Deep learning-based non-invasive profiling of tumor transcriptomes from cell-free DNA for precision oncology
Tumor gene expression profiling provides crucial diagnostic information for guiding therapy, but standard tissue biopsies are invasive, spatially biased, and may inadequately sample metastatic disease. Cell-free DNA (cfDNA) provides a minimally invasive alternative for tumor genotyping, yet reconstructing robust, transcriptome-wide expression from standard-depth cfDNA whole-genome sequencing (WGS) remains a major challenge. We developed a deep learning framework comprising Triton, for comprehensive cfDNA feature extraction, and Proteus, a probabilistic model that infers single-gene expression from standard-depth cfDNA WGS. Proteus outperformed prior cfDNA approaches in reconstructing molecular phenotypes from matched tumor transcriptomes across multiple cancer types, including prostate, lung, and bladder cancer cohorts, with uncertainty-guided withholding improving model reliability. Proteus further enabled assessment of therapeutic target activity, prognostic transcriptional programs, and candidate treatment-emergent resistance states, establishing a generalizable framework for minimally invasive functional genomics in precision oncology.