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M.J.T. Reinders

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Advancing protein design is crucial for breakthroughs in medicine and biotechnology. Traditional approaches for protein sequence representation often rely solely on the 20 canonical amino acids, limiting the representation of non-canonical amino acids and residues that undergo post-translational modifications. This work explores discrete diffusion models for generating novel protein sequences using the all-atom chemical representation SELFIES. By encoding the atomic composition of each amino acid in the protein, this approach expands the design possibilities beyond standard sequence representations. Using a modified ByteNet architecture within the discrete diffusion D3PM framework, we evaluate the impact of this all-atom representation on protein quality, diversity, and novelty, compared to conventional amino acid-based models. To this end, we develop a comprehensive assessment pipeline to determine whether generated SELFIES sequences translate into valid proteins containing both canonical and non-canonical amino acids. Additionally, we examine the influence of two noise schedules within the diffusion process—uniform (random replacement of tokens) and absorbing (progressive masking)—on generation performance. While models trained on the all-atom representation struggle to consistently generate fully valid proteins, the successfully generated proteins show improved novelty and diversity compared to their amino acid-based model counterparts. Furthermore, the all-atom representation achieves structural foldability results comparable to those of amino acid-based models. Lastly, our results highlight the absorbing noise schedule as the most effective for both representations. Data and code are available at https://github.com/Intelligent-molecular-systems/All-Atom-Protein-Sequence-Generation. ...
Journal article (2026) - Laura Monteiro Rente Dias, Hugo Schnack, Daniel Geisler, Marcel Reinders, Tonya White, Gwen Dieleman, Xucong Zhang
Resting-state fMRI has been used to study aberrant functional connectivity properties in patients with anorexia nervosa (AN) at several stages of the illness. One popular way to extract these metrics is to use graph theory to showcase aberrant brain connectivity between patients with AN versus controls. However, most studies use classic analyses to investigate these differences, which could limit the number and choices of features used in one model. Instead, machine learning models have proven to be a promising tool in studying the functional connectivity of various disorders. In this study, we employ a combination of local graph metrics and a support vector machine to distinguish between first-onset AN (N = 56) cases and controls (N = 64). We replicate and extend prior work evaluating the predictive value of an existing machine learning approaches in detecting functional connectivity differences in patients with AN. Our method achieves an average classification accuracy of 65% with cross-validation evaluation. We further demonstrate that the results are driven mainly by the participation index of the nodes that are implicated in distinguishing the two groups. Our findings contribute to the growing body of evidence supporting the predictive value of resting-state fMRI in the study of anorexia nervosa. ...
Transcriptomic differences between individuals and sexes are well-documented across tissues, affecting cell-type identity. Single-cell atlases often have skewed sex ratios or limited donor diversity, potentially leading to sex- or donor-biased annotations using automatic classification methods. This might cause models to exacerbate existing biases from their training data. We investigated this by varying the sex ratio in a training set and assessing a cell-type classifier’s performance on fixed single-sex test sets. To separate sex and donor effects, we ran the experiment with and without donor information. We found that differences between donors negatively impact classification, as evidenced by poorer performance on unseen donors. However, this is not primarily due to sex bias; the model classified male and female cells similarly well, even when trained on highly sex-skewed data. We also found that large sex-based abundance differences between cell types can confound performance interpretation, creating apparent sex-biased patterns. Our findings suggest that atlas creators and classifier developers must carefully consider donor-specific biases in scRNA-seq data. ...
Journal article (2026) - Lieke Michielsen, Justine Hsu, Anoushka Joglekar, Natan Belchikov, Marcel J.T. Reinders, Hagen U. Tilgner, Ahmed Mahfouz
BACKGROUND: Alternative splicing contributes to molecular diversity across brain cell types. RNA-binding proteins (RBPs) regulate splicing, but the genome-wide mechanisms underlying cell-type-specific splicing remain poorly understood. RESULTS: Here, we want to unravel cell-type-specific splicing mechanisms by using RBP binding sites and/or the genomic sequence to predict exon inclusion in neurons and glia as measured by long-read single-cell data in the human hippocampus and frontal cortex. We found that exon inclusion of variable exons is harder to predict in neurons compared to glia in both brain regions. Comparing neurons and glia, the position of RBP binding sites in alternatively spliced exons in neurons differ more from non-variable exons indicating distinct splicing mechanisms. Model interpretation pinpointed RBPs, including QKI, potentially regulating alternative splicing between neurons and glia. Finally, we accurately predict and prioritize the effect of splicing QTLs. CONCLUSIONS: Our results indicate that the splicing mechanisms in variable exons in neurons diverged more from the standard mechanisms. Splicing in neurons might be less sequence-dependent and influenced more by, for instance, chromatin accessibility or methylation. Taken together, these results highlight new insights into the mechanisms regulating cell-type-specific alternative splicing in the brain. ...
Journal article (2026) - F.A. Bogaards, I. Groenendijk, T. Gehrmann, M. Beekman, N. Lakenberg, H. Eka D. Suchiman, L.P.G.M. de Groot, M.J.T. Reinders, P. E. Slagboom
Background: Nutritional weight-loss interventions are known to reduce bone mineral density (BMD), which can be prevented by adding (resistance) exercise training. However, this combined effect is not well studied in non-obese adults. In addition, the association between biomarkers and metabolite-based composite health markers with changes in BMD in such an intervention has not been studied as thoroughly. Objective: The aims of the current study were to investigate the effect of a combined nutritional and activity lifestyle intervention on lumbar spine and total body BMD in healthy middle-aged to older adults, and to relate these effects to a selection of immune-metabolic biomarkers, muscle mass and fat mass measurements, and two composite metabolite-based health scores. Methods: In this ancillary study of the single-arm Growing Old TOgether (GOTO) trial (trial registration number GOTNL3301 [https://onderzoekmetmensen.nl/nl/trial/27183], NL-OMON27183), 134 participants (mean age 62.9 years, 49% female) undertook a 13-week lifestyle modification, incorporating 12.5% caloric restriction and 12.5% increase in physical activity. The impact on lumbar spine and total body BMD was evaluated using dual-energy X-ray absorptiometry (DEXA). The intervention effect on BMD was related to changes in immune-metabolic biomarkers and two metabolite-based immune-metabolic health scores. Results: The trial significantly reduced bodyweight with 3.3 and 3.4 kg, consisting of 1.4 and 1.1 kg lean mass, in males (fdr < 0.001) and females (fdr < 0.001), respectively. Lean mass reduced by 1.4 kg in males (fdr < 0.001) and 1.1 kg in females (fdr < 0.001), whereas total body fat% reduced significantly with −1.5% (fdr < 0.001) in males and −1.5% (fdr < 0.001) in females. In males, lumbar spine BMD increased with 3.0% (fdr < 0.001) and total body BMD with 0.7% (fdr = 0.002). In females, the lumbar spine BMD had a trend in the upwards direction (1.2%, fdr = 0.09) and the total body BMD remained stable (0.4%, fdr = 0.07). In males, the increase in lumbar spine BMD was significantly associated with decreased weight (fdr = 0.001) and with decreased body and trunk fat% (fdr = 0.001, fdr = 0.001) and improved immune-metabolic health (fdr = 0.02). Males with higher BMD but a poor metabolite-based health score at baseline had a stronger increase in lumbar spine BMD (fdr = 0.03). Conclusions: A combined nutritional and activity lifestyle intervention significantly improved BMD of males with good bone health at baseline while at the same time improving metabolic health. Nutritional weight-loss interventions may not harm BMD when combined with exercise. ...
Journal article (2026) - F. Dijkstra Zegers, L. Qin, D. Selani, G. Gomon, T. Maarseveen, K. Glas, M. Reinders, Erik van den Akker, Rachel Knevel, More Authors
BackgroundOnline symptom checkers are often developed and validated on data subject to self-selection and selective attrition, potentially introducing biases in prediction models.ObjectivesTo assess recruitment, selection, and attrition patterns in a large Dutch online symptom checker for musculoskeletal complaints and to evaluate potential biases by comparing participant characteristics across recruitment sources and with external target populations.MethodsUsing data from the online Dutch Rheumatic? Questionnaire on musculoskeletal complaints, we compared baseline characteristics and key self-reported symptoms between responders to the follow-up survey and nonresponders. The survey responders were furthermore compared according to source of recruitment to the questionnaire, i.e., via primary care clinics, secondary care clinics, or via different online sources. Sex, age and BMI distributions from the total study group were compared to external data of potential target populations of primary and secondary care patients within the Netherlands.ResultsThe total study group of answers to the questionnaire comprised 31,457 responders, of which 50% (n = 15,591) responded to the follow-up survey. Study participants were predominantly female (76%), middle-aged (one-third 50–60 years), never-smokers (66%), and overweight. While participants recruited through healthcare settings resembled target populations, follow-up survey responders were older, had more rheumatic diagnoses (49% vs. 32%), and reported more symptoms than non-responders. Participant characteristics varied by recruitment source, with social media attracting younger females while healthcare routes reached more diverse populations with varying symptom presentations.ConclusionPatterns of recruitment and attrition produced differences in participant characteristics. Healthcare-based recruitment yielded participants resembling intended target populations, and follow-up survey responders differed on some points from nonresponders. Awareness of these selection processes is essential when using real-world symptom checker data for model development. ...
Journal article (2026) - Swier Garst, Lieke Kuiper, Erik van den Akker, Niels van den Berg, Mohsen Ghanbari, Simon Mooijaart, Marian Beekman, Marcel Reinders, P. Eline Slagboom, Joyce van Meurs
Many molecular aging biomarkers have been developed to capture heterogeneity in individual aging rates. Yet, systematic comparison of the modeling choices underlying these biomarkers has been limited. In this study, we trained aging biomarkers on the Rockwood frailty index (FI) and all-cause mortality using UK Biobank Olink proteomics and metabolomics (1H-NMR) data (n = 40,696). We systematically established the impact of model choice, target outcome, and molecular data source on several age-related outcomes. From this, we developed two aging biomarkers, ProteinFrailty (ProtFI) and ProteinMortality (ProtMort), which are both ElasticNet models that use a minimal set of proteins to predict FI and mortality, respectively. In particular, ProtFI outperformed established aging biomarkers in relation to diverse outcomes, including incident cardiovascular disease, handgrip strength, and self-rated health, both in internal validation and two Dutch external cohorts (n = 995, n = 500). Our findings show that an efficient frailty-trained proteomic biomarker robustly predicts age-related decline. ...

Proposed Machine Learning–Based Multimodal Framework to Inform Clinical Decision-Making

Review (2026) - Daniyal Selani, Rachel Knevel, Marcel Reinders, Erik B. van den Akker
Rheumatic diseases are chronic, immune-mediated conditions characterized by significant heterogeneity in presentation and disease course. However, current clinical approaches often rely on snapshot-based assessments that fail to capture the complex longitudinal evolution of these conditions. To address these limitations and support the implementation of precision medicine, we present the design for the Rheumatic Digital Twin, a novel, modular conceptual framework intended to integrate heterogeneous multimodal data, ranging from electronic health records and clinical notes to imaging and omics, into a dynamic, computational representation of the patient journey. Our theoretical architecture addresses challenges related to data silos and variable availability of data modalities through a multistage approach that envisions the use of domain-specific foundation models to independently process distinct data modalities. To effectively model the temporal progression inherent in chronic diseases, the proposed design utilizes Transformer architectures, leveraging self-attention mechanisms to treat patient events, such as lab results or medication changes, as sequential data tokens. We describe how these unimodal representations would subsequently be fused via joint embedding techniques to construct a shared, multimodal representational space. Envisioned to function analogously to a recommender system, the Rheumatic Digital Twin framework is modeled to map patients into a latent space where proximity reflects clinical and biological similarity. By identifying “nearest neighbors,” historical patients with comparable trajectories, the system aims to enable in silico cohorting, theoretically allowing clinicians to forecast key clinical events, predict treatment responses, and identify likely disease courses based on the outcomes of similar peers. ...
Journal article (2025) - Desiree D.S.H. de Bruin, Martin A. Haagmans, Kristiaan J. van der Gaag, Jerry Hoogenboom, Natalie E.C. Weiler, Niccoló Tesi, Henne Holstege, Marcel Reinders, Peter Henneman, More authors...
Introduction
The field of forensic DNA analysis has undergone rapid advancements in recent decades. The integration of massively parallel sequencing (MPS) has notably expanded the forensic toolkit, moving beyond identity matching to predicting phenotypic traits and biogeographical ancestry. This shift is of particular significance in cases where conventional DNA profiling fails to identify a single suspect. Supplementing forensic analyses with estimated biological age may be valuable but involves a complex and time-consuming DNA methylation analysis. This study explores and validates the performance of a comprehensive forensic third-generation sequencing assay utilizing Oxford Nanopore Technologies (ONT) in an adaptive and direct sequencing approach. We incorporated the most widely used forensic markers, i.e., STRs, SNPs, InDels, mitochondrial DNA (mtDNA), and two methylation-based clock classifiers, thereby combining forensic genetic and epigenetic analysis in one single workflow.

Methods and results
In our investigation, DNA from six anonymous individuals was sequenced using the ONT standard adaptive direct sequencing approach, reaching a mean percentage of on-target reads ranging from 6.6 % to 7.7 % per sample. ONT data was compared to standard MPS data and Illumina EPIC DNA methylation profiles. Basecalling employed recommended ONT software packages. TREAT was used for ONT-based analysis of autosomal and Y-chromosome STRs, achieving 90–92 % correct calls depending on allelic read depth thresholds. InDel analyses for two lower-quality samples proved challenging due to inadequate read depth, while the remaining four samples significantly contributed to the observed percentage markers (60.9 %) and correct calls (97.8 %). SNP analysis achieved a 98 % call rate, with only two mismatches and two missed alleles. ONT-generated DNA methylation data demonstrated Pearson’s correlation coefficients with EPIC data ranging from 0.67 to 0.97 for Horvath’s clock. Additional age-associated markers exhibited Pearson’s correlation coefficients with chronological age between 0.14 (ELOVL2) and 0.96 (FHL2) at read depths of <30 and <20, respectively. Despite excluding mtDNA from our targeted sequencing approach, adaptive proof-reading fragments covered the complete mtDNA with an average read depth of 21–72, showing 100 % concordance with reference data.

Discussion
Our exploratory study using ONT adaptive sequencing for conventional forensic and age associated DNA methylation markers showed high sequencing accuracy for a significant number of markers, showcasing ONT as a promising (epi)genetic forensic method. Future studies must address three critical aspects: determining clear quantity and quality measures and detection thresholds for accuracy, optimizing input DNA quantity for forensic casework expectations, and addressing ethical considerations associated with phenotype and ancestry analysis to prevent ethnic biases. ...
Journal article (2025) - Marc Hulsman, Itziar de Rojas, Catarina B. Ferreira, Sven van der Lee, Iris Jansen, Gennady Roshchupkin, More Authors..., Sven van der Lee, Henne Holstege, Jeroen van Rooij, Jasper Van Dongen, Niccolo Tesí, Marcel J.T. Reinders, Marc Hulsman, Georgios Hadjigeorgiou
Traditional statistical approaches have advanced our understanding of the genetics of complex diseases, yet are limited to linear additive models. Here we applied machine learning (ML) to genome-wide data from 41,686 individuals in the largest European consortium on Alzheimer’s disease (AD) to investigate the effectiveness of various ML algorithms in replicating known findings, discovering novel loci, and predicting individuals at risk. We utilised Gradient Boosting Machines (GBMs), biological pathway-informed Neural Networks (NNs), and Model-based Multifactor Dimensionality Reduction (MB-MDR) models. ML approaches successfully captured all genome-wide significant genetic variants identified in the training set and 22% of associations from larger meta-analyses. They highlight 6 novel loci which replicate in an external dataset, including variants which map to ARHGAP25, LY6H, COG7, SOD1 and ZNF597. They further identify novel association in AP4E1, refining the genetic landscape of the known SPPL2A locus. Our results demonstrate that machine learning methods can achieve predictive performance comparable to classical approaches in genetic epidemiology and have the potential to uncover novel loci that remain undetected by traditional GWAS. These insights provide a complementary avenue for advancing the understanding of AD genetics. ...

Mechanistic modelling of time-series gene module expression

Journal article (2025) - Ben Noordijk, Marcel Reinders, Aalt D.J. van Dijk, Dick de Ridder
Plants respond to stresses like drought and heat through complex gene regulatory networks (GRNs). To improve resilience, understanding these is crucial, but large-scale GRNs (>100 genes) are difficult to model using ordinary differential equations (ODEs) due to the high number of parameters that have to be estimated. Here we solve this problem by introducing BADDADAN, which uses machine learning to identify gene modules—groups of co-expressed and/or co-regulated genes—and constructs an ODE model that predicts gene module dynamics under stress. By integrating time-series gene expression data with prior co-expression data it finds modules that are both coherent and interpretable. We demonstrate BADDADAN on heat and drought datasets of A. thaliana, modelling over 1,000 genes, recovering known mechanistic insights, and proposing new hypotheses. By combining machine learning with mechanistic modelling, BADDADAN deepens our understanding of stress-related GRNs in plants and potentially other organisms. ...
Journal article (2025) - Harold Bae, Zeyuan Song, Amanat Ali, Niccolò Tesi, Marc Hulsman, Sven van der Lee, Natasja M. van Schoor, Marcel Reinders, Henne Holstege, More Authors...
We constructed a polygenic protective score specific to Alzheimer’s disease (AD PPS) based on the current literature among the participants enrolled in five studies of healthy aging and extreme longevity in the USA, Europe, and Asia. This AD PPS did not include variants on apolipoprotein E (APOE) gene. Comparisons of AD PPS in different data sets of healthy agers and centenarians showed that centenarians have stronger genetic protection against AD compared to individuals without familial longevity. The current study also shows evidence that this genetic protection increases with increasingly older ages in centenarians (centenarians who died before reaching age 105 years, semi-supercentenarians who reached age 105 to 109 years, and supercentenarians who reached age 110 years and older). However, the genetic protection was of modest size: the average increase in AD PPS was approximately one additional protective allele per 5 years of gained lifetime. Additionally, we show that the higher AD PPS was associated with better cognitive function and decreased mortality. Taken together, this analysis suggests that individuals who achieve the most extreme ages, on average, have the greatest protection against AD. This finding is robust to different genetic backgrounds with important implications for universal applicability of therapeutics that target this AD PPS. ...

A multi-center retrospective study (SWITCH)

Journal article (2025) - Jim M. Smit, Jasper Van Bommel, Diederik A.M.P.J. Gommers, Marcel J.T. Reinders, Michel E. Van Genderen, Jesse H. Krijthe, Annemijn H. Jonkman
Background
Switching from controlled to assisted ventilation is crucial in the trajectory of intensive care unit (ICU) stay, but no guidelines exist. We described current practices, analyzed patient characteristics associated with switch success or failure, and explored the feasibility to predict switch failure.

Methods
In this retrospective study, we obtained highly granular longitudinal ICU data sets from three medical centers, covering demographics, severity scores, vital signs, ventilation, and laboratory parameters. The primary endpoint was switch success, considering a switch attempt to be successful if a patient did not return to controlled ventilation for the next 72 h while alive, and to be failed otherwise. We compared the characteristics of patients with successful vs. failed first switch attempts at ICU admission, immediately before, and 3 h after the attempt. We trained LASSO logistic regression models to predict switch failure.

Results
In 4524/6715 (67%) patients attempting a switch, the first attempt failed. The first switch attempt, regardless of success or failure, was generally made at normalized PaCO2 and pH levels, with PEEP < 10 cmH2O and PaO2/FiO2 indicating mild injury. Despite very similar baseline disease severity, switch failure was associated with significantly worse outcomes, including a 28-day mortality of 27% vs. 16% and median ventilator-free days of 16 vs. 22 (p < 0.001). Failed attempts were initiated significantly earlier than successful ones (median 1.8 vs. 1.3 days, p < 0.001). Before the switch, PaO2/FiO2, if measured at PEEP > 10 cmH2O, and respiratory system compliance was lower in patients with switch failure (median 185 vs. 205 mmHg, p < 0.001; 39 vs. 41 mL/cmH2O, P = 0.001), and post-switch, patients with switch failure experienced greater deterioration in gas exchange and minimal improvement in ventilatory parameters post-switch. Contrary to our hypotheses, patient characteristics for failed vs. successful switches were surprisingly similar, resulting in prediction models with limited discriminative performance.

Conclusions
Approximately two-thirds of attempts to switch patients to assisted ventilation fail, which are associated with significantly worse clinical outcomes, despite similar baseline disease severity. Contrary to our hypotheses, patients with successful and failed attempts showed similar characteristics, making switch failure difficult to predict. These findings underscore the importance of preventing switch failures and, given the retrospective nature of this study, highlight the need for prospective studies to better understand the reasons for switch failure and when spontaneous breathing can be safely initiated. ...
Journal article (2025) - Aude Nicolas, Richard Sherva, Benjamin Grenier-Boley, Yoontae Kim, Masataka Kikuchi, Jigyasha Timsina, Itziar de Rojas, Marcel J.T. Reinders, Jean-Charles Lambert, More authors...
A polygenic score (PGS) for Alzheimer’s disease (AD) was derived recently from data on genome-wide significant loci in European ancestry populations. We applied this PGS to populations in 17 European countries and observed a consistent association with the AD risk, age at onset and cerebrospinal fluid levels of AD biomarkers, independently of apolipoprotein E locus (APOE). This PGS was also associated with the AD risk in many other populations of diverse ancestries. A cross-ancestry polygenic risk score improved the association with the AD risk in most of the multiancestry populations tested when the APOE region was included. Finally, we found that the PGS/polygenic risk score captured AD-specific information because the association weakened as the diagnosis was broadened. In conclusion, a simple PGS captures the AD-specific genetic information that is common to populations of different ancestries, although studies of more diverse populations are still needed to better characterize the genetics of AD. ...
Journal article (2025) - Pedro Mateus, Swier Garst, Jing Yu, Davy Cats, Alexander G.J. Harms, Mahlet Birhanu, Marian Beekman, Marcel Reinders, Esther E. Bron, More authors...
While biological age scores have been shown to characterize aging by estimating chronological age based on physiological biomarkers, interactions between different age scores are largely unknown. To study this, large-scale multi-modal data are crucial. However, such data are scarce as population-based cohorts are generally restricted in sharing their data. Here, we employ federated learning to study the relationship between the two types of biological age scores: BrainAge based on brain MRI and MetaboAge based on metabolites. Using three large population-based cohorts, we trained a federated deep learning model to estimate BrainAge and compared its performance to models trained in a single cohort. The federated BrainAge model yielded significantly lower error for age prediction across the cohorts than locally trained models. Harmonizing the age interval between cohorts further improved BrainAge accuracy. Subsequently, we compared BrainAge and MetaboAge by performing association analysis and survival analysis for dementia and mortality prediction to further characterize both scores. The association analysis showed a weak association between BrainAge and MetaboAge, while the survival analysis indicated complementary predictive values for the mortality risk of the two scores. Federated learning has been shown to be a valuable technique for enabling the use of research cohorts that are restricted in data sharing. We conclude that BrainAge and MetaboAge act synergetically for the prediction of time to all-cause mortality, and both aging scores capture different aspects of the aging process. ...
Journal article (2025) - Mario Tranfa, Leonard Pieperhoff, Giuseppe Pontillo, Emma S. Luckett, Lyduine E. Collij, Tiago Gil Oliveira, Niccoló Tesi, Natalia Vilor-Tejedor, M.J.T. Reinders, More authors...
Background: The accumulation of amyloid-β1−42 (Aβ1−42) peptides and phosphorylated-Tau181 (p-Tau181) tangles from the preclinical stages of Alzheimer’s disease (AD) has led to a biological definition of the disease. However, among Aβ1−42-positive individuals, cognitive decline onset varies, and some never develop symptoms. Genetic influences on molecular pathways and their interactions with proteinopathy may underlie this heterogeneity. Leveraging data from a large sample of cognitively intact older adults in the European Prevention of Alzheimer Dementia (EPAD) cohort, we examined how AD-related pathophysiological changes (i.e., Aβ1−42 and p-Tau181), polygenic pathways and their interaction are associated with WM micro- and macrostructural properties. Methods: We selected 803 individuals (mean age = 64.7 ± 7.3 years, 458 [57.0%] females, 275 [34.2%] APOE-ε4 carriers) with CSF-Aβ1−42 and p-Tau181 measurements available, full genotyping, and structural and diffusion MRI. Polygenic risk scores (PRSs) were computed using 85 AD-related genetic variants. These were mapped to their corresponding genes and, after excluding those belonging to the APOE locus, clustered by function into six pathway-specific PRSs (i.e., immune activation, signal transduction, inflammation, lipid, amyloid, and clearance pathways). Diffusion MRIs were processed through the fixel-based analysis framework to derive fiber density (FD) and fiber cross-section (FC) metrics, which were averaged within WM tracts. Linear models assessed the effects of AD-related pathophysiological changes, global and pathway-specific PRSs, and their interactions on FD and FC at both the tract and fixel levels. Models were corrected for multiple comparisons. Results: P-Tau181 was primarily associated with greater FD. The lipid pathway was associated with greater FD and FC, with these effects predominantly occurring in the left hemisphere, consistent with evidence of hemispheric dominance. The clearance pathway moderated the effect of Aβ1−42 on FD, with a positive slope in A + compared to A- individuals. The immune activation pathway moderated the effect of p-Tau181 on FD, with a negative slope in T + compared to T- individuals. Conclusions: Pathway-specific genetic vulnerability to AD is associated with alterations in WM tracts both directly and by moderating the effects of AD-related pathophysiological changes. AD-associated genetic risk should be integrated into the AD diagnostic framework to enable targeted screening and intervention for future preclinical trials aimed at specific biological pathways. ...
Journal article (2025) - Jie Ju, Ioannis Ntafoulis, Michelle Klein, Marcel J.T. Reinders, Martine Lamfers, Andrew P. Stubbs, Yunlei Li
While deep learning (DL) is used in patients’ outcome predictions, the insufficiency of patient samples limits the accuracy. In this study, we investigated how transfer learning (TL) alleviates the small sample size problem. A 2-step TL framework was constructed for a difficult task: predicting the response of the drug temozolomide (TMZ) in glioblastoma (GBM) cell cultures. The GBM is aggressive, and most patients do not benefit from the only approved chemotherapeutic agent TMZ. O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status is the only biomarker for TMZ responsiveness but has shown limited predictive power. The 2-step TL framework was built on 3 datasets: (1) the subset of the Genomics of Drug Sensitivity in Cancer (GDSC) dataset, including miscellaneous cell cultures treated by TMZ, cyclophosphamide, bortezomib, and oxaliplatin, as the source dataset; (2) the Human Glioblastoma Cell Culture (HGCC) dataset, for fine-tuning; and (3) a small target dataset GSE232173, for validation. The latter two included specifically TMZ-treated GBM cell cultures. The DL models were pretrained on the cell cultures treated by each of the 4 drugs from GDSC, respectively. Then, the DL models were refined on HGCC, where the best source drug was identified. Finally, the DL model was validated on GSE232173. Using 2-step TL with pretraining on oxaliplatin was not only superior to those without TL and with 1-step TL but also better than 3 benchmark methods, including MGMT. The oxaliplatin-based TL improved the performance probably by increasing the weights of cell cycle-related genes, which relates to the TMZ response processes. Our findings support the potential of oxaliplatin being an alternative therapy for patients with GBM and TL facilitating drug repurposing research. We recommend that following our methodology, using mixed cancers and a related drug as the source and then fine-tuning the model with the target cancer and the target drug will enhance drug response prediction. ...
Journal article (2025) - Sven J. Van Der Lee, Marc Hulsman, Rosalina Van Spaendonk, Jetske Van Der Schaar, Janna Dijkstra, Niccoló Tesi, Marcel Reinders, Itziar De Rojas, Henne Holstege, More Authors...
Background and ObjectivesIdentifying genetic causes of dementia in patients visiting memory clinics is important for patient care and family planning. Traditional clinical selection criteria for genetic testing may miss carriers of pathogenic variants in dementia-related genes. This study aimed identify how many carriers we are missing and to optimize criteria for selecting patients for genetic counseling in memory clinics.MethodsIn this clinical cohort study, we retrospectively genetically tested patients during 2.5 years (2010-2012) visiting the Alzheimer Center Amsterdam, a specialized memory clinic. Genetic tests consisted of a 54-gene dementia panel, focusing on Class IV/V variants per American College of Medical Genetics and Genomics guidelines, including APP duplications and the C9ORF72 repeat expansion. We determined the prevalence of pathogenic variants and propose new eligibility criteria for genetic testing in memory clinics. The eligibility criteria were prospectively applied for 1 year (2021-2022), and results were compared with the retrospective cohort.ResultsGenetic tests were retrospectively performed in in 1,022 of 1,138 patients (90%) who consecutively visited the memory clinic. Among these, 1,022 patients analyzed (mean age 62.1 ± 8.9 years; 40.4% were female), 34 pathogenic variant carriers were identified (3.3%), with 24 being symptomatic. Previous clinical criteria would have identified only 15 carriers (44% of all carriers, 65% of symptomatic carriers). The proposed criteria increased identification to 22 carriers (62.5% of all carriers, 91% of symptomatic carriers). In the prospective cohort, 148 (28.7%) of 515 patients were eligible for testing under the new criteria. Of the 90 eligible patients who consented to testing, 13 pathogenic carriers were identified, representing a 73% increase compared with the previous criteria.DiscussionWe found that patients who visit a memory clinic and carry a pathogenic genetic variant are often not eligible for genetic testing. The proposed new criteria improve the identification of patients with a genetic cause for their cognitive complaints. In systems without practical or financial barriers to genetic testing, the new criteria can enhance personalized care. In other countries where the health care systems differs and in other genetic ancestry groups, the performance of the criteria may be different. ...

Charting a personalised approach – Authors’ reply

Journal article (2025) - Jim M. Smit, Jesse H. Krijthe, Gianfranco U. Meduri, Pierre François Dequin, Harin Karunajeewa, Antoni Torres, Marcel J.T. Reinders, Henrik Endeman, Philip A. Van Der Zee
We appreciate the opportunity to further clarify our findings in response to the insightful comments from Shota Yamamoto and colleagues and Luis Felipe Reyes and Ignacio Martin-Loeches regarding our recent community-acquired pneumonia (CAP) study. [...] ...