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      From hype to reality: data science enabling personalized medicine

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          Abstract

          Background

          Personalized, precision, P4, or stratified medicine is understood as a medical approach in which patients are stratified based on their disease subtype, risk, prognosis, or treatment response using specialized diagnostic tests. The key idea is to base medical decisions on individual patient characteristics, including molecular and behavioral biomarkers, rather than on population averages. Personalized medicine is deeply connected to and dependent on data science, specifically machine learning (often named Artificial Intelligence in the mainstream media). While during recent years there has been a lot of enthusiasm about the potential of ‘big data’ and machine learning-based solutions, there exist only few examples that impact current clinical practice. The lack of impact on clinical practice can largely be attributed to insufficient performance of predictive models, difficulties to interpret complex model predictions, and lack of validation via prospective clinical trials that demonstrate a clear benefit compared to the standard of care. In this paper, we review the potential of state-of-the-art data science approaches for personalized medicine, discuss open challenges, and highlight directions that may help to overcome them in the future.

          Conclusions

          There is a need for an interdisciplinary effort, including data scientists, physicians, patient advocates, regulatory agencies, and health insurance organizations. Partially unrealistic expectations and concerns about data science-based solutions need to be better managed. In parallel, computational methods must advance more to provide direct benefit to clinical practice.

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          Most cited references55

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          Deep Learning in Medical Image Analysis

          This review covers computer-assisted analysis of images in the field of medical imaging. Recent advances in machine learning, especially with regard to deep learning, are helping to identify, classify, and quantify patterns in medical images. At the core of these advances is the ability to exploit hierarchical feature representations learned solely from data, instead of features designed by hand according to domain-specific knowledge. Deep learning is rapidly becoming the state of the art, leading to enhanced performance in various medical applications. We introduce the fundamentals of deep learning methods and review their successes in image registration, detection of anatomical and cellular structures, tissue segmentation, computer-aided disease diagnosis and prognosis, and so on. We conclude by discussing research issues and suggesting future directions for further improvement.
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            Network-based classification of breast cancer metastasis

            Mapping the pathways that give rise to metastasis is one of the key challenges of breast cancer research. Recently, several large-scale studies have shed light on this problem through analysis of gene expression profiles to identify markers correlated with metastasis. Here, we apply a protein-network-based approach that identifies markers not as individual genes but as subnetworks extracted from protein interaction databases. The resulting subnetworks provide novel hypotheses for pathways involved in tumor progression. Although genes with known breast cancer mutations are typically not detected through analysis of differential expression, they play a central role in the protein network by interconnecting many differentially expressed genes. We find that the subnetwork markers are more reproducible than individual marker genes selected without network information, and that they achieve higher accuracy in the classification of metastatic versus non-metastatic tumors.
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              Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

              Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.
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                Author and article information

                Contributors
                holger.froehlich@ucb.com
                rudi.balling@uni.lu
                niko.beerenwinkel@bsse.ethz.ch
                oliver.kohlbacher@uni-tuebingen.de
                santosh.kumar@memphis.edu
                lengauer@mpi-inf.mpg.de
                marloes.maathuis@stat.math.ethz.ch
                moreau@esat.kleuven.be
                samurphy@fas.harvard.edu
                przytyck@ncbi.nlm.nih.gov
                michael.rebhan@novartis.com
                hannes.rost@utoronto.ca
                schuppert@combine.rwth-aachen.de
                matthias.schwab@ikp-stuttgart.de
                rainer.spang@klinik.uni-r.de
                stekhoven@nexus.ethz.ch
                jimeng.sun@gmail.com
                weber@cs.uni-bonn.de
                Daniel.Ziemek@pfizer.com
                blaz.zupan@fri.uni-lj.si
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                27 August 2018
                27 August 2018
                2018
                : 16
                : 150
                Affiliations
                [1 ]ISNI 0000 0004 0455 9792, GRID grid.420204.0, UCB Biosciences GmbH, ; Alfred-Nobel-Str. Str. 10, 40789 Monheim, Germany
                [2 ]ISNI 0000 0001 2295 9843, GRID grid.16008.3f, University of Luxembourg, ; 6 avenue du Swing, 4367 Belvaux, Luxembourg
                [3 ]ISNI 0000 0001 2156 2780, GRID grid.5801.c, Department of Biosciences and Engineering, , ETH Zurich, ; Mattenstr. 26, 4058 Basel, Switzerland
                [4 ]ISNI 0000 0001 2190 1447, GRID grid.10392.39, University of Tübingen, WSI/ZBIT, ; Sand 14, 72076 Tübingen, Germany
                [5 ]ISNI 0000 0000 9560 654X, GRID grid.56061.34, Department of Computer Science, , University of Memphis, ; 2222 Dunn Hall, Memphis, TN 38152 USA
                [6 ]ISNI 0000 0004 0491 9823, GRID grid.419528.3, Max-Planck-Institute for Informatics, ; 66123 Saarbrücken, Germany
                [7 ]ISNI 0000 0001 2156 2780, GRID grid.5801.c, ETH Zurich, Seminar für Statistik, ; Rämistrasse 101, 8092 Zurich, Switzerland
                [8 ]ISNI 0000 0001 0668 7884, GRID grid.5596.f, University of Leuven, ESAT, ; Kasteelpark Arenberg 10, 3001 Leuven, Belgium
                [9 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard University, ; Science Center 400 Suite, Oxford Street, Cambridge, MA 02138-2901 USA
                [10 ]ISNI 0000 0000 9635 8082, GRID grid.420089.7, National Center of Biotechnology Information, National Institute of Health, ; 8600 Rockville Pike, Bethesda, MD 20894-6075 USA
                [11 ]ISNI 0000 0001 1515 9979, GRID grid.419481.1, Novartis Institutes for Biomedical Research, ; 4056 Basel, Switzerland
                [12 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Donnelly Centre for Cellular and Biomolecular Research, , University of Toronto, ; 160 College Street, Toronto, ON M5S 3E1 Canada
                [13 ]ISNI 0000 0001 0728 696X, GRID grid.1957.a, RWTH Aachen, Joint Research Center for Computational Biomedicine, ; Pauwelsstrasse 19, 52074 Aachen, Germany
                [14 ]ISNI 0000 0004 0564 2483, GRID grid.418579.6, Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, ; Aucherbachstrasse 112, 70376 Stuttgart, Germany
                [15 ]ISNI 0000 0001 2190 5763, GRID grid.7727.5, University of Regensburg, Institute of Functional Genomics, ; Am BioPark 9, 93053 Regensburg, Germany
                [16 ]ISNI 0000 0001 2156 2780, GRID grid.5801.c, ETH Zurich, NEXUS Personalized Health Technol., ; Otto-Stern-Weg 7, 8093 Zurich, Switzerland
                [17 ]ISNI 0000 0001 2097 4943, GRID grid.213917.f, Georgia Tech University, ; 801 Atlantic Drive, Atlanta, GA 30332-0280 USA
                [18 ]ISNI 0000 0001 2240 3300, GRID grid.10388.32, Institute for Computer Science, , University of Bonn, ; Endenicher Allee 19a, 53115 Bonn, Germany
                [19 ]ISNI 0000 0004 4904 8590, GRID grid.476393.c, Pfizer, Worldwide Research and Development, ; Linkstraße 10, 10785 Berlin, Germany
                [20 ]ISNI 0000 0001 0721 6013, GRID grid.8954.0, Faculty of Computer and Information Science, , University of Ljubljana, ; Večna pot 113, SI-1000 Ljubljana, Slovenia
                [21 ]ISNI 0000 0001 2240 3300, GRID grid.10388.32, University of Bonn, Bonn-Aachen International Center for IT, ; Endenicher Allee 19c, 53115 Bonn, Germany
                [22 ]ISNI 0000 0001 1014 8330, GRID grid.419495.4, Max Planck Institute for Developmental Biology, ; Max-Planck-Ring 5, 72076 Tübingen, Germany
                [23 ]ISNI 0000 0001 2190 1447, GRID grid.10392.39, Quantitative Biology Center, University of Tübingen, ; Auf der Morgenstelle 8, 72076 Tübingen, Germany
                [24 ]ISNI 0000 0001 0196 8249, GRID grid.411544.1, Institute for Translational Bioinformatics, , University Medical Center Tübingen, ; Sand 14, 72076 Tübingen, Germany
                [25 ]ISNI 0000 0001 2190 1447, GRID grid.10392.39, University of Tübingen, Departments of Clinical Pharmacology and of Pharmacy and Biochemistry, ; Tübingen, Germany
                Author information
                http://orcid.org/0000-0002-5328-1243
                Article
                1122
                10.1186/s12916-018-1122-7
                6109989
                30145981
                8139fb06-7aa3-48b9-8b79-a5d38d8749e3
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 March 2018
                : 9 July 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010663, H2020 European Research Council;
                Award ID: 668353
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100010682, H2020 Society;
                Funded by: FundRef http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;
                Categories
                Debate
                Custom metadata
                © The Author(s) 2018

                Medicine
                personalized medicine,precision medicine,stratified medicine,p4 medicine,machine learning,artificial intelligence,big data,biomarkers

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