Predicting Quantifiability from Primary Screens to Prioritize Dose-Response Profiling

Treating patients with combinations of drugs reduces the risk of resistance to any individual drug. Finding effective combinations is difficult because the large search space makes combinatorial screens prohibitively expensive, time consuming, and often technically infeasible. Predictive models can fill this gap, yet existing methods typically require molecular profiling of each sample and per-cohort training, limiting their applicability when time and tissue are scarce. To address this challenge, we introduce ScreenShot, a hierarchical transformer pretrained on 40 drug screening datasets covering 3,700 drugs and 6,000 biological samples, whose architecture mirrors the nested structure of screening data. Given a few-shot context of observations from a new patient, ScreenShot predicts the response of the sample to combination therapies through in-context learning, operating directly on functional measurements with no fine-tuning and no molecular profiling. On four held-out datasets, ScreenShot outperforms all baselines in both prediction accuracy and identification of selectively effective treatments. ScreenShot's internal representations are directly useful for experimental design: we use them to drive a weighted k-means++ active learning strategy that selects which experiments to run, achieving the same hit detection as uniform screening with a third of the budget. Source code and interactive dashboard: https://github.com/tansey-lab/screenshot.

High-throughput screening (HTS) assays are central to early-stage drug discovery but are often limited by extreme data sparsity, as primary screens typically use only a single replicate per test substance. This sparsity makes conventional machine-learning performance metrics, such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC), difficult to estimate empirically because they require adequately sized labeled samples. Here, we introduce a model-based framework that derives these classification metrics from the strictly standardized mean difference (SSMD), a well-established HTS effect-size parameter. Under a Gaussian equal-variance assumption, we derive closed-form relationships linking SSMD to Youden-optimal sensitivity and specificity, and sensitivity at a preset specificity, yielding explicit estimators and exact confidence intervals from the noncentral t-distribution, even under single-replicate designs. Unlike classical statistical power, which approaches 1 as sample size grows regardless of how small the true non-zero difference between group means is, the SSMD-derived sensitivity converges to a finite population value that reflects the true degree of separation between two groups, making it a more meaningful and stable performance measure for hit selection. We demonstrate the utility of this framework in a hepatitis C virus primary siRNA screen comprising approximately 22,000 single-replicate measurements, showing that SSMD, AUROC, and sensitivity-based thresholds yield equivalent and interpretable hit sets. This work bridges classical HTS statistics and machine-learning evaluation theory, providing a statistically principled, reproducible way to estimate classification performance in ultra-low-replication screening workflows.

Motivation: The scalable identification of bioactive compounds is essential for contemporary drug discovery. This process faces a key trade-off: structural screening offers scalability but lacks biological context, whereas high-content phenotypic profiling provides deep biological insights but is resource-intensive. The primary challenge is to extract robust biological signals from noisy data and encode them into representations that do not require biological data at inference. Results: This study presents DECODE (DEcomposing Cellular Observations of Drug Effects), a framework that bridges this gap by empowering chemical representations with intrinsic biological semantics to enable structure-based in silico biological profiling. DECODE leverages limited paired transcriptomic and morphological data as supervisory signals during training, enabling the extraction of a measurement-invariant biological fingerprint from chemical structures and explicit filtering of experimental noise. Our evaluations demonstrate that DECODE retrieves functionally similar drugs in zero-shot settings with over 20% relative improvement over chemical baselines in mechanism-of-action (MOA) prediction. Furthermore, the framework achieves a 6-fold increase in hit rates for novel anti-cancer agents during external validation. Availability and implementation: The codes and datasets of DECODE are available at https://github.com/lian-xiao/DECODE.