Dissecting inflammatory complications in critically injured patients by within-patient gene expression changes: a longitudinal clinical genomics study.

BACKGROUND: Trauma is the number one killer of individuals 1-44 y of age in the United States. The prognosis and treatment of inflammatory complications in critically injured patients continue to be challenging, with a history of failed clinical trials and poorly understood biology. New approaches are therefore needed to improve our ability to diagnose and treat this clinical condition. METHODS AND FINDINGS: We conducted a large-scale study on 168 blunt-force trauma patients over 28 d, measuring ∼400 clinical variables and longitudinally profiling leukocyte gene expression with ∼800 microarrays. Marshall MOF (multiple organ failure) clinical score trajectories were first utilized to organize the patients into five categories of increasingly poor outcomes. We then developed an analysis framework modeling early within-patient expression changes to produce a robust characterization of the genomic response to trauma. A quarter of the genome shows early expression changes associated with longer-term post-injury complications, captured by at least five dynamic co-expression modules of functionally related genes. In particular, early down-regulation of MHC-class II genes and up-regulation of p38 MAPK signaling pathway were found to strongly associate with longer-term post-injury complications, providing discrimination among patient outcomes from expression changes during the 40-80 h window post-injury. CONCLUSIONS: The genomic characterization provided here substantially expands the scope by which the molecular response to trauma may be characterized and understood. These results may be instrumental in furthering our understanding of the disease process and identifying potential targets for therapeutic intervention. Additionally, the quantitative approach we have introduced is potentially applicable to future genomics studies of rapidly progressing clinical conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT00257231

Cross-Dimensional Inference of Dependent High-Dimensional Data.

A growing number of modern scientific problems in areas such as genomics, neurobiology, and spatial epidemiology involve the measurement and analysis of thousands of related features that may be stochastically dependent at arbitrarily strong levels. In this work, we consider the scenario where the features follow a multivariate Normal distribution. We demonstrate that dependence is manifested as random variation shared among features, and that standard methods may yield highly unstable inference due to dependence, even when the dependence is fully parameterized and utilized in the procedure. We propose a "cross-dimensional inference" framework that alleviates the problems due to dependence by modeling and removing the variation shared among features, while also properly regularizing estimation across features. We demonstrate the framework on both simultaneous point estimation and multiple hypothesis testing in scenarios derived from the scientific applications of interest.