Using Markov chains and temporal alignment to identify clinical patterns in Dementia.

In the healthcare sector, resorting to big data and advanced analytics is a great advantage when dealing with complex groups of patients in terms of comorbidities, representing a significant step towards personalized targeting. In this work, we focus on understanding key features and clinical pathways of patients with multimorbidity suffering from Dementia. This disease can result from many heterogeneous factors, potentially becoming more prevalent as the population ages. We present a set of methods that allow us to identify medical appointment patterns within a cohort of 1924 patients followed from January 2007 to August 2021 in Hospital da Luz (Lisbon), and to stratify patients into subgroups that exhibit similar patterns of interaction. With Markov Chains, we are able to identify the most prevailing medical appointments attended by Dementia patients, as well as recurring transitions between these. To perform patient stratification, we applied AliClu, a temporal sequence alignment algorithm for clustering longitudinal clinical data, which allowed us to successfully identify patient subgroups with similar medical appointment activity. A feature analysis per cluster obtained allows the identification of distinct patterns and characteristics. This pipeline provides a tool to identify prevailing clinical pathways of medical appointments within the dataset, as well as the most common transitions between medical specialities within Dementia patients. This methodology, alongside demographic and clinical data, has the potential to provide early signalling of the most likely clinical pathways and serve as a support tool for health providers in deciding the best course of treatment, considering a patient as a whole.

Identification of biomarkers predictive of metastasis development in early-stage colorectal cancer using network-based regularization.

Colorectal cancer (CRC) is the third most common cancer and the second most deathly worldwide. It is a very heterogeneous disease that can develop via distinct pathways where metastasis is the primary cause of death. Therefore, it is crucial to understand the molecular mechanisms underlying metastasis. RNA-sequencing is an essential tool used for studying the transcriptional landscape. However, the high-dimensionality of gene expression data makes selecting novel metastatic biomarkers problematic. To distinguish early-stage CRC patients at risk of developing metastasis from those that are not, three types of binary classification approaches were used: (1) classification methods (decision trees, linear and radial kernel support vector machines, logistic regression, and random forest) using differentially expressed genes (DEGs) as input features; (2) regularized logistic regression based on the Elastic Net penalty and the proposed iTwiner-a network-based regularizer accounting for gene correlation information; and (3) classification methods based on the genes pre-selected using regularized logistic regression. Classifiers using the DEGs as features showed similar results, with random forest showing the highest accuracy. Using regularized logistic regression on the full dataset yielded no improvement in the methods' accuracy. Further classification using the pre-selected genes found by different penalty factors, instead of the DEGs, significantly improved the accuracy of the binary classifiers. Moreover, the use of network-based correlation information (iTwiner) for gene selection produced the best classification results and the identification of more stable and robust gene sets. Some are known to be tumor suppressor genes (OPCML-IT2), to be related to resistance to cancer therapies (RAC1P3), or to be involved in several cancer processes such as genome stability (XRCC6P2), tumor growth and metastasis (MIR602) and regulation of gene transcription (NME2P2). We show that the classification of CRC patients based on pre-selected features by regularized logistic regression is a valuable alternative to using DEGs, significantly increasing the models' predictive performance. Moreover, the use of correlation-based penalization for biomarker selection stands as a promising strategy for predicting patients' groups based on RNA-seq data.

Time-Lagged Correlation Analysis of Shellfish Toxicity Reveals Predictive Links to Adjacent Areas, Species, and Environmental Conditions.

Diarrhetic Shellfish Poisoning (DSP) is an acute intoxication caused by the consumption of contaminated shellfish, which is common in many regions of the world. To safeguard human health, most countries implement programs focused on the surveillance of toxic phytoplankton abundance and shellfish toxicity levels, an effort that can be complemented by a deeper understanding of the underlying phenomena. In this work, we identify patterns of seasonality in shellfish toxicity across the Portuguese coast and analyse time-lagged correlations between this toxicity and various potential risk factors. We extend the understanding of these relations through the introduction of temporal lags, allowing the analysis of time series at different points in time and the study of the predictive power of the tested variables. This study confirms previous findings about toxicity seasonality patterns on the Portuguese coast and provides further quantitative data about the relations between shellfish toxicity and geographical location, shellfish species, toxic phytoplankton abundances, and environmental conditions. Furthermore, multiple pairs of areas and shellfish species are identified as having correlations high enough to allow for a predictive analysis. These results represent the first step towards understanding the dynamics of DSP toxicity in Portuguese shellfish producing areas, such as temporal and spatial variability, and towards the development of a shellfish safety forecasting system.

Kidney Cancer Biomarker Selection Using Regularized Survival Models.

Clear cell renal cell carcinoma (ccRCC) is the most common subtype of RCC showing a significant percentage of mortality. One of the priorities of kidney cancer research is to identify RCC-specific biomarkers for early detection and screening of the disease. With the development of high-throughput technology, it is now possible to measure the expression levels of thousands of genes in parallel and assess the molecular profile of individual tumors. Studying the relationship between gene expression and survival outcome has been widely used to find genes associated with cancer survival, providing new information for clinical decision-making. One of the challenges of using transcriptomics data is their high dimensionality which can lead to instability in the selection of gene signatures. Here we identify potential prognostic biomarkers correlated to the survival outcome of ccRCC patients using two network-based regularizers (EN and TCox) applied to Cox models. Some genes always selected by each method were found (COPS7B, DONSON, GTF2E2, HAUS8, PRH2, and ZNF18) with known roles in cancer formation and progression. Afterward, different lists of genes ranked based on distinct metrics (logFC of DEGs or ß coefficients of regression) were analyzed using GSEA to try to find over- or under-represented mechanisms and pathways. Some ontologies were found in common between the gene sets tested, such as nuclear division, microtubule and tubulin binding, and plasma membrane and chromosome regions. Additionally, genes that were more involved in these ontologies and genes selected by the regularizers were used to create a new gene set where we applied the Cox regression model. With this smaller gene set, we were able to significantly split patients into high/low risk groups showing the importance of studying these genes as potential prognostic factors to help clinicians better identify and monitor patients with ccRCC.

Totoro: Identifying Active Reactions During the Transient State for Metabolic Perturbations.

Motivation: The increasing availability of metabolomic data and their analysis are improving the understanding of cellular mechanisms and how biological systems respond to different perturbations. Currently, there is a need for novel computational methods that facilitate the analysis and integration of increasing volume of available data. Results: In this paper, we present Totoro a new constraint-based approach that integrates quantitative non-targeted metabolomic data of two different metabolic states into genome-wide metabolic models and predicts reactions that were most likely active during the transient state. We applied Totoro to real data of three different growth experiments (pulses of glucose, pyruvate, succinate) from Escherichia coli and we were able to predict known active pathways and gather new insights on the different metabolisms related to each substrate. We used both the E. coli core and the iJO1366 models to demonstrate that our approach is applicable to both smaller and larger networks. Availability: Totoro is an open source method (available at https://gitlab.inria.fr/erable/totoro) suitable for any organism with an available metabolic model. It is implemented in C++ and depends on IBM CPLEX which is freely available for academic purposes.

ROSIE: RObust Sparse ensemble for outlIEr detection and gene selection in cancer omics data.

The extraction of novel information from omics data is a challenging task, in particular, since the number of features (e.g. genes) often far exceeds the number of samples. In such a setting, conventional parameter estimation leads to ill-posed optimization problems, and regularization may be required. In addition, outliers can largely impact classification accuracy.Here we introduce ROSIE, an ensemble classification approach, which combines three sparse and robust classification methods for outlier detection and feature selection and further performs a bootstrap-based validity check. Outliers of ROSIE are determined by the rank product test using outlier rankings of all three methods, and important features are selected as features commonly selected by all methods.We apply ROSIE to RNA-Seq data from The Cancer Genome Atlas (TCGA) to classify observations into Triple-Negative Breast Cancer (TNBC) and non-TNBC tissue samples. The pre-processed dataset consists of 16,600 genes and more than 1,000 samples. We demonstrate that ROSIE selects important features and outliers in a robust way. Identified outliers are concordant with the distribution of the commonly selected genes by the three methods, and results are in line with other independent studies. Furthermore, we discuss the association of some of the selected genes with the TNBC subtype in other investigations. In summary, ROSIE constitutes a robust and sparse procedure to identify outliers and important genes through binary classification. Our approach is ad hoc applicable to other datasets, fulfilling the overall goal of simultaneously identifying outliers and candidate disease biomarkers to the targeted in therapy research and personalized medicine frameworks.

Dynamic modeling of bone remodeling, osteolytic metastasis and PK/PD therapy: introducing variable order derivatives as a simplification technique.

Bone is constantly being renewed: in the adult skeleton, bone resorption and formation are in a tightly coupled balance, allowing for a constant bone density to be maintained. Yet this micro-environment provides the necessary conditions for the growth and proliferation of tumor cells, and thus bone is a common site for the development of metastases, mainly from primary breast and prostate cancer. Mathematical and computational models with differential equations can replicate this bone remodeling process. These models have been extended to include the effects of disruptive tumor pathologies in the bone dynamics, as metastases contribute to the decoupling between bone resorption and formation and to the self-perpetuating tumor growth cycle. Such models may also contemplate the counteraction effects of currently used therapies, and, in the case of treatments with drugs, their pharmocokinetics and pharmacodynamics. We present a thorough overview of biochemical models for bone remodeling, in the presence of a tumour together with anti-cancer and anti-resorptive therapy, formulated as systems of first-order differential equations, or simplified using variable order derivatives. The latter models, of which some are new to this paper, result in equations with fewer parameters, and allow accounting for anomalous diffusion processes. In this way, more compact and parsimonious models, that promptly highlight tumorous bone interactions, are achieved, providing an effective framework to counteract the loss of bone integrity on the affected areas.

Predicting Biologic Therapy Outcome of Patients With Spondyloarthritis: Joint Models for Longitudinal and Survival Analysis.

BACKGROUND: Rheumatic diseases are one of the most common chronic diseases worldwide. Among them, spondyloarthritis (SpA) is a group of highly debilitating diseases, with an early onset age, which significantly impacts patients' quality of life, health care systems, and society in general. Recent treatment options consist of using biologic therapies, and establishing the most beneficial option according to the patients' characteristics is a challenge that needs to be overcome. Meanwhile, the emerging availability of electronic medical records has made necessary the development of methods that can extract insightful information while handling all the challenges of dealing with complex, real-world data. OBJECTIVE: The aim of this study was to achieve a better understanding of SpA patients' therapy responses and identify the predictors that affect them, thereby enabling the prognosis of therapy success or failure. METHODS: A data mining approach based on joint models for the survival analysis of the biologic therapy failure is proposed, which considers the information of both baseline and time-varying variables extracted from the electronic medical records of SpA patients from the database, Reuma.pt. RESULTS: Our results show that being a male, starting biologic therapy at an older age, having a larger time interval between disease start and initiation of the first biologic drug, and being human leukocyte antigen (HLA)-B27 positive are indicators of a good prognosis for the biological drug survival; meanwhile, having disease onset or biologic therapy initiation occur in more recent years, a larger number of education years, and higher values of C-reactive protein or Bath Ankylosing Spondylitis Functional Index (BASFI) at baseline are all predictors of a greater risk of failure of the first biologic therapy. CONCLUSIONS: Among this Portuguese subpopulation of SpA patients, those who were male, HLA-B27 positive, and with a later biologic therapy starting date or a larger time interval between disease start and initiation of the first biologic therapy showed longer therapy adherence. Joint models proved to be a valuable tool for the analysis of electronic medical records in the field of rheumatic diseases and may allow for the identification of potential predictors of biologic therapy failure.

Coupling sparse Cox models with clustering of longitudinal transcriptomics data for trauma prognosis.

BACKGROUND: Longitudinal gene expression analysis and survival modeling have been proved to add valuable biological and clinical knowledge. This study proposes a novel framework to discover gene signatures and patterns in a high-dimensional time series transcriptomics data and to assess their association with hospital length of stay. METHODS: We investigated a longitudinal and high-dimensional gene expression dataset from 168 blunt-force trauma patients followed during the first 28 days after injury. To model the length of stay, an initial dimensionality reduction step was performed by applying Cox regression with elastic net regularization using gene expression data from the first hospitalization days. Also, a novel methodology to impute missing values to the genes selected previously was proposed. We then applied multivariate time series (MTS) clustering to analyse gene expression over time and to stratify patients with similar trajectories. The validation of the patients' partitions obtained by MTS clustering was performed using Kaplan-Meier curves and log-rank tests. RESULTS: We were able to unravel 22 genes strongly associated with hospital's discharge. Their expression values in the first days after trauma showed to be good predictors of the length of stay. The proposed mixed imputation method allowed to achieve a complete dataset of short time series with a minimum loss of information for the 28 days of follow-up. MTS clustering enabled to group patients with similar genes trajectories and, notably, with similar discharge days from the hospital. Patients within each cluster have comparable genes' trajectories and may have an analogous response to injury. CONCLUSION: The proposed framework was able to tackle the joint analysis of time-to-event information with longitudinal multivariate high-dimensional data. The application to length of stay and transcriptomics data revealed a strong relationship between gene expression trajectory and patients' recovery, which may improve trauma patient's management by healthcare systems. The proposed methodology can be easily adapted to other medical data, towards more effective clinical decision support systems for health applications.

The Role of Network Science in Glioblastoma.

Network science has long been recognized as a well-established discipline across many biological domains. In the particular case of cancer genomics, network discovery is challenged by the multitude of available high-dimensional heterogeneous views of data. Glioblastoma (GBM) is an example of such a complex and heterogeneous disease that can be tackled by network science. Identifying the architecture of molecular GBM networks is essential to understanding the information flow and better informing drug development and pre-clinical studies. Here, we review network-based strategies that have been used in the study of GBM, along with the available software implementations for reproducibility and further testing on newly coming datasets. Promising results have been obtained from both bulk and single-cell GBM data, placing network discovery at the forefront of developing a molecularly-informed-based personalized medicine.

A comprehensive evaluation of binning methods to recover human gut microbial species from a non-redundant reference gene catalog.

The human gut microbiota performs functions that are essential for the maintenance of the host physiology. However, characterizing the functioning of microbial communities in relation to the host remains challenging in reference-based metagenomic analyses. Indeed, as taxonomic and functional analyses are performed independently, the link between genes and species remains unclear. Although a first set of species-level bins was built by clustering co-abundant genes, no reference bin set is established on the most used gut microbiota catalog, the Integrated Gene Catalog (IGC). With the aim to identify the best suitable method to group the IGC genes, we benchmarked nine taxonomy-independent binners implementing abundance-based, hybrid and integrative approaches. To this purpose, we designed a simulated non-redundant gene catalog (SGC) and computed adapted assessment metrics. Overall, the best trade-off between the main metrics is reached by an integrative binner. For each approach, we then compared the results of the best-performing binner with our expected community structures and applied the method to the IGC. The three approaches are distinguished by specific advantages, and by inherent or scalability limitations. Hybrid and integrative binners show promising and potentially complementary results but require improvements to be used on the IGC to recover human gut microbial species.

Structured sparsity regularization for analyzing high-dimensional omics data.

The development of new molecular and cell technologies is having a significant impact on the quantity of data generated nowadays. The growth of omics databases is creating a considerable potential for knowledge discovery and, concomitantly, is bringing new challenges to statistical learning and computational biology for health applications. Indeed, the high dimensionality of these data may hamper the use of traditional regression methods and parameter estimation algorithms due to the intrinsic non-identifiability of the inherent optimization problem. Regularized optimization has been rising as a promising and useful strategy to solve these ill-posed problems by imposing additional constraints in the solution parameter space. In particular, the field of statistical learning with sparsity has been significantly contributing to building accurate models that also bring interpretability to biological observations and phenomena. Beyond the now-classic elastic net, one of the best-known methods that combine lasso with ridge penalizations, we briefly overview recent literature on structured regularizers and penalty functions that have been applied in biomedical data to build parsimonious models in a variety of underlying contexts, from survival to generalized linear models. These methods include functions of $\ell _k$-norms and network-based penalties that take into account the inherent relationships between the features. The successful application to omics data illustrates the potential of sparse structured regularization for identifying disease's molecular signatures and for creating high-performance clinical decision support systems towards more personalized healthcare. Supplementary information: Supplementary data are available at Briefings in Bioinformatics online.

TCox: Correlation-Based Regularization Applied to Colorectal Cancer Survival Data.

Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity in the world. Being a heterogeneous disease, cancer therapy and prognosis represent a significant challenge to medical care. The molecular information improves the accuracy with which patients are classified and treated since similar pathologies may show different clinical outcomes and other responses to treatment. However, the high dimensionality of gene expression data makes the selection of novel genes a problematic task. We propose TCox, a novel penalization function for Cox models, which promotes the selection of genes that have distinct correlation patterns in normal vs. tumor tissues. We compare TCox to other regularized survival models, Elastic Net, HubCox, and OrphanCox. Gene expression and clinical data of CRC and normal (TCGA) patients are used for model evaluation. Each model is tested 100 times. Within a specific run, eighteen of the features selected by TCox are also selected by the other survival regression models tested, therefore undoubtedly being crucial players in the survival of colorectal cancer patients. Moreover, the TCox model exclusively selects genes able to categorize patients into significant risk groups. Our work demonstrates the ability of the proposed weighted regularizer TCox to disclose novel molecular drivers in CRC survival by accounting for correlation-based network information from both tumor and normal tissue. The results presented support the relevance of network information for biomarker identification in high-dimensional gene expression data and foster new directions for the development of network-based feature selection methods in precision oncology.

MOMO - multi-objective metabolic mixed integer optimization: application to yeast strain engineering.

BACKGROUND: In this paper, we explore the concept of multi-objective optimization in the field of metabolic engineering when both continuous and integer decision variables are involved in the model. In particular, we propose a multi-objective model that may be used to suggest reaction deletions that maximize and/or minimize several functions simultaneously. The applications may include, among others, the concurrent maximization of a bioproduct and of biomass, or maximization of a bioproduct while minimizing the formation of a given by-product, two common requirements in microbial metabolic engineering. RESULTS: Production of ethanol by the widely used cell factory Saccharomyces cerevisiae was adopted as a case study to demonstrate the usefulness of the proposed approach in identifying genetic manipulations that improve productivity and yield of this economically highly relevant bioproduct. We did an in vivo validation and we could show that some of the predicted deletions exhibit increased ethanol levels in comparison with the wild-type strain. CONCLUSIONS: The multi-objective programming framework we developed, called MOMO, is open-source and uses POLYSCIP (Available at http://polyscip.zib.de/). as underlying multi-objective solver. MOMO is available at http://momo-sysbio.gforge.inria.fr.

Tracking intratumoral heterogeneity in glioblastoma via regularized classification of single-cell RNA-Seq data.

BACKGROUND: Understanding cellular and molecular heterogeneity in glioblastoma (GBM), the most common and aggressive primary brain malignancy, is a crucial step towards the development of effective therapies. Besides the inter-patient variability, the presence of multiple cell populations within tumors calls for the need to develop modeling strategies able to extract the molecular signatures driving tumor evolution and treatment failure. With the advances in single-cell RNA Sequencing (scRNA-Seq), tumors can now be dissected at the cell level, unveiling information from their life history to their clinical implications. RESULTS: We propose a classification setting based on GBM scRNA-Seq data, through sparse logistic regression, where different cell populations (neoplastic and normal cells) are taken as classes. The goal is to identify gene features discriminating between the classes, but also those shared by different neoplastic clones. The latter will be approached via the network-based twiner regularizer to identify gene signatures shared by neoplastic cells from the tumor core and infiltrating neoplastic cells originated from the tumor periphery, as putative disease biomarkers to target multiple neoplastic clones. Our analysis is supported by the literature through the identification of several known molecular players in GBM. Moreover, the relevance of the selected genes was confirmed by their significance in the survival outcomes in bulk GBM RNA-Seq data, as well as their association with several Gene Ontology (GO) biological process terms. CONCLUSIONS: We presented a methodology intended to identify genes discriminating between GBM clones, but also those playing a similar role in different GBM neoplastic clones (including migrating cells), therefore potential targets for therapy research. Our results contribute to a deeper understanding on the genetic features behind GBM, by disclosing novel therapeutic directions accounting for GBM heterogeneity.

Benchmarking of alignment-free sequence comparison methods.

BACKGROUND: Alignment-free (AF) sequence comparison is attracting persistent interest driven by data-intensive applications. Hence, many AF procedures have been proposed in recent years, but a lack of a clearly defined benchmarking consensus hampers their performance assessment. RESULTS: Here, we present a community resource (http://afproject.org) to establish standards for comparing alignment-free approaches across different areas of sequence-based research. We characterize 74 AF methods available in 24 software tools for five research applications, namely, protein sequence classification, gene tree inference, regulatory element detection, genome-based phylogenetic inference, and reconstruction of species trees under horizontal gene transfer and recombination events. CONCLUSION: The interactive web service allows researchers to explore the performance of alignment-free tools relevant to their data types and analytical goals. It also allows method developers to assess their own algorithms and compare them with current state-of-the-art tools, accelerating the development of new, more accurate AF solutions.

Twiner: correlation-based regularization for identifying common cancer gene signatures.

BACKGROUND: Breast and prostate cancers are typical examples of hormone-dependent cancers, showing remarkable similarities at the hormone-related signaling pathways level, and exhibiting a high tropism to bone. While the identification of genes playing a specific role in each cancer type brings invaluable insights for gene therapy research by targeting disease-specific cell functions not accounted so far, identifying a common gene signature to breast and prostate cancers could unravel new targets to tackle shared hormone-dependent disease features, like bone relapse. This would potentially allow the development of new targeted therapies directed to genes regulating both cancer types, with a consequent positive impact in cancer management and health economics. RESULTS: We address the challenge of extracting gene signatures from transcriptomic data of prostate adenocarcinoma (PRAD) and breast invasive carcinoma (BRCA) samples, particularly estrogen positive (ER+), and androgen positive (AR+) triple-negative breast cancer (TNBC), using sparse logistic regression. The introduction of gene network information based on the distances between BRCA and PRAD correlation matrices is investigated, through the proposed twin networks recovery (twiner) penalty, as a strategy to ensure similarly correlated gene features in two diseases to be less penalized during the feature selection procedure. CONCLUSIONS: Our analysis led to the identification of genes that show a similar correlation pattern in BRCA and PRAD transcriptomic data, and are selected as key players in the classification of breast and prostate samples into ER+ BRCA/AR+ TNBC/PRAD tumor and normal tissues, and also associated with survival time distributions. The results obtained are supported by the literature and are expected to unveil the similarities between the diseases, disclose common disease biomarkers, and help in the definition of new strategies for more effective therapies.

Modelling cancer outcomes of bone metastatic patients: combining survival data with N-Telopeptide of type I collagen (NTX) dynamics through joint models.

BACKGROUND: Joint models (JM) have emerged as a promising statistical framework to concurrently analyse survival data and multiple longitudinal responses. This is particularly relevant in clinical studies where the goal is to estimate the association between time-to-event data and the biomarkers evolution. In the context of oncological data, JM can indeed provide interesting prognostic markers for the event under study and thus support clinical decisions and treatment choices. However, several problems arise when dealing with this type of data, such as the high-dimensionality of the covariates space, the lack of knowledge about the function structure of the time series and the presence of missing data, facts that may hamper the accurate estimation of the JM. METHODS: We propose to apply JM for the analysis of bone metastatic patients and infer the association of their survival with several covariates, in particular the N-Telopeptide of Type I Collagen (NTX) dynamics. This biomarker has been identified as a relevant prognostic factor in patients with metastatic cancer, but only using static information in some specific time points. RESULTS: We extended this analysis using the full NTX time series for a larger cohort of patients with bone metastasis, and compared the results obtained by the JM and the extended Cox regression model. Imputation based on fuzzy clustering was used to deal with missing values and several functions for NTX evolution were compared, such as rational, exponential and cubic splines. CONCLUSIONS: The JM obtained confirm the association between NTX values and patients' response, attesting the importance of this time series, and additionally provide a deep understanding of the key survival covariates.

AliClu - Temporal sequence alignment for clustering longitudinal clinical data.

BACKGROUND: Patient stratification is a critical task in clinical decision making since it can allow physicians to choose treatments in a personalized way. Given the increasing availability of electronic medical records (EMRs) with longitudinal data, one crucial problem is how to efficiently cluster the patients based on the temporal information from medical appointments. In this work, we propose applying the Temporal Needleman-Wunsch (TNW) algorithm to align discrete sequences with the transition time information between symbols. These symbols may correspond to a patient's current therapy, their overall health status, or any other discrete state. The transition time information represents the duration of each of those states. The obtained TNW pairwise scores are then used to perform hierarchical clustering. To find the best number of clusters and assess their stability, a resampling technique is applied. RESULTS: We propose the AliClu, a novel tool for clustering temporal clinical data based on the TNW algorithm coupled with clustering validity assessments through bootstrapping. The AliClu was applied for the analysis of the rheumatoid arthritis EMRs obtained from the Portuguese database of rheumatologic patient visits (Reuma.pt). In particular, the AliClu was used for the analysis of therapy switches, which were coded as letters corresponding to biologic drugs and included their durations before each change occurred. The obtained optimized clusters allow one to stratify the patients based on their temporal therapy profiles and to support the identification of common features for those groups. CONCLUSIONS: The AliClu is a promising computational strategy to analyse longitudinal patient data by providing validated clusters and by unravelling the patterns that exist in clinical outcomes. Patient stratification is performed in an automatic or semi-automatic way, allowing one to tune the alignment, clustering, and validation parameters. The AliClu is freely available at https://github.com/sysbiomed/AliClu.

Robust identification of target genes and outliers in triple-negative breast cancer data.

Correct classification of breast cancer subtypes is of high importance as it directly affects the therapeutic options. We focus on triple-negative breast cancer which has the worst prognosis among breast cancer types. Using cutting edge methods from the field of robust statistics, we analyze Breast Invasive Carcinoma transcriptomic data publicly available from The Cancer Genome Atlas data portal. Our analysis identifies statistical outliers that may correspond to misdiagnosed patients. Furthermore, it is illustrated that classical statistical methods may fail to identify outliers due to their heavy influence, prompting the need for robust statistics. Using robust sparse logistic regression we obtain 36 relevant genes, of which ca. 60% have been previously reported as biologically relevant to triple-negative breast cancer, reinforcing the validity of the method. The remaining 14 genes identified are new potential biomarkers for triple-negative breast cancer. Out of these, JAM3, SFT2D2, and PAPSS1 were previously associated to breast tumors or other types of cancer. The relevance of these genes is confirmed by the new DetectDeviatingCells outlier detection technique. A comparison of gene networks on the selected genes showed significant differences between triple-negative breast cancer and non-triple-negative breast cancer data. The individual role of FOXA1 in triple-negative breast cancer and non-triple-negative breast cancer, and the strong FOXA1-AGR2 connection in triple-negative breast cancer stand out. The goal of our paper is to contribute to the breast cancer/triple-negative breast cancer understanding and management. At the same time it demonstrates that robust regression and outlier detection constitute key strategies to cope with high-dimensional clinical data such as omics data.