Complex autoimmune diseases, such as multiple sclerosis (MS), develop as a result of perturbations in the regulatory system controlling the function of immune cells. The disease course of MS is heterogeneous but is characterised by chronic inflammation in the central nervous system causing neurodegeneration resulting in gradual disability worsening. Disease biomarkers which are present at early stages of a disease can help clinicians to tailor treatment strategies to the expected disease course of individual persons. Gene products, i.e. RNA and proteins, serve as promising disease biomarkers due to the possibility to detect changes in abundance at early stages of a disease. Putative biomarkers can be identified by modelling different levels of gene regulation from high-throughput measurements of gene product abundance. Extracting information of disease relevance from high-throughput data is a complex problem which requires the use of efficient and targeted computational algorithms. 

The aim of this thesis was to develop and refine methods for identifying key biomarkers involved in the development and progression of complex diseases, with the main focus on MS. In Paper I, we used a machine learning approach to identify a combination of protein biomarkers, present in the cerebrospinal fluid, which could predict the disease trajectory of persons in the early stages of MS. The abundance of proteins is a result of an intricate network of multiple regulatory factors controlling the expression of genes. A large part of the expression of genes is controlled by a few key regulators, which are believed to be crucial for the development of diseases. In addition, disease-associated genes are believed to colocalise in these networks forming so called disease modules. In Paper II, we developed a method, named ComHub, for extracting the key regulators of gene expression. In Paper III, we combined ComHub with the tool MODifieR, for disease module predictions, in a network analysis pipeline for identifying a limited set of disease-associated genes. Using this network analysis pipeline we identified a set of MS-associated genes, as well as a promising key regulator of MS. 

The work performed in this doctoral thesis covers development of new and refined methods for modelling complex diseases, while simultaneously utilising these methods to identify disease biomarkers important for the development and progression of MS. The identified biomarkers can be used for understanding the pathology of MS, as candidate drug targets, and as promising biomarkers to aid clinicians in tailoring treatment strategies to individual persons. 

Sensitive and reliable protein biomarkers are needed to predict disease trajectory and personalize treatment strategies for multiple sclerosis (MS). Here, we use the highly sensitive proximity-extension assay combined with next-generation sequencing (Olink Explore) to quantify 1463 proteins in cerebrospinal fluid (CSF) and plasma from 143 people with early-stage MS and 43 healthy controls. With longitudinally followed discovery and replication cohorts, we identify CSF proteins that consistently predicted both short- and long-term disease progression. Lower levels of neurofilament light chain (NfL) in CSF is superior in predicting the absence of disease activity two years after sampling (replication AUC = 0.77) compared to all other tested proteins. Importantly, we also identify a combination of 11 CSF proteins (CXCL13, LTA, FCN2, ICAM3, LY9, SLAMF7, TYMP, CHI3L1, FYB1, TNFRSF1B and NfL) that predict the severity of disability worsening according to the normalized age-related MS severity score (replication AUC = 0.90). The identification of these proteins may help elucidate pathogenetic processes and might aid decisions on treatment strategies for persons with MS.

Network-based disease modules have proven to be a powerful concept for extracting knowledge about disease mechanisms, predicting for example disease risk factors and side effects of treatments. Plenty of tools exist for the purpose of module inference, but less effort has been put on simultaneously utilizing knowledge about regulatory mechanisms for predicting disease module hub regulators.We developed MODalyseR, a novel software for identifying disease module regulators and reducing modules to the most disease-associated genes. This pipeline integrates and extends previously published software packages MODifieR and ComHub and hereby provides a user-friendly network medicine framework combining the concepts of disease modules and hub regulators for precise disease gene identification from transcriptomics data. To demonstrate the usability of the tool, we designed a case study for multiple sclerosis that revealed IKZF1 as a promising hub regulator, which was supported by independent ChIP-seq data.MODalyseR is available as a Docker image at https://hub.docker.com/r/ddeweerd/modalyser with user guide and installation instructions found at https://gustafsson-lab.gitlab.io/MODalyseR/.Supplementary data are available at Bioinformatics Advances online.

Motivation: Complex diseases are due to the dense interactions of many disease-associated factors that dysregulate genes that in turn form the so-called disease modules, which have shown to be a powerful concept for understanding pathological mechanisms. There exist many disease module inference methods that rely on somewhat different assumptions, but there is still no gold standard or best-performing method. Hence, there is a need for combining these methods to generate robust disease modules. Results: We developed MODule IdentiFIER (MODifieR), an ensemble R package of nine disease module inference methods from transcriptomics networks. MODifieR uses standardized input and output allowing the possibility to combine individual modules generated from these methods into more robust disease-specific modules, contributing to a better understanding of complex diseases.