Large language models (LLMs) have transformed AI and achieved breakthrough performance on a wide range of tasks that require human intelligence. In science, perhaps the most interesting application of LLMs is for hypothesis formation. A feature of LLMs, which results from their probabilistic structure, is that the output text is not necessarily a valid inference from the training text. These are 'hallucinations', and are a serious problem in many applications. However, in science, hallucinations may be useful: they are novel hypotheses whose validity may be tested by laboratory experiments. Here we experimentally test the use of LLMs as a source of scientific hypotheses using the domain of breast cancer treatment. We applied the LLM GPT4 to hypothesize novel pairs of FDA-approved non-cancer drugs that target the MCF7 breast cancer cell line relative to the non-tumorigenic breast cell line MCF10A. In the first round of laboratory experiments GPT4 succeeded in discovering three drug combinations (out of 12 tested) with synergy scores above the positive controls. These combinations were itraconazole + atenolol, disulfiram + simvastatin and dipyridamole + mebendazole. GPT4 was then asked to generate new combinations after considering its initial results. It then discovered three more combinations with positive synergy scores (out of four tested), these were disulfiram + fulvestrant, mebendazole + quinacrine and disulfiram + quinacrine. A limitation of GPT4 as a generator of hypotheses was that its explanations for them were formulaic and unconvincing. We conclude that LLMs are an exciting novel source of scientific hypotheses.

In this mini-review, we explore the new prediction methods for drug combination synergy relying on high-throughput combinatorial screens. The fast progress of the field is witnessed in the more than thirty original machine learning methods published since 2021, a clear majority of them based on deep learning techniques. We aim to put these papers under a unifying lens by highlighting the core technologies, the data sources, the input data types and synergy scores used in the methods, as well as the prediction scenarios and evaluation protocols that the papers deal with. Our finding is that the best methods accurately solve the synergy prediction scenarios involving known drugs or cell lines while the scenarios involving new drugs or cell lines still fall short of an accurate prediction level.

The pursuit of optimizing cancer therapies is significantly advanced by the accurate prediction of drug synergy. Traditional methods, such as clinical trials, are reliable yet encumbered by extensive time and financial demands. The emergence of high-throughput screening and computational innovations has heralded a shift towards more efficient methodologies for exploring drug interactions. In this study, we present VQSynergy, a novel framework that employs the Vector Quantization (VQ) mechanism, integrated with gated residuals and a tailored attention mechanism, to enhance the precision and generalizability of drug synergy predictions. Our findings demonstrate that VQSynergy surpasses existing models in terms of robustness, particularly under Gaussian noise conditions, highlighting its superior performance and utility in the complex and often noisy domain of drug synergy research. This study underscores the potential of VQSynergy in revolutionizing the field through its advanced predictive capabilities, thereby contributing to the optimization of cancer treatment strategies.

Synergistic drug combinations provide huge potentials to enhance therapeutic efficacy and to reduce adverse reactions. However, effective and synergistic drug combination prediction remains an open question because of the unknown causal disease signaling pathways. Though various deep learning (AI) models have been proposed to quantitatively predict the synergism of drug combinations, the major limitation of existing deep learning methods is that they are inherently not interpretable, which makes the conclusions of AI models untransparent to human experts, henceforth limiting the robustness of the model conclusion and the implementation ability of these models in real-world human--AI healthcare. In this paper, we develop an interpretable graph neural network (GNN) that reveals the underlying essential therapeutic targets and the mechanism of the synergy (MoS) by mining the sub-molecular network of great importance. The key point of the interpretable GNN prediction model is a novel graph pooling layer, a self-attention-based node and edge pool (henceforth SANEpool), that can compute the attention score (importance) of genes and connections based on the genomic features and topology. As such, the proposed GNN model provides a systematic way to predict and interpret the drug combination synergism based on the detected crucial sub-molecular network. Experiments on various well-adopted drug-synergy-prediction datasets demonstrate that (1) the SANEpool model has superior predictive ability to generate accurate synergy score prediction, and (2) the sub-molecular networks detected by the SANEpool are self-explainable and salient for identifying synergistic drug combinations.

For large libraries of small molecules, exhaustive combinatorial chemical screens become infeasible to perform when considering a range of disease models, assay conditions, and dose ranges. Deep learning models have achieved state of the art results in silico for the prediction of synergy scores. However, databases of drug combinations are biased towards synergistic agents and these results do not necessarily generalise out of distribution. We employ a sequential model optimization search utilising a deep learning model to quickly discover synergistic drug combinations active against a cancer cell line, requiring substantially less screening than an exhaustive evaluation. Our small scale wet lab experiments only account for evaluation of ~5% of the total search space. After only 3 rounds of ML-guided in vitro experimentation (including a calibration round), we find that the set of drug pairs queried is enriched for highly synergistic combinations; two additional rounds of ML-guided experiments were performed to ensure reproducibility of trends. Remarkably, we rediscover drug combinations later confirmed to be under study within clinical trials. Moreover, we find that drug embeddings generated using only structural information begin to reflect mechanisms of action. Prior in silico benchmarking suggests we can enrich search queries by a factor of ~5-10x for highly synergistic drug combinations by using sequential rounds of evaluation when compared to random selection, or by a factor of >3x when using a pretrained model selecting all drug combinations at a single time point.

Treatments targeting complex diseases, such as cancer, frequently lead to acquired drug resistance, due to patient-specific variability. For instance, drugs targeting only one key component of growth or proliferation pathways, may lead to selective pressure and activation of a compensatory mechanism [1], thus making this treatment suboptimal. However, during multi-target inhibition with reduced stringency, drug resistance is less likely. Therefore, the implementation of combination therapy might improve patient treatment as different drugs may target distinct pathways or genes, likely leading to decreased cancer cell survival. In addition to the increased efficacy, combination therapy often reduces toxicity and decreases the likelihood of treatment resistance compared to monotherapy (i.e., single drug) treatments [2]. Due to advancements in high-throughput screening (HTS), the number of drug screening datasets has been growing in recent years. Some examples include the NCI-ALMANAC dataset [3] which contains 103 FDA-approved drugs tested in 60 different cell lines (NCI-60) [4] or the large oncology dataset produced by Merck&Co [5] which is composed of 38 drugs tested in 39 different cell lines from 6 different tissue types.

We investigate molecular mechanisms of resistant or sensitive response of cancer drug combination therapies in an inductive and interpretable manner. Though deep learning algorithms are widely used in the drug synergy prediction problem, it is still an open problem to formulate the prediction model with biological meaning to investigate the mysterious mechanisms of synergy (MoS) for the human-AI collaboration in healthcare systems. To address the challenges, we propose a deep graph neural network, IDSP (Interpretable Deep Signaling Pathways), to incorporate the gene-gene as well as gene-drug regulatory relationships in synergic drug combination predictions. IDSP automatically learns weights of edges based on the gene and drug node relations, i.e., signaling interactions, by a multi-layer perceptron (MLP) and aggregates information in an inductive manner. The proposed architecture generates interpretable drug synergy prediction by detecting important signaling interactions, and can be implemented when the underlying molecular mechanism encounters unseen genes or signaling pathways. We test IDWSP on signaling networks formulated by genes from 46 core cancer signaling pathways and drug combinations from NCI ALMANAC drug combination screening data. The experimental results demonstrated that 1) IDSP can learn from the underlying molecular mechanism to make prediction without additional drug chemical information while achieving highly comparable performance with current state-of-art methods; 2) IDSP show superior generality and flexibility to implement the synergy prediction task on both transductive tasks and inductive tasks. 3) IDSP can generate interpretable results by detecting different salient signaling patterns (i.e. MoS) for different cell lines.

One of the promising methods for the treatment of complex diseases such as cancer is combinational therapy. Due to the combinatorial complexity, machine learning models can be useful in this field, where significant improvements have recently been achieved in determination of synergistic combinations. In this study, we investigate the effectiveness of different compound representations in predicting the drug synergy. On a large drug combination screen dataset, we first demonstrate the use of a promising representation that has not been used for this problem before, then we propose an ensemble on representation-model combinations that outperform each of the baseline models. 1 Scientific Background A drug combination is called synergistic if the effect of the drug combination on the reference cell is greater than the total effect taken from the administration of the individual drugs. If the opposite situation is observed, the drug combination is called antagonistic . Understanding whether a combination is antagonistic or synergistic is a resource and time intensive task.

Drug resistance is still a major challenge in cancer therapy. Drug combination is expected to overcome drug resistance. However, the number of possible drug combinations is enormous, and thus it is infeasible to experimentally screen all effective drug combinations considering the limited resources. Therefore, computational models to predict and prioritize effective drug combinations is important for combinatory therapy discovery in cancer. In this study, we proposed a novel deep learning model, AuDNNsynergy, to prediction drug combinations by integrating multi-omics data and chemical structure data. In specific, three autoencoders were trained using the gene expression, copy number and genetic mutation data of all tumor samples from The Cancer Genome Atlas. Then the physicochemical properties of drugs combined with the output of the three autoencoders, characterizing the individual cancer cell-lines, were used as the input of a deep neural network that predicts the synergy value of given pair-wise drug combinations against the specific cancer cell-lines. The comparison results showed the proposed AuDNNsynergy model outperforms four state-of-art approaches, namely DeepSynergy, Gradient Boosting Machines, Random Forests, and Elastic Nets. Moreover, we conducted the interpretation analysis of the deep learning model to investigate potential vital genetic predictors and the underlying mechanism of synergistic drug combinations on specific cancer cell-lines.