Precision medicine provides targeted treatment for an individual patient based on disease mechanisms, promoting health care. Matched transcriptomes derived from a single subject enable uncovering patient-specific dynamic changes associated with disease status. Yet, conventional statistical methodologies remain largely unavailable for single-subject transcriptome analysis due to the "single-observation" challenge. We hypothesize that, with statistical learning approaches and large-scale inferences, one can learn useful information from single-subject transcriptome data by identifying differentially expressed genes (DEG) / pathways (DEP) between two transcriptomes of an individual. This dissertation is an ensemble of my research work in single-subject transcriptome analytics, including three projects with varying focuses. The first project describes a two-step approach to identify DEPs by employing a parametric Gaussian mixture model followed by Fisher's exact tests. The second project relaxes the parametric assumption and develops a nonparametric algorithm based on k-means, which is more flexible and robust. The third project proposes a novel variance stabilizing framework to transform raw gene counts before identifying DEGs, and the transformation strategically by-passes the challenge of variance estimation in single-subject transcriptome analysis. In this dissertation, I present the main statistical methods and computational algorithms for all the three projects, as well as their real-data applications to personalized treatments.

Background: Transcriptome analytic tools are commonly used across patient cohorts to develop drugs and predict clinical outcomes. However, as precision medicine pursues more accurate and individualized treatment decisions, these methods are not designed to address single-patient transcriptome analyses. We previously developed and validated the N-of-1-pathways framework using two methods, Wilcoxon and Mahalanobis Distance (MD), for personal transcriptome analysis derived from a pair of samples of a single patient. Although, both methods uncover concordantly dysregulated pathways, they are not designed to detect dysregulated pathways with up- and down-regulated genes (bidirectional dysregulation) that are ubiquitous in biological systems. Results: We developed N-of-1-pathways MixEnrich, a mixture model followed by a gene set enrichment test, to uncover bidirectional and concordantly dysregulated pathways one patient at a time. We assess its accuracy in a comprehensive simulation study and in a RNA-Seq data analysis of head and neck squamous cell carcinomas (HNSCCs). In presence of bidirectionally dysregulated genes in the pathway or in presence of high background noise, MixEnrich substantially outperforms previous single-subject transcriptome analysis methods, both in the simulation study and the HNSCCs data analysis (ROC Curves; higher true positive rates; lower false positive rates). Bidirectional and concordant dysregulated pathways uncovered by MixEnrich in each patient largely overlapped with the quasi-gold standard compared to other single-subject and cohort-based transcriptome analyses. Conclusion: The greater performance of MixEnrich presents an advantage over previous methods to meet the promise of providing accurate personal transcriptome analysis to support precision medicine at point of care.