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Anatomically aware simulation of patient-specific glioblastoma xenografts. 患者特异性胶质母细胞瘤异种移植的解剖学感知模拟。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013831
Adam A Malik, Cecilia Krona, Soumi Kundu, Philip Gerlee, Sven Nelander

Patient-derived cells (PDC) mouse xenografts are increasingly important tools in glioblastoma (GBM) research, essential to investigate case-specific growth patterns and treatment responses. Despite the central role of xenograft models in the field, few good simulation models are available to probe the dynamics of tumor growth and to support therapy design. We therefore propose a new framework for the patient-specific simulation of GBM in the mouse brain. Unlike existing methods, our simulations leverage a high-resolution map of the mouse brain anatomy to yield patient-specific results that are in good agreement with experimental observations. To facilitate the fitting of our model to histological data, we use Approximate Bayesian Computation. Because our model uses few parameters, reflecting growth, invasion and niche dependencies, it is well suited for case comparisons and for probing treatment effects. We demonstrate how our model can be used to simulate different treatment by perturbing the different model parameters. We expect in silico replicates of mouse xenograft tumors can improve the assessment of therapeutic outcomes and boost the statistical power of preclinical GBM studies.

患者源性细胞(PDC)小鼠异种移植在胶质母细胞瘤(GBM)研究中越来越重要,对于研究病例特异性生长模式和治疗反应至关重要。尽管异种移植模型在该领域发挥着核心作用,但很少有好的模拟模型可用于探索肿瘤生长动力学并支持治疗设计。因此,我们提出了一种新的框架,用于小鼠大脑中GBM的患者特异性模拟。与现有方法不同,我们的模拟利用小鼠大脑解剖的高分辨率地图来产生与实验观察结果非常一致的患者特异性结果。为了便于我们的模型与组织学数据的拟合,我们使用了近似贝叶斯计算。由于我们的模型使用了很少的参数,反映了生长、入侵和生态位依赖性,因此它非常适合于病例比较和探索治疗效果。我们演示了如何通过扰动不同的模型参数来使用我们的模型来模拟不同的处理。我们期望小鼠异种移植肿瘤的计算机复制可以改善治疗结果的评估,并提高临床前GBM研究的统计能力。
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引用次数: 0
Linking spatial drug heterogeneity to microbial growth dynamics in theory and experiment. 将空间药物异质性与微生物生长动力学的理论和实验联系起来。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013896
Zhijian Hu, Yuzhen Wu, Tomas Freire, Erida Gjini, Kevin Wood

Drugs play a central role in limiting bacterial population spread, yet laboratory studies typically assume well-mixed environments when assessing microbial drug responses. In contrast, bacteria in the human body often occupy spatially structured habitats where drug concentrations vary. Understanding how this heterogeneity shapes growth and decline is therefore essential for controlling infections and mitigating resistance evolution. Here, we developed a minimal robot-automated system to study how spatial drug heterogeneity affects short-term population dynamics in E. faecalis, a Gram-positive opportunistic pathogen. This system was combined with a theoretical framework to interpret and explain the observed outcomes. We first recapitulated the classic critical-patch-size model result: in a spatially homogeneous environment, a population persists in a finite domain only when growth outpaces diffusive losses at the boundaries. In heterogeneous environments, we found certain conditions that population persistence can depend critically on the spatial arrangement of the drug, even when its total amount is fixed. Using theoretical and experimental approaches, we identified the arrangements that produce the strongest growth and the fastest decline, revealing the range of possible outcomes under drug heterogeneity. We further tested this framework in more complex environments, including ring-shaped communities, and observed consistent arrangement-dependent behavior. Overall, our results extend the classical growth-condition framework to general heterogeneous environments and demonstrate that spatial drug arrangement - not only total dose - can strongly influence bacterial population dynamics. These findings highlight the importance of spatially structured dosing strategies and motivate further theoretical and experimental investigation.

药物在限制细菌种群传播方面发挥着核心作用,然而实验室研究通常在评估微生物药物反应时假设混合良好的环境。相比之下,人体内的细菌通常占据药物浓度变化的空间结构栖息地。因此,了解这种异质性如何影响生长和衰退对于控制感染和减轻耐药性进化至关重要。在这里,我们开发了一个最小的机器人自动化系统来研究空间药物异质性如何影响粪肠杆菌(一种革兰氏阳性机会性病原体)的短期种群动态。该系统与理论框架相结合来解释和解释观察到的结果。我们首先概括了经典的临界斑块大小模型的结果:在空间均匀的环境中,只有当增长速度超过边界上的扩散损失时,种群才能在有限域中持续存在。在异质环境中,我们发现在某些条件下,种群持久性可能严重依赖于药物的空间排列,即使其总量是固定的。利用理论和实验方法,我们确定了产生最强增长和最快下降的排列,揭示了药物异质性下可能结果的范围。我们进一步在更复杂的环境中测试了这个框架,包括环形社区,并观察到一致的安排依赖行为。总的来说,我们的研究结果将经典的生长条件框架扩展到一般的异质环境,并证明空间药物排列-不仅仅是总剂量-可以强烈影响细菌种群动态。这些发现突出了空间结构给药策略的重要性,并激发了进一步的理论和实验研究。
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引用次数: 0
Correction: Simulation insights on the compound action potential in multifascicular nerves. 更正:多束神经复合动作电位的模拟见解。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013902

[This corrects the article DOI: 10.1371/journal.pcbi.1013452.].

[这更正了文章DOI: 10.1371/journal.pcbi.1013452.]。
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引用次数: 0
Evaluating the limitations of Bayesian metabolic control analysis. 评价贝叶斯代谢控制分析的局限性。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-16 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1012987
Janis Shin, James M Carothers, Herbert M Sauro

Bayesian Metabolic Control Analysis (BMCA) is a promising framework for inferring metabolic control coefficients in data-limited scenarios, combining Bayesian inference with linear-logarithmic (lin-log) rate laws. These metabolic control coefficients quantify how changes in enzyme activities affect steady-state fluxes and metabolite concentrations across a metabolic network. However, its predictive accuracy and limitations remain underexplored. This study systematically evaluates BMCA's ability to infer elasticity values, flux control coefficients (FCC), and concentration control coefficients (CCC) under varying data availability conditions using three synthetic metabolic network models. We demonstrate that BMCA predictions are highly dependent on the inclusion of flux and enzyme concentration data, with the omission of these datasets leading to severe inaccuracies. In our synthetic, enzyme-perturbation datasets, external metabolite concentrations had minimal impact and, in some cases, their exclusion improved predictions; when external-nutrient perturbations were introduced and those concentrations were observed, gains were at most modest. Additionally, we find that posterior estimation with both ADVI and HMC can underestimate large-magnitude elasticities in our synthetic settings, with ADVI showing somewhat higher variance under strong up-regulation; thus, recovering |elasticity| [Formula: see text]1.5 remains challenging regardless of the inference engine. ADVI also fails to accurately infer allosteric interactions, even when regulatory effects are strong. While BMCA maintains reasonable accuracy in partially recovering the rankings of the highest FCC values, its estimates of absolute values remain constrained by prior assumptions and data limitations. Our findings reveal the BMCA algorithm's strengths and weaknesses, providing guidance on its application in metabolic engineering, and highlighting the need for methodological refinements to enhance its predictive capabilities.

贝叶斯代谢控制分析(BMCA)是一个很有前途的框架,用于在数据有限的情况下推断代谢控制系数,它将贝叶斯推理与线性-对数(林-对数)速率定律相结合。这些代谢控制系数量化了酶活性的变化如何影响代谢网络中的稳态通量和代谢物浓度。然而,其预测准确性和局限性仍未得到充分探讨。本研究使用三种合成代谢网络模型系统地评估了BMCA在不同数据可用性条件下推断弹性值、通量控制系数(FCC)和浓度控制系数(CCC)的能力。我们证明,BMCA预测高度依赖于通量和酶浓度数据的包含,这些数据集的遗漏导致严重的不准确性。在我们的合成酶摄动数据集中,外部代谢物浓度的影响最小,在某些情况下,它们的排除改善了预测;当引入外部营养扰动并观察到这些浓度时,收益是最有限的。此外,我们发现ADVI和HMC的后验估计都低估了我们的合成设置中的大幅度弹性,ADVI在强上调下显示出更高的方差;因此,无论使用何种推理引擎,恢复|弹性|[公式:见文本]1.5仍然具有挑战性。即使调控作用很强,ADVI也不能准确地推断变构相互作用。虽然BMCA在部分恢复最高FCC值排名方面保持了合理的准确性,但其绝对值估计仍然受到先前假设和数据限制的约束。我们的研究结果揭示了BMCA算法的优点和缺点,为其在代谢工程中的应用提供了指导,并强调了改进方法以提高其预测能力的必要性。
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引用次数: 0
Structural analysis of antigenic variation and adaptive evolution of the H5N1 neuraminidase gene. H5N1型神经氨酸酶基因抗原变异及适应性进化的结构分析。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-16 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013903
Muyiwa S Adegbaju, Oluwabuyikunmi Owo-Odusi, Eden T Wirtz, Olanrewaju B Morenikeji, Olusola Ojurongbe, Bolaji N Thomas
<p><p>The concern regarding H5N1 outbreak, particularly the accelerated mutagenesis of its core genomic elements, underscores the persistent threat of influenza to global health. Neuraminidase (NA), a pivotal sialidase integral to virion egress and propagation, comprises nine distinct isoforms, exhibiting unique evolutionary trajectories and structural adaptations. Despite extensive characterization of hemagglutinin subtypes, the functional divergence of the nine NA subtypes remains inadequately understood. To address this gap, we conducted a structural analysis of NA subtypes, employing structural superimposition and motif-guided sequence alignment to delineate subtype-specific residues. Hierarchical clustering stratified the nine NA subtypes into four distinct subgroups: NA2 (subgroup I), NA1 and NA4 (subgroup II), NA9/NA7/NA6/NA3 (subgroup III), and NA8/NA5 (subgroup 4). We identified 40 highly conserved and functionally significant amino acid loci, likely modulating enzymatic activity and substrate specificity across subtypes. To investigate the structural basis of adaptation in H5N1, we generated NA1 mutants by swapping family specific position (FSP) residues and analyzed their dynamics using Molecular Dynamics (MD) simulations, complemented by a deep phylogenetic analysis across six host reservoirs. MD simulation parameters reveal a dynamic paradox: the Wild-Type (WT) NA1 maintains a conserved global compactness Rg, which masks a complex, bi-modal switching mechanism essential for its catalytic function, validated by multi-basin free energy landscape (FEL) topography. We identify Lysine-207 (K207) as the master determinant of this switching mechanism and the enzyme's dynamic fate. Substitutions at this conserved nexus produced diametrically opposite outcomes: K207W imposed structural rigidification (abolishing the switch), K207H achieved dynamic preservation, and K207I drove expanded disorder and collapse. Furthermore, dynamic correlation analysis shows that these single-point substitutions function as molecular switches that significantly re-wire the enzyme's allosteric communication networks, extending far beyond the active site. To assess the role of NA1 in host tropism and adaptive evolution, we conducted a phylogenetic analysis of NA1 genes from H5N1 isolates across multiple host reservoirs; H. sapiens, G. gallus, Anser anser domesticus, M. gallopavo, B. taurus, and C. olor. Notably, we observed opposing selection pressures and diversification patterns: G. gallus isolates showed signatures of positive selection consistent with hyper-reassortment, while human isolates displayed highly diverse, sporadic spillover events. We conclude that the evolutionary contribution of NA1 to H5N1 host adaptation is not encoded in static structure, but certain residues such as K207 defines a pivotal mechanism for regulating the enzyme's function through dynamic states. Our MD data thus proposes a novel strategy for next-generation antivirals by targetin
对H5N1疫情的关注,特别是对其核心基因组要素的加速诱变,强调了流感对全球卫生的持续威胁。神经氨酸酶(NA)是病毒粒子输出和繁殖的关键唾液酸酶,包括9种不同的亚型,表现出独特的进化轨迹和结构适应性。尽管广泛表征血凝素亚型,九NA亚型的功能差异仍然不充分了解。为了解决这一空白,我们对NA亚型进行了结构分析,采用结构叠加和基序引导序列比对来描绘亚型特异性残基。将9种NA亚型分为4个不同的亚组:NA2(亚组I)、NA1和NA4(亚组II)、NA9/NA7/NA6/NA3(亚组III)和NA8/NA5(亚组4)。我们确定了40个高度保守和功能显著的氨基酸位点,可能调节不同亚型的酶活性和底物特异性。为了研究H5N1病毒适应的结构基础,我们通过交换家族特定位置(FSP)残基生成了NA1突变体,并利用分子动力学(MD)模拟分析了它们的动态,同时对6个宿主宿主进行了深入的系统发育分析。MD模拟参数揭示了一个动态悖论:野生型(WT) NA1保持保守的全局紧度Rg,这掩盖了其催化功能所必需的复杂的双峰切换机制,多流域自由能源景观(FEL)地形证实了这一点。我们确定赖氨酸-207 (K207)是这种开关机制和酶的动态命运的主要决定因素。在这个保守关系上的替换产生了截然相反的结果:K207W造成了结构僵化(取消了开关),K207H实现了动态保存,而K207I导致了扩展的无序和崩溃。此外,动态相关分析表明,这些单点取代作为分子开关,显著地重新连接酶的变构通信网络,远远超出活性位点。为了评估NA1在宿主趋向性和适应性进化中的作用,我们对H5N1病毒在多个宿主宿主中分离的NA1基因进行了系统发育分析;智人、野鸡、家鸡、野鸡、金牛和野鸡。值得注意的是,我们观察到相反的选择压力和多样化模式:鸡的分离物表现出与高度重组一致的正选择特征,而人类分离物表现出高度多样化的零星溢出事件。我们得出结论,NA1对H5N1宿主适应的进化贡献不是在静态结构中编码的,但某些残基(如K207)定义了通过动态状态调节酶功能的关键机制。因此,我们的MD数据为下一代抗病毒药物提出了一种新的策略,即针对这种动态漏洞——动态消融的Nexus——永久地以非功能构象携带酶。
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引用次数: 0
Conditions for replay of neuronal assemblies. 重放神经元集合的条件。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-16 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013844
Gaspar Cano, Richard Kempter

From cortical synfire chains to hippocampal replay, the idea that neural populations can be activated sequentially with precise spike timing is thought to be essential for several brain functions. It has been shown that neuronal sequences with weak feedforward connectivity can be replayed due to amplification via intra-assembly recurrent connections. However, the mechanisms behind this phenomenon are still unclear. Here, we simulate spiking networks with different excitatory and inhibitory connectivity and find that an exclusively excitatory network is sufficient for this amplification to occur. To explain the spiking network behavior, we introduce a population model of membrane-potential distributions, and we analytically describe how different connectivity structures determine replay speed, with weaker feedforward connectivity generating slower and wider pulses that can be sustained by recurrent connections. Pulse propagation is facilitated if the neuronal membrane time constant is large compared to the pulse width. Together, our simulations and analytical results predict the conditions for replay of neuronal assemblies.

从皮质共火链到海马体回放,神经群可以通过精确的脉冲时间顺序激活的想法被认为对几种大脑功能至关重要。研究表明,具有弱前馈连接的神经元序列可以通过组装内循环连接的放大而重放。然而,这一现象背后的机制尚不清楚。在这里,我们模拟了具有不同兴奋性和抑制性连接的尖峰网络,并发现一个专门的兴奋性网络足以使这种放大发生。为了解释脉冲网络行为,我们引入了一个膜电位分布的种群模型,并分析描述了不同的连接结构如何决定重放速度,较弱的前馈连接产生更慢、更宽的脉冲,这些脉冲可以通过循环连接来维持。与脉冲宽度相比,如果神经元膜时间常数较大,则有利于脉冲传播。我们的模拟和分析结果共同预测了神经元组装重播的条件。
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引用次数: 0
TCR2HLA: Calibrated inference of HLA genotypes from TCR repertoires enables identification of immunologically relevant metaclonotypes. TCR2HLA:从TCR基因库中对HLA基因型进行校准推断,可以识别免疫相关的元克隆型。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-16 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013767
Koshlan Mayer-Blackwell, Anastasia Minervina, Mikhail Pogorelyy, Puneet Rawat, Melanie R Shapiro, Leeana D Peters, Emily S Ford, Amanda L Posgai, Kasi Vegesana, Samuel Minot, David M Koelle, Victor Greiff, Philip Bradley, Todd M Brusko, Paul G Thomas, Andrew Fiore-Gartland

T cell receptors (TCRs) recognize peptides presented by polymorphic human leukocyte antigen (HLA) molecules, but HLA genotype data are often missing from TCR repertoire sequencing studies. To address this, we developed TCR2HLA, an open-source tool that infers HLA genotypes from TCRβ repertoires. Expanding on work linking public TRBV-CDR3 sequences to HLA genotypes, we incorporated "quasi-public" metaclonotypes - composed of rarer TCRβ sequences with shared amino acid features - enriched by HLA genotypes. Using four TCRβseq datasets from 3,150 individuals, we applied TRBV gene partitioning and locality-sensitive hashing to identify ~96,000 TCRβ features strongly associated with specific HLA alleles from 71M input TCRs. Binary HLA classifiers built with these features achieved high balanced accuracy (>0.9) across common HLA-A (9/12), B (9/12), C (6/13), DRB1 (11/11) alleles and prevalent DPA1/DPB1 (6/10), DQA1/DQB1 (8/17) heterodimers. We also introduced a high-sensitivity calibration to support predictions in samples with as few as 5,000 unique clonotypes. Calibrated predictions with confidence filtering improved reliability. Beyond genotype imputation, TCR2HLA enables the discovery of novel HLA- and exposure-associated TCRs, as shown by the identification of SARS-CoV-2 related TCRs in a large COVID-19 dataset lacking HLA data. TCR2HLA provides a scalable framework for bridging the gap between TCRseq data and HLA genotype for biomarker discovery.

T细胞受体(TCR)识别由多态人类白细胞抗原(HLA)分子呈现的肽,但在TCR库测序研究中往往缺少HLA基因型数据。为了解决这个问题,我们开发了TCR2HLA,这是一个从TCRβ基因库推断HLA基因型的开源工具。在将公共TRBV-CDR3序列与HLA基因型联系起来的基础上,我们引入了“准公共”元克隆型-由具有共享氨基酸特征的罕见TCRβ序列组成-通过HLA基因型富集。利用来自3150个个体的4个TCRβ序列数据集,我们应用TRBV基因划分和位置敏感哈希,从71M个输入tcr中鉴定出约96,000个与特定HLA等位基因密切相关的TCRβ特征。利用这些特征构建的HLA二元分类器在常见的HLA- a(9/12)、B(9/12)、C(6/13)、DRB1(11/11)等位基因和常见的DPA1/DPB1(6/10)、DQA1/DQB1(8/17)异源二聚体中获得了较高的平衡精度(>.9)。我们还引入了一种高灵敏度校准方法,以支持在只有5000种独特克隆型的样品中进行预测。用置信度滤波校准预测提高了可靠性。除了基因型代入之外,TCR2HLA还可以发现新的HLA和暴露相关的tcr,如在缺乏HLA数据的大型COVID-19数据集中鉴定出SARS-CoV-2相关的tcr所示。TCR2HLA为弥合TCRseq数据和HLA基因型之间的差距提供了一个可扩展的框架,用于生物标志物的发现。
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引用次数: 0
Correction: Competition and cooperation: The plasticity of bacterial interactions across environments. 更正:竞争与合作:细菌在不同环境中相互作用的可塑性。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-15 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013809
Josephine Solowiej-Wedderburn, Jennifer T Pentz, Ludvig Lizana, Bjoern O Schroeder, Peter A Lind, Eric Libby

[This corrects the article DOI: 10.1371/journal.pcbi.1013213.].

[这更正了文章DOI: 10.1371/journal.pcbi.1013213.]。
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引用次数: 0
Powerful large scale inference in high dimensional mediation analysis. 高维中介分析中强大的大规模推理。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-14 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013880
Asmita Roy, Xianyang Zhang

In genome-wide epigenetic studies, determining how exposures (e.g., Single Nucleotide Polymorphisms) affect outcomes (e.g., gene expression) through intermediate variables, such as DNA methylation, is a key challenge. Mediation analysis provides a framework to identify these causal pathways; however, testing for mediation effects involves a complex composite null hypothesis. Existing methods, such as Sobel's test or the Max-P test, are often underpowered in this context because they rely on null distributions determined under only a subset of the null space and are not optimized for the multiple testing burden inherent in high-dimensional data. To address these limitations, we introduce MLFDR (Mediation Analysis using Local False Discovery Rates), a novel method for high-dimensional mediation analysis. MLFDR leverages local false discovery rates, calculated from the coefficients of structural equation models, to construct an optimal rejection region. We demonstrate theoretically and through simulation that MLFDR asymptotically controls the false discovery rate and achieves superior statistical power compared to recent high-dimensional mediation methods. In real data applications, MLFDR identified 20%-50% more significant mediators than existing methods, demonstrating its ability to uncover biological signals missed by conventional approaches.

在全基因组表观遗传学研究中,确定暴露(如单核苷酸多态性)如何通过中间变量(如DNA甲基化)影响结果(如基因表达)是一个关键挑战。调解分析提供了一个框架,以确定这些因果途径;然而,中介效应的检验涉及一个复杂的复合零假设。现有的方法,如Sobel测试或Max-P测试,在这种情况下往往能力不足,因为它们依赖于仅在零空间的一个子集下确定的零分布,并且没有针对高维数据固有的多重测试负担进行优化。为了解决这些限制,我们引入了MLFDR(使用局部错误发现率的中介分析),这是一种用于高维中介分析的新方法。MLFDR利用从结构方程模型的系数计算的局部错误发现率来构建最优拒绝区域。我们从理论和仿真两方面证明了MLFDR算法可以渐近地控制错误发现率,并且与现有的高维中介方法相比,具有更好的统计能力。在实际数据应用中,MLFDR识别出的重要介质比现有方法多20%-50%,证明了其发现传统方法遗漏的生物信号的能力。
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引用次数: 0
Peak strain dispersion as a nonlinear mediator in HFpEF: Unraveling subtype-specific pathways via SHAP-augmented ensemble modeling. 峰值应变色散作为HFpEF的非线性介质:通过shap增强集合模型揭示亚型特异性途径。
IF 3.6 2区 生物学 Q1 BIOCHEMICAL RESEARCH METHODS Pub Date : 2026-01-14 eCollection Date: 2026-01-01 DOI: 10.1371/journal.pcbi.1013891
Mingming Lin, Kai Li, Xiaofan Wang, Juanjuan Sun, Kun Gong, Zhibin Wang, Pin Sun
<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) represents a heterogeneous syndrome with diverse pathophysiological mechanisms and limited therapeutic options. Peak strain dispersion (PSD) has emerged as a potential mediator in HFpEF pathophysiology. This study aimed to identify distinct HFpEF subtypes and investigate PSD's subtype-specific mediating pathways.</p><p><strong>Methods: </strong>This prospective single-center study included 150 HFpEF patients recruited from December 2023 to December 2024. Unsupervised K-means clustering was performed on the entire cohort to identify patient subtypes. For detailed analysis, rigorous data quality control was performed by removing cases with missing values in any of the 25 baseline features or outcome variables. Consequently, 84 patients with complete data were retained for analysis. Comprehensive clinical and echocardiographic data were collected, including PSD measured by speckle-tracking echocardiography and myocardial work parameters (global work waste and global work efficiency). Unsupervised K-means clustering was performed to identify distinct patient subtypes using eight key variables. Machine learning models with feature engineering (incorporating five clinically meaningful interaction terms: PSD_LVEF, age_HTN, eGFR_BNP, RWT_E/e', and GLS_LVMI) were developed to predict myocardial work parameters and assess feature importance using SHAP (SHapley Additive exPlanations) analysis. Nonlinear mediation analysis was conducted within each subtype to evaluate the mediating pathways through which clinical factors influence myocardial work outcomes.</p><p><strong>Results: </strong>Two distinct HFpEF subtypes were identified: Cluster 0 characterized by younger age (58.6 ± 13.2 years), severe renal dysfunction (eGFR 12.8[8.9-19.9] mL/min/1.73m²), higher PSD (56.0[48.0-64.5] ms), and lower global work efficiency; and Cluster 1 characterized by older age (71.2 ± 9.7 years), preserved renal function (eGFR 104.0[78.5-126.0] mL/min/1.73m²), lower PSD (41.0[35.0-49.0] ms), and higher GWE. Machine learning models achieved moderate to good predictive performance (R² = 0.58-0.61 for GWE and GWW). SHAP analysis revealed that PSD was the most important predictor, with the PSD×LVEF interaction term showing prominent importance in GWE prediction. Nonlinear mediation analysis demonstrated striking subtype-specific differences in mediation patterns.In Cluster 0, eGFR showed a trend toward mediating its effects on GWW through PSD (indirect effect = 0.313), reflecting complex cardiorenal interactions in younger patients with severe renal disease. In contrast, Cluster 1 demonstrated significant mediation effects: BNP's effect on GWW was significantly mediated through PSD (indirect effect = -0.4877, P < 0.05), and BNP's effect on GWE was entirely mediated through PSD (indirect effect = 0.5389, P < 0.05).</p><p><strong>Conclusion: </strong>This study identified two distinct HFpEF subtype
背景:保留射血分数的心力衰竭(HFpEF)是一种异质性综合征,具有多种病理生理机制和有限的治疗选择。峰值应变分散(PSD)已成为HFpEF病理生理的潜在介质。本研究旨在鉴定不同的HFpEF亚型,并探讨PSD亚型特异性的介导途径。方法:本前瞻性单中心研究纳入了从2023年12月至2024年12月招募的150例HFpEF患者。对整个队列进行无监督k均值聚类以确定患者亚型。为了进行详细的分析,通过去除25个基线特征或结果变量中任何缺失值的病例,进行了严格的数据质量控制。因此,84例数据完整的患者被保留用于分析。收集全面的临床和超声心动图数据,包括斑点跟踪超声心动图测量的PSD和心肌工作参数(全局工作浪费和全局工作效率)。使用8个关键变量进行无监督k均值聚类来识别不同的患者亚型。采用特征工程的机器学习模型(包含五个临床有意义的相互作用术语:PSD_LVEF、age_HTN、eGFR_BNP、RWT_E/e’和GLS_LVMI)被开发出来,用于预测心肌工作参数,并使用SHAP (SHapley Additive exPlanations)分析评估特征的重要性。对各亚型进行非线性中介分析,评价临床因素影响心肌工作结果的中介途径。结果:确定了两种不同的HFpEF亚型:集群0的特征是年龄较小(58.6±13.2岁),肾功能严重(eGFR 12.8[8.9-19.9] mL/min/1.73m²),PSD较高(56.0[48.0-64.5]ms),整体工作效率较低;第1组年龄较大(71.2±9.7岁),肾功能保存(eGFR 104.0[78.5-126.0] mL/min/1.73m²),PSD低(41.0[35.0-49.0]ms), GWE高。机器学习模型实现了中等到良好的预测性能(对于GWE和GWW, R²= 0.58-0.61)。SHAP分析显示PSD是最重要的预测因子,PSD×LVEF相互作用项在GWE预测中表现出突出的重要性。非线性中介分析显示了显著的亚型特异性中介模式差异。在第0组中,eGFR表现出通过PSD介导GWW的趋势(间接效应= 0.313),反映了年轻重症肾病患者复杂的心肾相互作用。与此相反,第1组表现出显著的中介作用:BNP对GWW的影响是通过PSD介导的(间接效应= -0.4877,P)。结论:本研究确定了两种不同的HFpEF亚型,它们的病理生理机制有着根本不同。集群0通过心肾相互作用显示PSD介导的作用,而集群1显示较弱的PSD介导作用,表明年龄相关机制通过较少依赖于心肌机械非同步化的途径起作用。这些发现支持HFpEF的异质性,并强调PSD是亚型特异性风险分层和治疗靶向的有价值的生物标志物。
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