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    Improving drug development with a vast map of the immune system

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    The human immune system is a network made up of trillions of cells that are constantly circulating throughout the body. The cellular network orchestrates interactions with every organ and tissue to carry out an impossibly long list of functions that scientists are still working to understand. All that complexity limits our ability to predict which patients will respond to treatments and which ones might suffer debilitating side effects.

    The issue often leads pharmaceutical companies to stop developing drugs that could help certain patients, halting clinical trials even when drugs show promising results for some people.

    Now, Immunai is helping to predict how patients will respond to treatments by building a comprehensive map of the immune system. The company has assembled a vast database it calls AMICA, that combines multiple layers of gene and protein expression data in cells with clinical trial data to match the right drugs to the right patients.

    “Our starting point was creating what I call the Google Maps for the immune system,” Immunai co-founder and CEO Noam Solomon says. “We started with single-cell RNA sequencing, and over time we’ve added more and more ‘omics’: genomics, proteomics, epigenomics, all to measure the immune system’s cellular expression and function, to measure the immune environment holistically. Then we started working with pharmaceutical companies and hospitals to profile the immune systems of patients undergoing treatments to really get to the root mechanisms of action and resistance for therapeutics.”

    Immunai’s big data foundation is a result of its founders’ unique background. Solomon and co-founder Luis Voloch ’13, SM ’15 hold degrees in mathematics and computer science. In fact, Solomon was a postdoc in MIT’s Department of Mathematics at the time of Immunai’s founding.

    Solomon frames Immunai’s mission as stopping the decades-long divergence of computer science and the life sciences. He believes the single biggest factor driving the explosion of computing has been Moore’s Law — our ability to exponentially increase the number of transistors on a chip over the past 60 years. In the pharmaceutical industry, the reverse is happening: By one estimate, the cost of developing a new drug roughly doubles every nine years. The phenomenon has been dubbed Eroom’s Law (“Eroom” for “Moore” spelled backward).

    Solomon sees the trend eroding the case for developing new drugs, with huge consequences for patients.

    “Why should pharmaceutical companies invest in discovery if they won’t get a return on investment?” Solomon asks. “Today, there’s only a 5 to 10 percent chance that any given clinical trial will be successful. What we’ve built through a very robust and granular mapping of the immune system is a chance to improve the preclinical and clinical stages of drug development.”

    A change in plans

    Solomon entered Tel Aviv University when he was 14 and earned his bachelor’s degree in computer science by 19. He earned two PhDs in Israel, one in computer science and the other in mathematics, before coming to MIT in 2017 as a postdoc to continue his mathematical research career.

    That year Solomon met Voloch, who had already earned bachelor’s and master’s degrees in math and computer science from MIT. But the researchers were soon exposed to a problem that would take them out of their comfort zones and change the course of their careers.

    Voloch’s grandfather was receiving a cocktail of treatments for cancer at the time. The cancer went into remission, but he suffered terrible side effects that caused him to stop taking his medication.

    Voloch and Solomon began wondering if their expertise could help patients like Voloch’s grandfather.

    “When we realized we could make an impact, we made the difficult decision to stop our academic pursuits and start a new journey,” Solomon recalls. “That was the starting point for Immunai.”

    Voloch and Solomon soon partnered with Immunai scientific co-founders Ansu Satpathy, a researcher at Stanford University at the time, and Danny Wells, a researcher at the Parker Institute for Cancer Immunotherapy. Satpathy and Wells had shown that single-cell RNA sequencing could be used to gain insights into why patients respond differently to a common cancer treatment.

    The team began analyzing single-cell RNA sequencing data published in scientific papers, trying to link common biomarkers with patient outcomes. Then they integrated data from the United Kingdom’s Biobank public health database, finding they were able to improve their models’ predictions. Soon they were incorporating data from hospitals, academic research institutions, and pharmaceutical companies, analyzing information about the structure, function, and environment of cells — multiomics — to get a clearer picture of immune activity.

    “Single cell sequencing gives you metrics you can measure in thousands of cells, where you can look at 20,000 different genes, and those metrics give you an immune profile,” Solomon explains. “When you measure all of that over time, especially before and after getting therapy, and compare patients who do respond with patients who don’t, you can apply machine learning models to understand why.”

    Those data and models make up AMICA, what Immunai calls the world’s largest cell-level immune knowledge base. AMICA stands for Annotated Multiomic Immune Cell Atlas. It analyzes single cell multiomic data from almost 10,000 patients and bulk-RNA data from 100,000 patients across more than 800 cell types and 500 diseases.

    At the core of Immunai’s approach is a focus on the immune system, which other companies shy away from because of its complexity.

    “We don’t want to be like other groups that are studying mainly tumor microenvironments,” Solomon says. “We look at the immune system because the immune system is the common denominator. It’s the one system that is implicated in every disease, in your body’s response to everything that you encounter, whether it’s a viral infection or bacterial infection or a drug that you are receiving — even how you are aging.”

    Turning data into better treatments

    Immunai has already partnered with some of the largest pharmaceutical companies in the world to help them identify promising treatments and set up their clinical trials for success. Immunai’s insights can help partners make critical decisions about treatment schedules, dosing, drug combinations, patient selection, and more.

    “Everyone is talking about AI, but I think the most exciting aspect of the platform we have built is the fact that it’s vertically integrated, from wet lab to computational modeling with multiple iterations,” Solomon says. “For example, we may do single-cell immune profiling of patient samples, then we upload that data to the cloud and our computational models come up with insights, and with those insights we do in vitro or in vivo validation to see if our models are right and iteratively improve them.”

    Ultimately Immunai wants to enable a future where lab experiments can more reliably turn into impactful new recommendations and treatments for patients.

    “Scientists can cure nearly every type of cancer, but only in mice,” Solomon says. “In preclinical models we know how to cure cancer. In human beings, in most cases, we still don’t. To overcome that, most scientists are looking for better ex vivo or in vivo models. Our approach is to be more agnostic as to the model system, but feed the machine with more and more data from multiple model systems. We’re demonstrating that our algorithms can repeatedly beat the top benchmarks in identifying the top preclinical immune features that match to patient outcomes.” More

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      Large language models help decipher clinical notes

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      Electronic health records (EHRs) need a new public relations manager. Ten years ago, the U.S. government passed a law that required hospitals to digitize their health records with the intent of improving and streamlining care. The enormous amount of information in these now-digital records could be used to answer very specific questions beyond the scope of clinical trials: What’s the right dose of this medication for patients with this height and weight? What about patients with a specific genomic profile?

      Unfortunately, most of the data that could answer these questions is trapped in doctor’s notes, full of jargon and abbreviations. These notes are hard for computers to understand using current techniques — extracting information requires training multiple machine learning models. Models trained for one hospital, also, don’t work well at others, and training each model requires domain experts to label lots of data, a time-consuming and expensive process. 

      An ideal system would use a single model that can extract many types of information, work well at multiple hospitals, and learn from a small amount of labeled data. But how? Researchers from MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) believed that to disentangle the data, they needed to call on something bigger: large language models. To pull that important medical information, they used a very big, GPT-3 style model to do tasks like expand overloaded jargon and acronyms and extract medication regimens. 

      For example, the system takes an input, which in this case is a clinical note, “prompts” the model with a question about the note, such as “expand this abbreviation, C-T-A.” The system returns an output such as “clear to auscultation,” as opposed to say, a CT angiography. The objective of extracting this clean data, the team says, is to eventually enable more personalized clinical recommendations. 

      Medical data is, understandably, a pretty tricky resource to navigate freely. There’s plenty of red tape around using public resources for testing the performance of large models because of data use restrictions, so the team decided to scrape together their own. Using a set of short, publicly available clinical snippets, they cobbled together a small dataset to enable evaluation of the extraction performance of large language models. 

      “It’s challenging to develop a single general-purpose clinical natural language processing system that will solve everyone’s needs and be robust to the huge variation seen across health datasets. As a result, until today, most clinical notes are not used in downstream analyses or for live decision support in electronic health records. These large language model approaches could potentially transform clinical natural language processing,” says David Sontag, MIT professor of electrical engineering and computer science, principal investigator in CSAIL and the Institute for Medical Engineering and Science, and supervising author on a paper about the work, which will be presented at the Conference on Empirical Methods in Natural Language Processing. “The research team’s advances in zero-shot clinical information extraction makes scaling possible. Even if you have hundreds of different use cases, no problem — you can build each model with a few minutes of work, versus having to label a ton of data for that particular task.”

      For example, without any labels at all, the researchers found these models could achieve 86 percent accuracy at expanding overloaded acronyms, and the team developed additional methods to boost this further to 90 percent accuracy, with still no labels required.

      Imprisoned in an EHR 

      Experts have been steadily building up large language models (LLMs) for quite some time, but they burst onto the mainstream with GPT-3’s widely covered ability to complete sentences. These LLMs are trained on a huge amount of text from the internet to finish sentences and predict the next most likely word. 

      While previous, smaller models like earlier GPT iterations or BERT have pulled off a good performance for extracting medical data, they still require substantial manual data-labeling effort. 

      For example, a note, “pt will dc vanco due to n/v” means that this patient (pt) was taking the antibiotic vancomycin (vanco) but experienced nausea and vomiting (n/v) severe enough for the care team to discontinue (dc) the medication. The team’s research avoids the status quo of training separate machine learning models for each task (extracting medication, side effects from the record, disambiguating common abbreviations, etc). In addition to expanding abbreviations, they investigated four other tasks, including if the models could parse clinical trials and extract detail-rich medication regimens.  

      “Prior work has shown that these models are sensitive to the prompt’s precise phrasing. Part of our technical contribution is a way to format the prompt so that the model gives you outputs in the correct format,” says Hunter Lang, CSAIL PhD student and author on the paper. “For these extraction problems, there are structured output spaces. The output space is not just a string. It can be a list. It can be a quote from the original input. So there’s more structure than just free text. Part of our research contribution is encouraging the model to give you an output with the correct structure. That significantly cuts down on post-processing time.”

      The approach can’t be applied to out-of-the-box health data at a hospital: that requires sending private patient information across the open internet to an LLM provider like OpenAI. The authors showed that it’s possible to work around this by distilling the model into a smaller one that could be used on-site.

      The model — sometimes just like humans — is not always beholden to the truth. Here’s what a potential problem might look like: Let’s say you’re asking the reason why someone took medication. Without proper guardrails and checks, the model might just output the most common reason for that medication, if nothing is explicitly mentioned in the note. This led to the team’s efforts to force the model to extract more quotes from data and less free text.

      Future work for the team includes extending to languages other than English, creating additional methods for quantifying uncertainty in the model, and pulling off similar results with open-sourced models. 

      “Clinical information buried in unstructured clinical notes has unique challenges compared to general domain text mostly due to large use of acronyms, and inconsistent textual patterns used across different health care facilities,” says Sadid Hasan, AI lead at Microsoft and former executive director of AI at CVS Health, who was not involved in the research. “To this end, this work sets forth an interesting paradigm of leveraging the power of general domain large language models for several important zero-/few-shot clinical NLP tasks. Specifically, the proposed guided prompt design of LLMs to generate more structured outputs could lead to further developing smaller deployable models by iteratively utilizing the model generated pseudo-labels.”

      “AI has accelerated in the last five years to the point at which these large models can predict contextualized recommendations with benefits rippling out across a variety of domains such as suggesting novel drug formulations, understanding unstructured text, code recommendations or create works of art inspired by any number of human artists or styles,” says Parminder Bhatia, who was formerly Head of Machine Learning at AWS Health AI and is currently Head of ML for low-code applications leveraging large language models at AWS AI Labs. “One of the applications of these large models [the team has] recently launched is Amazon CodeWhisperer, which is [an] ML-powered coding companion that helps developers in building applications.”

      As part of the MIT Abdul Latif Jameel Clinic for Machine Learning in Health, Agrawal, Sontag, and Lang wrote the paper alongside Yoon Kim, MIT assistant professor and CSAIL principal investigator, and Stefan Hegselmann, a visiting PhD student from the University of Muenster. First-author Agrawal’s research was supported by a Takeda Fellowship, the MIT Deshpande Center for Technological Innovation, and the MLA@CSAIL Initiatives. More

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      Neurodegenerative disease can progress in newly identified patterns

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      Neurodegenerative diseases — like amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), Alzheimer’s, and Parkinson’s — are complicated, chronic ailments that can present with a variety of symptoms, worsen at different rates, and have many underlying genetic and environmental causes, some of which are unknown. ALS, in particular, affects voluntary muscle movement and is always fatal, but while most people survive for only a few years after diagnosis, others live with the disease for decades. Manifestations of ALS can also vary significantly; often slower disease development correlates with onset in the limbs and affecting fine motor skills, while the more serious, bulbar ALS impacts swallowing, speaking, breathing, and mobility. Therefore, understanding the progression of diseases like ALS is critical to enrollment in clinical trials, analysis of potential interventions, and discovery of root causes.

      However, assessing disease evolution is far from straightforward. Current clinical studies typically assume that health declines on a downward linear trajectory on a symptom rating scale, and use these linear models to evaluate whether drugs are slowing disease progression. However, data indicate that ALS often follows nonlinear trajectories, with periods where symptoms are stable alternating with periods when they are rapidly changing. Since data can be sparse, and health assessments often rely on subjective rating metrics measured at uneven time intervals, comparisons across patient populations are difficult. These heterogenous data and progression, in turn, complicate analyses of invention effectiveness and potentially mask disease origin.

      Now, a new machine-learning method developed by researchers from MIT, IBM Research, and elsewhere aims to better characterize ALS disease progression patterns to inform clinical trial design.

      “There are groups of individuals that share progression patterns. For example, some seem to have really fast-progressing ALS and others that have slow-progressing ALS that varies over time,” says Divya Ramamoorthy PhD ’22, a research specialist at MIT and lead author of a new paper on the work that was published this month in Nature Computational Science. “The question we were asking is: can we use machine learning to identify if, and to what extent, those types of consistent patterns across individuals exist?”

      Their technique, indeed, identified discrete and robust clinical patterns in ALS progression, many of which are non-linear. Further, these disease progression subtypes were consistent across patient populations and disease metrics. The team additionally found that their method can be applied to Alzheimer’s and Parkinson’s diseases as well.

      Joining Ramamoorthy on the paper are MIT-IBM Watson AI Lab members Ernest Fraenkel, a professor in the MIT Department of Biological Engineering; Research Scientist Soumya Ghosh of IBM Research; and Principal Research Scientist Kenney Ng, also of IBM Research. Additional authors include Kristen Severson PhD ’18, a senior researcher at Microsoft Research and former member of the Watson Lab and of IBM Research; Karen Sachs PhD ’06 of Next Generation Analytics; a team of researchers with Answer ALS; Jonathan D. Glass and Christina N. Fournier of the Emory University School of Medicine; the Pooled Resource Open-Access ALS Clinical Trials Consortium; ALS/MND Natural History Consortium; Todd M. Herrington of Massachusetts General Hospital (MGH) and Harvard Medical School; and James D. Berry of MGH.

      Play video

      MIT Professor Ernest Fraenkel describes early stages of his research looking at root causes of amyotrophic lateral sclerosis (ALS).

      Reshaping health decline

      After consulting with clinicians, the team of machine learning researchers and neurologists let the data speak for itself. They designed an unsupervised machine-learning model that employed two methods: Gaussian process regression and Dirichlet process clustering. These inferred the health trajectories directly from patient data and automatically grouped similar trajectories together without prescribing the number of clusters or the shape of the curves, forming ALS progression “subtypes.” Their method incorporated prior clinical knowledge in the way of a bias for negative trajectories — consistent with expectations for neurodegenerative disease progressions — but did not assume any linearity. “We know that linearity is not reflective of what’s actually observed,” says Ng. “The methods and models that we use here were more flexible, in the sense that, they capture what was seen in the data,” without the need for expensive labeled data and prescription of parameters.

      Primarily, they applied the model to five longitudinal datasets from ALS clinical trials and observational studies. These used the gold standard to measure symptom development: the ALS functional rating scale revised (ALSFRS-R), which captures a global picture of patient neurological impairment but can be a bit of a “messy metric.” Additionally, performance on survivability probabilities, forced vital capacity (a measurement of respiratory function), and subscores of ALSFRS-R, which looks at individual bodily functions, were incorporated.

      New regimes of progression and utility

      When their population-level model was trained and tested on these metrics, four dominant patterns of disease popped out of the many trajectories — sigmoidal fast progression, stable slow progression, unstable slow progression, and unstable moderate progression — many with strong nonlinear characteristics. Notably, it captured trajectories where patients experienced a sudden loss of ability, called a functional cliff, which would significantly impact treatments, enrollment in clinical trials, and quality of life.

      The researchers compared their method against other commonly used linear and nonlinear approaches in the field to separate the contribution of clustering and linearity to the model’s accuracy. The new work outperformed them, even patient-specific models, and found that subtype patterns were consistent across measures. Impressively, when data were withheld, the model was able to interpolate missing values, and, critically, could forecast future health measures. The model could also be trained on one ALSFRS-R dataset and predict cluster membership in others, making it robust, generalizable, and accurate with scarce data. So long as 6-12 months of data were available, health trajectories could be inferred with higher confidence than conventional methods.

      The researchers’ approach also provided insights into Alzheimer’s and Parkinson’s diseases, both of which can have a range of symptom presentations and progression. For Alzheimer’s, the new technique could identify distinct disease patterns, in particular variations in the rates of conversion of mild to severe disease. The Parkinson’s analysis demonstrated a relationship between progression trajectories for off-medication scores and disease phenotypes, such as the tremor-dominant or postural instability/gait difficulty forms of Parkinson’s disease.

      The work makes significant strides to find the signal amongst the noise in the time-series of complex neurodegenerative disease. “The patterns that we see are reproducible across studies, which I don’t believe had been shown before, and that may have implications for how we subtype the [ALS] disease,” says Fraenkel. As the FDA has been considering the impact of non-linearity in clinical trial designs, the team notes that their work is particularly pertinent.

      As new ways to understand disease mechanisms come online, this model provides another tool to pick apart illnesses like ALS, Alzheimer’s, and Parkinson’s from a systems biology perspective.

      “We have a lot of molecular data from the same patients, and so our long-term goal is to see whether there are subtypes of the disease,” says Fraenkel, whose lab looks at cellular changes to understand the etiology of diseases and possible targets for cures. “One approach is to start with the symptoms … and see if people with different patterns of disease progression are also different at the molecular level. That might lead you to a therapy. Then there’s the bottom-up approach, where you start with the molecules” and try to reconstruct biological pathways that might be affected. “We’re going [to be tackling this] from both ends … and finding if something meets in the middle.”

      This research was supported, in part, by the MIT-IBM Watson AI Lab, the Muscular Dystrophy Association, Department of Veterans Affairs of Research and Development, the Department of Defense, NSF Gradate Research Fellowship Program, Siebel Scholars Fellowship, Answer ALS, the United States Army Medical Research Acquisition Activity, National Institutes of Health, and the NIH/NINDS. More

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      In-home wireless device tracks disease progression in Parkinson’s patients

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      Parkinson’s disease is the fastest-growing neurological disease, now affecting more than 10 million people worldwide, yet clinicians still face huge challenges in tracking its severity and progression.

      Clinicians typically evaluate patients by testing their motor skills and cognitive functions during clinic visits. These semisubjective measurements are often skewed by outside factors — perhaps a patient is tired after a long drive to the hospital. More than 40 percent of individuals with Parkinson’s are never treated by a neurologist or Parkinson’s specialist, often because they live too far from an urban center or have difficulty traveling.

      In an effort to address these problems, researchers from MIT and elsewhere demonstrated an in-home device that can monitor a patient’s movement and gait speed, which can be used to evaluate Parkinson’s severity, the progression of the disease, and the patient’s response to medication.

      The device, which is about the size of a Wi-Fi router, gathers data passively using radio signals that reflect off the patient’s body as they move around their home. The patient does not need to wear a gadget or change their behavior. (A recent study, for example, showed that this type of device could be used to detect Parkinson’s from a person’s breathing patterns while sleeping.)

      The researchers used these devices to conduct a one-year at-home study with 50 participants. They showed that, by using machine-learning algorithms to analyze the troves of data they passively gathered (more than 200,000 gait speed measurements), a clinician could track Parkinson’s progression and medication response more effectively than they would with periodic, in-clinic evaluations.

      “By being able to have a device in the home that can monitor a patient and tell the doctor remotely about the progression of the disease, and the patient’s medication response so they can attend to the patient even if the patient can’t come to the clinic — now they have real, reliable information — that actually goes a long way toward improving equity and access,” says senior author Dina Katabi, the Thuan and Nicole Pham Professor in the Department of Electrical Engineering and Computer Science (EECS), and a principle investigator in the Computer Science and Artificial Intelligence Laboratory (CSAIL) and the MIT Jameel Clinic.

      The co-lead authors are EECS graduate students Yingcheng Liu and Guo Zhang. The research is published today in Science Translational Medicine.

      A human radar

      This work utilizes a wireless device previously developed in the Katabi lab that analyzes radio signals that bounce off people’s bodies. It transmits signals that use a tiny fraction of the power of a Wi-Fi router — these super-low-power signals don’t interfere with other wireless devices in the home. While radio signals pass through walls and other solid objects, they are reflected off humans due to the water in our bodies.  

      This creates a “human radar” that can track the movement of a person in a room. Radio waves always travel at the same speed, so the length of time it takes the signals to reflect back to the device indicates how the person is moving.

      The device incorporates a machine-learning classifier that can pick out the precise radio signals reflected off the patient even when there are other people moving around the room. Advanced algorithms use these movement data to compute gait speed — how fast the person is walking.

      Because the device operates in the background and runs all day, every day, it can collect a massive amount of data. The researchers wanted to see if they could apply machine learning to these datasets to gain insights about the disease over time.

      They gathered 50 participants, 34 of whom had Parkinson’s, and conducted a one-year study of in-home gait measurements Through the study, the researchers collected more than 200,000 individual measurements that they averaged to smooth out variability due to the conditions irrelevant to the disease. (For example, a patient may hurry up to answer an alarm or walk slower when talking on the phone.)

      They used statistical methods to analyze the data and found that in-home gait speed can be used to effectively track Parkinson’s progression and severity. For instance, they showed that gait speed declined almost twice as fast for individuals with Parkinson’s, compared to those without. 

      “Monitoring the patient continuously as they move around the room enabled us to get really good measurements of their gait speed. And with so much data, we were able to perform aggregation that allowed us to see very small differences,” Zhang says.

      Better, faster results

      Drilling down on these variabilities offered some key insights. For instance, the researchers showed that daily fluctuations in a patient’s walking speed correspond with how they are responding to their medication — walking speed may improve after a dose and then begin to decline after a few hours, as the medication impact wears off.

      “This enables us to objectively measure how your mobility responds to your medication. Previously, this was very cumbersome to do because this medication effect could only be measured by having the patient keep a journal,” Liu says.

      A clinician could use these data to adjust medication dosage more effectively and accurately. This is especially important since drugs used to treat disease symptoms can cause serious side effects if the patient receives too much.

      The researchers were able to demonstrate statistically significant results regarding Parkinson’s progression after studying 50 people for just one year. By contrast, an often-cited study by the Michael J. Fox Foundation involved more than 500 individuals and monitored them for more than five years, Katabi says.

      “For a pharmaceutical company or a biotech company trying to develop medicines for this disease, this could greatly reduce the burden and cost and speed up the development of new therapies,” she adds.

      Katabi credits much of the study’s success to the dedicated team of scientists and clinicians who worked together to tackle the many difficulties that arose along the way. For one, they began the study before the Covid-19 pandemic, so team members initially visited people’s homes to set up the devices. When that was no longer possible, they developed a user-friendly phone app to remotely help participants as they deployed the device at home.

      Through the course of the study, they learned to automate processes and reduce effort, especially for the participants and clinical team.

      This knowledge will prove useful as they look to deploy devices in at-home studies of other neurological disorders, such as Alzheimer’s, ALS, and Huntington’s. They also want to explore how these methods could be used, in conjunction with other work from the Katabi lab showing that Parkinson’s can be diagnosed by monitoring breathing, to collect a holistic set of markers that could diagnose the disease early and then be used to track and treat it.

      “This radio-wave sensor can enable more care (and research) to migrate from hospitals to the home where it is most desired and needed,” says Ray Dorsey, a professor of neurology at the University of Rochester Medical Center, co-author of Ending Parkinson’s, and a co-author of this research paper. “Its potential is just beginning to be seen. We are moving toward a day where we can diagnose and predict disease at home. In the future, we may even be able to predict and ideally prevent events like falls and heart attacks.”

      This work is supported, in part, by the National Institutes of Health and the Michael J. Fox Foundation. More

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      An “oracle” for predicting the evolution of gene regulation

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      Despite the sheer number of genes that each human cell contains, these so-called “coding” DNA sequences comprise just 1 percent of our entire genome. The remaining 99 percent is made up of “non-coding” DNA — which, unlike coding DNA, does not carry the instructions to build proteins.

      One vital function of this non-coding DNA, also called “regulatory” DNA, is to help turn genes on and off, controlling how much (if any) of a protein is made. Over time, as cells replicate their DNA to grow and divide, mutations often crop up in these non-coding regions — sometimes tweaking their function and changing the way they control gene expression. Many of these mutations are trivial, and some are even beneficial. Occasionally, though, they can be associated with increased risk of common diseases, such as Type 2 diabetes, or more life-threatening ones, including cancer.

      To better understand the repercussions of such mutations, researchers have been hard at work on mathematical maps that allow them to look at an organism’s genome, predict which genes will be expressed, and determine how that expression will affect the organism’s observable traits. These maps, called fitness landscapes, were conceptualized roughly a century ago to understand how genetic makeup influences one common measure of organismal fitness in particular: reproductive success. Early fitness landscapes were very simple, often focusing on a limited number of mutations. Much richer datasets are now available, but researchers still require additional tools to characterize and visualize such complex data. This ability would not only facilitate a better understanding of how individual genes have evolved over time, but would also help to predict what sequence and expression changes might occur in the future.

      In a new study published on March 9 in Nature, a team of scientists has developed a framework for studying the fitness landscapes of regulatory DNA. They created a neural network model that, when trained on hundreds of millions of experimental measurements, was capable of predicting how changes to these non-coding sequences in yeast affected gene expression. They also devised a unique way of representing the landscapes in two dimensions, making it easy to understand the past and forecast the future evolution of non-coding sequences in organisms beyond yeast — and even design custom gene expression patterns for gene therapies and industrial applications.

      “We now have an ‘oracle’ that can be queried to ask: What if we tried all possible mutations of this sequence? Or, what new sequence should we design to give us a desired expression?” says Aviv Regev, a professor of biology at MIT (on leave), core member of the Broad Institute of Harvard and MIT (on leave), head of Genentech Research and Early Development, and the study’s senior author. “Scientists can now use the model for their own evolutionary question or scenario, and for other problems like making sequences that control gene expression in desired ways. I am also excited about the possibilities for machine learning researchers interested in interpretability; they can ask their questions in reverse, to better understand the underlying biology.”

      Prior to this study, many researchers had simply trained their models on known mutations (or slight variations thereof) that exist in nature. However, Regev’s team wanted to go a step further by creating their own unbiased models capable of predicting an organism’s fitness and gene expression based on any possible DNA sequence — even sequences they’d never seen before. This would also enable researchers to use such models to engineer cells for pharmaceutical purposes, including new treatments for cancer and autoimmune disorders.

      To accomplish this goal, Eeshit Dhaval Vaishnav, a graduate student at MIT and co-first author; Carl de Boer, now an assistant professor at the University of British Columbia; and their colleagues created a neural network model to predict gene expression. They trained it on a dataset generated by inserting millions of totally random non-coding DNA sequences into yeast, and observing how each random sequence affected gene expression. They focused on a particular subset of non-coding DNA sequences called promoters, which serve as binding sites for proteins that can switch nearby genes on or off.

      “This work highlights what possibilities open up when we design new kinds of experiments to generate the right data to train models,” Regev says. “In the broader sense, I believe these kinds of approaches will be important for many problems — like understanding genetic variants in regulatory regions that confer disease risk in the human genome, but also for predicting the impact of combinations of mutations, or designing new molecules.”

      Regev, Vaishnav, de Boer, and their coauthors went on to test their model’s predictive abilities in a variety of ways, in order to show how it could help demystify the evolutionary past — and possible future — of certain promoters. “Creating an accurate model was certainly an accomplishment, but, to me, it was really just a starting point,” Vaishnav explains.

      First, to determine whether their model could help with synthetic biology applications like producing antibiotics, enzymes, and food, the researchers practiced using it to design promoters that could generate desired expression levels for any gene of interest. They then scoured other scientific papers to identify fundamental evolutionary questions, in order to see if their model could help answer them. The team even went so far as to feed their model a real-world population dataset from one existing study, which contained genetic information from yeast strains around the world. In doing so, they were able to delineate thousands of years of past selection pressures that sculpted the genomes of today’s yeast.

      But, in order to create a powerful tool that could probe any genome, the researchers knew they’d need to find a way to forecast the evolution of non-coding sequences even without such a comprehensive population dataset. To address this goal, Vaishnav and his colleagues devised a computational technique that allowed them to plot the predictions from their framework onto a two-dimensional graph. This helped them show, in a remarkably simple manner, how any non-coding DNA sequence would affect gene expression and fitness, without needing to conduct any time-consuming experiments at the lab bench.

      “One of the unsolved problems in fitness landscapes was that we didn’t have an approach for visualizing them in a way that meaningfully captured the evolutionary properties of sequences,” Vaishnav explains. “I really wanted to find a way to fill that gap, and contribute to the long-standing vision of creating a complete fitness landscape.”

      Martin Taylor, a professor of genetics at the University of Edinburgh’s Medical Research Council Human Genetics Unit who was not involved in the research, says the study shows that artificial intelligence can not only predict the effect of regulatory DNA changes, but also reveal the underlying principles that govern millions of years of evolution.

      Despite the fact that the model was trained on just a fraction of yeast regulatory DNA in a few growth conditions, he’s impressed that it’s capable of making such useful predictions about the evolution of gene regulation in mammals.

      “There are obvious near-term applications, such as the custom design of regulatory DNA for yeast in brewing, baking, and biotechnology,” he explains. “But extensions of this work could also help identify disease mutations in human regulatory DNA that are currently difficult to find and largely overlooked in the clinic. This work suggests there is a bright future for AI models of gene regulation trained on richer, more complex, and more diverse datasets.”

      Even before the study was formally published, Vaishnav began receiving queries from other researchers hoping to use the model to devise non-coding DNA sequences for use in gene therapies.

      “People have been studying regulatory evolution and fitness landscapes for decades now,” Vaishnav says. “I think our framework will go a long way in answering fundamental, open questions about the evolution and evolvability of gene regulatory DNA — and even help us design biological sequences for exciting new applications.” More

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      Deep-learning technique predicts clinical treatment outcomes

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      When it comes to treatment strategies for critically ill patients, clinicians want to be able to consider all their options and timing of administration, and make the optimal decision for their patients. While clinician experience and study has helped them to be successful in this effort, not all patients are the same, and treatment decisions at this crucial time could mean the difference between patient improvement and quick deterioration. Therefore, it would be helpful for doctors to be able to take a patient’s previous known health status and received treatments and use that to predict that patient’s health outcome under different treatment scenarios, in order to pick the best path.

      Now, a deep-learning technique, called G-Net, from researchers at MIT and IBM provides a window into causal counterfactual prediction, affording physicians the opportunity to explore how a patient might fare under different treatment plans. The foundation of G-Net is the g-computation algorithm, a causal inference method that estimates the effect of dynamic exposures in the presence of measured confounding variables — ones that may influence both treatments and outcomes. Unlike previous implementations of the g-computation framework, which have used linear modeling approaches, G-Net uses recurrent neural networks (RNN), which have node connections that allow them to better model temporal sequences with complex and nonlinear dynamics, like those found in the physiological and clinical time series data. In this way, physicians can develop alternative plans based on patient history and test them before making a decision.

      “Our ultimate goal is to develop a machine learning technique that would allow doctors to explore various ‘What if’ scenarios and treatment options,” says Li-wei Lehman, MIT research scientist in the MIT Institute for Medical Engineering and Science and an MIT-IBM Watson AI Lab project lead. “A lot of work has been done in terms of deep learning for counterfactual prediction but [it’s] been focusing on a point exposure setting,” or a static, time-varying treatment strategy, which doesn’t allow for adjustment of treatments as patient history changes. However, her team’s new prediction approach provides for treatment plan flexibility and chances for treatment alteration over time as patient covariate history and past treatments change. “G-Net is the first deep-learning approach based on g-computation that can predict both the population-level and individual-level treatment effects under dynamic and time varying treatment strategies.”

      The research, which was recently published in the Proceedings of Machine Learning Research, was co-authored by Rui Li MEng ’20, Stephanie Hu MEng ’21, former MIT postdoc Mingyu Lu MD, graduate student Yuria Utsumi, IBM research staff member Prithwish Chakraborty, IBM Research director of Hybrid Cloud Services Daby Sow, IBM data scientist Piyush Madan, IBM research scientist Mohamed Ghalwash, and IBM research scientist Zach Shahn.

      Tracking disease progression

      To build, validate, and test G-Net’s predictive abilities, the researchers considered the circulatory system in septic patients in the ICU. During critical care, doctors need to make trade-offs and judgement calls, such as ensuring the organs are receiving adequate blood supply without overworking the heart. For this, they could give intravenous fluids to patients to increase blood pressure; however, too much can cause edema. Alternatively, physicians can administer vasopressors, which act to contract blood vessels and raise blood pressure.

      In order to mimic this and demonstrate G-Net’s proof-of-concept, the team used CVSim, a mechanistic model of a human cardiovascular system that’s governed by 28 input variables characterizing the system’s current state, such as arterial pressure, central venous pressure, total blood volume, and total peripheral resistance, and modified it to simulate various disease processes (e.g., sepsis or blood loss) and effects of interventions (e.g., fluids and vasopressors). The researchers used CVSim to generate observational patient data for training and for “ground truth” comparison against counterfactual prediction. In their G-Net architecture, the researchers ran two RNNs to handle and predict variables that are continuous, meaning they can take on a range of values, like blood pressure, and categorical variables, which have discrete values, like the presence or absence of pulmonary edema. The researchers simulated the health trajectories of thousands of “patients” exhibiting symptoms under one treatment regime, let’s say A, for 66 timesteps, and used them to train and validate their model.

      Testing G-Net’s prediction capability, the team generated two counterfactual datasets. Each contained roughly 1,000 known patient health trajectories, which were created from CVSim using the same “patient” condition as the starting point under treatment A. Then at timestep 33, treatment changed to plan B or C, depending on the dataset. The team then performed 100 prediction trajectories for each of these 1,000 patients, whose treatment and medical history was known up until timestep 33 when a new treatment was administered. In these cases, the prediction agreed well with the “ground-truth” observations for individual patients and averaged population-level trajectories.

      A cut above the rest

      Since the g-computation framework is flexible, the researchers wanted to examine G-Net’s prediction using different nonlinear models — in this case, long short-term memory (LSTM) models, which are a type of RNN that can learn from previous data patterns or sequences — against the more classical linear models and a multilayer perception model (MLP), a type of neural network that can make predictions using a nonlinear approach. Following a similar setup as before, the team found that the error between the known and predicted cases was smallest in the LSTM models compared to the others. Since G-Net is able to model the temporal patterns of the patient’s ICU history and past treatment, whereas a linear model and MLP cannot, it was better able to predict the patient’s outcome.

      The team also compared G-Net’s prediction in a static, time-varying treatment setting against two state-of-the-art deep-learning based counterfactual prediction approaches, a recurrent marginal structural network (rMSN) and a counterfactual recurrent neural network (CRN), as well as a linear model and an MLP. For this, they investigated a model for tumor growth under no treatment, radiation, chemotherapy, and both radiation and chemotherapy scenarios. “Imagine a scenario where there’s a patient with cancer, and an example of a static regime would be if you only give a fixed dosage of chemotherapy, radiation, or any kind of drug, and wait until the end of your trajectory,” comments Lu. For these investigations, the researchers generated simulated observational data using tumor volume as the primary influence dictating treatment plans and demonstrated that G-Net outperformed the other models. One potential reason could be because g-computation is known to be more statistically efficient than rMSN and CRN, when models are correctly specified.

      While G-Net has done well with simulated data, more needs to be done before it can be applied to real patients. Since neural networks can be thought of as “black boxes” for prediction results, the researchers are beginning to investigate the uncertainty in the model to help ensure safety. In contrast to these approaches that recommend an “optimal” treatment plan without any clinician involvement, “as a decision support tool, I believe that G-Net would be more interpretable, since the clinicians would input treatment strategies themselves,” says Lehman, and “G-Net will allow them to be able to explore different hypotheses.” Further, the team has moved on to using real data from ICU patients with sepsis, bringing it one step closer to implementation in hospitals.

      “I think it is pretty important and exciting for real-world applications,” says Hu. “It’d be helpful to have some way to predict whether or not a treatment might work or what the effects might be — a quicker iteration process for developing these hypotheses for what to try, before actually trying to implement them in in a years-long, potentially very involved and very invasive type of clinical trial.”

      This research was funded by the MIT-IBM Watson AI Lab. More

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      Probing how proteins pair up inside cells

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      Despite its minute size, a single cell contains billions of molecules that bustle around and bind to one another, carrying out vital functions. The human genome encodes about 20,000 proteins, most of which interact with partner proteins to mediate upwards of 400,000 distinct interactions. These partners don’t just latch onto one another haphazardly; they only bind to very specific companions that they must recognize inside the crowded cell. If they create the wrong pairings — or even the right pairings at the wrong place or wrong time — cancer or other diseases can ensue. Scientists are hard at work investigating these protein-protein relationships, in order to understand how they work, and potentially create drugs that disrupt or mimic them to treat disease.

      The average human protein is composed of approximately 400 building blocks called amino acids, which are strung together and folded into a complex 3D structure. Within this long string of building blocks, some proteins contain stretches of four to six amino acids called short linear motifs (SLiMs), which mediate protein-protein interactions. Despite their simplicity and small size, SLiMs and their binding partners facilitate key cellular processes. However, it’s been historically difficult to devise experiments to probe how SLiMs recognize their specific binding partners.

      To address this problem, a group led by Theresa Hwang PhD ’21 designed a screening method to understand how SLiMs selectively bind to certain proteins, and even distinguish between those with similar structures. Using the detailed information they gleaned from studying these interactions, the researchers created their own synthetic molecule capable of binding extremely tightly to a protein called ENAH, which is implicated in cancer metastasis. The team shared their findings in a pair of eLife studies, one published on Dec. 2, 2021, and the other published Jan. 25.

      “The ability to test hundreds of thousands of potential SLiMs for binding provides a powerful tool to explore why proteins prefer specific SLiM partners over others,” says Amy Keating, professor of biology and biological engineering and the senior author on both studies. “As we gain an understanding of the tricks that a protein uses to select its partners, we can apply these in protein design to make our own binders to modulate protein function for research or therapeutic purposes.”

      Most existing screens for SLiMs simply select for short, tight binders, while neglecting SLiMs that don’t grip their partner proteins quite as strongly. To survey SLiMs with a wide range of binding affinities, Keating, Hwang, and their colleagues developed their own screen called MassTitr.

      The researchers also suspected that the amino acids on either side of the SLiM’s core four-to-six amino acid sequence might play an underappreciated role in binding. To test their theory, they used MassTitr to screen the human proteome in longer chunks comprised of 36 amino acids, in order to see which “extended” SLiMs would associate with the protein ENAH.

      ENAH, sometimes referred to as Mena, helps cells to move. This ability to migrate is critical for healthy cells, but cancer cells can co-opt it to spread. Scientists have found that reducing the amount of ENAH decreases the cancer cell’s ability to invade other tissues — suggesting that formulating drugs to disrupt this protein and its interactions could treat cancer.

      Thanks to MassTitr, the team identified 33 SLiM-containing proteins that bound to ENAH — 19 of which are potentially novel binding partners. They also discovered three distinct patterns of amino acids flanking core SLiM sequences that helped the SLiMs bind even tighter to ENAH. Of these extended SLiMs, one found in a protein called PCARE bound to ENAH with the highest known affinity of any SLiM to date.

      Next, the researchers combined a computer program called dTERMen with X-ray crystallography in order understand how and why PCARE binds to ENAH over ENAH’s two nearly identical sister proteins (VASP and EVL). Hwang and her colleagues saw that the amino acids flanking PCARE’s core SliM caused ENAH to change shape slightly when the two made contact, allowing the binding sites to latch onto one another. VASP and EVL, by contrast, could not undergo this structural change, so the PCARE SliM did not bind to either of them as tightly.

      Inspired by this unique interaction, Hwang designed her own protein that bound to ENAH with unprecedented affinity and specificity. “It was exciting that we were able to come up with such a specific binder,” she says. “This work lays the foundation for designing synthetic molecules with the potential to disrupt protein-protein interactions that cause disease — or to help scientists learn more about ENAH and other SLiM-binding proteins.”  

      Ylva Ivarsson, a professor of biochemistry at Uppsala University who was not involved with the study, says that understanding how proteins find their binding partners is a question of fundamental importance to cell function and regulation. The two eLife studies, she explains, show that extended SLiMs play an underappreciated role in determining the affinity and specificity of these binding interactions.

      “The studies shed light on the idea that context matters, and provide a screening strategy for a variety of context-dependent binding interactions,” she says. “Hwang and co-authors have created valuable tools for dissecting the cellular function of proteins and their binding partners. Their approach could even inspire ENAH-specific inhibitors for therapeutic purposes.”

      Hwang’s biggest takeaway from the project is that things are not always as they seem: even short, simple protein segments can play complex roles in the cell. As she puts it: “We should really appreciate SLiMs more.” More

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      The promise and pitfalls of artificial intelligence explored at TEDxMIT event

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      Scientists, students, and community members came together last month to discuss the promise and pitfalls of artificial intelligence at MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) for the fourth TEDxMIT event held at MIT. 

      Attendees were entertained and challenged as they explored “the good and bad of computing,” explained CSAIL Director Professor Daniela Rus, who organized the event with John Werner, an MIT fellow and managing director of Link Ventures; MIT sophomore Lucy Zhao; and grad student Jessica Karaguesian. “As you listen to the talks today,” Rus told the audience, “consider how our world is made better by AI, and also our intrinsic responsibilities for ensuring that the technology is deployed for the greater good.”

      Rus mentioned some new capabilities that could be enabled by AI: an automated personal assistant that could monitor your sleep phases and wake you at the optimal time, as well as on-body sensors that monitor everything from your posture to your digestive system. “Intelligent assistance can help empower and augment our lives. But these intriguing possibilities should only be pursued if we can simultaneously resolve the challenges that these technologies bring,” said Rus. 

      The next speaker, CSAIL principal investigator and professor of electrical engineering and computer science Manolis Kellis, started off by suggesting what sounded like an unattainable goal — using AI to “put an end to evolution as we know it.” Looking at it from a computer science perspective, he said, what we call evolution is basically a brute force search. “You’re just exploring all of the search space, creating billions of copies of every one of your programs, and just letting them fight against each other. This is just brutal. And it’s also completely slow. It took us billions of years to get here.” Might it be possible, he asked, to speed up evolution and make it less messy?

      The answer, Kellis said, is that we can do better, and that we’re already doing better: “We’re not killing people like Sparta used to, throwing the weaklings off the mountain. We are truly saving diversity.”

      Knowledge, moreover, is now being widely shared, passed on “horizontally” through accessible information sources, he noted, rather than “vertically,” from parent to offspring. “I would like to argue that competition in the human species has been replaced by collaboration. Despite having a fixed cognitive hardware, we have software upgrades that are enabled by culture, by the 20 years that our children spend in school to fill their brains with everything that humanity has learned, regardless of which family came up with it. This is the secret of our great acceleration” — the fact that human advancement in recent centuries has vastly out-clipped evolution’s sluggish pace.

      The next step, Kellis said, is to harness insights about evolution in order to combat an individual’s genetic susceptibility to disease. “Our current approach is simply insufficient,” he added. “We’re treating manifestations of disease, not the causes of disease.” A key element in his lab’s ambitious strategy to transform medicine is to identify “the causal pathways through which genetic predisposition manifests. It’s only by understanding these pathways that we can truly manipulate disease causation and reverse the disease circuitry.” 

      Kellis was followed by Aleksander Madry, MIT professor of electrical engineering and computer science and CSAIL principal investigator, who told the crowd, “progress in AI is happening, and it’s happening fast.” Computer programs can routinely beat humans in games like chess, poker, and Go. So should we be worried about AI surpassing humans? 

      Madry, for one, is not afraid — or at least not yet. And some of that reassurance stems from research that has led him to the following conclusion: Despite its considerable success, AI, especially in the form of machine learning, is lazy. “Think about being lazy as this kind of smart student who doesn’t really want to study for an exam. Instead, what he does is just study all the past years’ exams and just look for patterns. Instead of trying to actually learn, he just tries to pass the test. And this is exactly the same way in which current AI is lazy.”

      A machine-learning model might recognize grazing sheep, for instance, simply by picking out pictures that have green grass in them. If a model is trained to identify fish from photos of anglers proudly displaying their catches, Madry explained, “the model figures out that if there’s a human holding something in the picture, I will just classify it as a fish.” The consequences can be more serious for an AI model intended to pick out malignant tumors. If the model is trained on images containing rulers that indicate the size of tumors, the model may end up selecting only those photos that have rulers in them.

      This leads to Madry’s biggest concerns about AI in its present form. “AI is beating us now,” he noted. “But the way it does it [involves] a little bit of cheating.” He fears that we will apply AI “in some way in which this mismatch between what the model actually does versus what we think it does will have some catastrophic consequences.” People relying on AI, especially in potentially life-or-death situations, need to be much more mindful of its current limitations, Madry cautioned.

      There were 10 speakers altogether, and the last to take the stage was MIT associate professor of electrical engineering and computer science and CSAIL principal investigator Marzyeh Ghassemi, who laid out her vision for how AI could best contribute to general health and well-being. But in order for that to happen, its models must be trained on accurate, diverse, and unbiased medical data.

      It’s important to focus on the data, Ghassemi stressed, because these models are learning from us. “Since our data is human-generated … a neural network is learning how to practice from a doctor. But doctors are human, and humans make mistakes. And if a human makes a mistake, and we train an AI from that, the AI will, too. Garbage in, garbage out. But it’s not like the garbage is distributed equally.”

      She pointed out that many subgroups receive worse care from medical practitioners, and members of these subgroups die from certain conditions at disproportionately high rates. This is an area, Ghassemi said, “where AI can actually help. This is something we can fix.” Her group is developing machine-learning models that are robust, private, and fair. What’s holding them back is neither algorithms nor GPUs. It’s data. Once we collect reliable data from diverse sources, Ghassemi added, we might start reaping the benefits that AI can bring to the realm of health care.

      In addition to CSAIL speakers, there were talks from members across MIT’s Institute for Data, Systems, and Society; the MIT Mobility Initiative; the MIT Media Lab; and the SENSEable City Lab.

      The proceedings concluded on that hopeful note. Rus and Werner then thanked everyone for coming. “Please continue to reflect about the good and bad of computing,” Rus urged. “And we look forward to seeing you back here in May for the next TEDxMIT event.”

      The exact theme of the spring 2022 gathering will have something to do with “superpowers.” But — if December’s mind-bending presentations were any indication — the May offering is almost certain to give its attendees plenty to think about. And maybe provide the inspiration for a startup or two. More