Deep learning-driven morphology analysis enables label-free classification of therapeutic agent- naive versus resistant cancer cells

Therapeutic drug treatments of solid tumors are often undermined by various resistance mechanisms. Identification of drug-resistance phenotypes at the single cell level is challenging because conventional molecular methods are cell-destructive, labor-intensive, and cost-prohibitive. To overcome these challenges, we developed an orthogonal approach to drug-resistance phenotyping, through the use of deep-learning-driven morphology analysis of single, high resolution cell images. Specifically, we trained deep learning-based drug resistance classifiers using cell images from 5 different cell lines that were rendered resistant to 5 different therapeutic agents, using a foundation model framework. With high accuracy, the classifier correctly predicted naive or resistance phenotypes across all cancer types and across all the therapeutic agent types (chemotherapeutic, targeted) tested. These results showed that morphology can capture complex phenotype information in the context of drug treatment. To demonstrate the potential clinical utility of the drug resistance classifier, it was applied to a dissociated tumor biopsy and the resulting phenotype predictions were in close concordance with scRNASeq analysis of the biopsy. Our study highlights the potential of deep-learning-driven morphology analysis to provide complex phenotype information, and ultimately shape oncology drug treatment strategies at the patient-level in a clinical context.