Ellington, C. N.; Addagudi, S.; Wang, J.; Lengerich, B. J.; Xing, E. P.

Virtual screening methods prioritize therapeutic candidates by predicting molecular properties and interactions. However, molecular models are insufficient to predict higher-order effects that arise in real biological systems, leading to late-stage failures in drug discovery. Virtual cells have been posed as a solution to this problem by predicting gene expression responses to drugs, but they remain weakly validated as screening tools; gene expression is only an intermediate in understanding drug success or failure. Despite burgeoning progress in virtual cells, some basic questions remain. Is expression even a good representation of higher-order drug effects? How can expression and other cell-level representations be applied to prioritize therapeutic candidates? Can cell-level methods be fairly compared against traditional molecular-level screens? We address these questions in a two-pronged approach. First, we curate two benchmarks, Drug-Disease Retrieval Bench (DDR-Bench) and Drug-Target Retrieval Bench (DTR-Bench), which directly compare cell-level methods against traditional molecular methods on canonical drug discovery tasks. DDR-Bench evaluates a method's ability to prioritize disease indications for drugs with novel target profiles. DTR-Bench evaluates a method's ability to reconstruct drug-target interactions from separate perturbation modalities that act on shared mechanisms, bridging the gap between cell-level methods and classic molecular screens. We identify shortcomings of existing screening methods on these benchmarks, and propose an alternative representation of drug effects: perturbed gene networks. Inferring post-perturbation gene networks on-demand for unseen drugs requires methods that generalize beyond traditional plug-in network estimators. We develop a scalable differentiable surrogate loss for multivariate Gaussians, which we apply to train a context-adaptive amortized estimator that maps perturbation metadata to gene-gene dependency network parameters. The resulting model, CellVS-Net, achieves SOTA on predicting how gene networks restructure under a variety of complex multivariate experimental conditions, including different cell types, small molecule therapeutics, signaling molecules, gene knockdowns, and gene over-expressions. When compared to other molecular and cell-level representations of drugs, we find that CellVS-Net achieves SOTA on both virtual screening benchmarks. Overall, CellVS-Net demonstrates that cell-level virtual screening methods are a viable alternative to molecular screening, and associated benchmarks enable hill-climbing on relevant drug discovery tasks.