Alexander Gusev

Intae Moon, Stefan Groha, Alexander Gusev

Effective learning from electronic health records (EHR) data for prediction of clinical outcomes is often challenging because of features recorded at irregular timesteps and loss to follow-up as well as competing events such as death or disease progression. To that end, we propose a generative time-to-event model, SurvLatent ODE, which adopts an Ordinary Differential Equation-based Recurrent Neural Networks (ODE-RNN) as an encoder to effectively parameterize dynamics of latent states under irregularly sampled input data. Our model then utilizes the resulting latent embedding to flexibly estimate survival times for multiple competing events without specifying shapes of event-specific hazard function. We demonstrate competitive performance of our model on MIMIC-III, a freely-available longitudinal dataset collected from critical care units, on predicting hospital mortality as well as the data from the Dana-Farber Cancer Institute (DFCI) on predicting onset of Venous Thromboembolism (VTE), a life-threatening complication for patients with cancer, with death as a competing event. SurvLatent ODE outperforms the current clinical standard Khorana Risk scores for stratifying VTE risk groups, while providing clinically meaningful and interpretable latent representations.

Yepeng Huang, Xiaorui Su, Varun Ullanat et al.

Predicting clinical outcomes from preclinical data is essential for identifying safe and effective drug combinations, reducing late-stage clinical failures, and accelerating the development of precision therapies. Current AI models rely on structural or target-based features but fail to incorporate the multimodal data necessary for accurate, clinically relevant predictions. Here, we introduce Madrigal, a multimodal AI model that learns from structural, pathway, cell viability, and transcriptomic data to predict drug-combination effects across 953 clinical outcomes and 21,842 compounds, including combinations of approved drugs and novel compounds in development. Madrigal uses an attention bottleneck module to unify preclinical drug data modalities while handling missing data during training and inference, a major challenge in multimodal learning. It outperforms single-modality methods and state-of-the-art models in predicting adverse drug interactions, and ablations show both modality alignment and multimodality are necessary. It captures transporter-mediated interactions and aligns with head-to-head clinical trial differences for neutropenia, anemia, alopecia, and hypoglycemia. In type 2 diabetes and MASH, Madrigal supports polypharmacy decisions and prioritizes resmetirom among safer candidates. Extending to personalization, Madrigal improves patient-level adverse-event prediction in a longitudinal EHR cohort and an independent oncology cohort, and predicts ex vivo efficacy in primary acute myeloid leukemia samples and patient-derived xenograft models. Madrigal links preclinical multimodal readouts to safety risks of drug combinations and offers a generalizable foundation for safer combination design.

Stefan Groha, Caroline Weis, Alexander Gusev et al.

Identifying subgroups and properties of cancer biopsy samples is a crucial step towards obtaining precise diagnoses and being able to perform personalized treatment of cancer patients. Recent data collections provide a comprehensive characterization of cancer cell data, including genetic data on copy number alterations (CNAs). We explore the potential to capture information contained in cancer genomic information using a novel topology-based approach that encodes each cancer sample as a persistence diagram of topological features, i.e., high-dimensional voids represented in the data. We find that this technique has the potential to extract meaningful low-dimensional representations in cancer somatic genetic data and demonstrate the viability of some applications on finding substructures in cancer data as well as comparing similarity of cancer types.

Stefan Groha, Sebastian M Schmon, Alexander Gusev

Survival models are a popular tool for the analysis of time to event data with applications in medicine, engineering, economics, and many more. Advances like the Cox proportional hazard model have enabled researchers to better describe hazard rates for the occurrence of single fatal events, but are unable to accurately model competing events and transitions. Common phenomena are often better described through multiple states, for example: the progress of a disease modeled as healthy, sick and dead instead of healthy and dead, where the competing nature of death and disease has to be taken into account. Moreover, Cox models are limited by modeling assumptions, like proportionality of hazard rates and linear effects. Individual characteristics can vary significantly between observational units, like patients, resulting in idiosyncratic hazard rates and different disease trajectories. These considerations require flexible modeling assumptions. To overcome these issues, we propose the use of neural ordinary differential equations as a flexible and general method for estimating multi-state survival models by directly solving the Kolmogorov forward equations. To quantify the uncertainty in the resulting individual cause-specific hazard rates, we further introduce a variational latent variable model and show that this enables meaningful clustering with respect to multi-state outcomes as well as interpretability regarding covariate values. We show that our model exhibits state-of-the-art performance on popular survival data sets and demonstrate its efficacy in a multi-state setting