NPASS Compound

Natural Product: NPC174066

Natural Product ID	NPC174066
Common Name ? The InCHIKey will be temporarily assigned as the "Common Name" if no IUPAC name or alternative short name is available.	LTSPMIHIWVJPLS-BTZBWVEISA-N
IUPAC Name	n.a.
Synonyms
Synthetic Gene Cluster	n.a.
ChEMBL Identifier	n.a.
PubChem CID	n.a.
Chemical Classification	CHEMONTID:0000000 [Organic compounds] [CHEMONTID:0000012] Lipids and lipid-like molecules [CHEMONTID:0000259] Prenol lipids [CHEMONTID:0001553] Triterpenoids

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 78 82 0 0 0 0 0 0 0 0999 V2000 6.7662 2.0193 0.6674 C 0 0 0 0 0 0 0 0 0 0 0 0 7.1135 0.6326 1.1854 C 0 0 0 0 0 0 0 0 0 0 0 0 8.4234 0.2290 0.5859 C 0 0 0 0 0 0 0 0 0 0 0 0 6.0726 -0.3565 0.7629 C 0 0 0 0 0 0 0 0 0 0 0 0 4.8871 -0.5755 0.1104 C 0 0 0 0 0 0 0 0 0 0 0 0 3.7511 -0.0438 -0.6548 C 0 0 0 0 0 0 0 0 0 0 0 0 2.4127 -0.2952 0.0660 C 0 0 1 0 0 0 0 0 0 0 0 0 2.4944 0.3922 1.3872 C 0 0 0 0 0 0 0 0 0 0 0 0 1.2915 0.1015 -0.8159 C 0 0 2 0 0 0 0 0 0 0 0 0 1.3181 1.5760 -1.2123 C 0 0 0 0 0 0 0 0 0 0 0 0 -0.0960 1.6427 -1.8393 C 0 0 0 0 0 0 0 0 0 0 0 0 -0.8504 1.0109 -0.7379 C 0 0 1 0 0 0 0 0 0 0 0 0 -2.2535 0.6460 -0.8959 C 0 0 2 0 0 0 0 0 0 0 0 0 -3.1403 1.8408 -1.2755 C 0 0 0 0 0 0 0 0 0 0 0 0 -4.4862 1.2525 -1.6285 C 0 0 0 0 0 0 0 0 0 0 0 0 -5.0554 0.7127 -0.3333 C 0 0 1 0 0 0 0 0 0 0 0 0 -6.4250 0.1387 -0.5112 C 0 0 0 0 0 0 0 0 0 0 0 0 -7.0200 -0.0843 0.8637 C 0 0 2 0 0 0 0 0 0 0 0 0 -6.0041 0.1329 1.9535 C 0 0 0 0 0 0 0 0 0 0 0 0 -4.7109 -0.5833 1.6904 C 0 0 0 0 0 0 0 0 0 0 0 0 -4.1592 -0.3260 0.2908 C 0 0 1 0 0 0 0 0 0 0 0 0 -4.2810 -1.5850 -0.5047 C 0 0 0 0 0 0 0 0 0 0 0 0 -2.7468 0.1816 0.4585 C 0 0 1 0 0 0 0 0 0 0 0 0 -1.8482 -0.6938 1.2080 C 0 0 0 0 0 0 0 0 0 0 0 0 -0.3711 -0.5106 1.0027 C 0 0 0 0 0 0 0 0 0 0 0 0 -0.0781 -0.2563 -0.4377 C 0 0 2 0 0 0 0 0 0 0 0 0 -0.5214 -1.4569 -1.2178 C 0 0 0 0 0 0 0 0 0 0 0 0 -7.5773 -1.3520 0.9815 O 0 0 0 0 0 0 0 0 0 0 0 0 5.5831 -1.7317 0.7357 C 0 0 1 0 0 0 0 0 0 0 0 0 6.2922 -2.6903 -0.2257 C 0 0 0 0 0 0 0 0 0 0 0 0 5.6792 2.0390 0.4575 H 0 0 0 0 0 0 0 0 0 0 0 0 7.2817 2.2268 -0.2910 H 0 0 0 0 0 0 0 0 0 0 0 0 6.9543 2.7799 1.4461 H 0 0 0 0 0 0 0 0 0 0 0 0 7.1324 0.6250 2.2956 H 0 0 0 0 0 0 0 0 0 0 0 0 8.9688 -0.3965 1.3258 H 0 0 0 0 0 0 0 0 0 0 0 0 8.2997 -0.3632 -0.3460 H 0 0 0 0 0 0 0 0 0 0 0 0 9.0909 1.1094 0.3850 H 0 0 0 0 0 0 0 0 0 0 0 0 3.8586 1.0320 -0.9039 H 0 0 0 0 0 0 0 0 0 0 0 0 3.6245 -0.5606 -1.6505 H 0 0 0 0 0 0 0 0 0 0 0 0 2.4187 -1.3891 0.2657 H 0 0 0 0 0 0 0 0 0 0 0 0 3.5888 0.5463 1.6273 H 0 0 0 0 0 0 0 0 0 0 0 0 2.1233 -0.2274 2.2311 H 0 0 0 0 0 0 0 0 0 0 0 0 2.0812 1.4207 1.3661 H 0 0 0 0 0 0 0 0 0 0 0 0 1.5160 -0.3904 -1.8212 H 0 0 0 0 0 0 0 0 0 0 0 0 1.3357 2.2413 -0.3431 H 0 0 0 0 0 0 0 0 0 0 0 0 2.0906 1.8021 -1.9496 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.0978 1.0550 -2.7572 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.3770 2.6926 -1.9681 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.7832 1.7219 0.1436 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.5029 -0.1320 -1.6230 H 0 0 0 0 0 0 0 0 0 0 0 0 -3.2675 2.4203 -0.3407 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.6992 2.4188 -2.0974 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.3157 0.4555 -2.3782 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.1983 2.0227 -1.9884 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.1427 1.5767 0.3575 H 0 0 0 0 0 0 0 0 0 0 0 0 -6.4551 -0.8341 -1.0380 H 0 0 0 0 0 0 0 0 0 0 0 0 -7.0831 0.8068 -1.1280 H 0 0 0 0 0 0 0 0 0 0 0 0 -7.8477 0.6439 0.9821 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.8727 1.2011 2.2247 H 0 0 0 0 0 0 0 0 0 0 0 0 -6.4367 -0.3461 2.8779 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.8884 -1.6591 1.8341 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.0053 -0.2457 2.4768 H 0 0 0 0 0 0 0 0 0 0 0 0 -4.2334 -1.4252 -1.6119 H 0 0 0 0 0 0 0 0 0 0 0 0 -3.4334 -2.2597 -0.2768 H 0 0 0 0 0 0 0 0 0 0 0 0 -5.1874 -2.1777 -0.2278 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.8745 1.1521 1.0403 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.0008 -0.4860 2.3139 H 0 0 0 0 0 0 0 0 0 0 0 0 -2.0843 -1.7715 1.1245 H 0 0 0 0 0 0 0 0 0 0 0 0 0.1589 -1.3623 1.4558 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.0682 0.4058 1.5743 H 0 0 0 0 0 0 0 0 0 0 0 0 -1.0997 -2.1812 -0.6076 H 0 0 0 0 0 0 0 0 0 0 0 0 0.4291 -2.0383 -1.4527 H 0 0 0 0 0 0 0 0 0 0 0 0 -0.9390 -1.2462 -2.2117 H 0 0 0 0 0 0 0 0 0 0 0 0 -6.9709 -2.0027 1.3999 H 0 0 0 0 0 0 0 0 0 0 0 0 5.1577 -2.2365 1.6024 H 0 0 0 0 0 0 0 0 0 0 0 0 5.5475 -3.4274 -0.5826 H 0 0 0 0 0 0 0 0 0 0 0 0 7.1799 -3.1357 0.2246 H 0 0 0 0 0 0 0 0 0 0 0 0 6.5666 -2.0691 -1.1133 H 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 0 2 3 1 0 2 4 1 0 4 5 2 0 5 6 1 0 6 7 1 0 7 8 1 0 7 9 1 0 9 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 0 17 18 1 0 18 19 1 0 19 20 1 0 20 21 1 0 21 22 1 6 21 23 1 0 23 24 1 0 24 25 1 0 25 26 1 0 26 27 1 6 18 28 1 0 5 29 1 0 29 30 1 0 29 4 1 0 26 9 1 0 26 12 1 0 23 13 1 0 21 16 1 0 1 31 1 0 1 32 1 0 1 33 1 0 2 34 1 0 3 35 1 0 3 36 1 0 3 37 1 0 6 38 1 0 6 39 1 0 7 40 1 1 8 41 1 0 8 42 1 0 8 43 1 0 9 44 1 6 10 45 1 0 10 46 1 0 11 47 1 0 11 48 1 0 12 49 1 1 13 50 1 6 14 51 1 0 14 52 1 0 15 53 1 0 15 54 1 0 16 55 1 1 17 56 1 0 17 57 1 0 18 58 1 1 19 59 1 0 19 60 1 0 20 61 1 0 20 62 1 0 22 63 1 0 22 64 1 0 22 65 1 0 23 66 1 1 24 67 1 0 24 68 1 0 25 69 1 0 25 70 1 0 27 71 1 0 27 72 1 0 27 73 1 0 28 74 1 0 29 75 1 1 30 76 1 0 30 77 1 0 30 78 1 0 M END

Standard InCHIKey	LTSPMIHIWVJPLS-BTZBWVEISA-N
Standard InCHI	InChI=1S/C29H48O/c1-17(2)27-19(4)23(27)15-18(3)24-9-10-25-22-8-7-20-16-21(30)11-13-28(20,5)26(22)12-14-29(24,25)6/h17-22,24-26,30H,7-16H2,1-6H3/t18-,19-,20+,21+,22+,24+,25+,26+,28+,29-/m1/s1
SMILES	CC(C)C1=C(C[C@@H](C)[C@@H]2CC[C@H]3[C@@H]4CC[C@H]5C[C@H](CC[C@]5(C)[C@H]4CC[C@]23C)O)[C@H]1C

Calculated Properties

Physi-Chem Properties

Molecular Weight:	412.37	Volume:	473.512 ? Van der Waals volume.
Dense:	0.871	LogP:	7.657 ? The logarithm of the n-octanol/water distribution coefficients.
logD7.4:	5.242 ? The logarithm of the n-octanol/water distribution coefficient at pH=7.4.	LogS:	-7.5 ? The logarithm of aqueous solubility value.
Rotatable Bonds:	4.0	Rigid Bonds:	23.0
TPSA:	20.23 ? Topological Polar Surface Area.	H-Bond Acceptor:	1.0
H-Bond Donor:	1.0	Rings:	5.0
Heavy Atoms:	1.0

MedChem Properties

QED Drug-Likeness Score:	0.47	GASA:	1.0 ? GASA represents the probability of being difficult to synthesize, ranging from 0 to 1.
Synthetic Accessibility Score:	4.732	Fsp³:	0.931
MCE-18:	84.571 ? MCE-18 stands for medicinal chemistry evolution.MCE-18≥45 is considered a suitable value.	Lipinski Rule-of-5:	Rejected
Pfizer Rule:	Accepted	GSK Rule:	Accepted
Golden Triangle Rule:	Accepted	BMS Rule:	0
Chelating Alert:	0	PAINS Alert:	0
Colloidal aggregators:	0.928	Fluc inhibitor:	0.0 ? The fluc inhibitor value is the probability of being fLuc inhibitors, within the range of 0 to 1.
Blue fluorescence:	0.066 ? 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:	0.517	Promiscuous compounds:	0.054

ADMET Properties (ADMETlab3.0)

ADMET: Absorption

Caco-2 Permeability:	-4.807	MDCK Permeability:	-4.897
Pgp-inhibitor:	0.961	Pgp-substrate:	0.029
PAMPA:	0.005 ? 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):	0.0
20% Bioavailability (F20%):	0.047	30% Bioavailability (F30%):	0.135
50% Bioavailability (F50%):	0.982

ADMET: Distribution

Blood-Brain-Barrier Penetration (BBB):	0.001	MRP1:	0.42
Plasma Protein Binding (PPB):	96.9%	Volume Distribution (VD):	0.002
Fu:	3.35% ? The fraction unbound in plasms.	OATP1B1 inhibitor:	1.0
OATP1B3 inhibitor:	0.997	BCRP inhibitor:	0.152
BSEP inhibitor:	0.998

ADMET: Metabolism

CYP1A2-inhibitor:	0.002	CYP1A2-substrate:	0.232
CYP2C19-inhibitor:	0.899	CYP2C19-substrate:	0.145
CYP2C9-inhibitor:	0.0	CYP2C9-substrate:	0.884
CYP2D6-inhibitor:	0.0	CYP2D6-substrate:	0.716
CYP3A4-inhibitor:	1.0	CYP3A4-substrate:	1.0
CYP2B6-substrate:	0.0	CYP2C8-inhibitor:	1.0
HLM stability:	0.86 ? 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):

13.369

Half-life (T1/2):

0.679

ADMET: Toxicity

hERG Blockers:	0.171	hERG Blockers (10um):	0.343
Human Hepatotoxicity (H-HT):	0.696	Drug-induced Liver Injury (DILI):	0.446
AMES Toxicity:	0.121	Rat Oral Acute Toxicity:	0.08
Maximum Recommended Daily Dose:	0.694	Skin Sensitization:	0.888
Carcinogencity:	0.914	Eye Corrosion:	0.342
Eye Irritation:	0.972	Respiratory Toxicity:	0.923
Drug-induced Neurotoxicity:	0.034	Ototoxicity:	0.66
Hematotoxicity:	0.488	Drug-induced Nephrotoxicity:	0.789
Genotoxicity:	0.02	RPMI-8226 Immunitoxicity:	0.037
A549 Cytotoxicity:	0.302	Hek293 Cytotoxicity:	0.731
BCF:	2.998 ? 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:	4.615 ? 48 hour Tetrahymena pyriformis IGC50. The unit of IGC50 is -log10[(mg/L)/(1000*MW)].
LC50DM:	5.085 ? 48 hour Daphnia magna LC50. The unit of LC50DM is -log10[(mg/L)/(1000*MW)].	LC50FM:	5.267 ? 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
NPO13611	Ambavia gerrardii	Species	Annonaceae	Eukaryota	n.a.	root	n.a.	PMID[21504145]
NPO13611	Ambavia gerrardii	Species	Annonaceae	Eukaryota	n.a.	Madagascar Dry Forest	n.a.	PMID[21504145]
NPO13611	Ambavia gerrardii	Species	Annonaceae	Eukaryota	n.a.	n.a.	n.a.	Database[COCONUT]
NPO13611	Ambavia gerrardii	Species	Annonaceae	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

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

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 NPC174066 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	27254
0.1-0.2	20177
0.2-0.3	2123
0.3-0.4	245
0.4-0.5	36
0.5-0.6	14
0.6-0.7	10
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	Natural Product ID
0.6875	Remote Similarity	NPC71460
0.6875	Remote Similarity	NPC218585
0.6735	Remote Similarity	NPC148174
0.6383	Remote Similarity	NPC114891
0.6111	Remote Similarity	NPC167702
0.6111	Remote Similarity	NPC280026
0.6	Remote Similarity	NPC320549
0.6	Remote Similarity	NPC156277
0.6	Remote Similarity	NPC58057
0.6	Remote Similarity	NPC151018
0.566	Remote Similarity	NPC254340
0.56	Remote Similarity	NPC281540
0.56	Remote Similarity	NPC159654
0.56	Remote Similarity	NPC167995
0.56	Remote Similarity	NPC118937
0.5536	Remote Similarity	NPC192456
0.55	Remote Similarity	NPC323180
0.5238	Remote Similarity	NPC320478
0.5185	Remote Similarity	NPC327728
0.5185	Remote Similarity	NPC6120
0.5185	Remote Similarity	NPC131892
0.5185	Remote Similarity	NPC213178
0.5185	Remote Similarity	NPC103822
0.5085	Remote Similarity	NPC477819

Similar Clinical/Approved Drugs

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

● The left chart: Distribution of similarity level between NPC174066 and all drugs/candidates.
● The right table: Most similar clinical/approved drugs (Tc>=0.5 or Top200).

range	Tanimoto Coefficient
0-0.1	7997
0.1-0.2	1014
0.2-0.3	106
0.3-0.4	20
0.4-0.5	6
0.5-0.6	4
0.6-0.7	3
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
0.6111	Remote Similarity	NPD6113	Clinical (unspecified phase)
0.6	Remote Similarity	NPD4808	Phase 2
0.6	Remote Similarity	NPD4809	Phase 4
0.5185	Remote Similarity	NPD3699	Clinical (unspecified phase)
0.5185	Remote Similarity	NPD3700	Clinical (unspecified phase)
0.5091	Remote Similarity	NPD4787	Phase 1
0.5088	Remote Similarity	NPD3671	Phase 1

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