Zhijian Yang

Zhijian Yang, Junhao Wen, Ahmed Abdulkadir et al.

Disease heterogeneity has been a critical challenge for precision diagnosis and treatment, especially in neurologic and neuropsychiatric diseases. Many diseases can display multiple distinct brain phenotypes across individuals, potentially reflecting disease subtypes that can be captured using MRI and machine learning methods. However, biological interpretability and treatment relevance are limited if the derived subtypes are not associated with genetic drivers or susceptibility factors. Herein, we describe Gene-SGAN - a multi-view, weakly-supervised deep clustering method - which dissects disease heterogeneity by jointly considering phenotypic and genetic data, thereby conferring genetic correlations to the disease subtypes and associated endophenotypic signatures. We first validate the generalizability, interpretability, and robustness of Gene-SGAN in semi-synthetic experiments. We then demonstrate its application to real multi-site datasets from 28,858 individuals, deriving subtypes of Alzheimer's disease and brain endophenotypes associated with hypertension, from MRI and SNP data. Derived brain phenotypes displayed significant differences in neuroanatomical patterns, genetic determinants, biological and clinical biomarkers, indicating potentially distinct underlying neuropathologic processes, genetic drivers, and susceptibility factors. Overall, Gene-SGAN is broadly applicable to disease subtyping and endophenotype discovery, and is herein tested on disease-related, genetically-driven neuroimaging phenotypes.

Junhao Wen, Cynthia H. Y. Fu, Duygu Tosun et al.

Late-life depression (LLD) is characterized by considerable heterogeneity in clinical manifestation. Unraveling such heterogeneity would aid in elucidating etiological mechanisms and pave the road to precision and individualized medicine. We sought to delineate, cross-sectionally and longitudinally, disease-related heterogeneity in LLD linked to neuroanatomy, cognitive functioning, clinical symptomatology, and genetic profiles. Multimodal data from a multicentre sample (N=996) were analyzed. A semi-supervised clustering method (HYDRA) was applied to regional grey matter (GM) brain volumes to derive dimensional representations. Two dimensions were identified, which accounted for the LLD-related heterogeneity in voxel-wise GM maps, white matter (WM) fractional anisotropy (FA), neurocognitive functioning, clinical phenotype, and genetics. Dimension one (Dim1) demonstrated relatively preserved brain anatomy without WM disruptions relative to healthy controls. In contrast, dimension two (Dim2) showed widespread brain atrophy and WM integrity disruptions, along with cognitive impairment and higher depression severity. Moreover, one de novo independent genetic variant (rs13120336) was significantly associated with Dim 1 but not with Dim 2. Notably, the two dimensions demonstrated significant SNP-based heritability of 18-27% within the general population (N=12,518 in UKBB). Lastly, in a subset of individuals having longitudinal measurements, Dim2 demonstrated a more rapid longitudinal decrease in GM and brain age, and was more likely to progress to Alzheimers disease, compared to Dim1 (N=1,413 participants and 7,225 scans from ADNI, BLSA, and BIOCARD datasets).

Zhijian Yang, Ilya M. Nasrallah, Haochang Shou et al.

Heterogeneity of brain diseases is a challenge for precision diagnosis/prognosis. We describe and validate Smile-GAN (SeMI-supervised cLustEring-Generative Adversarial Network), a novel semi-supervised deep-clustering method, which dissects neuroanatomical heterogeneity, enabling identification of disease subtypes via their imaging signatures relative to controls. When applied to MRIs (2 studies; 2,832 participants; 8,146 scans) including cognitively normal individuals and those with cognitive impairment and dementia, Smile-GAN identified 4 neurodegenerative patterns/axes: P1, normal anatomy and highest cognitive performance; P2, mild/diffuse atrophy and more prominent executive dysfunction; P3, focal medial temporal atrophy and relatively greater memory impairment; P4, advanced neurodegeneration. Further application to longitudinal data revealed two distinct progression pathways: P1$\rightarrow$P2$\rightarrow$P4 and P1$\rightarrow$P3$\rightarrow$P4. Baseline expression of these patterns predicted the pathway and rate of future neurodegeneration. Pattern expression offered better yet complementary performance in predicting clinical progression, compared to amyloid/tau. These deep-learning derived biomarkers offer promise for precision diagnostics and targeted clinical trial recruitment.

Zhijian Yang, Junhao Wen, Christos Davatzikos

Machine learning methods applied to complex biomedical data has enabled the construction of disease signatures of diagnostic/prognostic value. However, less attention has been given to understanding disease heterogeneity. Semi-supervised clustering methods can address this problem by estimating multiple transformations from a (e.g. healthy) control (CN) group to a patient (PT) group, seeking to capture the heterogeneity of underlying pathlogic processes. Herein, we propose a novel method, Smile-GANs (SeMi-supervIsed cLustEring via GANs), for semi-supervised clustering, and apply it to brain MRI scans. Smile-GANs first learns multiple distinct mappings by generating PT from CN, with each mapping characterizing one relatively distinct pathological pattern. Moreover, a clustering model is trained interactively with mapping functions to assign PT into corresponding subtype memberships. Using relaxed assumptions on PT/CN data distribution and imposing mapping non-linearity, Smile-GANs captures heterogeneous differences in distribution between the CN and PT domains. We first validate Smile-GANs using simulated data, subsequently on real data, by demonstrating its potential in characterizing heterogeneity in Alzheimer's Disease (AD) and its prodromal phases. The model was first trained using baseline MRIs from the ADNI2 database and then applied to longitudinal data from ADNI1 and BLSA. Four robust subtypes with distinct neuroanatomical patterns were discovered: 1) normal brain, 2) diffuse atrophy atypical of AD, 3) focal medial temporal lobe atrophy, 4) typical-AD. Further longitudinal analyses discover two distinct progressive pathways from prodromal to full AD: i) subtypes 1 - 2 - 4, and ii) subtypes 1 - 3 - 4. Although demonstrated on an important biomedical problem, Smile-GANs is general and can find application in many biomedical and other domains.