NPASS Compound

Natural Product: NPC16701

Natural Product ID	NPC16701
Common Name ? The InCHIKey will be temporarily assigned as the "Common Name" if no IUPAC name or alternative short name is available.	KWAUEUQHUYWWTO-CBFFWNJESA-N
IUPAC Name	n.a.
Synonyms	6Alpha-Hydroxycinobufagin
Synthetic Gene Cluster	n.a.
ChEMBL Identifier	CHEMBL515220
PubChem CID	10939450
Chemical Classification	CHEMONTID:0000000 [Organic compounds] [CHEMONTID:0000012] Lipids and lipid-like molecules [CHEMONTID:0000258] Steroids and steroid derivatives [CHEMONTID:0001125] Steroid lactones [CHEMONTID:0001557] Bufanolides and derivatives

The Chemical Classification was calculated by Classyfire, a software for chemical taxonomy calculation. Reference: DOI:10.1186/s13321-016-0174-y.

Chemical Representations

RDKit 3D 67 72 0 0 0 0 0 0 0 0999 V2000 -5.9759 -1.2017 1.9992 O 0 0 0 0 0 0 0 0 0 0 0 0 -4.7319 -0.6913 1.5548 C 0 0 1 0 0 0 0 0 0 0 0 0 -3.9034 -1.8732 1.1457 C 0 0 0 0 0 0 0 0 0 0 0 0 -3.6801 -1.7687 -0.3425 C 0 0 0 0 0 0 0 0 0 0 0 0 -2.9203 -0.5012 -0.6866 C 0 0 1 0 0 0 0 0 0 0 0 0 -3.8512 0.6565 -0.3851 C 0 0 1 0 0 0 0 0 0 0 0 0 -5.0353 0.2603 0.4453 C 0 0 0 0 0 0 0 0 0 0 0 0 -3.1896 1.8315 0.2340 C 0 0 1 0 0 0 0 0 0 0 0 0 -3.3212 1.8436 1.6449 O 0 0 0 0 0 0 0 0 0 0 0 0 -1.7856 2.0812 -0.1938 C 0 0 0 0 0 0 0 0 0 0 0 0 -0.9535 0.8700 -0.4472 C 0 0 2 0 0 0 0 0 0 0 0 0 -1.6795 -0.3215 0.1362 C 0 0 2 0 0 0 0 0 0 0 0 0 -0.8247 -1.5279 0.2696 C 0 0 0 0 0 0 0 0 0 0 0 0 0.4644 -1.5051 -0.4635 C 0 0 0 0 0 0 0 0 0 0 0 0 1.2518 -0.2386 -0.3976 C 0 0 1 0 0 0 0 0 0 0 0 0 0.4415 0.9670 0.0295 C 0 0 1 0 0 0 0 0 0 0 0 0 1.0284 2.2046 -0.5537 O 0 0 0 0 0 0 0 0 0 0 0 0 1.1644 1.8204 0.7928 C 0 0 2 0 0 0 0 0 0 0 0 0 2.5461 1.1922 1.0362 C 0 0 1 0 0 0 0 0 0 0 0 0 2.2625 -0.2960 0.6955 C 0 0 2 0 0 0 0 0 0 0 0 0 3.4695 -1.0500 0.5079 C 0 0 0 0 0 0 0 0 0 0 0 0 4.4558 -0.9506 1.4938 C 0 0 0 0 0 0 0 0 0 0 0 0 5.6149 -1.6812 1.3372 C 0 0 0 0 0 0 0 0 0 0 0 0 5.8219 -2.5020 0.2377 C 0 0 0 0 0 0 0 0 0 0 0 0 6.8614 -3.1737 0.0711 O 0 0 0 0 0 0 0 0 0 0 0 0 4.8733 -2.5553 -0.6443 O 0 0 0 0 0 0 0 0 0 0 0 0 3.7333 -1.8646 -0.5331 C 0 0 0 0 0 0 0 0 0 0 0 0 3.4683 1.6363 0.0793 O 0 0 0 0 0 0 0 0 0 0 0 0 4.6822 2.1908 0.3462 C 0 0 0 0 0 0 0 0 0 0 0 0 5.0581 2.3409 1.5268 O 0 0 0 0 0 0 0 0 0 0 0 0 5.5661 2.6200 -0.7533 C 0 0 0 0 0 0 0 0 0 0 0 0 1.8352 0.0757 -1.7559 C 0 0 0 0 0 0 0 0 0 0 0 0 -2.6394 -0.5694 -2.1761 C 0 0 0 0 0 0 0 0 0 0 0 0 -6.6396 -0.4807 1.8916 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.2849 -0.2102 2.4397 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.4342 -2.8536 1.3078 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.9656 -1.9551 1.7227 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.7081 -1.6256 -0.7921 H 0 0 0 0 0 0 0 0 0 0 0 0 -3.2773 -2.6662 -0.8051 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.2849 0.9997 -1.3733 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.4178 1.2072 0.9309 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.8903 -0.0794 -0.1866 H 0 0 0 0 0 0 0 0 0 0 0 0 -3.7782 2.7520 -0.0710 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.5563 2.3457 1.9947 H 0 0 0 0 0 0 0 0 0 0 0 0 -1.7419 2.7746 -1.0852 H 0 0 0 0 0 0 0 0 0 0 0 0 -1.2965 2.6804 0.6226 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.9126 0.7391 -1.5707 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.0109 -0.0185 1.1526 H 0 0 0 0 0 0 0 0 0 0 0 0 -1.3892 -2.4296 -0.0778 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.6042 -1.7521 1.3566 H 0 0 0 0 0 0 0 0 0 0 0 0 0.3554 -1.8628 -1.5183 H 0 0 0 0 0 0 0 0 0 0 0 0 1.1063 -2.3088 0.0133 H 0 0 0 0 0 0 0 0 0 0 0 0 0.7858 2.4996 1.5652 H 0 0 0 0 0 0 0 0 0 0 0 0 2.8491 1.3115 2.0741 H 0 0 0 0 0 0 0 0 0 0 0 0 1.7286 -0.6373 1.6433 H 0 0 0 0 0 0 0 0 0 0 0 0 4.3463 -0.3268 2.3696 H 0 0 0 0 0 0 0 0 0 0 0 0 6.4018 -1.6221 2.0923 H 0 0 0 0 0 0 0 0 0 0 0 0 3.0523 -2.0089 -1.3274 H 0 0 0 0 0 0 0 0 0 0 0 0 5.9504 3.6516 -0.6369 H 0 0 0 0 0 0 0 0 0 0 0 0 5.0096 2.6128 -1.7296 H 0 0 0 0 0 0 0 0 0 0 0 0 6.4112 1.8878 -0.9094 H 0 0 0 0 0 0 0 0 0 0 0 0 2.9170 0.3000 -1.7394 H 0 0 0 0 0 0 0 0 0 0 0 0 1.3795 1.0373 -2.1623 H 0 0 0 0 0 0 0 0 0 0 0 0 1.5406 -0.6688 -2.5394 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.6738 0.4851 -2.5714 H 0 0 0 0 0 0 0 0 0 0 0 0 -1.6677 -0.9677 -2.4340 H 0 0 0 0 0 0 0 0 0 0 0 0 -3.4075 -1.1295 -2.7268 H 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 0 2 3 1 0 3 4 1 0 4 5 1 0 5 6 1 0 6 7 1 0 6 8 1 0 8 9 1 0 8 10 1 0 10 11 1 0 11 12 1 0 12 13 1 0 13 14 1 0 14 15 1 0 15 16 1 0 16 17 1 6 17 18 1 0 18 19 1 0 19 20 1 0 20 21 1 0 21 22 1 0 22 23 2 0 23 24 1 0 24 25 2 0 24 26 1 0 26 27 1 0 19 28 1 0 28 29 1 0 29 30 2 0 29 31 1 0 15 32 1 6 5 33 1 6 7 2 1 0 16 11 1 0 27 21 2 0 12 5 1 0 20 15 1 0 18 16 1 0 1 34 1 0 2 35 1 1 3 36 1 0 3 37 1 0 4 38 1 0 4 39 1 0 6 40 1 6 7 41 1 0 7 42 1 0 8 43 1 6 9 44 1 0 10 45 1 0 10 46 1 0 11 47 1 6 12 48 1 1 13 49 1 0 13 50 1 0 14 51 1 0 14 52 1 0 18 53 1 1 19 54 1 1 20 55 1 1 22 56 1 0 23 57 1 0 27 58 1 0 31 59 1 0 31 60 1 0 31 61 1 0 32 62 1 0 32 63 1 0 32 64 1 0 33 65 1 0 33 66 1 0 33 67 1 0 M END

Standard InCHIKey	KWAUEUQHUYWWTO-CBFFWNJESA-N
Standard InCHI	InChI=1S/C26H34O7/c1-13(27)32-22-21(14-4-5-20(30)31-12-14)25(3)9-7-16-17(26(25)23(22)33-26)11-19(29)18-10-15(28)6-8-24(16,18)2/h4-5,12,15-19,21-23,28-29H,6-11H2,1-3H3/t15-,16-,17+,18-,19-,21-,22+,23+,24+,25+,26+/m0/s1
SMILES	O[C@H]1CC[C@]2([C@@H](C1)[C@@H](O)C[C@@H]1[C@@H]2CC[C@]2([C@]31O[C@@H]3[C@@H]([C@@H]2c1ccc(=O)oc1)OC(=O)C)C)C

Calculated Properties

Physi-Chem Properties

Molecular Weight:	458.23	Volume:	457.899 ? Van der Waals volume.
Dense:	1.001	LogP:	2.247 ? The logarithm of the n-octanol/water distribution coefficients.
logD7.4:	2.599 ? The logarithm of the n-octanol/water distribution coefficient at pH=7.4.	LogS:	-4.44 ? The logarithm of aqueous solubility value.
Rotatable Bonds:	3.0	Rigid Bonds:	30.0
TPSA:	109.5 ? Topological Polar Surface Area.	H-Bond Acceptor:	7.0
H-Bond Donor:	2.0	Rings:	6.0
Heavy Atoms:	7.0

MedChem Properties

QED Drug-Likeness Score:	0.518	GASA:	1.0 ? GASA represents the probability of being difficult to synthesize, ranging from 0 to 1.
Synthetic Accessibility Score:	5.393	Fsp³:	0.769
MCE-18:	180.087 ? MCE-18 stands for medicinal chemistry evolution.MCE-18≥45 is considered a suitable value.	Lipinski Rule-of-5:	Rejected
Pfizer Rule:	Rejected	GSK Rule:	Accepted
Golden Triangle Rule:	Rejected	BMS Rule:	0
Chelating Alert:	0	PAINS Alert:	0
Colloidal aggregators:	0.876	Fluc inhibitor:	0.001 ? The fluc inhibitor value is the probability of being fLuc inhibitors, within the range of 0 to 1.
Blue fluorescence:	0.407 ? The blue fluorescence value is the probability of being blue fluorescence, within the range of 0 to 1	Green fluorescence:	0.0 ? The green fluorescence value is the probability of being green fluorescence, within the range of 0 to 1
Reactive compounds:	0.046	Promiscuous compounds:	0.48

ADMET Properties (ADMETlab3.0)

ADMET: Absorption

Caco-2 Permeability:	-5.632	MDCK Permeability:	-5.136
Pgp-inhibitor:	0.068	Pgp-substrate:	0.006
PAMPA:	0.712 ? The experimental data for Peff was logarithmically transformed (logPeff). Molecules with log Peff values below 2.0 were classified as low-permeability (Category 0), while those with log Peff values exceeding 2.5 were classified as high-permeability (Category 1).	Human Intestinal Absorption (HIA):	0.002
20% Bioavailability (F20%):	0.895	30% Bioavailability (F30%):	0.904
50% Bioavailability (F50%):	0.958

ADMET: Distribution

Blood-Brain-Barrier Penetration (BBB):	0.006	MRP1:	0.989
Plasma Protein Binding (PPB):	59.626%	Volume Distribution (VD):	-0.316
Fu:	42.358% ? The fraction unbound in plasms.	OATP1B1 inhibitor:	1.0
OATP1B3 inhibitor:	1.0	BCRP inhibitor:	0.001
BSEP inhibitor:	0.967

ADMET: Metabolism

CYP1A2-inhibitor:	0.0	CYP1A2-substrate:	0.0
CYP2C19-inhibitor:	0.016	CYP2C19-substrate:	0.002
CYP2C9-inhibitor:	0.003	CYP2C9-substrate:	0.002
CYP2D6-inhibitor:	0.0	CYP2D6-substrate:	0.006
CYP3A4-inhibitor:	0.021	CYP3A4-substrate:	0.001
CYP2B6-substrate:	0.0	CYP2C8-inhibitor:	0.319
HLM stability:	0.192 ? Human liver microsomal (HLM) stability. Category 0: stable+ (HLM > 30 min); Category 1: unstable- (HLM ≤ 30 min). The output value is the probability of human liver microsomal instability, where a value closer to 1 indicates a higher likelihood of instability.

ADMET: Excretion

Clearance (CL):

10.779

Half-life (T1/2):

1.831

ADMET: Toxicity

hERG Blockers:	0.018	hERG Blockers (10um):	0.078
Human Hepatotoxicity (H-HT):	0.432	Drug-induced Liver Injury (DILI):	0.422
AMES Toxicity:	0.742	Rat Oral Acute Toxicity:	0.561
Maximum Recommended Daily Dose:	0.871	Skin Sensitization:	0.97
Carcinogencity:	0.845	Eye Corrosion:	0.004
Eye Irritation:	0.466	Respiratory Toxicity:	0.514
Drug-induced Neurotoxicity:	0.129	Ototoxicity:	0.342
Hematotoxicity:	0.591	Drug-induced Nephrotoxicity:	0.834
Genotoxicity:	0.997	RPMI-8226 Immunitoxicity:	0.229
A549 Cytotoxicity:	0.487	Hek293 Cytotoxicity:	0.658
BCF:	0.498 ? Bioconcentration factors are used for considering secondary poisoning potential and assessing risks to human health via the food chain. The unit is -log10[(mg/L)/(1000*MW)].	IGC50:	3.219 ? 48 hour Tetrahymena pyriformis IGC50. The unit of IGC50 is -log10[(mg/L)/(1000*MW)].
LC50DM:	4.788 ? 48 hour Daphnia magna LC50. The unit of LC50DM is -log10[(mg/L)/(1000*MW)].	LC50FM:	4.07 ? 96 hour fathead minnow LC50. The unit of LC50FM is -log10[(mg/L)/(1000*MW)].

Species Source

Organism ID	Organism Name	Taxonomy Level	Family	SuperKingdom	Isolation Part	Collection Location	Collection Time	Reference
NPO33241	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	PMID[11575946]
NPO33241	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	PMID[12141860]
NPO11981	Bufo gargarizans	Species	Bufonidae	Eukaryota	venom	n.a.	n.a.	PMID[24050254]
NPO11981	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	PMID[28256122]
NPO33241	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[COCONUT]
NPO8733	Duttaphrynus melanostictus	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[COCONUT]
NPO8733	Duttaphrynus melanostictus	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[TCMID]
NPO11981	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[TCMID]
NPO11981	Bufo gargarizans	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[UNPD]
NPO8733	Duttaphrynus melanostictus	Species	Bufonidae	Eukaryota	n.a.	n.a.	n.a.	Database[UNPD]

Note for Reference:
In addition to directly collecting NP source organism data from primary literature (where reference will provided as NCBI PMID or DOI links), NPASS also integrated them from below databases:
☉ UNPD: Universal Natural Products Database [PMID: 23638153].
☉ StreptomeDB: a database of streptomycetes natural products [PMID: 33051671].
☉ TM-MC: a database of medicinal materials and chemical compounds in Northeast Asian traditional medicine [PMID: 26156871].
☉ TCM@Taiwan: a Traditional Chinese Medicine database [PMID: 21253603].
☉ TCMID: a Traditional Chinese Medicine database [PMID: 29106634].
☉ TCMSP: The traditional Chinese medicine systems pharmacology database and analysis platform [PMID: 24735618].
☉ HerDing: a herb recommendation system to treat diseases using genes and chemicals [PMID: 26980517].
☉ MetaboLights: a metabolomics database [PMID: 27010336].
☉ FooDB: a database of constituents, chemistry and biology of food species [www.foodb.ca].

NP Quantity Composition/Concentration

Organism ID	Organism Name	Organism Material Preparation	Organism Part	NP Quantity (Standard)	NP Quantity (Minimum)	NP Quantity (Maximum)	Quantity Unit	Reference

Note for Reference:
In addition to directly collecting NP quantitative data from primary literature (where reference will provided as NCBI PMID or DOI links), NPASS also integrated NP quantitative records for specific NP domains (e.g., NPS from foods or herbs) from domain-specific databases. These databases include:
☉ DUKE: Dr. Duke's Phytochemical and Ethnobotanical Databases.
☉ PHENOL EXPLORER: is the first comprehensive database on polyphenol content in foods [PMID: 24103452], its homepage can be accessed at here.
☉ FooDB: a database of constituents, chemistry and biology of food species [www.foodb.ca].

Biological Activity

Activity Type	# Activity
IC50	9

Activity Type	# Activity
Cell line	9

Molecular-level activity

Target ID	Target Type	Target Name	Target Organism	Activity Type	Activity Relation	Value	Unit	Reference

In vitro activity

Target ID	Target Type	Target Name	Target Organism	Activity Type	Activity Relation	Value	Unit	Reference
NPT91	Cell line	KB	Homo sapiens	IC50	=	0.87	ug.mL-1	PMID[11575946]
NPT116	Cell line	HL-60	Homo sapiens	IC50	=	0.038	ug.mL-1	PMID[11575946]
NPT1366	Cell line	MH60	Mus musculus	IC50	>	25.0	ug.mL-1	PMID[11575946]
NPT1081	Cell line	BXPC-3	Homo sapiens	IC50	=	0.46	ug.mL-1	PMID[11575946]
NPT83	Cell line	MCF7	Homo sapiens	IC50	=	0.36	ug.mL-1	PMID[11575946]
NPT395	Cell line	SF-268	Homo sapiens	IC50	=	0.32	ug.mL-1	PMID[11575946]
NPT397	Cell line	NCI-H460	Homo sapiens	IC50	=	0.74	ug.mL-1	PMID[11575946]
NPT575	Cell line	KM-20L2	Homo sapiens	IC50	=	0.28	ug.mL-1	PMID[11575946]
NPT90	Cell line	DU-145	Homo sapiens	IC50	=	0.21	ug.mL-1	PMID[11575946]

In vivo activity

Target ID	Target Type	Target Name	Target Organism	Activity Type	Activity Relation	Value	Unit	Reference

Experimental ADME

Experiment Model	Experiment Tissue	ADME Type	ADME Relation	ADME Value	ADME Unit	Reference

Experimental Toxicity

Quantitative toxicity

Experiment Model	Experiment Organism	Toxicity Type	Toxicity Relation	Toxicity Value	Toxicity Unit	Reference

Common Abbreviations:
LC: Lethal Concentration; LD: Lethal Dose; LT:Lethal Time; NOAEL: No-observed-adverse-effect Level; BMDL: Benchmark Dose Lower Confidence Limit; BMD: Benchmark Dose; BMC:Benchmark Concentration; LOAEL: Lowest Observed Adverse Effect Level; RfD:Reference Dose; RfC:Reference Concentration; MRL: Minimal Risk Level; MEG: Maximum Exposure Guideline; PAC: Protective Action Criteria

Categorical toxicity labels

Hepatotoxicity	Carcinogenicity	Mutagenicity	Cardiotoxicity	Respiratory Toxicity	Eye Irritation	Endocrine Disruption

Note for Reference:
In addition to directly collecting NP quantitative data from primary literature (where reference will provided as NCBI PMID or DOI links), NPASS also integrated NP toxicity records from domain-specific databases. These databases include:
☉ ToxValDB: a curated database that compiles quantitative toxicity values for chemicals from diverse public sources to support toxicological research and risk assessment.
☉ TOXRIC: a comprehensive, free-to-access, online database providing toxicological/feature data. The toxicity labels are retrieved from this database. [PMID: 36400569]

Chemically structural similarity

Similar Active Natural Products in NPASS

Top-200 similar NPs were calculated against the active-NP-set (includes approximately 50,000 NPs with experimentally-derived bioactivity available in NPASS)

Similarity is measured using the Tanimoto coefficient (Tc) , which compares the binary fingerprints of two molecules. Tc is calculated as the intersection divided by the union of '1' bits in the fingerprints, ranging from 0 to 1, with 1 indicating highest similarity.

● The left chart: Distribution of similarity level between NPC16701 and all remaining natural products in the NPASS database.
● The right table: Most similar natural products (Tc>=0.5 or Top200).

range	Tanimoto Coefficient
0-0.1	10623
0.1-0.2	36718
0.2-0.3	2440
0.3-0.4	48
0.4-0.5	14
0.5-0.6	10
0.6-0.7	2
0.7-0.8	0
0.8-0.85	1
0.85-0.9	0
0.9-0.95	0
0.95-1	0

Similarity Score	Similarity Level	Natural Product ID
0.8133	Intermediate Similarity	NPC157380
0.7436	Intermediate Similarity	NPC485877
0.6829	Remote Similarity	NPC213761
0.6627	Remote Similarity	NPC35171
0.5843	Remote Similarity	NPC485878
0.5529	Remote Similarity	NPC185287
0.5529	Remote Similarity	NPC43063
0.5529	Remote Similarity	NPC79298
0.5474	Remote Similarity	NPC312481
0.5393	Remote Similarity	NPC485880
0.5341	Remote Similarity	NPC75389
0.5149	Remote Similarity	NPC6193
0.5055	Remote Similarity	NPC485879
0.5055	Remote Similarity	NPC221414

Similar Clinical/Approved Drugs

Similarity level is defined by Tanimoto coefficient (Tc) between two molecules.

● The left chart: Distribution of similarity level between NPC16701 and all drugs/candidates.
● The right table: Most similar clinical/approved drugs (Tc>=0.5 or Top200).

range	Tanimoto Coefficient
0-0.1	3344
0.1-0.2	5725
0.2-0.3	79
0.3-0.4	2
0.4-0.5	0
0.5-0.6	0
0.6-0.7	0
0.7-0.8	0
0.8-0.85	0
0.85-0.9	0
0.9-0.95	0
0.95-1	0

Similarity Score	Similarity Level	Drug ID	Developmental Stage
		NPD

Bioactivity similarity

Similar Natural Products in NPASS

Similarity level is defined by Bioactivity similarity was calculated based on bioactivity descriptors of compounds. The bioactivity descriptors were calculated by a recently developed AI algorithm Chemical Checker (CC) [Nature Biotechnology, 38:1087–1096, 2020; Nature Communications, 12:3932, 2021], which evaluated bioactivity similarities at five levels:
☉ A: chemistry similarity;
☉ B: biological targets similarity;
☉ C: networks similarity;
☉ D: cell-based bioactivity similarity;
☉ E: similarity based on clinical data.
Those 5 categories of CC bioactivity descriptors were calculated and then subjected to manifold projection using UMAP algorithm, to project all NPs on a 2-Dimensional space. The current NP was highlighted with a small circle in the 2-D map. Below figures: left-to-right, A-to-E.

A: chemistry similarity

B: biological targets similarity

C: networks similarity

D: cell-based bioactivity similarity

E: similarity based on clinical data