here, we leverage nearly 2 billion longitudinal laboratory measurements from over 1.6 million individuals across North America, the Middle East, and East Asia, to show that while laboratory values are highly individual, purely personalized intervals routinely overfit, classifying up to 68% of measurements as abnormal, without corresponding associations with adverse clinical outcomes. We then introduce NORMA, a conditional transformer-based framework that generates reference intervals by conditioning on both a patient's history and population-level data about "normal" variation. NORMA-derived intervals achieve higher precision for predicting outcomes, including mortality, acute kidney injury, and chronic disease. These findings caution against over-personalization in laboratory medicine and demonstrate that anchoring individual trajectories to population-level priors outperforms either approach alone. To promote transparency, we publicly release the model, code, and an interactive user interface for accessible, individualized laboratory interpretation.

Ayush Noori, Joaquín Polonuer, Katharina Meyer et al.

Neurological diseases are the leading global cause of disability, yet most lack disease-modifying treatments. We present PROTON, a heterogeneous graph transformer that generates testable hypotheses across molecular, organoid, and clinical systems. To evaluate PROTON, we apply it to Parkinson's disease (PD), bipolar disorder (BD), and Alzheimer's disease (AD). In PD, PROTON linked genetic risk loci to genes essential for dopaminergic neuron survival and predicted pesticides toxic to patient-derived neurons, including the insecticide endosulfan, which ranked within the top 1.29% of predictions. In silico screens performed by PROTON reproduced six genome-wide $α$-synuclein experiments, including a split-ubiquitin yeast two-hybrid system (normalized enrichment score [NES] = 2.30, FDR-adjusted $p < 1 \times 10^{-4}$), an ascorbate peroxidase proximity labeling assay (NES = 2.16, FDR $< 1 \times 10^{-4}$), and a high-depth targeted exome sequencing study in 496 synucleinopathy patients (NES = 2.13, FDR $< 1 \times 10^{-4}$). In BD, PROTON predicted calcitriol as a candidate drug that reversed proteomic alterations observed in cortical organoids derived from BD patients. In AD, we evaluated PROTON predictions in health records from $n = 610,524$ patients at Mass General Brigham, confirming that five PROTON-predicted drugs were associated with reduced seven-year dementia risk (minimum hazard ratio = 0.63, 95% CI: 0.53-0.75, $p < 1 \times 10^{-7}$). PROTON generated neurological hypotheses that were evaluated across molecular, organoid, and clinical systems, defining a path for AI-driven discovery in neurological disease.

Jifan Zhang, Michelle M. Li, Elena Zheleva

Causal disentanglement from soft interventions is identifiable under the assumptions of linear interventional faithfulness and availability of both observational and interventional data. Previous research has looked into this problem from the perspective of i.i.d. data. Here, we develop a framework, GraCE-VAE, for non-i.i.d. settings, in which structured context in the form of network data is available. GraCE-VAE integrates discrepancy-based variational autoencoders with graph neural networks to jointly recover the true latent causal graph and intervention effects. We show that the theoretical results of identifiability from i.i.d. data hold in our setup. We also empirically evaluate GraCE-VAE against state-of-the-art baselines on three genetic perturbation datasets to demonstrate the impact of leveraging structured context for causal disentanglement.

Michelle M. Li, Ben Y. Reis, Adam Rodman et al.

Medical AI, including clinical language models, vision-language models, and multimodal health record models, already summarizes notes, answers questions, and supports decisions. Their adaptation to new populations, specialties, or care settings often relies on fine-tuning, prompting, or retrieval from external knowledge bases. These strategies can scale poorly and risk contextual errors: outputs that appear plausible but miss critical patient or situational information. We envision context switching as a solution. Context switching adjusts model reasoning at inference without retraining. Generative models can tailor outputs to patient biology, care setting, or disease. Multimodal models can reason on notes, laboratory results, imaging, and genomics, even when some data are missing or delayed. Agent models can coordinate tools and roles based on tasks and users. In each case, context switching enables medical AI to adapt across specialties, populations, and geographies. It requires advances in data design, model architectures, and evaluation frameworks, and establishes a foundation for medical AI that scales to infinitely many contexts while remaining reliable and suited to real-world care.

Michelle M. Li, Kevin Li, Yasha Ektefaie et al.

Conditional generation models for longitudinal sequences can generate new or modified trajectories given a conditioning input. While effective at generating entire sequences, these models typically lack control over the timing and scope of the edits. Most existing approaches either operate on univariate sequences or assume that the condition affects all variables and time steps. However, many scientific and clinical applications require more precise interventions, where a condition takes effect only after a specific time and influences only a subset of variables. We introduce CLEF, a controllable sequence editing model for conditional generation of immediate and delayed effects in multivariate longitudinal sequences. CLEF learns temporal concepts that encode how and when a condition alters future sequence evolution. These concepts allow CLEF to apply targeted edits to the affected time steps and variables while preserving the rest of the sequence. We evaluate CLEF on 6 datasets spanning cellular reprogramming and patient health trajectories, comparing against 9 state-of-the-art baselines. CLEF improves immediate sequence editing accuracy by up to 36.01% (MAE). Unlike prior models, CLEF enables one-step conditional generation at arbitrary future times, outperforming them in delayed sequence editing by up to 65.71% (MAE). We test CLEF under counterfactual inference assumptions and show up to 63.19% (MAE) improvement on zero-shot conditional generation of counterfactual trajectories. In a case study of patients with type 1 diabetes mellitus, CLEF identifies clinical interventions that generate realistic counterfactual trajectories shifted toward healthier outcomes.

Anna L. Trella, Peniel N. Argaw, Michelle M. Li et al.

Within epidemiological modeling, the majority of analyses assume a single epidemic process for generating ground-truth data. However, this assumed data generation process can be unrealistic, since data sources for epidemics are often aggregated across geographic regions and communities. As a result, state-of-the-art models for estimating epidemiological parameters, e.g.~transmission rates, can be inappropriate when faced with complex systems. Our work empirically demonstrates some limitations of applying epidemiological models to aggregated datasets. We generate three complex outbreak scenarios by combining incidence curves from multiple epidemics that are independently simulated via SEIR models with different sets of parameters. Using these scenarios, we assess the robustness of a state-of-the-art Bayesian inference method that estimates the epidemic trajectory from viral load surveillance data. We evaluate two data-generating models within this Bayesian inference framework: a simple exponential growth model and a highly flexible Gaussian process prior model. Our results show that both models generate accurate transmission rate estimates for the combined incidence curve at the cost of generating biased estimates for each underlying epidemic, reflecting highly heterogeneous underlying population dynamics. The exponential growth model, while interpretable, is unable to capture the complexity of the underlying epidemics. With sufficient surveillance data, the Gaussian process prior model captures the shape of complex trajectories, but is imprecise for periods of low data coverage. Thus, our results highlight the potential pitfalls of neglecting complexity and heterogeneity in the data generation process, which can mask underlying location- and population-specific epidemic dynamics.

Michelle M. Li, Marinka Zitnik

Spatial context is central to understanding health and disease. Yet reference protein interaction networks lack such contextualization, thereby limiting the study of where protein interactions likely occur in the human body and how they may be altered in disease. Contextualized protein interactions could better characterize genes with disease-specific interactions and elucidate diseases' manifestation in specific cell types. Here, we introduce AWARE, a graph neural message passing approach to inject cellular and tissue context into protein embeddings. AWARE optimizes for a multi-scale embedding space, whose structure reflects network topology at a single-cell resolution. We construct a multi-scale network of the Human Cell Atlas and apply AWARE to learn protein, cell type, and tissue embeddings that uphold cell type and tissue hierarchies. We demonstrate AWARE's utility on the novel task of predicting whether a protein is altered in disease and where that association most likely manifests in the human body. To this end, AWARE outperforms generic embeddings without contextual information by at least 12.5%, showing AWARE's potential to reveal context-dependent roles of proteins in disease.

Michelle M. Li, Kexin Huang, Marinka Zitnik

Biomedical networks (or graphs) are universal descriptors for systems of interacting elements, from molecular interactions and disease co-morbidity to healthcare systems and scientific knowledge. Advances in artificial intelligence, specifically deep learning, have enabled us to model, analyze, and learn with such networked data. In this review, we put forward an observation that long-standing principles of systems biology and medicine -- while often unspoken in machine learning research -- provide the conceptual grounding for representation learning on graphs, explain its current successes and limitations, and even inform future advancements. We synthesize a spectrum of algorithmic approaches that, at their core, leverage graph topology to embed networks into compact vector spaces. We also capture the breadth of ways in which representation learning has dramatically improved the state-of-the-art in biomedical machine learning. Exemplary domains covered include identifying variants underlying complex traits, disentangling behaviors of single cells and their effects on health, assisting in diagnosis and treatment of patients, and developing safe and effective medicines.

Emily Alsentzer, Samuel G. Finlayson, Michelle M. Li et al.

Deep learning methods for graphs achieve remarkable performance on many node-level and graph-level prediction tasks. However, despite the proliferation of the methods and their success, prevailing Graph Neural Networks (GNNs) neglect subgraphs, rendering subgraph prediction tasks challenging to tackle in many impactful applications. Further, subgraph prediction tasks present several unique challenges: subgraphs can have non-trivial internal topology, but also carry a notion of position and external connectivity information relative to the underlying graph in which they exist. Here, we introduce SubGNN, a subgraph neural network to learn disentangled subgraph representations. We propose a novel subgraph routing mechanism that propagates neural messages between the subgraph's components and randomly sampled anchor patches from the underlying graph, yielding highly accurate subgraph representations. SubGNN specifies three channels, each designed to capture a distinct aspect of subgraph topology, and we provide empirical evidence that the channels encode their intended properties. We design a series of new synthetic and real-world subgraph datasets. Empirical results for subgraph classification on eight datasets show that SubGNN achieves considerable performance gains, outperforming strong baseline methods, including node-level and graph-level GNNs, by 19.8% over the strongest baseline. SubGNN performs exceptionally well on challenging biomedical datasets where subgraphs have complex topology and even comprise multiple disconnected components.