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Importance SARS-CoV-2 has infected over 200 million people worldwide, resulting in more than 4 million deaths. Randomized controlled trials are the single best tool to identify effective treatments against this novel pathogen. Objective To describe the characteristics of randomized controlled trials of treatments for COVID-19 in the United States launched in the first 9 months of the pandemic. Design, Setting, and Participants We conducted a cross-sectional study of all completed or actively enrolling randomized, interventional, clinical trials for the treatment of COVID-19 in the United States registered on www.clinicaltrials.gov as of August 10, 2020. We excluded trials of vaccines and other interventions intended to prevent COVID-19. Main Outcomes and Measures We used descriptive statistics to characterize the clinical trials and the statistical power for the available studies. For the late-phase trials (i.e., phase 3 and 2/3 studies), we compared the geographic distribution of the clinical trials with the geographic distribution of people diagnosed with COVID-19. Results We identified 200 randomized controlled trials of treatments for people with COVID-19. Across all trials, 87 (43.5%) were single-center, 64 (32.0%) were unblinded, and 80 (40.0%) were sponsored by industry. The most common treatments included monoclonal antibodies (N=46 trials), small molecule immunomodulators (N=28), antiviral medications (N=24 trials), and hydroxychloroquine (N=20 trials). Of the 9 trials completed by August 2020, the median sample size was 450 (IQR 67–1113); of the 191 ongoing trials, the median planned sample size was 150 (IQR 60–400). Of the late-phase trials (N=54), the most common primary outcome was a severity scale (N=23, 42.6%), followed by a composite of mortality and ventilation (N=10, 18.5%), and mortality alone (N=6, 11.1%). Among these late-phase trials, all trials of antivirals, monoclonal antibodies, or chloroquine/hydroxychloroquine had a power of less than 25% to detect a 20% relative risk reduction in mortality. Had the individual trials for a given class of treatments instead formed a single trial, the power to detect that same reduction in mortality would have been greater than 98%. There was large variability in access to trials with the highest number of trials per capita in the Northeast and the lowest in the Midwest. Conclusions and Relevance A large number of randomized trials were launched early in the pandemic to evaluate treatments for COVID-19. However, many trials were underpowered for important clinical endpoints and substantial geographic disparities were observed, highlighting the importance of improving national clinical trial infrastructure. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07167-9.

Single-cell transcriptomic data measured across distinct samples has led to a surge in computational methods for data integration. Few studies have explicitly examined the common case of cell-type imbalance between datasets to be integrated, and none have characterized its impact on downstream analyses. To address this gap, we developed theIniquitatepipeline for assessing the stability of single-cell RNA sequencing (scRNA-seq) integration results after perturbing the degree of imbalance between datasets. Through benchmarking 5 state-of-the-art scRNA-seq integration techniques in 1600 perturbed integration scenarios for a multi-sample peripheral blood mononuclear cell (PBMC) dataset, our results indicate that sample imbalance has significant impacts on downstream analyses and the biological interpretation of integration results. We observed significant variation in clustering, cell-type classification, marker gene-based annotation, and query-to-reference mapping in imbalanced settings. Two key factors were found to lead to quantitation differences after scRNA-seq integration - the cell-type imbalance within and between samples (relative cell-type support) and the relatedness of cell-types across samples (minimum cell-type center distance). To account for evaluation gaps in imbalanced contexts, we developed novel clustering metrics robust to sample imbalance, including the balanced Adjusted Rand Index (bARI) and balanced Adjusted Mutual Information (bAMI). Our analysis quantifies biologically-relevant effects of dataset imbalance in integration scenarios and introduces guidelines and novel metrics for integration of disparate datasets. The Iniquitate pipeline and balanced clustering metrics are available athttps://github.com/hsmaan/Iniquitateandhttps://github.com/hsmaan/balanced-clustering, respectively.

PurposeScreening with low-dose computed tomography can reduce lung cancer-related mortality. However, most screen-detected pulmonary abnormalities do not develop into cancer and it remains challenging to identify high-risk nodules among those with indeterminate appearance. We aim to develop and validate prediction models to discriminate between benign and malignant pulmonary lesions based on radiological features.MethodsUsing four international lung cancer screening studies, we extracted 2,060 radiomic features for each of 16,797 nodules among 6,865 participants. After filtering out redundant and low-quality radiomic features, 642 radiomic and 9 epidemiologic features remained for model development. We used cross-validation and grid search to assess three machine learning models (XGBoost, Random Forest, LASSO) for their ability to accurately predict risk of malignancy for pulmonary nodules. We fit the top-performing ML model in the full training set. We report model performance based on the area under the curve (AUC) and calibration metrics in the held-out test set.ResultsThe ML models that yielded the best predictive performance in cross-validation were XGBoost and LASSO, and among these models, LASSO had superior model calibration, which we considered to be the optimal model. We fit the final LASSO model based on the optimized hyperparameter from cross-validation. Our radiomics model was both well-calibrated and had a test-set AUC of 0.930 (95% CI: 0.901-0.957) and out-performed the established Brock model (AUC=0.868, 95% CI: 0.847-0.888) for nodule assessment.ConclusionWe developed highly-accurate machine learning models based on radiomic and epidemiologic features from four international lung cancer screening studies that may be suitable for assessing suspicious, but indeterminate, screen-detected pulmonary nodules for risk of malignancy.

Angiogenesis inhibitor drugs targeting vascular endothelial growth factor (VEGF) signaling to the endothelial cell (EC) are used to treat various cancer types. However, primary or secondary resistance to therapy is common. Clinical and pre-clinical studies suggest that alternative pro-angiogenic factors are upregulated after VEGF pathway inhibition. Therefore, identification of alternative pro-angiogenic pathway(s) is critical for the development of more effective anti-angiogenic therapy. Here we study the role of apelin as a pro-angiogenic G-protein-coupled receptor ligand in tumor growth and angiogenesis. We found that loss of apelin in mice delayed the primary tumor growth of Lewis lung carcinoma 1 and B16F10 melanoma when combined with the VEGF receptor tyrosine kinase inhibitor, sunitinib. Targeting apelin in combination with sunitinib markedly reduced the tumor vessel density, and decreased microvessel remodeling. Apelin loss reduced angiogenic sprouting and tip cell marker gene expression in comparison to the sunitinib-alone-treated mice. Single-cell RNA sequencing of tumor EC demonstrated that the loss of apelin prevented EC tip cell differentiation. Thus, apelin is a potent pro-angiogenic cue that supports initiation of tumor neovascularization. Together, our data suggest that targeting apelin may be useful as adjuvant therapy in combination with VEGF signaling inhibition to inhibit the growth of advanced tumors.

Many practical applications require optimization of multiple, computationally expensive, and possibly competing objectives that are well-suited for multi-objective Bayesian optimization (MOBO) procedures. However, for many types of biomedical data, measures of data analysis workflow success are often heuristic and therefore it is not known a priori which objectives are useful. Thus, MOBO methods that return the full Pareto front may be suboptimal in these cases. Here we propose a novel MOBO method that adaptively updates the scalarization function using properties of the posterior of a multi-output Gaussian process surrogate function. This approach selects useful objectives based on a flexible set of desirable criteria, allowing the functional form of each objective to guide optimization. We demonstrate the qualitative behaviour of our method on toy data and perform proof-of-concept analyses of single-cell RNA sequencing and highly multiplexed imaging datasets.