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. 2014 Oct 9;9(10):e108358. doi: 10.1371/journal.pone.0108358

Inferring Tree Causal Models of Cancer Progression with Probability Raising

Loes Olde Loohuis 1,*,#, Giulio Caravagna 2,#, Alex Graudenzi 2,#, Daniele Ramazzotti 2,#, Giancarlo Mauri 2, Marco Antoniotti 2, Bud Mishra 3
Editor: Lars Kaderali4
PMCID: PMC4191986  PMID: 25299648

Abstract

Existing techniques to reconstruct tree models of progression for accumulative processes, such as cancer, seek to estimate causation by combining correlation and a frequentist notion of temporal priority. In this paper, we define a novel theoretical framework called CAPRESE (CAncer PRogression Extraction with Single Edges) to reconstruct such models based on the notion of probabilistic causation defined by Suppes. We consider a general reconstruction setting complicated by the presence of noise in the data due to biological variation, as well as experimental or measurement errors. To improve tolerance to noise we define and use a shrinkage-like estimator. We prove the correctness of our algorithm by showing asymptotic convergence to the correct tree under mild constraints on the level of noise. Moreover, on synthetic data, we show that our approach outperforms the state-of-the-art, that it is efficient even with a relatively small number of samples and that its performance quickly converges to its asymptote as the number of samples increases. For real cancer datasets obtained with different technologies, we highlight biologically significant differences in the progressions inferred with respect to other competing techniques and we also show how to validate conjectured biological relations with progression models.

Introduction

Cancer is a disease of evolution. Its initiation and progression are caused by dynamic somatic alterations to the genome manifested as point mutations, structural alterations, DNA methylation and histone modification changes [1].

These genomic alterations are generated by random processes, and since individual tumor cells compete for space and resources, the fittest variants are naturally selected for. For example, if through some mutations a cell acquires the ability to ignore anti-growth signals from the body, this cell may thrive and divide, and its progeny may eventually dominate some part(s) of the tumor. This clonal expansion can be seen as a discrete state of the cancer's progression, marked by the acquisition of a set of genetic events. Cancer progression can then be thought of as a sequence of these discrete steps, where the tumor acquires certain distinct properties at each state. Different progression sequences are possible, but some are more common than others, and not every order is viable [2].

In the last two decades, many specific genes and genetic mechanisms that are involved in different types of cancer have been identified (see e.g. [3], [4] for an overview of common cancer genes and [5], [6] for specific genetic analyses of ovarian carcinoma and lung adenocarcinoma, respectively), and therapies targeting the activity of these genes are now being developed at a fast pace [2]. However, unfortunately, the causal and temporal relations among the genetic events driving cancer progression remain largely elusive.

The main reason for this state of affairs is that information revealed in the data is usually obtained only at one (or a few) points in time, rather than over the course of the disease. Extracting this dynamic information from the available cross-sectional data is challenging, and a combination of mathematical, statistical and computational techniques is needed. In recent years, several methods to extract progression models from cross-sectional data have been developed, starting from the seminal work on single-path-models by Fearon and Vogelstein [7]. In particular, different models of oncogenetic trees were developed over the years. At the core of some of these methods, e.g. [8], [9], is the use of correlation to identify relations among genetic events. These techniques reconstruct tree models of progression as independent acyclic paths with branches and no confluences. Distinct models of oncogenetic trees are instead based on maximum likelihood estimation, e.g., [10], [11], [12]. More general Markov chain models, e.g., [13], describe more flexible probabilistic networks, despite the computationally expensive parameter estimation. Other recent models are Conjunctive Bayesian Networks, CBNs [14], [15], that extract directed acyclic graphs, yet imposing specific constraints on the joint occurrence of events. Finally, in a slightly different context, temporal models were reconstructed from time-course gene expression data [16], [17].

In this paper we present a novel theoretical framework called CAPRESE (CAncer PRogression Extraction with Single Edges) to reconstruct cumulative progressive phenomena, such as cancer progression. We assume the original problem setting of [8], and propose a new a technique to infer probabilistic progression trees from cross-sectional data. Unlike maximum likelihood estimation-based techniques, our goal is the extraction of the minimal progression model explaining the order in which mutations occur and accumulate. The method is technology agnostic, i.e., it can be applied to dataset derived from all types of (epi-)genetic data such as deep exome sequencing, bisulfite sequencing, SNP arrays, etc., (see Results), and takes as input a set of pre-selected genetic events of which the presence or the absence of each event is recorded for each sample.

CAPRESE is based on two main ingredients: Inline graphic rather than using correlation to infer progression structures, we base our technique on a notion of probabilistic causation, and Inline graphic, to increase robustness against noise, we adopt a shrinkage-like estimator to measure causation among any pair of events. More specifically, with respect to our first ingredient, we adopt the notion of (prima facie) causation proposed by Suppes in [18]. Its basic intuition is simple: event Inline graphic causes event Inline graphic if Inline graphic Inline graphic occurs before Inline graphic and Inline graphic the occurrence of Inline graphic raises the probability of observing Inline graphic. This is a very basic notion of probabilistic causation that in itself does not address many of the problems associated with it (such as asymmetry, common causes, and screening off [19]), and includes spurious as well as genuine causes. However, as it turns out, this basic notion combined with a filter for independent progressions starting from the same root, is an excellent tool to guide progression extraction from cross-sectional data – one that outperforms the commonly used correlation-based methods.

Probabilistic causation was used in biomedical applications before (e.g., to find driver genes from CNV data in [20], and to extract causes from biological time series data in [21]), but, to the best of our knowledge, never to infer progression models in the absence of direct temporal information.

The extraction problem is complicated by the presence of both false positive and false negative observations (see [22] for a discussion on this issue based on the reconstruction by [8]), such as the one provided by the intrinsic variability of biological processes (e.g., genetic heterogeneity) and experimental errors. This poses a problem, because while probability raising is a very precise tool, it, by itself, is not robust enough against noise. Conditional on the amount of noise, we will rely both on probabilistic causation and on a more robust (but less precise) correlation-based metric in an optimal way. To do this we introduce our second ingredient, a shrinkage-like estimator to measure causation among any pair of events. The intuition behind this estimator, which is closely related to a shrinkage estimator from [23], is to find the optimal balance between probability raising on the one hand and correlation on the other, depending on the amount of noise.

We prove correctness of our algorithm by showing that with increasing sample sizes, the reconstructed tree asymptotically converges to the correct one (Theorem 3). Under mild constraints on the noise rates, this result holds for the reconstruction problem in the presence of uniform noise as well.

We also study the performance of CAPRESE in more realistic settings with limited sample sizes. Using synthetic data, we show that under these conditions, our algorithm outperforms the state-of-the-art tree reconstruction algorithm of [8] (see Results). In particular, our shrinkage-like estimator provides, on average, an increased robustness to noise which ensures it to outperform oncotrees [8]. Performance is defined in terms of structural similarity between the reconstructed tree and the actual tree, rather than on their induced distribution as is done, e.g., in [11]. This metric is especially appropriate for the goal of reconstructing a progression model where data-likelihood fit is secondary to “calling” the possibly minimal set of causal relations.

Also, we show that CAPRESE works well already with a relatively low number of samples and that its performance quickly converges to its asymptote as the number of samples increases. This outcome hints at the applicability of the algorithm with relatively small datasets without compromising its efficiency.

We remark that further analyses on synthetic data suggests that CAPRESE outperforms a well known bayesian probabilistic graphical model as well (i.e., Conjunctive Bayesian Networks [14], [15]), which was originally conceived for the reconstruction of more complex topologies, e.g. DAGs, but was proven effective in reconstructing tree topologies as well [24] (see Results).

Finally, we apply our technique to alterations assessed with both Comparative Genomic Hybridization and Next Generation Sequencing techniques (see Results). In the former case, we show that the algorithm of [8] and CAPRESE highlight biologically important differences in ovarian, gastrointestinal and oral cancer, but our inferences are statistically more significant. In the latter, we validate a recently discovered relation among two key genes involved in leukemia.

Methods

Problem setting

The set-up of the reconstruction problem is as follows. Assuming that we have a set Inline graphic of Inline graphic mutations (events, in probabilistic terminology) and Inline graphic samples, we represent a cross-sectional dataset as an Inline graphic binary matrix in which an entry Inline graphic if the mutation Inline graphic was observed in sample Inline graphic, and Inline graphic otherwise. The problem we solve in this paper is to extract a set of edges Inline graphic yielding a progression tree Inline graphic from this matrix which, we remark, only implicitly provides information of progression timing. The root of Inline graphic is modeled using a (special) event Inline graphic such that heterogenous progression paths or forests can be reconstructed. More precisely, we aim at reconstructing a rooted tree that satisfies: Inline graphic each node has at most one incoming edge, Inline graphic the root has no incoming edges Inline graphic there are no cycles.

Each progression tree subsumes a distribution of observing a subset of the mutations in a cancer sample that can be formalized as follows:

Definition 1. (Tree-induced distribution) Let Inline graphic be a tree and Inline graphic a labeling function denoting the independent probability of each edge, Inline graphic generates a distribution where the probability of observing a sample with the set of alterations Inline graphic is

graphic file with name pone.0108358.e030.jpg (1)

where all events in Inline graphic are assumed to be reachable from the root Inline graphic , and Inline graphic is the set of edges connecting the root to the events in Inline graphic .

We would like to emphasize two properties related to the tree-induced distribution. First, the distribution subsumes that, given any oriented edge Inline graphic, an observed sample contains alteration Inline graphic with probability Inline graphic, that is the probability of observing Inline graphic after Inline graphic. For this reason, if Inline graphic causes Inline graphic, the probability of observing Inline graphic will be greater than the probability of observing Inline graphic accordingly to the temporal priority principle which states that all causes must precede, in time, their effects [25].

Second, the input dataset is a set of samples generated, ideally, from an unknown distribution induced by an unknown tree or forest that we aim at reconstructing. However, in some cases, it could be that no tree exists whose induced distribution generates exactly those input data. When this happens, the set of observed samples slightly diverges from any tree-induced distribution. To model these situations a notion of noise can be introduced, which depends on the context in which data are gathered. Adding noise to the model complicates the reconstruction problem (see Results).

The oncotree approach

In [8] Desper et al. developed a method to extract progression trees, named “oncotrees”, from static CNV data. In [22] Szabo et al. extended the setting of Desper's reconstruction problem to account for both false positives and negatives in the input data. In these oncotrees, nodes represent CNV events and edges correspond to possible progressions from one event to the next.

The reconstruction problem is exactly as described above, and each tree is rooted in the special event Inline graphic. The choice of which edge to include in a tree is based on the estimator

graphic file with name pone.0108358.e045.jpg (2)

which assigns to each edge Inline graphic a weight accounting for both the relative and joint frequencies of the events – thus measuring correlation. The estimator is evaluated after including Inline graphic to each sample of the dataset. In this definition the rightmost term is the (symmetric) likelihood ratio for Inline graphic and Inline graphic occurring together, while the leftmost is the asymmetric temporal priority measured by rate of occurrence. This implicit form of timing assumes that, if Inline graphic occurs more often than Inline graphic, then it likely occurs earlier, thus satisfying

graphic file with name pone.0108358.e052.jpg

An oncotree is the rooted tree whose total weight (i.e., sum of all the weights of the edges) is maximized, and can be reconstructed in Inline graphic steps using Edmond's algorithm [26]. By construction, the resulting graph is a proper tree rooted in Inline graphic: each event occurs only once, confluences are absent, i.e., any event is caused by at most one other event. This method has been used to derive progressions for various cancer datasets e.g., [27], [28], [29]), and even though several methods that extend this framework exists (e.g. [9], [11], [15]), to the best of our knowledge, it is currently the only method that aims to solve exactly the same problem as the one investigated in this paper and thus provide a benchmark to compare against.

A probabilistic approach to causation

We briefly review the approach to probabilistic causation, on which our method is based. For an extensive discussion on this topic we refer to [19].

In his seminal work [18], Suppes proposed the following notion.

Definition 2. (Probabilistic causation, [18]). For any two events Inline graphic and Inline graphic , occurring respectively at times Inline graphic and Inline graphic , under the mild assumptions that Inline graphic , the event Inline graphic is a prima facie cause of the event Inline graphic if it occurs before the effect and the cause raises the probability of the effect, i.e.,

graphic file with name pone.0108358.e062.jpg (3)

As discussed in [19] the above conditions are not, in general, sufficient to claim that event Inline graphic is a cause of event Inline graphic. In fact a prima facie cause is either genuine or spurious. In the latter case, the fact that the conditions hold in the observations is due either to coincidence or to the presence of a certain third confounding factor, related both to Inline graphic and to Inline graphic [18]. Genuine causes, instead, satisfy Definition 2 and are not screened-off by any confounding factor. However, they need not be direct causes. See Figure 1.

Figure 1. Prima facie topology.

Figure 1

Example prima facie topology where all edges Inline graphic represent prima facie causes, according to Definition 3: Inline graphic is a probability raiser of Inline graphic and it occurs more frequently. In left, we filter out spurious causes and select only the real ones among the genuine, yielding a single-cause prima facie topology.

Note that we consider cross-sectional data where no information about Inline graphic and Inline graphic is available, so in our reconstruction setting we are restricted to consider solely the probability raising (PR) property, i.e., Inline graphic, which makes it harder to discriminate among genuine and spurious causes. Now we review some of its properties.

Proposition 1. (Dependency). Whenever the PR holds between two events Inline graphic and Inline graphic , then the events are statistically dependent in a positive sense, i.e.,

graphic file with name pone.0108358.e075.jpg (4)

This and the next proposition are well-known facts of the PR; their derivation as well as the proofs of all the results we present is in the File S1. Notice that the opposite implication holds as well: when the events Inline graphic and Inline graphic are still dependent but in a negative sense, i.e., Inline graphic, the PR does not hold, i.e., Inline graphic.

We would like to use the asymmetry of the PR to determine whether a pair of events Inline graphic and Inline graphic satisfy a causation relation so to place Inline graphic before Inline graphic in the progression tree but, unfortunately, the PR satisfies the following property.

Proposition 2. (Mutual PR). Inline graphic.

That is, if Inline graphic raises the probability of observing Inline graphic, then Inline graphic raises the probability of observing Inline graphic too.

Nevertheless, in order to determine causes and effects among the genetic events, we can use our degree of confidence in our estimate of probability raising to decide the direction of the causation relationship between pairs of events. In other words, if Inline graphic raises the probability of Inline graphic more than the other way around, then Inline graphic is a more likely cause of Inline graphic than Inline graphic of Inline graphic. Notice that this is sound as long as each event has at most one cause; otherwise, frequent late events with more than one cause, which are rather common in biological progressive phenomena, should be treated differently. As mentioned, the PR is not symmetric, and the direction of probability raising depends on the relative frequencies of the events. We make this asymmetry precise in the following proposition.

Proposition 3. (Probability raising and temporal priority). For any two events Inline graphic and Inline graphic such that the probability raising Inline graphic holds, we have

graphic file with name pone.0108358.e098.jpg (5)

That is, given that the PR holds between two events, Inline graphic raises the probability of Inline graphic more than Inline graphic raises the probability of Inline graphic, if and only if Inline graphic is observed more frequently than Inline graphic. Notice that we use the ratio to assess the PR inequality. The proof of this proposition is technical and can be found in the File S1. From this result it follows that if we measure the timing of an event by the rate of its occurrence (that is, Inline graphic implies that Inline graphic happens before Inline graphic), this notion of PR subsumes the same notion of temporal priority induced by a tree. We also remark that this is also the temporal priority made explicit in the coefficients of Desper's method. Given these results, we define the following notion of causation.

Definition 3. We state that Inline graphic is a prima facie cause of Inline graphic if Inline graphic is a probability raiser of Inline graphic , and it occurs more frequently:

graphic file with name pone.0108358.e112.jpg

We term prima facie topology a directed acyclic graph (over some events) where each edge represents a prima facie cause. When at most a single incoming edge is assigned to each event (i.e., an event has at most a unique cause, in the real world), we term this structure single-cause prima facie topology. Intuitively, this last class of topologies correspond to the trees or, more generally forests when they have disconnected components, that we aim at reconstructing.

Before moving on to introducing our algorithm let us discuss our definition of causation, its role in the definition of the reconstruction problem and some of its limitations. As already mentioned, it may be that for some prima facie cause Inline graphic of an event Inline graphic, there is a third event Inline graphic prior to both, such that Inline graphic causes Inline graphic and ultimately Inline graphic causes Inline graphic. Alternatively, Inline graphic may cause both Inline graphic and Inline graphic independently, and the causation relationship observed from Inline graphic to Inline graphic is merely spurious. In the context of the tree-reconstruction problem, namely when it is assumed that each event has at most a unique cause, the aim is to filter out the spurious edges from a general prima facie topology, so to extract a single-cause prima facie structure (see Figure 1).

Definition 3 summarizes Suppes basic notion of prima facie cause, while it is ignoring deeper discussions of causation that aim at distinguishing between actual genuine and spurious causes, e.g. screening-off, background context, d-separation [30], [31], [19]. For our purposes however, the above definition is sufficient when Inline graphic all the significant events are considered, i.e., all the genuine causes are observed as in a closed-world assumption, and Inline graphic we aim at extracting the order of progression among them (or determine that there is no apparent relation), rather than extracting causalities per se. Note that these assumptions are strong and might be weakened in the future (see Discussions), but are shared by us and [8].

Finally, we recall a few algebraic requirements necessary for our framework to be well-defined. First of all, the PR must be computable: every mutation Inline graphic should be observed with probability strictly Inline graphic. Moreover, we need each pair of mutations Inline graphic to be distinguishable in terms of PR, that is, for each pair of mutations Inline graphic and Inline graphic, Inline graphic or Inline graphic similarly to the above condition. Any non-distinguishable pair of events can be merged as a single composite event. From now on, we will assume these conditions to be verified.

Performance measure and synthetic datasets

We made use of synthetic data to evaluate the performance of CAPRESE as a function of dataset size and the false positive and negative rates. Many distinct synthetic datasets were created for this purpose, as explained below. The algorithm's performance was measured in terms of Tree Edit Distance (TED, [32]), i.e., the minimum-cost sequence of node edit operations (relabeling, deletion and insertion) that transforms the reconstructed trees into the ones generating the data. The choice of this measure of evaluation is motivated by the fact that we are interested in the structure behind the progressive phenomenon of cancer evolution and, in particular, we are interested in a measure of the genuine causes that we miss and of the spurious causes that we fail to recognize (and eliminate). Also, since topologies with similar distributions can be structurally different we choose to measure performance using structural distance rather than a distance in terms of distributions. Within the realm of ‘structural metrics' however, we have also evaluated the performance with the Hamming Distance [33], another commonly used structural metric, and we obtained analogous results (not shown here).

Synthetic data generation and experimental setting

Synthetic datasets were generated by sampling from various random trees constrained to have depth Inline graphic, since wide branches are harder to reconstruct than straight paths, and by sampling event probabilities in Inline graphic (see File S1).

Unless explicitly specified, in all the experiments we used Inline graphic distinct random trees (or forests, accordingly to the test to perform) of Inline graphic events each. This seems a fairly reasonable number of events and is in line with the usual size of reconstructed trees, e.g. [34], [35], [36], [37]. The scalability of the techniques was tested against the number of samples by ranging Inline graphic from Inline graphic to Inline graphic, with a step of Inline graphic, and by replicating Inline graphic independent datasets for each parameters setting (see the caption of the figures for details).

We included a form of noise in generating the datasets, in order to account for Inline graphic the realistic presence of biological noise (such as the one provided by bystander mutations, genetic heterogeneity, etc.) and Inline graphic experimental errors. A noise parameter Inline graphic denotes the probability that any event assumes a random value (with uniform probability), after sampling from the tree-induced distribution. Algorithmically this process generates, on average, Inline graphic random entries in each sample (e.g. with Inline graphic we have, on average, one error per sample). We wish to assess whether these noisy samples can mislead the reconstruction process, even for low values of Inline graphic. Notice that assuming a uniformly distributed noise may appear simplistic since some events may be more robust, or easy to measure, than others. However, introducing in the data both false positives (at rate Inline graphic) and negatives (at rate Inline graphic) makes the inference problem substantially harder, and was first investigated in [22].

In the Results section, we refer to datasets generated with rate Inline graphic as noisy synthetic dataset. In the numerical experiments, Inline graphic is usually discretized by Inline graphic, (i.e., Inline graphic noise).

Results

Extracting progression trees with probability raising and a shrinkage-like estimator

The CAPRESE reconstruction method is described in Algorithm 1. The algorithm is similar to Desper's and Szabo's algorithm, the main difference being an alternative weight function based on a shrinkage-like estimator.

Algorithm 1. CAPRESE: a tree-like reconstruction with a shrinkage-like estimator.

  • 1: consider a set of Inline graphic genetic events Inline graphic plus a special event Inline graphic, added to each sample of the dataset;

  • 2: define a Inline graphic matrix Inline graphic where each entry contains the shrinkage-like estimator Inline graphic according to the observed probability of the events Inline graphic and Inline graphic;

  • 3: [PR causation] define a tree Inline graphic where Inline graphic for Inline graphic if and only if: Inline graphic

  • 4: [Independent progressions filter] define Inline graphic, replace edge Inline graphic with edge Inline graphic if, for all Inline graphic, it holds Inline graphic

Definition 4. (Shrinkage-like estimator). We define the shrinkage-like estimator Inline graphic of the confidence in the causation relationship from Inline graphic to Inline graphic as

graphic file with name pone.0108358.e175.jpg (6)

where Inline graphic and

graphic file with name pone.0108358.e177.jpg (7)

This estimator is similar in spirit to a shrinkage estimator (see [23]) and combines a normalized version of PR, the raw estimate Inline graphic, with a correction factor Inline graphic (in our case a correlation-based measure of temporal distance among events), to define a proper order in the confidence of each causation relationship. Our Inline graphic is the analogous of the shrinkage coefficient and can have a Bayesian interpretation based on the strength of our belief that Inline graphic and Inline graphic are causally relevant to one another and the evidence that Inline graphic raises the probability of Inline graphic. In the absence of a closed form solution for the optimal value of Inline graphic, one may rely on cross-validation of simulated data. The power of shrinkage (and our shrinkage-like estimator) lies in the possibility of determining an optimal value for Inline graphic to balance the effect of the correction factor on the raw model estimate to ensure optimal performances on ill posed instances of the inference problem. A crucial difference, however, between our estimator and classical shrinkage, is that our estimator aims at improving the performance of the overall reconstruction process, not limited to the performance of the estimator itself as is the case in shrinkage. That is, the metric Inline graphic induces an ordering to the events reflecting our confidence for their causation. Furthermore, since we make no assumption about the underlying distribution, we learn it empirically by cross-validation. In the next sections we show that the shrinkage-like estimator is an effective way to get such an ordering especially when data are noisy. In CAPRESE we use a pairwise matrix version of the estimator.

The raw estimator and the correction factor

By considering only the raw estimator Inline graphic, we would include an edge Inline graphic in the tree consistently in terms of Inline graphic Definition 3 (Methods) and Inline graphic if Inline graphic is the best probability raiser for Inline graphic. When Inline graphic the events Inline graphic and Inline graphic are indistinguishable in terms of temporal priority, thus Inline graphic is not sufficient to decide their causal relation, if any. This intrinsic ambiguity is unlikely in practice even if, in principle, it is possible. Notice that this formulation of Inline graphic is a monotonic normalized version of the PR ratio.

Proposition 4. (Monotonic normalization). For any two events Inline graphic and Inline graphic we have

graphic file with name pone.0108358.e201.jpg (8)

This raw model estimator satisfies Inline graphic: when it tends to Inline graphic the pair of events appear disjointly (i.e., they show an anti- causation pattern), when it tends to Inline graphic no causation or anti- causation can be inferred and the two events are statistically independent and, when it tends to Inline graphic, the causation relationship between the two events is genuine. Therefore, Inline graphic provides a quantification of the degree of confidence for a PR causation relationship. In fact, for any given possible causation edge Inline graphic, the term Inline graphic gives an estimate of the error rate of Inline graphic, therefore the numerator of the raw model Inline graphic provides an estimate of how often Inline graphic is actually caused by Inline graphic. The Inline graphic estimator is then normalized to range between Inline graphic and Inline graphic.

However, Inline graphic does not provide a general criterion to disambiguate among genuine causes of a given event. We show a specific case in which Inline graphic is not a sufficient estimator. Let us consider, for instance, a causal linear path: Inline graphic. In this case, when evaluating the candidate parents Inline graphic and Inline graphic for Inline graphic we have: Inline graphic, so Inline graphic and Inline graphic are genuine causes of Inline graphic, though we would like to select Inline graphic, instead of Inline graphic. Accordingly, we can only infer that Inline graphic and Inline graphic, i.e., a partial ordering, which does not help to disentangle the relation among Inline graphic and Inline graphic with respect to Inline graphic.

In this case, the Inline graphic coefficient can be used to determine which of the two genuine causes occurs closer, in time, to Inline graphic (Inline graphic, in the example above). In general, such a correction factor provides information on the temporal distance between events, in terms of statistical dependency. In other words, the higher the Inline graphic coefficient, the closer two events are. Therefore, when dealing with noisy data and limited sample sizes, there are situations where, by using the Inline graphic estimator alone, we could infer a wrong transitive edge to be the most likely cause even in the presence of the real cause. For this reason, we reduce the Inline graphic estimator to the correction factor Inline graphic, which, for each given edge Inline graphic, is normalized within Inline graphic and Inline graphic.

The shrinkage-like estimator Inline graphic then results in the combination of the raw PR estimator Inline graphic and of the Inline graphic correction factor, which respects the temporal priority induced by Inline graphic.

Proposition 5. (Coherence in dependency and temporal priority). The Inline graphic correction factor is symmetrical and subsumes the same notion of dependency of the raw estimator Inline graphic , that is

graphic file with name pone.0108358.e249.jpg (9)

The independent progressions filter

As in Desper's approach, we also add a root Inline graphic with Inline graphic in order to separate different progression paths, i.e., the different sub-trees rooted in Inline graphic. CAPRESE initially builds a unique tree by using the estimator; typically, the most likely event will be at the top of the progression even if there may be rare cases where more than one event has no valid parent, in these cases we would already be reconstructing a forest. In the reconstructed tree, all the edges represent the most confident prima facie cause, although some of those could still be spurious causes. Then the correlation-like weight between any node Inline graphic and Inline graphic is computed as

graphic file with name pone.0108358.e255.jpg

If this quantity is greater than the weight of Inline graphic with each upstream connected element Inline graphic, we consider the best prima facie cause of Inline graphic to be a spurious cause and we substitute the edge Inline graphic with the edge Inline graphic. Note that in this work we are ignoring deeper discussions of probabilistic causation that aim at distinguishing between actual genuine causes and spurious causes. Instead, we remove spurious causes by using a filter based on correlation because the probability raising of the omnipresent event Inline graphic is not well defined (see Methods). In addition, we remark that the evaluation for an edge to be a genuine or a spurious cause takes into account all the given events. Because of this, if events are added or removed from the dataset, the same edge can be defined to be genuine or spurious as the set of events included in the model is varied arbitrarily. However, since we do not consider the problem of selecting the set of progression events, we assume that all and only the relevant events for the problem at hand are already known a priori and included in the model.

Finally, note that this filter is indeed implying a non-negative threshold for the shrinkage-like estimator, when an edge is valid.

Theorem 1. (Independent progressions). Let Inline graphic a set of Inline graphic prima facie causes for some Inline graphic , and let Inline graphic . The reconstructed tree by CAPRESE contains edge Inline graphic instead of Inline graphic if, for all Inline graphic

graphic file with name pone.0108358.e269.jpg (10)

The proof of this theorem can be found in the File S1. What this theorem suggests is that, in principle, by examining the level of statistical dependency of each pair of events, it would be possible to determine how many trees compose the reconstructed forest. Furthermore, it suggests that CAPRESE could be defined by first processing the independent progressions filter, and then using Inline graphic to build the independent progression trees in the forest.

To conclude, the algorithm reconstructs a well defined tree (or, more in general, forest).

Theorem 2. (Algorithm correctness). CAPRESE reconstructs a well defined tree Inline graphic without disconnected components, transitive connections and cycles.

Additionally, asymptotically with the number of samples, the reconstructed tree is the correct one.

Theorem 3. (Asymptotic convergence). Let Inline graphic be the forest to reconstruct from a set of Inline graphic input samples, given as the input matrix Inline graphic . If Inline graphic is strictly sampled from the distribution induced by Inline graphic and infinite samples are available, i.e., Inline graphic , CAPRESE with Inline graphic correctly reconstructs Inline graphic .

The proof of these Theorems are also in the File S1. These theorems considered datasets where the observed and theoretical probabilities match, because of Inline graphic. However, data often contains false positives and negatives (i.e., data are noisy) and resistance to their effects is desirable in any inferential technique. With this in mind, we prove a corollary of the theorem analoguos to a result appearing in [22].

Corollary 1. (Uniform noise). Let the input matrix Inline graphic be strictly sampled from the distribution induced by Inline graphic with sample size Inline graphic , but let it be corrupted by noise levels of false positives Inline graphic and false negatives Inline graphic . Let Inline graphic , CAPRESE correctly reconstructs Inline graphic for Inline graphic whenever

graphic file with name pone.0108358.e289.jpg

and Inline graphic.

Essentially, this corollary states that CAPRESE (and so the estimator Inline graphic) is robust against a noise affecting all samples equally. Also, the fact that it holds for Inline graphic is sound with the theory of shrinkage estimators for which, asymptotically, the corrector factor is not needed to regularize the ill posed problem.

Optimal shrinkage-like coefficient

Theorem 3 and Corollary 1 state that with infinite samples and mild constraints on the false positive/negative rates we get optimal results with Inline graphic. Precisely, for the uniform noise model that we applied to synthetic data (see Methods) we have Inline graphic, thus the hypothesis required by Corollary 1 is

graphic file with name pone.0108358.e295.jpg

For Inline graphic, which we set in data generation (see File S1), this inequality implies correct reconstruction for Inline graphic (a Inline graphic error rate), with infinite samples. However, we are interested in performance and the optimal value of Inline graphic in situations in which we have finite sample sizes as well. Here, we empirically estimate the optimal Inline graphic value, both in the case of trees and forests, as a function of noise and sample size. In the next section, we assess performance of our algorithm empirically.

In Figure 2, we show the variation of the performance of CAPRESE as a function of Inline graphic, for datasets with 150 samples generated from tree topologies. The optimal value, i.e., lowest Tree Edit Distance (TED, see Methods), for noise-free datasets (i.e., Inline graphic) is obtained for Inline graphic, whereas for the noisy datasets a series of U-shaped curves suggests a unique optimum value for Inline graphic, immediately observable for Inline graphic. Identical results are obtained when dealing with forests (not shown here). In addition, further experiments with Inline graphic varying around the typical sample size (Inline graphic) show that the optimal Inline graphic is largely insensitive to the dataset size (see Figure 3). Thus we have limited our analysis to datasets with the typical sample size that is characteristic of data currently available.

Figure 2. Optimal shrinkage-like coefficient for reconstruction performance.

Figure 2

We show here the performance in the reconstruction of trees (TED surface) with Inline graphic samples as a function of the shrinkage-like coefficient Inline graphic. Notice the global optimal performance for Inline graphic when Inline graphic and for Inline graphic when Inline graphic.

Figure 3. Optimal Inline graphic with datasets of different size.

Figure 3

We show the analogous of Figure 2 with 50 and 250 samples. The estimation of the optimal shrinkage-like coefficient Inline graphic appears to be irrespective of the sample size.

Summarizing, Figures 2 and 3 suggest that for sample size below 250 without false positives and negatives the PR raw estimate Inline graphic suffices to drive reconstruction to good results (TED is 0 with 250 samples), i.e.,

graphic file with name pone.0108358.e318.jpg (11)

which is obtained by setting Inline graphic to a very small value, e.g. Inline graphic, in order to consider at least a small contribution of the correction factor too. Conversely, when Inline graphic, the best performance is obtained by averaging the shrinkage-like effect, i.e.,

graphic file with name pone.0108358.e322.jpg (12)

These results suggest that, in general, a unique optimal value for the shrinkage-like coefficient can be determined, even in situations not captured by Theorem 3 and Corollary 1.

Performance of CAPRESE compared to oncotrees

An analogue of Theorem 3 holds for Despers's oncotrees (Theorem 3.3, [8]), and an analogue of Corollary 1 holds for Szabo's extension with uniform noise (Reconstruction Theorem 1, [22]). Thus, with infinite samples both approaches reconstruct the correct trees/forests. With finite samples and noise, however, their performance may show different patterns, as speed of convergence may vary. We investigate this issue in the current section.

In Figure 4 we compare the performance of CAPRESE with oncotrees, for the case of noise-free synthetic data with the optimal shrinkage-like coefficient: Inline graphic, equation (11). Since Szabo's algorithm is equivalent to Desper's without false negatives and positives, we rely solely on Szabo's implementation [22]. In Figure 5 we show an example of reconstructed tree where CAPRESE infers the correct tree while oncotrees mislead a causation relation.

Figure 4. Comparison on noise-free synthetic data.

Figure 4

Performance of CAPRESE (dashed line) and oncotrees (full line) in average TED when data are generated by random trees (left) and forests (right). In this case Inline graphic (no false positives/negatives) and Inline graphic in the estimator Inline graphic.

Figure 5. Example of reconstructed trees.

Figure 5

Example of reconstruction from a dataset with 100 samples generated by the left tree (the theoretical probabilities are shown, i.e., the doubly-circled event appears in a sample with probability.08), with Inline graphic. In the sampled dataset oncotrees mislead the cause of the doubly-circled mutation (Inline graphic for the true edge and Inline graphic for the wrong one). CAPRESE infers the correct cause (the values of the estimator Inline graphic with Inline graphic are shown, similar results are obtained for Inline graphic).

In general, one can observe that the TED of CAPRESE is, on average, always bounded above by the TED of oncotrees, both in the case of trees and forests. For trees, with 50 samples the average TED of CAPRESE is around 6, whereas for Desper's technique it is around 13. The performance of both algorithms improves as long as the number of samples is increased: CAPRESE has the best performance (i.e., TED ≈0) with 250 samples, while oncotrees have TED around 6. When forests are considered, the difference between the performance of the algorithms reduces slightly, but also in this case CAPRESE clearly outperforms oncotrees.

Notice that the improvement due to the increase in the sample size seems to reach a plateau, and the initial TED for our estimator seems rather close to the plateau value. This empirical analysis suggests that CAPRESE has already good performances with few samples, a favorable adjoint to Theorem 3. This result has some important practical implications, particularly considering the scarcity of available biological data.

In Figure 6 we extend the comparison to noisy datasets. In this case, we used the optimal shrinkage-like coefficient: Inline graphic, equation (12). The results confirm what observed without false positives and negatives, as CAPRESE outperforms oncotrees up to Inline graphic, for all the sizes of the sample sets. In the File S1 we show similar plots for the noise-free case.

Figure 6. Reconstruction with noisy synthetic data and Inline graphic.

Figure 6

Performance of CAPRESE and oncotrees as a function of the number of samples and noise Inline graphic. According to Figure 2 the shrinkage-like coefficient is set to Inline graphic. The magnified image shows the convergence to Desper's performance for Inline graphic. The barplot represents the percentage of times the best performance is achieved at Inline graphic.

We can thus draw the conclusion that our algorithm performs better with finite samples and noise, since less samples are required to get good performances and a higher resistance to false positives and negatives is shown.

Performance of CAPRESE compared to Conjunctive Bayesian Networks

Inspired by Desper's seminal work, Beerenwinkel and others developed methods to estimate the constraints on the order in which mutations accumulate during cancer progression, using a probabilistic graphical model called Conjuntive Bayesian Networks (CBN) [14], [15]. While the goal of this research was to reconstruct direct acyclic graphs and not trees per se, evidence presented in [24] suggests that, in the absence of noise, these models perform better than oncotrees even at reconstructing trees. For this reason, we performed experiments similar to the ones suggested above, comparing CAPRESE to the extension of CBN called hidden-CBN (h-CBN) that accounts for noisy genotype observations [15]. This method combines CBNs with a simulated annealing algorithm for structure search and a denoising of the genotypes via the maximum a posteriori estimates to compute the most likely progression. One aspect that complicates a comparison between CAPRESE and (h-)CBN is that the methods assume different models. For example, at the heart of CBN is a monotonicity assumption (i.e., an event can only occur if all its predecessors have occurred) not assumed by CAPRESE. Despite the differences between the model assumptions, we present a preliminary comparison between the methods in Appendix S3, indicating that we not only outperform oncotrees, but h-CBNs as well. In particular, this suggests that CAPRESE converges much faster than h-CBNs with respect to the sample size, also in the presence of noise.

We also analyze the rate of false positives/negatives reconstructed by CAPRESE when (synthetic) data are sampled from DAGs (Appendix S3). The rate of false positives goes to 0 as the sample size increases, implying that CAPRESE is capable of reconstructing a tree subsumed by the underlying causal DAG topology. In addition, the number of false negatives approaches a value proportional to the connectivity of the model from which the data was generated. This is expected, since CAPRESE will assign at most one cause to each considered event. However, it should be noted that further experiments with samples selected from a wider array of topologies should be performed to confirm these results and compare both methods in full. While not within the scope of the current paper, these issues will be addressed in future work.

Case studies

In the next subsections we apply CAPRESE to real cancer data obtained by Comparative Genomic Hybridization (CGH) and Next Generation Sequencing (NGS). This shows the potential application of reconstruction techniques to various types of mutational profiles and various cancers.

Performance on cancer CGH datasets

Encouraged by the results in previous sections, we test our reconstruction approach on a real ovarian cancer dataset made available within the oncotree package [8]. The data was collected through the public platform SKY/M-FISH [38], used to allow investigators to share molecular cytogenetic data. The data was obtained by using the CGH technique on samples from papillary serous cystadenocarcinoma of the ovary. This technique uses fluorescent staining to detect CNV data at the resolution of chromosome arms. While the recent emergence of NGS approaches make the dataset itself rather outdated, the underlying principles remain the same and the dataset provides a valid test-case for our approach. The seven most commonly occurring events are selected from the 87 samples, and the set of events are the following gains and losses on chromosomes arms Inline graphic (e.g., Inline graphic denotes a deletion of the Inline graphic arm of the Inline graphic chromosome).

In Figure 7 we compare the trees reconstructed by the two approaches. Our technique differs from Desper's by predicting the causal sequence of alterations

graphic file with name pone.0108358.e344.jpg

when used either Inline graphic or Inline graphic. Notice that among the samples in the dataset some are not generated by the distribution induced by the recovered tree, thus comparing the reconstruction for both Inline graphics is necessary.

Figure 7. Reconstruction of ovarian cancer progression.

Figure 7

Trees reconstructed by oncotrees and CAPRESE (with Inline graphic, with Inline graphic the same tree is reconstructed). The set of CGH events considered are gains on Inline graphic, Inline graphic and Inline graphic and losses on Inline graphic, Inline graphic, Inline graphic and Inline graphic. Events on chromosomes arms containing the key genes for ovarian cancer are in bolded circles. In the left tree all edge weights are the observed probabilities of events. In the right the full edges are the causation inferred with the PR and the weights represent the scores used by CAPRESE. Weights on dashed lines are as in the left tree.

At this point, we do not have a biological interpretation for this result. However, we do know that common cancer genes reside in these regions, e.g. the tumor suppressor gene PDGFR on Inline graphic and the oncogene MYC on Inline graphic), and loss of heterozygosity on the short arm of chromosome Inline graphic is quite common (see, e.g., http://www.genome.jp/kegg/). Recently, evidence has been reported that Inline graphic contains many cooperating cancer genes [39].

In order to assign a confidence level to these inferences we applied both parametric and non-parametric bootstrapping methods to our results. Essentially, these tests consist of using the reconstructed trees (in the parametric case), or the probability observed in the dataset (in the non-parametric case) to generate new synthetic datasets, and then reconstructs again the progressions (see, e.g., [40] for an overview of these methods and [41] for the use of bootstrap for evalutating the confidence of oncogenetic trees.). The confidence is given by the number of times the trees in Figure 7 are reconstructed from the generated data. A similar approach can be used to estimate the confidence of every edge separately. For oncotrees the exact tree is obtained 83 times out of 1000 non-parametric resamples, so its estimated confidence is 8.3%. For CAPRESE the confidence is Inline graphic. In the parametric case with false positive and false negative error rates of 0.21 and 0.027, following [22], the confidence of oncotrees is Inline graphic while the confidence of our method is much higher: Inline graphic. When error rates are forced to 0 the confidence of oncotrees raises to Inline graphic and Inline graphic respectively.

For the non-parametric case, edges confidence is shown in Table 1. Most notably, our algorithm reconstructs the inference Inline graphic with high confidence (confidence Inline graphic, and Inline graphic for Inline graphic), while the confidence of the edge Inline graphic is only Inline graphic, almost the same as Inline graphic (confidence Inline graphic). The confidences are similar with either Inline graphic or Inline graphic.

Table 1. Estimated confidence for ovarian progression.

Oncotrees (overall confidence 8.3%)
Inline graphic Inline graphic Inline graphic Inline graphic Inline graphic Inline graphic Inline graphic Inline graphic
Inline graphic .99 .06 .51 .22 .004 .8 .06
Inline graphic 0 .92 .08 0.16 .04 .02 .007
Inline graphic .002 0 .04 0 0 .09 .04
Inline graphic .001 .002 0 .52 .39 .009 .16
Inline graphic 0 0 .27 0 .14 .05 .11
Inline graphic 0 0 .07 .08 0 .004 .59
Inline graphic 0 0 0 .004 0 0 0
Inline graphic 0 0 .003 .003 .04 .01 0

Frequency of edge occurrences in the non-parametric bootstrap test, for the trees shown in Figure 7. Bold entries are the edges recovered by the algorithms.

Analysis of other CGH datasets

We report the differences between the reconstructed trees also based on datasets of gastrointestinal and oral cancer ([35], [37] respectively). In the case of gastrointestinal stromal cancer, among the Inline graphic CGH events considered in [35] (gains on Inline graphic, Inline graphic and Inline graphic, losses on Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic and Inline graphic), oncotrees identify the path progression

graphic file with name pone.0108358.e422.jpg

while CAPRESE reconstructs the branch

graphic file with name pone.0108358.e423.jpg

In the case of oral cancer, among the 12 CGH events considered in [37] (gains on Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic, Inline graphic and Inline graphic, losses on Inline graphic, Inline graphic and Inline graphic), the reconstructed trees differ since oncotrees identifies the path

graphic file with name pone.0108358.e436.jpg

while our algorithm reconstructs the path

graphic file with name pone.0108358.e437.jpg

These examples show that CAPRESE provides important differences in the reconstruction compared to oncotrees.

Performance on cancer NGS datasets

In this section we show the application of reconstruction techniques to the validation of a specific relation among recurrent mutations involved in atypical Chronic Myeloid Leukemia (ACML).

In [42] Piazza et al. used high-throughput exome sequencing technology to identity somatically acquired mutations in 64 ACML patients, and found a previously unidentified recurring missense point mutation hitting SETBP1. By re-sequencing SETBP1 in samples with ACML and other common human cancers, they found that around 25% of the ACML patients tested positive for SETBP1, while most of the other types of tumors were negative. Assessing the possible relationship between SETBP1 variants and the mutations in many driver ACML oncogenes such as (e.g., ASXL1, TET2, KRAS, etc.) no significant association or mutual exclusion with SETBP1 was found but for ASXL1, which was frequently mutated together with SETBP1, hinting at a potential relation among the events. In particular, ASXL1 was presenting either a non-sense point or a indel type of somatic mutation.

Hence, we reconstructed ACML progression models from the datasets provided in [42], with the goal of assessing a potential causal dependency between mutated SETBP1 and ASXL1. A more extensive analysis is postponed, as we only seek to clearly illustrate the functionalities of the algorithm here.

As a first case (Figure 8, left), we treated the ASXL1 missense point and indel mutations as indistinguishable, and we merged the two events in the dataset. Afterwards, we separated the two types of mutations for ASXL1 (Figure 8, right).

Figure 8. Validating the Setbp1 - ASXL1 relation in atypical Chronic Myeloid Leukemia.

Figure 8

Progression models where ASXL1 indel and non-sense point are merged (left) and separate (right) suggest that a missense point mutation hitting SETBP1 can cause a non-sense point mutation in ASXL1, that the observed ASXL1 mutations might be independent and that indel ASXL1 is an early event with high confidence.

In particular, it is interesting to notice that, when the ASXL1 mutations are considered equivalent, the inference suggests that the mutations belong to two independent progression paths (i.e., the independent progression filters “breaks” every potential causal relation among the events). Conversely, when the mutations are kept separate, the progression model suggests that: Inline graphic the missense point mutation hitting SETBP1 can cause a non-sense point mutation in ASXL1 and Inline graphic the observed ASXL1 mutations seems to be independent. Concerning edges confidence, as before assessed via non-parametric bootstrap, it is worth noting that the confidence in the indel ASXL1 mutation being an early event raises consistently in the latter case.

All in all, it seems that a progression model allows to test the significance of the association firstly observed in [42] and also refines the knowledge by suggesting a specific causal and temporal relations among events. With this this in mind, ad-hoc sequencing experiments might be set up to assess these predictions, eventually providing a strong evidence that could be used to, e.g., synthesize a progression-specific ACML-effective drug.

Discussion

In this work we have introduced a novel framework for the reconstruction of the causal topologies underlying cumulative progressive phenomena, based on the probability raising notion of causation. Besides such a probabilistic notion, we also introduced the use of a shrinkage-like estimator to efficiently unravel ambiguous causal relations, often present when data are noisy. As a first step towards the definition of our new framework, we have here presented an effective novel technique called CAPRESE (CAncer PRogression Extraction with Single Edges) for the reconstruction of tree or, more generally, forest models of progression which combines probabilistic causation and a shrinkage-like estimation.

We prove correctness of CAPRESE by showing asymptotic convergence to the correct tree. Under mild constraints on the noise rates, this result holds for the reconstruction problem in the presence of uniform noise as well. Moreover, we also compare our technique to the standard tree reconstruction algorithm based on correlation (i.e., Oncontrees) and to a more general bayesian probabilistic graphical model (i.e., Conjunctive Bayesian Networks), and show that CAPRESE outperforms the state-of-the-art on synthetic data, also exhibiting a noteworthy efficiency with relatively small datasets. Furthermore, we tested our technique on ovarian, gastrointestinal and oral cancer CGH data and NGS leukemia data. The CGH analysis suggested that our approach can infer, with high confidence, novel causal relationships which would remain unpredictable in a correlation-based attack. The NGS analysis allowed validating a causal and temporal relation among key mutations in atypical chronic myeloid leukemia.

One of the strong points of CAPRESE is that it can be applied to genomic data of any kind, even heterogeneous, and at any resolution, as shown. In fact, it simply requires a set of samples in which the presence or the absence of some alterations supposed to be involved in a causal cumulative process have been assessed. Notice also that the results of our technique can be used not only to describe the progression of the process, but also to classify different progression types. In the case of cancer, for instance, this genome-level classifier could be used to group patients according to the position of the detected individual genomic alterations in the progression model (e.g., at a specific point of the tree) and, consequently, to set up a genome-specific therapy design aimed, for instance, at blocking or slowing certain progression paths instead of others, as was studied in [43].

Several future research directions are possible. First, more complex models of progression, e.g. directed acyclic graphs, could be inferred with probability raising and compared to the standard approaches of [14], [15], [44], as we explained in the introduction. These models, rather than trees, could explain the common phenomenon of preferential progression paths in the target process via, e.g., confluence among events. In the case of cancer, for instance, these models would be certainly more suitable than trees to describe the accumulation of mutations.

Second, the shrinkage-like estimator itself could be improved by introducing, for instance, different correction factors. In addition, an analytical formulation of the optimal shrinkage-like coefficient could be investigated by starting from the hypotheses which apply to our problem setting, along the lines of [45].

Third, advanced statistical techniques such as bootstrapping [40] could be used to account for more sophisticated models of noise within data, so as to decipher complex causal dependencies.

Finally, a further development of the framework could involve the introduction of timed data, in order to extend our techniques to settings where a temporal information on the samples is available.

Software availability

The implementation of CAPRESE is part of the TRanslational ONCOlogy (TRONCO) R package and is available for download at standard R repositories.

Supporting Information

File S1

Contains Proofs, Synthetic Data Generation, and Further Results.

(PDF)

Acknowledgments

We are grateful for the many excellent comments we received from anonymous reviewers.

Data Availability

The authors confirm that all data underlying the findings are fully available without restriction. All data are included within the paper.

Funding Statement

This work was supported by the National Science Foundation grants CCF-0836649 and CCF-0926166 and by Regione Lombardia (Italy) under the research projects RetroNet through the ASTIL [12-4-5148000-40]; U.A 053 and NEDD Project [ID14546A Rif SAL-7] Fondo Accordi Istituzionali 2009. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

File S1

Contains Proofs, Synthetic Data Generation, and Further Results.

(PDF)

Data Availability Statement

The authors confirm that all data underlying the findings are fully available without restriction. All data are included within the paper.


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