A robust clustering strategy for stratification unveils unique patient subgroups in acutely decompensated cirrhosis.

BACKGROUND: Patient heterogeneity poses significant challenges for managing individuals and designing clinical trials, especially in complex diseases. Existing classifications rely on outcome-predicting scores, potentially overlooking crucial elements contributing to heterogeneity without necessarily impacting prognosis. METHODS: To address patient heterogeneity, we developed ClustALL, a computational pipeline that simultaneously faces diverse clinical data challenges like mixed types, missing values, and collinearity. ClustALL enables the unsupervised identification of patient stratifications while filtering for stratifications that are robust against minor variations in the population (population-based) and against limited adjustments in the algorithm's parameters (parameter-based). RESULTS: Applied to a European cohort of patients with acutely decompensated cirrhosis (n = 766), ClustALL identified five robust stratifications, using only data at hospital admission. All stratifications included markers of impaired liver function and number of organ dysfunction or failure, and most included precipitating events. When focusing on one of these stratifications, patients were categorized into three clusters characterized by typical clinical features; notably, the 3-cluster stratification showed a prognostic value. Re-assessment of patient stratification during follow-up delineated patients' outcomes, with further improvement of the prognostic value of the stratification. We validated these findings in an independent prospective multicentre cohort of patients from Latin America (n = 580). CONCLUSIONS: By applying ClustALL to patients with acutely decompensated cirrhosis, we identified three patient clusters. Following these clusters over time offers insights that could guide future clinical trial design. ClustALL is a novel and robust stratification method capable of addressing the multiple challenges of patient stratification in most complex diseases.

Characterization of the Common Genetic Variation in the Spanish Population of Navarre.

Large-scale genomic studies have significantly increased our knowledge of genetic variability across populations. Regional genetic profiling is essential for distinguishing common benign variants from disease-causing ones. To this end, we conducted a comprehensive characterization of exonic variants in the population of Navarre (Spain), utilizing whole genome sequencing data from 358 unrelated individuals of Spanish origin. Our analysis revealed 61,410 biallelic single nucleotide variants (SNV) within the Navarrese cohort, with 35% classified as common (MAF > 1%). By comparing allele frequency data from 1000 Genome Project (excluding the Iberian cohort of Spain, IBS), Genome Aggregation Database, and a Spanish cohort (including IBS individuals and data from Medical Genome Project), we identified 1069 SNVs common in Navarre but rare (MAF ≤ 1%) in all other populations. We further corroborated this observation with a second regional cohort of 239 unrelated exomes, which confirmed 676 of the 1069 SNVs as common in Navarre. In conclusion, this study highlights the importance of population-specific characterization of genetic variation to improve allele frequency filtering in sequencing data analysis to identify disease-causing variants.

Reactivity of N-Phosphinoguanidines of the Formula (HNR)(Ph2PNR)C(NAr) toward Main Group Metal Alkyls: Facile Ligand Rearrangement from N-Phosphinoguanidinates to Phosphinimine-Amidinates.

We report the reactivity of N-phosphinoguanidines of the formula (HNR)(Ph2PNR)C(NAr) (R = iPr and Ar = 2,6-iPr2C6H3 [Dipp] for 1a, R = iPr and Ar = 2,4,6-Me3C6H2 [Mes] for 1b, and R = Cy and Ar = Dipp for 1c), prepared in high yields from the corresponding trisubstituted guanidines, toward main group metal alkyls AlMe3, ZnEt2, MgnBu2, and nBuLi to obtain novel phosphinoguanidinato and phosphinimine-amidinato compounds. Reactions of 1a-c with AlMe3 at room temperature led to the kinetic phosphinoguanidinato products [Al{κ2-N,N'-(NR)C(NAr)(NRPPh2)}Me2] (2a-c), whereas the mild heating (60-80 °C) of solutions of 2a-c give the thermodynamic phosphinimine-amidinato products [Al{κ2-N,N'-(NR)C(NAr)(PPh2NR)}Me2] (3a-c) after ligand rearrangement. The reactions of equimolar amounts of 1a-c and ZnEt2 initially give solutions containing unstable phosphinoguanidinato compounds [Zn{κ2-N,P-(NR)C(NAr)(NRPPh2)}Et] (4a-c), which rearrange upon mild heating to the phosphinimine-amidinato derivatives [Zn{κ2-N,N'-(NR)C(NAr)(PPh2NR)}Et] (6a-c). Bis(phosphinoguanidinato) compounds [Zn{κ2-N,P-(NR)C(NAr)(NRPPh2)}2] (5a-c) can be obtained under mild conditions (<45 °C) in THF, whereas bis(phosphinimine-amidinato) compounds [Zn{κ2-N,N'-(NR)C(NAr)(PPh2NR)}2] (7a-c) are also accessible under more forcing conditions (55-100 °C) from (i) ZnEt2 and 1b,c (2 equiv), (ii) 6a and 1a, or (iii) 5b,c. Equimolar mixtures of MgnBu2 and 1a-c in THF at room temperature give unstable phosphinimine-amidinato monoalkyl products [Mg{κ2-N,N'-(NR)C(NAr)(PPh2NR)}nBu(THF)2] (8a-c), whereas 2 equiv of 1a,b are required to reach the bischelate compounds [Mg{κ2-N,N'-(NiPr)C(NAr)(PPh2NiPr)}2] (9a,b). Finally, phosphinoguanidinato compounds [Li{κ2-N,P-(NR)C(NDipp)(NRPPh2)}(THF)2] (10a,c) were obtained in the reactions of 1a,c with nBuLi in THF under ambient conditions. The removal of the solvent from solutions of 10a,c under partial vacuum leads to the dinuclear compounds [Li2{µ-κ2-N,N':κ1-N-(NR)C(NDipp)(NRPPh2)}2(THF)2] (11a,c) after the decoordination of one of the THF molecules in 10a,c and dimerization. Heating solutions of 10a,c at 60 °C triggers ligand rearrangement to give phosphinimine-amidinato compounds [Li{κ2-N,N'-(NR)C(NDipp)(PPh2NR)}(THF)2] (12a,c). We also propose a mechanism for the ligand rearrangement reaction from 10a to give 12a, supported by DFT calculations, which fits nicely with our experimental results. It essentially involves a carbodiimide deinsertion reaction followed by a [3 + 2] cycloaddition between the resulting lithium phosphino-amide and the carbodiimide.

Coordination and Dehydrogenation of Diphosphine-Borane Ph2PCH2PPh2·BH3 at a Heterometallic MoRe Center to Give an Agostic Boryl-Bridged Derivative.

The coordination chemistry of the title diphosphine-borane adduct at heterometallic MoRe centers was examined through its reactions with the hydride complex [MoReCp(µ-H)(µ-PCy2)(CO)5(NCMe)] (Cp = η5-C5H5). The latter reacted rapidly with stoichiometric amounts of dppm·BH3 (dppm = Ph2PCH2PPh2) in refluxing toluene solution, with displacement of the nitrile ligand, to give [MoReCp(µ-H)(µ-PCy2)(CO)5(κ1P-dppm·BH3)], with a P-bound diphosphine-borane ligand arranged trans to the PCy2 group. Decarbonylation of the latter complex was accomplished rapidly upon irradiation with visible-UV light in toluene solution at 263 K, to give the agostic derivative [MoReCp(µ-H)(µ-PCy2)(CO)4(κ1P,η2-dppm·BH3)] as major product (Mo-Re = 3.2075(5) Å), along with small amounts of the diphosphine-bridged complex [MoReCp(µ-H)(µ-PCy2)(CO)4(µ-dppm)]. Extended photolysis of the agostic complex at 288 K promoted an unprecedented dehydrogenation process involving the borane group and the hydride ligand, to give the diphosphine-boryl complex [MoReCp(µ-η2:κ2P,B-H2B·dppm)(µ-PCy2)(CO)4] (Mo-Re = 3.075(1) Å). The latter displayed a boryl ligand in a novel bridging coordination mode, it being σ-bound to one of the metal atoms (B-Re = 2.38(2) Å) while interacting with the second metal atom via a strong side-on tricentric B-H-M interaction (B-Mo = 2.31(1); H-Mo = 1.9(1) Å). The overall dehydrogenation process was endergonic by 43 kJ/mol, according to density functional theory calculations.

Unusual ligand rearrangement: from N-phosphinoguanidinato to phosphinimine-amidinato compounds.

Novel N-phosphinoguanidines (HNiPr)(Ph2PNiPr)C(NAr) (Ar = 2,6-iPr2C6H3, 2,4,6-Me3C6H2) react with AlMe3 to afford phosphinimine-amidinato derivatives, via an unprecedented rearrangement of an initial N-phosphinoguanidinato intermediate. A reasonable mechanism has been proposed for this transformation, supported by DFT calculations, involving carbodiimide de-insertion followed by a [3+2] cycloaddition.

Acetonitrile Adduct [MoReCp(µ-H)(µ-PCy2)(CO)5(NCMe)]: A Surrogate of an Unsaturated Heterometallic Hydride Complex.

The title compound was prepared upon irradiation of acetonitrile solutions of the readily available hexacarbonyl [MoReCp(µ-H)(µ-PCy2)(CO)6]. The acetonitrile ligand in this compound could be replaced easily by donor molecules or displaced upon two-electron reduction. In most cases, the substitution step was followed by additional processes such as insertion into the M-H bonds, E-H bond cleavage, H2 elimination, and other transformations.