Abstract
The recent realization that human-associated microbial communities play a crucial role in determining our health and well-being1,2 has led to the ongoing development of microbiome-based therapies3 such as fecal microbiota transplantation4,5. Thosemicrobial communities are very complex, dynamic6 and highly personalized ecosystems3,7, exhibiting a high degree of inter-individual variability in both species assemblages8 and abundance profiles9. It is not known whether the underlying ecological dynamics, which can be parameterized by growth rates, intra- and inter-species interactions in population dynamics models10, are largely host-independent (i.e. “universal”) or host-specific. If the inter-individual variability reflects host-specific dynamics due to differences in host lifestyle11, physiology12, or genetics13, then generic microbiome manipulations may have unintended consequences, rendering them ineffectual or even detrimental. Alternatively, microbial ecosystems of different subjects may follow a universal dynamics with the inter-individual variability mainly stemming from differences in the sets of colonizing species7,14. Here we developed a novel computational method to characterize human microbial dynamics. Applying this method to cross-sectional data from two large-scale metagenomic studies, the Human Microbiome Project9,15 and the Student Microbiome Project16, we found that both gut and mouth microbiomes display pronounced universal dynamics, whereas communities associated with certain skin sites are likely shaped by differences in the host environment. Interestingly, the universality of gut microbial dynamics is not observed in subjects with recurrent Clostridium difficile infection17 but is observed in the same set of subjects after fecal microbiota transplantation. These results fundamentally improve our understanding of forces and processes shaping human microbial ecosystems, paving the way to design general microbiome-based therapies18.
The underlying dynamics of a microbial ecosystem, i.e. the ecological interactions that govern its change, equilibrium and stability, can be represented by a population dynamic model
(1) |
which describes the time-dependent abundance profile of N microbial species present in a particular body site of subject υ. Here, f (x(υ); Θ(υ)) is typically a nonlinear function and Θ(υ) captures all the ecological parameters, i.e. growth rates, intra- and inter-species interactions. Those parameters may generally depend on host-independent factors, e.g. biochemical processes and microbial metabolic pathways19; and host-specific ones, e.g. nutrient intake20 and host genetic make-up13. Three fundamental cases could represent the dynamics of M healthy subjects: a)Individual dynamics, where the ecological parameters are different in different subjects, i.e. Θ(1) ≠ ⋯ ≠ Θ(M); b)Group dynamics, where subjects can be classified into K groups (K ≪ M) based on certain host factors and subjects in the same group share the same set of parameters, i.e. Θ(υ) = ΘP for all subjects in group P (P = 1,⋯,K); c)Universal dynamics, where all the subjects share the same set of parameters, i.e. Θ(ν) = Θ for all subjects. If we represent the ecological parameters, e.g. the inter-species interactions, in a directed weighted ecological network, the above three cases can be easily visualized (see Fig. 1).
Despite its critical consequences, we don’t know which case best represents the microbial ecosystems of healthy individuals. Addressing this question is crucial for developing microbiome-based therapies3,18. Indeed, if the dynamics are universal, the inter-personal variability stems solely from the different assemblages of colonizing species in different individuals. Then we can design general interventions to control the microbial state (in terms of species assemblage and abundance profile) of different individuals. In contrast, if the dynamics are strongly host-specific, we must design truly personalized interventions, which must consider not only the unique microbial state of an individual but also the unique dynamics of the underlying microbial ecosystem. In addition, host-specific dynamics, if exist, raise a major safety concern for FMT because the healthy microbiota, though stable in the donor’s gut, may be shifted to an undesired state in the recipient’s gut.
The ideal approach to addressing this fundamental question would be to infer the dynamic model captured by (1)for a large number of healthy individuals from temporal metagenomic data, and then compare the system parameters Θ(υ) directly. However, empirical parameterization of the exact functional form of f (x(υ); Θ(υ)) is extremely difficult for complex ecological systems. Furthermore, inferring the system parameters typically requires high-quality time series data and well-designed experiments to ensure the system parameters are identifiable21. Such datasets are not currently available. A conventional correlation analysis of cross-sectional data cannot address this question either, because it only captures effective (or indirect) interactions and is subject to spurious correlations due to the compositionality of relative abundances in genomic survey data22.
To overcome these issues, we developed a novel method to detect “fingerprints” of universal microbial dynamics. This is achieved by restricting ourselves to answer the question of “whether the dynamics are universal or not”, rather than the broader and harder question of “what are the dynamics”. The key idea is that when comparing microbial communities (samples) from different subjects, we distinguish between two contributors to the inter-individual variability: the difference in species assemblages and the difference in abundance profiles. We quantify those two contributors by: O(x̃,ỹ), the overlap of the species assemblages, calculated from the relative abundances of the shared species; and D(x̂,ŷ), the dissimilarity between the renormalized abundance profiles of the shared species (see Methods section). Note that the two measures (overlap and dissimilarity) are not apriori dependent on each other. Indeed, D(x̂,ŷ) is mathematically not constrained by any value of O(x̃,ỹ) > 0 (see SI Sec.1.2.1 for the proof). Hence any constraints of D(x̂,ŷ) by O(x̃,ỹ) observed from real data deserve our attention and may have ecological interpretations (see Fig. 2a,b).
To systematically compare samples from a given microbiome dataset, we first calculate the overlap and dissimilarity of all the sample pairs and represent each sample pair as a point in the Dissimilarity-Overlap plane. We then perform nonparametric regression and bootstrap sampling to calculate the average Dissimilarity-Overlap Curve (DOC) and its confidence interval (see Fig. 2b and Methods section). In the case of (i) individual dynamics; or (ii) universal dynamics but without inter-species interactions, a flat DOC is expected (see SI Sec. 1.2.3). In contrast, for systems with universal dynamics and inter-species interactions, we expect the corresponding DOC to display a characteristic feature: a negative slope in the high-overlap region, i.e. abundance profiles of sample pairs become more similar as their overlap becomes higher(see SI Sec. 1.2 and Extended Data Fig. 1). A negative slope can also be seen in the DOC of microbial communities characterized by group dynamics. The existence of such group dynamics however can be easily detected by standard ordination techniques and clustering analysis23,24 and hence ruled out (see Data Extended Fig. 2). Note that the DOC analysis described above is not affected by the compositionality of the genomic survey data and requires neither time series data nor any apriori knowledge of the specific ecological dynamics. Instead, it only relies on a few reasonable assumptions (see Methods).
To verify our DOC analysis, we first applied it to synthetic data generated from the canonical Generalized Lotka-Volterra (GLV) model, which has been used for predictive modeling of the intestinal microbiota25–27. Extended Data Fig. 3 shows that in the case of universal dynamics with strong inter-species interactions, the DOC displays a clear negative slope in the high-overlap region. In contrast, in the case of individual dynamics or universal dynamics without inter-species interactions, a flat DOC is observed.
To directly verify the DOC analysis using real data, we analyzed longitudinal gut microbial samples of four healthy individuals from two microbiome studies11,28. For each individual, we expect a highly universal microbial dynamics throughout the period of measurement, i.e. the ecological parameters Θ(ν) of the corresponding microbial community are largely time-invariant. We found that the DOCs of all four subjects show a clear negative slope in the high-overlap region (Extended Data Fig. 4), consistent with our expectation.
Next, we systematically analyzed cross-sectional microbial samples of different body sites from two large-scale metagenomic studies, the Human Microbial Project (HMP)9,15 and the Student Microbiome Project (SMP)16. The results were shown in Fig. 3 and Extended Data Fig. 5. In Fig. 3, for each body site the DOCs calculated from real and randomized samples are shown in dark blue and red, respectively. The overlap distributions of the real between-subjects sample pairs are shown in red. Note that the characteristic overlap in a particular body site is different in the two studies. For example, the average overlap between HMP gut samples is about 0.4 and between SMP samples is about 0.75. To account for this fact and to fairly compare the DOCs across different body sites and different studies, we used two different measures to quantify the universality (see Methods). Interestingly, though these two measures quantify different features of the DOC analysis, the body sites stratification pattern is consistent across the two measures and the two studied datasets (Extended Data Fig. 6). In particular, the negative slope of DOC is most significantly observed in samples from the gut and mouth and least observed in samples from hand skin (palm and elbow). These findings strongly suggest the existence of universal dynamics characterized by inter-species interactions in the gut and mouth microbiomes.
An alternative explanation for the observed negative slope of the DOC for gut and mouth microbiomes of healthy subjects could be that some host factors not only select for the presence of certain microbes but also drive their relative abundances by enforcing certain optimally adapted compositions. To test this alternative explanation, we systematically analyzed microbial samples while controlling for the effect of several leading candidates for potential confounding factors, e.g. body mass index, age, long-term dietary pattern and stool consistency. We found that as long as their values are in the normal range those factors cannot explain the observed DOC pattern (see Extended Data Figs. 7,8). Hence, the alternative explanation for the negative slope in DOC is unlikely to be true. Of course, with currently available datasets we cannot possibly account for all other confounders, e.g. drugs, genetics, inflammation, or combinations of them. More datasets will be needed to test this intriguing alternative explanation.
The above results of healthy subjects raise an interesting question: Does the universality of microbial dynamics also exist in subjects with disrupted microbiomes? To address this question, we applied the DOC analysis to microbial samples of 17 subjects with recurrent Clostridium difficile infection (rCDI) and the same set of subjects after FMT17. Clostridium difficile is an opportunistic pathogen that causes disease worldwide and greatly increases morbidity and mortality in hospitalized patients. Fortunately, FMT is very efficacious in treating patients with rCDI, with pronounced clinical improvement even after a single treatment29. Interestingly, we found that the dissimilarity between rCDI subjects is largely independent of their species overlap, rendering a flat DOC (Fig. 4a). In contrast, after FMT (median, 4 days) the DOC displays a pronounced negative slope in the high-overlap region (Fig. 4b), suggesting a universal gut microbial dynamics. FMT treatments show the flexibility of microbial communities and their adaptation to composition changes. Our result suggests that this adaptive behavior may be associated with the observed universal microbial dynamics after FMT.
Finally, we anticipate that applying our DOC analysis to subjects with other diseases (especially non-gastrointestinal diseases) or infants at different developmental stages will offer deeper insights into how dynamical processes shape human microbial ecosystems. The developed DOC analysis can also be directly applied to other microbial ecosystems, e.g. soil, ocean, lakes, phyllosphere/rhizosphere and fermenters microbiome, to detect the universality of the underlying ecological dynamics (see Extended Data Fig. 9). This sheds light on the design of more advanced methods to extract dynamical information from microbial data.
Methods
Overlap between species assemblages
Consider two microbial samples, represented by two abundance vectors x = (x1,…,xN) ∈ ℝN and y = (y1,…,yN) ∈ ℝN. For genomic survey data of the human microbiome, only the relative abundances are known. Hence, we are dealing with the relative abundance profiles x̃ = (x̃1,…,x̃N) and ỹ = (x̃1,…,x̃N), where and . To quantify the similarity of the species assemblages (sets) of the two samples, denoted as X = {i|xi > 0} and y = {i|yi > 0}, we defined the overlap measure
where S ≡ X ∩ Y is the set of shared species present in both samples. In case S is empty, O(x̃, ỹ) = 0. If S = {1,…N}, i.e. all the species in X and Y are shared, then O(x̃, ỹ) = 1, but the abundance profiles x̃ and ỹ can still be very different. In the extreme case when the relative abundance is the same for all species in X and Y, the overlap measure can be written as a function of the classical Jaccard index. Yet, there are many advantages of using the overlap measure, instead of the Jaccard index, in our analysis (see SI Sec. 1.1.4).
Dissimilarity between abundance profiles
To compare the abundance profiles of two samples, we first renormalize the relative abundances of only the shared species (set S), yielding x̃ = {x̃i}i∈S and ỹ = {ỹi}i∈S. Here and ŷi is defined similarly. This way we remove the spurious dependence between the relative abundances of the shared and the non-shared species. More importantly, this renormalization assures that the calculated dissimilarity measure is mathematically independent of the overlap measure (see SI Sec. 1.2.1). The dissimilarity is then evaluated via the root Jensen-Shannon Divergence (rJSD) measure
where and is the Kullback-Leibler divergence between x̂ and ŷ. The dissimilarity can also be evaluated via any other classical dissimilarity measures in ecology and biology, e.g. Bray-Curtis Dissimilarity, Yue-Clayton Dissimilarity, and the negative Spearman correlation (see Extended Data Fig. 5). In this work, we focused on rJSD because it is a distance metric that satisfies non-negativity, identity, symmetry and triangle inequality (see SI Sec.1.1.1). Comparing sample pairs based on phylogenetic information, e.g. using weighted- and unweighted-UniFrac30 as quantitative and qualitative measures, respectively, has the potential to provide better insight on the communities’ dissimilarity-overlap behavior. However, since the weighted- and unweighted-UniFrac are not independent, they cannot be trivially integrated into our DOC analysis.
Dissimilarity-Overlap Curve (DOC)
To systematically compare sample pairs with a wide range of overlap values and analyze their dissimilarity-overlap relations, we calculate the overlap and dissimilarity of all the sample pairs from a given set of microbiome samples and represent each sample pair as a point in the Dissimilarity-Overlap plane. We then use the robust LOWESS (locally weighted scatterplot smoothing) method, a standard non-parametric regression method that is resistant to outliers, to calculate the DOC.
To get the confidence interval, we use the following bootstrap technique: (1) From a dataset of M samples we calculate the overlap and dissimilarity of the M(M − 1)/2 sample pairs, represented as M(M − 1)/2 points in the Overlap-Dissimilarity plane. (2) In each bootstrap realization, we resample a new set k = {k1,…,kM} from the M original samples with replacement. Some of the original samples might not be included and a few might be sampled more than once. (3) We create a new cloud of points C: a point associated with sample pair (i,j) is included in C only if both i,j ∈ k, while a point is chosen several times if the sample i or j were resampled more than once in k. (4)A new DOC is calculated for C using the robust LOWESS method. We set the smoothing parameter (“span”) to be 0.2.(5) We repeat steps (2)–(4) T times to create T DOCs. (6) The 3 and 97 percentiles of the T curves represent the 94% confidence interval for the DOC. In this work, we chose T = 100.
Assumptions of the DOC Analysis
There are two reasonable assumptions underlying the DOC analysis. First, the abundance profiles of the samples should represent the steady states of the microbial ecosystem and hence the fixed points of the underlying dynamics that satisfy ẋ = 0. This assumption is fairly reasonable because human gut microbiota is a relatively resilient ecosystem3, and until the next large perturbation (e.g. antibiotic administration or dramatic dietary change) is introduced, the system remains stable for months and possibly even years11,28,31. Second, if two communities have the same species assemblages and the same abundance profile (steady state), then the two communities have the same microbial dynamics. Mathematically, this is not necessarily true, because different dynamical systems can give rise to an identical steady state or fixed point. Yet, given the large number of species and all the other levels of complexity in their interactions, the possibility of having different dynamics with the same fixed point is very unlikely. Indeed, universal dynamics is the most plausible explanation for the observed pattern, i.e. the negative slope of DOC in the high-overlap region.
Limitations of the DOC Analysis
We point out that for overlap values close to zero, a positive slope may occur as the artifact of dissimilarity between relative abundance profiles with small number of species (see Fig. 3 e4, f1–4, g1–3, h, Extended Data Fig. 10, and SI Sec. 1.1.3).
We also emphasize that a flat DOC does not completely rule out the possibility of universal dynamics. For example, the DOC of the gut microbiome samples of rCDI patients is flat (Fig. 4a). There are two possibilities. First, the universality of microbial dynamics found in healthy subjects (Fig. 3a,d) is completely lost in the rCDI subjects, due to the infection or/and the dysbiosis caused by the extensive inciting antibiotic treatment. Second, the possibly universal microbial dynamics of the rCDI subjects are just undetectable by the DOC analysis. This could be due to the extremely liquid stool samples of the rCDI subjects that suffer from diarrhea, as stool consistency has been found to be strongly correlated with the gut microbiota compositions32,33. It is also possible that the abundance profiles of rCDI subjects are drastically varying over time and hence do not represent the steady states of the underlying microbial ecosystem (though a murine infection model doesn’t seem to support this hypothesis34).
If true multi-stability exists, i.e. multiple stable states (abundance profiles) are associated with the same set of species present in the same environment, then our DOC analysis may not detect it. However, true multi-stability in human-associated microbial communities has not been demonstrated experimentally, partially because any subtle differences in the species assemblages can drive those microbial communities35.
In sum, our DOC analysis hence detects universal dynamics under certain conditions. More precisely, it provides a means of discriminating dynamics into universal or possibly universal.
Universality Measures and Statistical Test
Note that the DOCs of different datasets/studies must be compared with caution, especially if the microbial samples were preprocessed by different pipelines36, e.g. with different OTU clustering thresholds, or different OTU picking methods, etc. As shown in Fig. 3, the characteristic overlap in a particular body site is different in the two studies. For example, the average overlap between HMP gut samples is about 0.4 and between SMP samples is about 0.75. To account for this fact and to fairly compare the DOCs across different body sites and different studies, we used two different measures to quantify the universality:
-
fns. For each cohort we determined the fraction of data points for which the DOC displays a negative slope, denoted as fns. Specifically, for a given DOC calculated from a cohort of M microbial samples, we first detected the “change point” Oc such that for any O > Oc, where y(O) is a smoothed curve of the DOC (e.g. using the default “smooth” function of Matlab with moving average over 5 neighbors). Then, fns is defined as
In Fig. 3a–h this is the area of the overlap distribution to the right of the green vertical line, which represents the change point, the minimal overlap above which a negative slope is observed. The results of fns for different body sites are shown in Extended Data Fig. 6a.
p-value. To estimate the slope of the DOC, we used a linear mixed-effects model, which explicitly takes into account the fact that those data points in the Dissimilarity-Overlap plane are not completely independent (because each sample affects (n − 1) data points). To avoid any potential biases due to the detection of change point, we use data points with overlap larger than the median value, that is 50% of all the data points, for all the datasets (from all the body sites). We repeated this step for 200 bootstrap realizations. The distributions of the slopes for different body sites are shown in Extended Data Fig. 6b. We than calculated the one-tailed p-value as the fraction of bootstrap realizations with a non-negative slope. Benjamini and Hochberg procedure was used to calculate the false discovery rate (FDR) for multiple comparisons.
We emphasize that those two measures are complementary. In the first measure (fns), we consider the existence of a negative slope and ask what is the fraction of data points that support it. In the second measure, we consider a fixed fraction of data points (50%) and asked whether a significant negative slope is observed. Interestingly, though these two measures quantify different features of the DOC analysis, the body sites stratification pattern is consistent across the two measures and the two studied datasets (see Extended Data Fig. 6).
Population Dynamics model
The GLV model represents the dynamics of N interacting species as a set of ordinary differential equations: , i = 1, N. Here, ri is the intrinsic growth rate of species i, aij is the interaction strength between species j and i and (with aii < 0) represents the logistic growth term. We considered a microbial “sample” as a steady state of a GLV model parameterized by the growth rate vector r = {ri} ∈ RN and the interaction matrix A = (aii) ∈ RN×N and we set N = 100 and aii = − 1 in our simulations. We generated different “cohorts”, each consists of M = 100 “samples”. The GLV models differ from each other in their specific parameters (ri and aij). To achieve that, for each cohort, we first constructed a “base” GLV model (r★, A★) as follows: is randomly chosen from the uniform distribution 𝕆 (0,1). is randomly chosen from the normal distribution ℕ (0, (σ̃σmax)2), σ̃ varies between 0 and 1, σmax is the maximal interaction strength allowed to ensure stability of the ecological system (here σmax = 0.1). Then, different GLV models (ν = 1,…,M) are generated as random variations of this base model with and where both and are randomly chosen from a uniform distribution 𝕆 (1 − δ, 1 + δ) so that the expected values of the parameters of those models in the same cohort are the same as the base model, i.e. E[r]ν = r★ and E[A]ν = A★. In other words, all the samples of the same cohort are generated from GLV models that share the same structure and sign pattern of the base interaction matrix A★. As δ → 0 the model parameters become identical in all the GLV models of the same cohort. Thus, δ̃ ≡ 1 − δ quantifies the “universality” of the dynamics of those models. Finally, for each cohort, the 100 samples (steady states) were generated by integrating the GLV differential equations with random initial conditions (both initial assemblage and abundance profile are randomly chosen).
Human microbiome datasets analyzed in this work
Longitudinal microbiome datasets
(1) Two time series of gut microbiome consist of 336 and 131 stool samples, respectively. A 16S rRNA gene-based dataset, variable region V4, analyzed here at the OTU level. For detailed description of this dataset see ref. 28. The data is available at http://qiita.ucsd.edu under study ID 550. (2) Two time series of gut microbiome consist of 299 and 180 stool samples, respectively. A 16S rRNA gene-based dataset, variable region V4, analyzed here at the OTU level. For detailed description of this dataset see ref.11. The data is available in the European Bioinformatics Institute (EBI) European Nucleotide Archive (ENA) under the nucleotide accession number ERP006059.
Cross-sectional microbiome datasets
In order to quantitatively compare the universality of microbial dynamics in different body sites, we used two large-scale microbiome datasets:(1) Human Microbiome Project (HMP)9,15. A 16S rRNA gene-based dataset, variable regions V3 to V5, of the human microbiome from 239 healthy subjects. The data is available at http://hmpdacc.org/ and was detailed inref.9,15. This dataset covers 18 body sites in five areas: the oral cavity (nine sites: saliva (M = 262), tongue dorsum (M = 291), palatine tonsils (M = 285), keratinized gingiva (M = 289), hard palate (M = 275), buccal mucosa (M = 287), throat (M = 283), and sub- and supragingival plaques ( M = 283 and M = 289, respectively)), the gut (one site: stool (M = 297)), the vagina (three sites: introitus (M = 115), mid-vagina (M = 124), and posterior fornix (M = 124)), the nasal cavity (one site: anterior nares (M = 230)), and the skin (four sites: left and right antecubital fossae (M = 161 and M = 171, respectively) and retroauricular creases (M = 240 and M = 257, respectively)). Full protocols are available on the HMP DACC website (http://hmpdacc.org/HMMCP). OTU level was used for our analysis. We used a single sample from each subject. In case more than one sample is available, we used the first visit. (2) Student Microbiome Project (SMP). A 16S rRNA gene-based dataset, variable region V4 from 85 college-aged adults. The dataset covers four body sites: gut (M = 72), tongue (M = 79), forehead skin (M = 78) and palm skin (M = 60). In case there are multiple samples measured for one subject, we used the sample from the first visit. For detailed description of this dataset seeRef.16. The data is available at https://github.com/gregcaporaso/student-microbiome-project/tree/master/otu-tables.
In order to rule out several leading candidates of confounding factors in our DOC analysis, we analyzed two additional datasets: (3) A data set of healthy volunteers (M = 98) from the Cross-sectional Study of Diet and Stool Microbiome Composition (COMBO). Diet information was collected using two questionnaires that queried recent diet (“Recall”) and habitual long-term diet (food frequency questionnaire; “FFQ”). Stool samples were collected, and DNA samples were analyzed by 454/Roche pyrosequencing of the variable region V1–V2 of the 16S rDNA gene segments. Samples were analyzed at the OTU taxonomic level. For detailed description of this dataset see Ref.37.(4) A dataset of healthy women (M = 53), aged 20–55 years (median 42.5), as part of the Flemish Gut Flora Project (FGFP). Stool consistency levels using Bristol Stool Scale (BSS)scores were self-reported. The V4 region of the 16S rDNA gene was sequenced. Samples were analyzed at the OTU taxonomic level. For detailed description of this dataset see Ref.33.
Clinical trial dataset
Stool samples of patients with recurrent Clostridium difficile infection (rCDI): before and after fecal microbiota transplantation (FMT). This clinical trial was approved by the Partners Human Research Committee as well as by the US Food and Drug Administration (FDA) (Investigational New Drug application number 15199) and registered at Clinical Trials.gov (NCT01704937). Informed consent was obtained from all participants. Microbial samples from 17 patients with rCDI were analyzed in the groups of “pre-FMT” and “post-FMT”. Only subjects for whom both pre- and post-FMT samples are available were included. In case where more than one post-FMT samples is available we included only the first one (median, 4 days after FMT). The V4 region of the 16S rRNA gene was sequenced using an Illumina MiSeq. Samples were analyzed at the OTU level. For detailed description of this dataset see ref.17.
Code availability
The Matlab code for computing the DOC and the universality measures as well as an example dataset (i.e. the dataset used to generate Fig. 2b) are freely available at the project webpage:http://scholar.harvard.edu/yyl/doc.
Extended Data
Supplementary Material
Acknowledgments
We thank Edwin K. Silverman, George Weinstock, Curtis Huttenhower, Rob Knight, Gail Ackermann, Domitilla Del Vecchio, Douglas Lauffenburger, Galeb Abu-Ali, Joanne Sordillo, Michael McGeachie, and Jeff Gore for helpful discussions. Special thanks to Albert-LászlóBarabási and Joseph Loscalzo for careful reading of the manuscript. This work was partially supported by the John Templeton Foundation (award number 51977) and National Institutes of Health (R01 HL091528).
Footnotes
Contributions Y.-Y.L. conceived and designed the project. A.B. developed the DOC analysis, performed numerical simulations, and analyzed all the real data. A.B. and Y.-Y.L. performed analytical calculations. A.B. and V.J.C. performed statistical tests. All authors analyzed the results. A.B. and Y.-Y.L. wrote the manuscript. All authors edited the manuscript.
The authors declare no competing financial interests.
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