Comorbidities of Keloid and Hypertrophic Scars Among Participants in UK Biobank

Importance

Keloids and hypertrophic scars (excessive scarring) are relatively understudied disfiguring chronic skin conditions with high treatment resistance.

Objective

To evaluate established comorbidities of excessive scarring in European individuals, with comparisons across ethnic groups, and to identify novel comorbidities via a phenome-wide association study (PheWAS).

Design, Setting, and Participants

This multicenter cross-sectional population-based cohort study used UK Biobank (UKB) data and fitted logistic regression models for testing associations between excessive scarring and a variety of outcomes, including previously studied comorbidities and 1518 systematically defined disease categories. Additional modeling was performed within subgroups of participants defined by self-reported ethnicity (as defined in UK Biobank). Of 502 701 UKB participants, analyses were restricted to 230078 individuals with linked primary care records.

Exposures

Keloid or hypertrophic scar diagnoses.

Main Outcomes and Measures

Previously studied disease associations (hypertension, uterine leiomyoma, vitamin D deficiency, atopic eczema) and phenotypes defined in the PheWAS Catalog.

Results

Of the 972 people with excessive scarring, there was a higher proportion of female participants compared with the 229 106 controls (65% vs 55%) and a lower proportion of White ethnicity (86% vs 95%); mean (SD) age of the total cohort was 64 (8) years. Associations were identified with hypertension and atopic eczema in models accounting for age, sex, and ethnicity, and the association with atopic eczema (odds ratio [OR], 1.68; 95% CI, 1.36-2.07; P < .001) remained statistically significant after accounting for additional potential confounders. Fully adjusted analyses within ethnic groups revealed associations with hypertension in Black participants (OR, 2.05; 95% CI, 1.13-3.72; P = .02) and with vitamin D deficiency in Asian participants (OR, 2.24; 95% CI, 1.26-3.97; P = .006). The association with uterine leiomyoma was borderline significant in Black women (OR, 1.93; 95% CI, 1.00-3.71; P = .05), whereas the association with atopic eczema was significant in White participants (OR, 1.68; 95% CI, 1.34-2.12; P < .001) and showed a similar trend in Asian (OR, 2.17; 95% CI, 1.01-4.67; P = .048) and Black participants (OR, 1.89; 95% CI, 0.83-4.28; P = .13). The PheWAS identified 110 significant associations across disease systems; of the nondermatological, musculoskeletal disease and pain symptoms were prominent.

Conclusions and Relevance

This cross-sectional study validated comorbidities of excessive scarring in UKB with comprehensive coverage of health outcomes. It also documented additional phenome-wide associations that will serve as a reference for future studies to investigate common underlying pathophysiologic mechanisms.

Primary cutaneous nodular amyloidosis associated with psoriasis

Primary cutaneous nodular amyloidosis (PCNA) presents as solitary or multiple firm, waxy nodules with a predilection for acral areas. Histologically, PCNA can be identical to myeloma-associated systemic amyloidosis with monoclonal immunoglobulin light chain deposits. We describe a patient in whom PCNA developed in a scar in an area affected by chronic plaque psoriasis. PCNA has previously been associated with other autoimmune diseases, but to our knowledge, this is the first association with psoriasis. Interestingly, T helper (Th)17 cells, which are crucial in psoriasis pathogenesis, have recently been implicated in promotion of myeloma and plasma cell dyscrasias. The association of psoriasis and plasma-cell light chain production in the skin, as in this case, suggests a possible role for Th17 cells in PCNA formation. The dermatopathological literature of this rare but important disease is discussed.

Machine learning approaches for predicting compounds that interact with therapeutic and ADMET related proteins

Computational methods for predicting compounds of specific pharmacodynamic and ADMET (absorption, distribution, metabolism, excretion and toxicity) property are useful for facilitating drug discovery and evaluation. Recently, machine learning methods such as neural networks and support vector machines have been explored for predicting inhibitors, antagonists, blockers, agonists, activators and substrates of proteins related to specific therapeutic and ADMET property. These methods are particularly useful for compounds of diverse structures to complement QSAR methods, and for cases of unavailable receptor 3D structure to complement structure-based methods. A number of studies have demonstrated the potential of these methods for predicting such compounds as substrates of P-glycoprotein and cytochrome P450 CYP isoenzymes, inhibitors of protein kinases and CYP isoenzymes, and agonists of serotonin receptor and estrogen receptor. This article is intended to review the strategies, current progresses and underlying difficulties in using machine learning methods for predicting these protein binders and as potential virtual screening tools. Algorithms for proper representation of the structural and physicochemical properties of compounds are also evaluated.

Usefulness of traditionally defined herbal properties for distinguishing prescriptions of traditional Chinese medicine from non-prescription recipes

Traditional Chinese medicine (TCM) has been widely practiced and is considered as an attractive to conventional medicine. Multi-herb recipes have been routinely used in TCM. These have been formulated by using TCM-defined herbal properties (TCM-HPs), the scientific basis of which is unclear. The usefulness of TCM-HPs was evaluated by analyzing the distribution pattern of TCM-HPs of the constituent herbs in 1161 classical TCM prescriptions, which shows patterns of multi-herb correlation. Two artificial intelligence (AI) methods were used to examine whether TCM-HPs are capable of distinguishing TCM prescriptions from non-TCM recipes. Two AI systems were trained and tested by using 1161 TCM prescriptions, 11,202 non-TCM recipes, and two separate evaluation methods. These systems correctly classified 83.1-97.3% of the TCM prescriptions, 90.8-92.3% of the non-TCM recipes. These results suggest that TCM-HPs are capable of separating TCM prescriptions from non-TCM recipes, which are useful for formulating TCM prescriptions and consistent with the expected correlation between TCM-HPs and the physicochemical properties of herbal ingredients responsible for producing the collective pharmacological and other effects of specific TCM prescriptions.

Computer prediction of cardiovascular and hematological agents by statistical learning methods

Computational methods have been explored for predicting agents that produce therapeutic or adverse effects in cardiovascular and hematological systems. The quantitative structure-activity relationship (QSAR) method is the first statistical learning methods successfully used for predicting various classes of cardiovascular and hematological agents. In recent years, more sophisticated statistical learning methods have been explored for predicting cardiovascular and hematological agents particularly those of diverse structures that might not be straightforwardly modelled by single QSAR models. These methods include partial least squares, multiple linear regressions, linear discriminant analysis, k-nearest neighbour, artificial neural networks and support vector machines. Their application potential has been exhibited in the prediction of various classes of cardiovascular and hematological agents including 1, 4-dihydropyridine calcium channel antagonists, angiotensin converting enzyme inhibitors, thrombin inhibitors, AchE inhibitors, HERG potassium channel inhibitors and blockers, potassium channel openers, platelet aggregation inhibitors, protein kinase inhibitors, dopamine antagonists and torsade de pointes causing agents. This article reviews the strategies, current progresses and problems in using statistical learning methods for predicting cardiovascular and hematological agents. It also evaluates algorithms for properly representing and extracting the structural and physicochemical properties of compounds relevant to the prediction of cardiovascular and hematological agents.

Database of traditional Chinese medicine and its application to studies of mechanism and to prescription validation

BACKGROUND AND PURPOSE

Traditional Chinese Medicine (TCM) is widely practised and is viewed as an attractive alternative to conventional medicine. Quantitative information about TCM prescriptions, constituent herbs and herbal ingredients is necessary for studying and exploring TCM.

EXPERIMENTAL APPROACH

We manually collected information on TCM in books and other printed sources in Medline. The Traditional Chinese Medicine Information Database TCM-ID, at http://tcm.cz3.nus.edu.sg/group/tcm-id/tcmid.asp, was introduced for providing comprehensive information about all aspects of TCM including prescriptions, constituent herbs, herbal ingredients, molecular structure and functional properties of active ingredients, therapeutic and side effects, clinical indication and application and related matters.

RESULTS

TCM-ID currently contains information for 1,588 prescriptions, 1,313 herbs, 5,669 herbal ingredients, and the 3D structure of 3,725 herbal ingredients. The value of the data in TCM-ID was illustrated by using some of the data for an in-silico study of molecular mechanism of the therapeutic effects of herbal ingredients and for developing a computer program to validate TCM multi-herb preparations.

CONCLUSIONS AND IMPLICATIONS

The development of systems biology has led to a new design principle for therapeutic intervention strategy, the concept of 'magic shrapnel' (rather than the 'magic bullet'), involving many drugs against multiple targets, administered in a single treatment. TCM offers an extensive source of examples of this concept in which several active ingredients in one prescription are aimed at numerous targets and work together to provide therapeutic benefit. The database and its mining applications described here represent early efforts toward exploring TCM for new theories in drug discovery.

Classification of a diverse set of Tetrahymena pyriformis toxicity chemical compounds from molecular descriptors by statistical learning methods

Toxicity of various compounds has been measured in many studies by their toxic effects against Tetrahymena pyriformis. Efforts have also been made to use computational quantitative structure-activity relationship (QSAR) and statistical learning methods (SLMs) for predicting Tetrahymena pyriformis toxicity (TPT) at impressive accuracies. Because of the diversity of compounds and toxicity mechanisms, it is desirable to explore additional methods and to examine if these methods are applicable to more diverse sets of compounds. We tested several SLMs (logistic regression, C4.5 decision tree, k-nearest neighbor, probabilistic neural network, support vector machines) for their capability in predicting TPT by using 1129 compounds (841 TPT and 288 non-TPT agents) which are more diverse than those in other studies. A feature selection method was used for improving prediction performance and selecting molecular descriptors responsible for distinguishing TPT and non-TPT agents. The prediction accuracies are 86.9% approximately 94.2% for TPT and 71.2% approximately 87.5% for non-TPT agents based on 5-fold cross-validation studies, which are comparable to some of earlier studies despite the use of more diverse sets of compounds. The selected molecular descriptors are consistent with those used in other studies and experimental findings. These suggest that SLMs are useful for predicting TPT potential of diverse sets of compounds and for characterizing the molecular descriptors associated with TPT.

Prediction of estrogen receptor agonists and characterization of associated molecular descriptors by statistical learning methods

Specific estrogen receptor (ER) agonists have been used for hormone replacement therapy, contraception, osteoporosis prevention, and prostate cancer treatment. Some ER agonists and partial-agonists induce cancer and endocrine function disruption. Methods for predicting ER agonists are useful for facilitating drug discovery and chemical safety evaluation. Structure-activity relationships and rule-based decision forest models have been derived for predicting ER binders at impressive accuracies of 87.1-97.6% for ER binders and 80.2-96.0% for ER non-binders. However, these are not designed for identifying ER agonists and they were developed from a subset of known ER binders. This work explored several statistical learning methods (support vector machines, k-nearest neighbor, probabilistic neural network and C4.5 decision tree) for predicting ER agonists from comprehensive set of known ER agonists and other compounds. The corresponding prediction systems were developed and tested by using 243 ER agonists and 463 ER non-agonists, respectively, which are significantly larger in number and structural diversity than those in previous studies. A feature selection method was used for selecting molecular descriptors responsible for distinguishing ER agonists from non-agonists, some of which are consistent with those used in other studies and the findings from X-ray crystallography data. The prediction accuracies of these methods are comparable to those of earlier studies despite the use of significantly more diverse range of compounds. SVM gives the best accuracy of 88.9% for ER agonists and 98.1% for non-agonists. Our study suggests that statistical learning methods such as SVM are potentially useful for facilitating the prediction of ER agonists and for characterizing the molecular descriptors associated with ER agonists.

In Silico Prediction of Pregnane X Receptor Activators by Machine Learning Approache

Pregnane X receptor (PXR) regulates drug metabolism and is involved in drug-drug interactions. Prediction of PXR activators is important for evaluating drug metabolism and toxicity. Computational pharmacophore and quantitative structure-activity relationship models have been developed for predicting PXR activators. Because of the structural diversity of PXR activators, more efforts are needed for exploring methods applicable to a broader spectrum of compounds. We explored three machine learning methods (MLMs) for predicting PXR activators, which were trained and tested by using significantly higher number of compounds, 128 PXR activators (98 human) and 77 PXR non-activators, than those of previous studies. The recursive feature-selection method was used to select molecular descriptors relevant to PXR activator prediction, which are consistent with conclusions from other computational and structural studies. In a 10-fold cross-validation test, our MLM systems correctly predicted 81.2 to 84.0% of PXR activators, 80.8 to 85.0% of hPXR activators, 61.2 to 70.3% of PXR nonactivators, and 67.7 to 73.6% of hPXR nonactivators. Our systems also correctly predicted 73.3 to 86.7% of 15 newly published hPXR activators. MLMs seem to be useful for predicting PXR activators and for providing clues to physicochemical features of PXR activation.

Prediction of compounds with specific pharmacodynamic, pharmacokinetic or toxicological property by statistical learning methods

Computational methods for predicting compounds of specific pharmacodynamic, pharmacokinetic, or toxicological property are useful for facilitating drug discovery and drug safety evaluation. The quantitative structure-activity relationship (QSAR) and quantitative structure-property relationship (QSPR) methods are the most successfully used statistical learning methods for predicting compounds of specific property. More recently, other statistical learning methods such as neural networks and support vector machines have been explored for predicting compounds of higher structural diversity than those covered by QSAR and QSPR. These methods have shown promising potential in a number of studies. This article is intended to review the strategies, current progresses and underlying difficulties in using statistical learning methods for predicting compounds of specific property. It also evaluates algorithms commonly used for representing structural and physicochemical properties of compounds.

Prediction of Genotoxicity of Chemical Compounds by Statistical Learning Methods

Various toxicological profiles, such as genotoxic potential, need to be studied in drug discovery processes and submitted to the drug regulatory authorities for drug safety evaluation. As part of the effort for developing low cost and efficient adverse drug reaction testing tools, several statistical learning methods have been used for developing genotoxicity prediction systems with an accuracy of up to 73.8% for genotoxic (GT+) and 92.8% for nongenotoxic (GT-) agents. These systems have been developed and tested by using less than 400 known GT+ and GT- agents, which is significantly less in number and diversity than the 860 GT+ and GT- agents known at present. There is a need to examine if a similar level of accuracy can be achieved for the more diverse set of molecules and to evaluate other statistical learning methods not yet applied to genotoxicity prediction. This work is intended for testing several statistical learning methods by using 860 GT+ and GT- agents, which include support vector machines (SVM), probabilistic neural network (PNN), k-nearest neighbor (k-NN), and C4.5 decision tree (DT). A feature selection method, recursive feature elimination, is used for selecting molecular descriptors relevant to genotoxicity study. The overall accuracies of SVM, k-NN, and PNN are comparable to and those of DT lower than the results from earlier studies, with SVM giving the highest accuracies of 77.8% for GT+ and 92.7% for GT- agents. Our study suggests that statistical learning methods, particularly SVM, k-NN, and PNN, are useful for facilitating the prediction of genotoxic potential of a diverse set of molecules.

Computer automated prediction of potential therapeutic and toxicity protein targets of bioactive compounds from Chinese medicinal plants

Understanding the molecular mechanism and pharmacology of bioactive compounds from Chinese medicinal plants (CMP) is important in facilitating scientific evaluation of novel therapeutic approaches in traditional Chinese medicine. It is also of significance in new drug development based on the mechanism of Chinese medicine. A key step towards this task is the determination of the therapeutic and toxicity protein targets of CMP compounds. In this work, newly developed computer software INVDOCK is used for automated identification of potential therapeutic and toxicity targets of several bioactive compounds isolated from Chinese medicinal plants. This software searches a protein database to find proteins to which a CMP compound can bind or weakly bind. INVDOCK results on three CMP compounds (allicin, catechin and camptotecin) show that 60% of computer-identified potential therapeutic protein targets and 27% of computer-identified potential toxicity targets have been implicated or confirmed by experiments. This software may potentially be used as a relatively fast-speed and low-cost tool for facilitating the study of molecular mechanism and pharmacology of bioactive compounds from Chinese medicinal plants and natural products from other sources.

Prediction of potential toxicity and side effect protein targets of a small molecule by a ligand-protein inverse docking approach

Determination of potential drug toxicity and side effect in early stages of drug development is important in reducing the cost and time of drug discovery. In this work, we explore a computer method for predicting potential toxicity and side effect protein targets of a small molecule. A ligand-protein inverse docking approach is used for computer-automated search of a protein cavity database to identify protein targets. This database is developed from protein 3D structures in the protein data bank (PDB). Docking is conducted by a procedure involving multiple conformer shape-matching alignment of a molecule to a cavity followed by molecular-mechanics torsion optimization and energy minimization on both the molecule and the protein residues at the binding region. Potential protein targets are selected by evaluation of molecular mechanics energy and, while applicable, further analysis of its binding competitiveness against other ligands that bind to the same receptor site in at least one PDB entry. Our results on several drugs show that 83% of the experimentally known toxicity and side effect targets for these drugs are predicted. The computer search successfully predicted 38 and missed five experimentally confirmed or implicated protein targets with available structure and in which binding involves no covalent bond. There are additional 30 predicted targets yet to be validated experimentally. Application of this computer approach can potentially facilitate the prediction of toxicity and side effect of a drug or drug lead.