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High-throughput drug combination screening provides a systematic strategy to discover unexpected combinatorial synergies in pre-clinical cell models. However, phenotypic combinatorial screening with multi-dose matrix assays is experimentally expensive, especially when the aim is to identify selective combination synergies across a large panel of cell lines or patient samples. Here, we implement DECREASE, an efficient machine learning model that requires only a limited set of pairwise dose–response measurements for accurate prediction of drug combination synergy in a given sample. Using a compendium of 23,595 drug combination matrices tested in various cancer cell lines and malaria and Ebola infection models, we demonstrate how cost-effective experimental designs with DECREASE capture almost the same degree of information for synergy and antagonism detection as the fully measured dose …