Large language models as synthetic clinical experts to inform longitudinal rare-disease modeling

Due to the limited amount of information, modeling longitudinal rare-disease data can benefit from integrating clinical knowledge. Yet, elicitation of expert knowledge and formalization for model fitting is challenging, in particular due to limited time of clinical experts. To nevertheless make domain knowledge accessible during model fitting, we use large language models (LLMs) as synthetic clinical experts to supervise a variational-autoencoder-based approach that learns low-dimensional latent summaries of visit-level observations. Specifically, LLMs are queried offline on textual descriptions of patient observations to obtain judgments, e.g., the suspected clinical category. To improve the variational autoencoder fit, we train a differentiable surrogate model on these judgments and augment the loss function to encourage reconstructions that preserve the clinical-label distribution of their corresponding input profile. In an application to longitudinal motor-function assessments from children with spinal muscular atrophy, we map visit-level clinical profiles to low-dimensional representations that are linked by a multivariate mixed-effects model. The synthetic expert loss discourages reconstructions that remain numerically close in data space but alter the clinical interpretation of the reconstructed motor function profile, such as by crossing a disease-type boundary. We thus reduced disagreement between original and reconstructed SMA type labels from about 11 to 7 percent. Furthermore, informing the latent representation by the synthetic expert improved prediction of motor function milestones compared with unsupervised latent representations and a data-level baseline. These results suggest that incorporating LLMs into model fitting can make clinical knowledge available to representation learning and improve clinical faithfulness for longitudinal rare-disease data.

Multi-Level Evidence Aggregation for Robust Facial Phenotype Retrieval in Rare Genetic Disorder Prioritization

AI-assisted facial phenotyping supports rare genetic disorder prioritization by retrieving visually similar diagnosed cases from facial image reference databases such as the GestaltMatcher Database (GMDB). Existing GestaltMatcher-based retrieval frameworks compare each test image with individual gallery images in a facial phenotype embedding space. However, this pointwise formulation does not fully exploit available evidence, because patients may have multiple images and disorders may be represented by multiple diagnosed gallery patients. We propose an inference-time multi-level evidence aggregation framework that improves facial phenotype retrieval without modifying the underlying GestaltMatcher-Arc encoder. The framework combines embedding-level patient aggregation of multiple images from the same individual, patient-weighted disorder centroids, and hybrid individual-centroid scoring to integrate test-patient observations, disorder-level gallery evidence, and local nearest-neighbor evidence. We evaluated the approach on GMDB v1.1.4 across disorders represented during training (GMDB-Freq), unseen disorders (GMDB-Rare), and multi-image patient subsets, using a unified gallery containing both GMDB-Freq and GMDB-Rare disorders. Multi-level evidence aggregation improved mean per-disorder top-$N$ retrieval accuracy across all evaluation subsets. Top-1 accuracy increased from 38.52% to 48.82% on GMDB-Freq and from 19.38% to 23.79% on GMDB-Rare. On multi-image subsets, top-1 accuracy increased from 46.12% to 60.94% on GMDB-Multi-Freq and from 18.54% to 26.71% on GMDB-Multi-Rare. These findings show that inference-time aggregation can improve next-generation facial phenotype retrieval without retraining the encoder, supporting a shift from isolated single-image matching toward multi-level aggregation of patient and disorder evidence for rare-disorder prioritization.

RareLens: Towards End-to-End Rare Disease Care via Aligning Divergent Large Language Model Reasoning

Rare diseases represent one of the most challenging settings for clinical decision-making, where heterogeneous presentations, sparse evidence and limited expertise create persistent uncertainty throughout the care pathway. Although artificial intelligence could help, existing systems largely address isolated tasks, particularly diagnosis, and usually rely on downstream investigations rather than information available at initial presentation. Here we show that clinical AI performance under uncertainty can be improved not by scaling a single model, but by exploiting the diversity of multiple imperfect reasoning systems. Across heterogeneous large language models, we identify divergent reasoning trajectories with complementary error patterns and develop RareLens, which learns to reconcile these perspectives into actionable decisions across four stages of rare disease care: risk screening, diagnosis, treatment planning and prognosis prediction. Built on RarelensBench, a real-world dataset of 157,525 cases spanning all 33 Orphanet categories and more than 7,000 conditions, RareLens outperformed every frontier model tested, including GPT-5, DeepSeek-R1, Claude-3.7-Sonnet and Gemini-2.5-Pro, across all stages. It achieved an area under the curve of 0.917 for screening and top-1 accuracies of 65.5% and 89.8% for diagnosis and treatment. In an external evaluation involving 1,287 cases and 23 physicians, autonomous RareLens and physicians assisted by RareLens both outperformed unaided physicians, while demonstrating that effective human-AI collaboration requires more than simply providing model outputs. These findings establish divergent model reasoning as an exploitable source of information and suggest a general strategy for building AI systems that operate reliably under high clinical uncertainty.

SYNRARE: Synthetic Rare Disease EHR Generation for ML Benchmarking

Motivation: Rare disease (RD) diagnosis is frequently delayed due to the similarities in symptoms to common disease variants. Machine Learning Algorithms applied to Electronic Health Records show promise for accelerating the diagnosis; however, legal and privacy concerns pose significant barriers. To address these issues, Synthetic Data Generation is an alternative method for obtaining Electronic Health Records and can be applied with any Machine Learning algorithm for benchmarking and development purposes. Despite the availability of Synthetic Data Generation algorithms, support for generating a subset of patients that differ in a definable degree from the majority to simulate patients with RD is often lacking. Results: We present SYNRARE, a graphical user interface based on the Synthea framework that enables easier modification and generation of synthetic Electronic Health Records of RD patients, which differ only to a definable degree from patients with common diseases, thereby enabling the benchmarking and testing of algorithms under controlled technical conditions. SYNRARE enables researchers to rapidly benchmark their Machine Learning algorithms across any scenario. Availability and implementation: SYNRARE, including detailed instructions for installing, is available at https://gitlab.sdu.dk/screen4care/synrare.

Verifiable Knowledge Expansion through Retrieval-Grounded Formal Concept Analysis

Ontology construction requires deciding which objects, attributes, and structural relations should be accepted as valid knowledge. Language models can propose such structures from text, but their outputs can still be unsupported or inconsistent. This paper proposes a retrieval-augmented small language model (SLM) framework that uses formal concept analysis (FCA) as a symbolic verification loop for knowledge expansion. Starting from seed attributes, FCA proposes implications over a growing formal context. A retrieval-grounded SLM oracle then validates each implication or returns a counterexample. The oracle also supports incidence judgments, consistency checks, and attribute proposals, making accepted implications, counterexamples, contradictions, and corrections inspectable. In a rare ataxia setting constructed from Orphadata resources, retrieval-grounded 10-seed runs obtain relation F1 of 0.29-0.52 and closure-based implication F1 of 0.22-0.30. Larger seed sets increase the number of evaluated implications and often improve implication F1. The lower implication scores reflect a stricter evaluation of derived implications, where one missed or extra relation can affect several implication judgments. Ablations show that incidence judgments in a fixed object-attribute setting can improve closure-based implication scores. However, identifying positive object-attribute pairs remains difficult even when the candidate objects and attributes are fixed.

LLM-Guided ODE Discovery and Parameter Inference from Small-Cohort Aggregate Data

Mechanistic modeling via ordinary differential equations (ODEs) provides interpretable descriptions of complex dynamics and enables inference of underlying mechanisms, which is particularly valuable in clinical settings. However, in rare diseases, both the structure and parameters of the model are typically unknown, while individual-level data is scarce, noisy, heterogeneous, and subject to privacy constraints. In such settings, population-level summary statistics provide a practical privacy-preserving data representation, while capturing heterogeneity further requires modeling parameters as distributions rather than fixed values. Yet no existing method jointly discovers ODE structure and refines parameter distributions solely from summary statistics. We present AgentODE, an end-to-end framework that addresses this gap. An LLM proposes candidate ODE structures, while a tool-augmented inference agent iteratively refines parameter distributions through a diagnosis--update loop, operating on population-level summary statistics alone. We evaluate AgentODE on three benchmark problems across different fields and two clinical datasets, including the rare disease recessive dystrophic epidermolysis bullosa (RDEB), with only 231 observations across 46 patients. AgentODE recovers functionally consistent ODE structures across all settings, and experiments on RDEB demonstrates that in sparse and noisy data settings reasoning from summary statistics promotes mechanistically principled structure discovery, whereas baselines with individual-level data access recover implausible structures despite better predictive performance. AgentODE opens new possibilities for mechanistic modeling of rare diseases directly from population-level summary statistics, where data scarcity and privacy constraints have traditionally limited such analyses.

DEEPMED Search: An Open-Source Agentic Platform for Medical Deep Research with Introspective Verification

Navigating the deluge of heterogeneous medical data, from academic literature (PubMed) to clinical guidelines (Web) and private knowledge bases, remains a critical bottleneck for evidence-based medicine. While commercial black-box tools lack transparency, standard open-source RAG implementations frequently suffer from reasoning drift when handling complex, long-tail queries. We present DEEPMED Search, a fully open-source, agentic platform designed for transparent medical deep research. Built on a high-performance Next.js architecture, DEEPMED Search features a source-adaptive router that autonomously dispatches sub-queries to PubMed, web search, or local graph-based knowledge bases based on information density. Crucially, the platform integrates an introspective verification module, powered by a causal-consistent multi-agent debate framework, to validate retrieved evidence against diagnostic logic before synthesis. To demonstrate its robustness, we showcase DEEPMED Search's ability to autonomously decompose high-difficulty rare disease queries, filter out confounding noise, and generate structured, citation-backed research reports in minutes. By open-sourcing this software, we provide the community with a robust infrastructure to democratize access to trustworthy, glass-box medical reasoning in research and prototyping settings.

Evo-RAD: Navigating Rare Retinal Disease Diagnosis via Self-Evolving Agentic Retrieval

Large-scale pretrained foundation models have revolutionized general medical screening, but often falter on rare diseases because such conditions are underrepresented in real-world clinical datasets. While retrieval-augmented diagnosis attempts to mitigate this, conventional static methods frequently succumb to the hubness problem, retrieving visually similar but semantically incorrect common diseases. To address this, we propose Evo-RAD, a self-evolving agentic framework that transforms evidence acquisition into a dynamic decision-making task. We formulate retrieval as a Markov Decision Process (MDP) where a graphbased agent observes the reference set state and executes actions to purge discordant evidence (DELETE), acquire pathologically consistent samples (INSERT), or conclude the evolution (TERMINATE). Optimized via Group Relative Policy Optimization (GRPO) with a homogeneityaware reward, the agent learns to maximize the diagnostic homogeneity of the support reference set. Experiments on retinal disease benchmarks show that Evo-RAD substantially improves rare-disease diagnosis, outperforming retinal foundation models by +21.04%, while also surpassing retrieval-based and parameter-efficient fine-tuning methods by +3.56%. Code is available at https://github.com/SDH-Lab/Evo-RAD.

Enhancing Spectral Embedding through Robust and Flexible Knowledge Transfer in Electronic Health Records

We propose a spectral-based, unsupervised representation learning framework to derive low-dimensional embeddings for clinical concepts and patients in rare disease cohorts from electronic health records, where data are high-dimensional but sample sizes are limited. To overcome this challenge, we incorporate a knowledge matrix extracted from a broader population that shares a partially overlapping subspace with the rare-disease cohort. Our method departs from existing approaches by relaxing restrictive one-to-one signal-alignment assumptions between the latent data matrix and knowledge matrix, allowing more flexible and realistic forms of structured sharing. We introduce a novel two-step spectral embedding procedure: first, we identify and remove irrelevant components from the knowledge matrix; then, we apply a projection-based method to separately recover shared and heterogeneous components. Simulations and an analysis of a real-world multiple sclerosis cohort show that the proposed method outperforms competing approaches, particularly in challenging scenarios where shared signals are weak and only partially aligned, as is common in rare-disease data.