Volume 16 Supplement 13
DMAP: a connectivity map database to enable identification of novel drug repositioning candidates
© Huang et al. 2015
Published: 1 December 2015
Drug repositioning is a cost-efficient and time-saving process to drug development compared to traditional techniques. A systematic method to drug repositioning is to identify candidate drug's gene expression profiles on target disease models and determine how similar these profiles are to approved drugs. Databases such as the CMAP have been developed recently to help with systematic drug repositioning.
To overcome the limitation of connectivity maps on data coverage, we constructed a comprehensive in silico drug-protein connectivity map called DMAP, which contains directed drug-to-protein effects and effect scores. The drug-to-protein effect scores are compiled from all database entries between the drug and protein have been previously observed and provide a confidence measure on the quality of such drug-to-protein effects.
In DMAP, we have compiled the direct effects between 24,121 PubChem Compound ID (CID), which were mapped from 289,571 chemical entities recognized from public literature, and 5,196 reviewed Uniprot proteins. DMAP compiles a total of 438,004 chemical-to-protein effect relationships. Compared to CMAP, DMAP shows an increase of 221 folds in the number of chemicals and 1.92 fold in the number of ATC codes. Furthermore, by overlapping DMAP chemicals with the approved drugs with known indications from the TTD database and literature, we obtained 982 drugs and 622 diseases; meanwhile, we only obtained 394 drugs with known indication from CMAP. To validate the feasibility of applying new DMAP for systematic drug repositioning, we compared the performance of DMAP and the well-known CMAP database on two popular computational techniques: drug-drug-similarity-based method with leave-one-out validation and Kolmogorov-Smirnov scoring based method. In drug-drug-similarity-based method, the drug repositioning prediction using DMAP achieved an Area-Under-Curve (AUC) score of 0.82, compared with that using CMAP, AUC = 0.64. For Kolmogorov-Smirnov scoring based method, with DMAP, we were able to retrieve several drug indications which could not be retrieved using CMAP. DMAP data can be queried using the existing C2MAP server or downloaded freely at: http://bio.informatics.iupui.edu/cmaps
Reliable measurements of how drug affect disease-related proteins are critical to ongoing drug development in the genome medicine era. We demonstrated that DMAP can help drug development professionals assess drug-to-protein relationship data and improve chances of success for systematic drug repositioning efforts.
To reposition drugs [1–3] from one approved indication to a new indication, drug developers could significantly save associated development cost  and lower development risks. With the rapid accumulation of genomics, functional genomics, and chemical informatics data in the past decade, several new systematic approaches to drug repositioning have been proposed. For example, one may study the drug-ligand structural binding relationships systematically for all approved drugs to discover their new targets implicated in other diseases using chemoinformatic tools . If the drug-drug similarity relationships, disease-disease similarity relationships, or side-effect-to-side-effect similarity relationships  are characterized, one may populate indications from one drug to another among all drugs under study that are closely related through shared disease, shared side effect, or shared target relationship profiles. Machine learning  and biomedical literature text mining  approaches can also help uncover non-obvious relationships between approved drugs and potential new indications.
Recently, there has been surging interest to apply "connectivity map" (CMAP) techniques, which attempt to match a repositioned drug's effects by their shared disease perturbation gene expression profiles [2, 3, 9–11]. A major resource--CMAP--was developed by Lamb et al.  to assay genome-wide transcriptional expression data across a wide range of cell lines treated with small drug molecules. Based on the CMAP data, Iorio et al.  proposed a drug repositioning method by constructing drug-drug similarity networks. Hu and Agarwal and Sirota et al.  also investigated how to pair drugs and disease indications based on negative correlation of drug perturbation and disease gene expression patterns identified from CMAP. The anti-correlation relationships between the drugs and diseases are demonstrated to suggest novel therapeutic indications for existing drugs. The primary advantage of CMAP is that it does not require prior knowledge of drug targets or a drug's detailed mechanism of actions to work. However, CMAP's limitation is also quite apparent: limited coverage of drugs, limited drug perturbation gene expression data, limited dosage-dependent conditions, and the dubious transferability of expression patterns from cell lines or animal models to human systems. Ultimately, it can be time-consuming and costly before a significant portion of current drugs in all safe dosage conditions can be tested in even a limited number of cell lines for CMAP according to the statistics in .
Develop DMAP context from existing databases
In DMAP, we collected, integrated and ranked each pair of drug-to-protein/gene relationship. The primary data for drug-protein information comes from the STITCH  database, and may be expanded easily to include other sources such as CTD  data. STITCH is an aggregated Cheminformatics database of chemical-to-protein interactions connecting over 300,000 chemicals and 2.6 million proteins for many species mined from biomedical literature. We parsed out STICH chemical protein interactions for Homo sapiens with those chemical-protein "edge actions" being either "activation" (stimulatory interaction) or "inhibition" (inhibitory interactions). To eliminate the synonymous chemicals with the same chemical structure, we mapped 289,571 chemicals to the PubChem database in the result of 24,121 distinct PubChem Compound ID (CID).
where d and p are specific drugs and proteins, respectively. N is the number of evidence for the interaction between d and p. prob i (d,p) is the confidence of each evidence i with a value within the range of 0. sign i has a value of 1 if the evidence i represents activation while has a value of -1 if the evidence i represents inhibition.
Here, p and q are proteins on the protein interaction network, k is an empirical constant (k=2 in this study), conf(p, q) is the confidence score assigned by HAPPI to each interaction between protein p and q, and N(p, q) holds the value of 1 if protein p interacts with q or the value of 0 if protein p does not interact with q.
Here, P-Score contains both the information of each drug's action on their interacting proteins and the importance of the protein in the protein-protein interaction network. This is different than the expression level based ranking in CMAP, which may be more suitable for biomarker discovery instead of drug discovery. With P-Score for each drug-protein interaction, DMAP is thus in a compatible format with CMAP .
Integrate drug therapeutic indication data
To construct a golden standard of known drug indications to evaluate DMAP's drug repositioning performance, we integrated the Therapeutic Target Database (TTD)  and the dataset from the PREDICT  paper. TTD is a database that provides information about drugs' known therapeutic protein targets and their targeted diseases. The PREDICT paper provides a compiled list of drug indications. We integrated these two sources to get 2,912 drug indication associations corresponding to 1,180 drugs and 726 indications.
Prepare disease expression signatures and drug expression signatures
To apply the Kolmogorov-Smirnov algorithms with DMAP or CMAP for the drug repositioning, we need the disease expression dataset as one of the inputs. We thus retrieved the disease gene expression profiles from Pacini C et al. 's paper. In total, 87 disease associated microarray experiments were compiled to represent 45 distinct diseases. According to Pacini C's paper, these datasets were obtained from the GEO microarray repository . The raw CEL files were normalized with RMA . For those gene expression profiles representing the same disease, they were combined with the median rank normalization by Warnat et al. .
The drug-gene expression datasets were obtained from Iorio et al.'s paper instead of directly from CMAP  to reduce the batch effect. Iorio et al. computed a single synthetic ranked list of genes, called Prototype Ranked List (PRL), by merging all the ranked list of the same compound in CMAP. Only consistently overexpressed/underexpressed genes are placed at the top/bottom of the RPL. This helped capture a consensus transcriptional response for each drug. We thus chose to use the PRL to represent the drug signatures from CMAP in this study.
Design drug similarity measurement
Here, d x and d y represent the two specific drugs, p x represents the set of proteins interacting with d x , p y represents the set protein interacting with d y . |p x ∪ p y | is the number of total distinct proteins in p x and p y . |p x+ ∩ p y+ | is the number of overlapped proteins on which both drugs have identical interactions (i.e. both activate or inhibit the shared proteins). |p x- ∩ p y- | is the number of shared related proteins on which the two drugs have opposite interactions (i.e. one activates while the other inhibits the shared proteins). SIM(d x, d y ) lies in the range of [-1,1] with 1 representing that the two drugs share the same interacting proteins and the drugs' action on each protein is the same while -1 representing that the two drugs share the same proteins but the drugs' action on each protein is opposite.
Evaluate the prediction performance
Implement Kolmogorov-Smirnov strategy
We implemented the nonparametric, rank-based strategy based on the algorithm originally introduced by Lamb et al. to generate a ranked list of candidate drugs for each disease. For each disease signature, we computed an enrichment score separately for the up- or down- regulated genes: esup and esdown. In specific, we constructed a vector V of the position of each of the up- or down- regulated genes on the basis of the values from the reference drug dataset. The vector was then sorted in ascending order such that V(j) is the position of disease gene j. The computation of the enrichment score is based on Kolmogorov-Smirnov statistic and the details can be referred to in the supplementary material in Lamb et al. . The drug score is set to zero, where esup and esdown have the same algebraic sign. Otherwise, we set the drug score to esup-esdown. To evaluate the statistical significance of the score, we applied a permutation approach by randomly selecting any drug signatures and re-calculated the score accordingly. We did the permutation 200 times for each drug-disease pair and computed the p-value by checking the actual score with the score distribution after randomization. We hypothesized that those drugs with a statistically significant negative score might be a possible treatment for the disease of interest.
Perform literature validation
To check whether the predicted drug-disease pairs have clinical literature evidence, we used the esearch API provided by NCBI. The query term we used is 'drug name AND disease name AND (Clinical Trial[ptyp] OR Clinical Trial, Phase I[ptyp] OR Clinical Trial, Phase II[ptyp] OR Clinical Trial, Phase III[ptyp] OR Clinical Trial, Phase IV[ptyp])'. We recorded the total number of clinical type PubMed articles for each association.
Results and discussion
Drug directionality Map (DMAP) Construction
Database statistics comparing CMAP (build 02) and the new DMAP.
CMAP (Build 02)
Chemical entities (including brand names)
Drugs with known indications
Drug entities with unique PubChem CID
Drugbank Approved (and %)
Drugbank Experimental (and %)
Coverage of Drug's Therapeutic Areas
ATC first level categories (and %)
ATC second level categories (and %)
ATC third level categories (and %)
Proteins by UniProtID (and %)
Drug-to-protein effect relationships
DMAP's utility for drug repositioning
To check DMAP's utility for drug repositioning, we applied the following two well-known drug-repositioning methods in literatures: (i) drug similarity approach , (ii) Kolmogorov-Smirnov algorithms .
DMAP outperforms CMAP in repurposing using drug similarity approach
We computed 481,671 pairwise drug similarities for the 982 drugs with known indications by calculating the Tanimoto Coefficient between their interacting proteins profiles and evaluate the prediction performance with "Leave-One-Out" cross-validation.
We observe that using the drug-protein interaction in DMAP, the repurposing performance significantly increases, compared to the performance using the same type of information in CMAP. The Overall AUC for the prediction based on DMAP achieved 0.82. Most importantly, early retrieval performed well, with a partial AUC of 0.72 for a specificity of 90% or above. Since one could only test the limited number of drugs in experimental setting, the good performance in high specificity region, approximately corresponding to the top ten candidates of all the predictions, would make the proposed drug repositioning more meaningful in practice.
Top 20 novel drug repositioning candidate identified and the count of PubMed publication support the proposed clinical indications
Leukemia, Acute Myeloid
DMAP outperforms CMAP in repurposing using Kolmogorov-Smirnov approach
We compiled the gene expression profiles for 45 distinct diseases and then queried them against DMAP and CMAP, respectively, to generate a ranked list of potential treatments for each of the diseases of interest. By using DMAP drug-protein interaction data, we were able to correctly retrieve the drugs' indications, which were unable to be retrieved using CMAP drug-protein interaction data. We examined results for diseases that are the leading causes of death in the US . For breast cancer, with the DMAP, we successfully retrieved Anastrozole, Capecitabine, Doxorubicin, Estradiol, Megestrol, Paclitaxel, Testosterone and Testolactone as possible therapeutic drugs for breast cancer. With the CMAP data, only Paclitaxel was retrieved as a potential therapeutic drug. For lung cancer, we retrieved Cisplatin and Etoposide by using the DMAP. However, when CMAP was used, we were not able to retrieve any drugs for lung cancer. Additional file 1 also contains the results for other diseases. To have statistical significance, we required a p-value of less than 0.05. CMAP did relatively better in the case for Alzheimer's disease and Leukemia. For these known relationships covered in CMAP but not DMAP, or vice-versa, some were due to having a borderline p-value while others were due to violating our hypothesis of negative correlation. Overall, DMAP and CMAP database were complimentary to each other.
Besides recalling the known drug-disease relationships, with DMAP, the Kolmogorov-Smirnov approach could also propose novel drug-disease associations. National Center for Advancing Translational Sciences (NCATS)  provides a list of drugs for translational medical research. We cross checked the novel predictions with their drug list. Here, we highlight three case studies for Vincristine, Nifedipine and Progestrone. Vincristine is a drug typically indicated for Leukemia and Wilm's tumor. A recent study performed by Indolfi et al. revealed that there is a potentially higher rate of survival in patients with bilateral Wilm's tumor when patients are given a dosage of vincristine/actinomycin D. Nifedipine is indicated to treat high blood pressure and angina. The DMAP results suggest that Nifedipine can also be used to treat asthma. Since Nifidipine is a PKC inhibitor and PKC is a potential therapeutic target for asthma , it is a potential treatment for asthma. Cheng et al  demonstrated in their study that Nifedipine can help control the constriction involved in sensitized tissue in asthma. Furthermore, another study by Barnes et al suggested that Nifidipine modifies exercise-induced asthma. Progesterone is a prescription drug used for women taking estrogens after menopause and is also used for treating amenorrhea. The DMAP results suggest that progesterone can be used to treat breast cancer. In the study by Groshong et al , it was determined that treatment with Progesterone can be used to regulate Breast Cancer cell growth.
Additional file 2 summarized all the novel drug repositioning predicted by both similarity approach and KS algorithms, which could be a starting point for further experimental validation.
Reliable measurements of how drugs affect disease proteins is critical to drug repositioning. In this work we presented a computational drug directionality resource called DMAP to address the challenges. We demonstrated that the resource can greatly facilitate the drug discovery process for the following reasons: access to disease gene-drug relationship data with high coverage and quality; incorporating prior knowledge about biological significance with protein interaction network.
This study differs from previous research in that it provides a comprehensive database of computationally derived drug-protein relationships. Previous efforts [2, 3, 9, 10] on pairing the expression of drugs and diseases mainly rely on experimental connectivity map. For example, Sirota et al. performed a large-scale integration of expression signatures of human diseases from the public data with CMAP drug signatures. This work provides another alternative resource of directed drug-protein relationships. The drug similarity study proves the validity of the probabilistic-based directionality for each drug-protein relationship. The implementation of K-S algorithm proves the compatibility of the pharmacology score based ranking with the expression based ranking in CMAP for the drug repositioning research. With these two major drug repositioning approaches, the knowledge base from DMAP performed better than directly using the microarray data from CMAP. It can thus serve as a valuable resource for drug repositioning studies.
One limitation of DMAP lies in that the number of interacting proteins for each drug is not a constant number. For the gene expression based profiles in the CMAP database, each drug was measured against the same number of proteins in experiments while in DMAP the number of interacting proteins varies from drug to drug. In DMAP, 13,717 drugs have at least 10 activated and inhibited proteins. Despite this limitation, the database served its purpose for systematic drug repositioning as demonstrated in this work.
Another limitation of DMAP is the dependency of drug-protein interaction scoring on protein-protein interaction (PPI) databases. As mentioned in , disease gene ranking should be performed using PPI data not only with reasonable quality but also high data coverage. In this work, we only used the PPI data to calculate the protein weight. Therefore, we believe the conclusions above still hold. In other words, we expect time and PPI quality to affect primarily drug-protein data significantly if and only if the drug-protein relationship score is relatively low; when the drug-protein relationship is high - suggesting that there're lots of data coverage for the relationships across many literature reports - the time or PPI quality effect is expected to be relatively small.
Publication of this article was funded in part by the National Institute of Health to Dr Jake Chen (co-PI of R21CA173918).
We acknowledge the support of Indiana Center for Systems Biology and Personalized Medicine during the design and implementation of the project. Our database servers and web applications are hosted and maintained with the generous support of Indiana University Information Technology and Support group.
This article has been published as part of BMC Bioinformatics Volume 16 Supplement 13, 2015: Proceedings of the 12th Annual MCBIOS Conference. The full contents of the supplement are available online at http://www.biomedcentral.com/bmcbioinformatics/supplements/16/S13.
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