Clinical risk prediction plays a crucial role in early disease detection and personalized intervention. While recent models increasingly incorporate multimodal data, their development typically assumes access to large-scale, multimodal datasets and substantial computational resources. In practice, however, most clinical sites operate under resource constraints, with access limited to EHR data alone and insufficient capacity to train complicated models. This gap highlights the urgent need to democratize clinical risk prediction by enabling effective deployment in data- and resource-limited local clinical settings. In this work, we propose a cross-cohort cross-modal knowledge transfer framework that leverages the multimodal model trained on a nationwide cohort and adapts it to local cohorts with only EHR data. We focus on EHR and genetic data as representative multimodal inputs and address two key challenges. First, to mitigate the influence of noisy or less informative biological signals, we propose a novel mixture-of-aggregations design to enhance the modeling of informative and relevant genetic features. Second, to support rapid model adaptation in low-resource sites, we develop a lightweight graph-guided fine-tuning method that adapts pretrained phenotypical EHR representations to target cohorts using limited patient data. Extensive experiments on real-world clinical data validate the effectiveness of our proposed model.

Transcriptome foundation models (TFMs) hold great promises of deciphering the transcriptomic language that dictate diverse cell functions by self-supervised learning on large-scale single-cell gene expression data, and ultimately unraveling the complex mechanisms of human diseases. However, current TFMs treat cells as independent samples and ignore the taxonomic relationships between cell types, which are available in cell ontology graphs. We argue that effectively leveraging this ontology information during the TFM pre-training can improve learning biologically meaningful gene co-expression patterns while preserving TFM as a general purpose foundation model for downstream zero-shot and fine-tuning tasks. To this end, we present **s**ingle **c**ell, **Cell**-**o**ntology guided TFM (scCello). We introduce cell-type coherence loss and ontology alignment loss, which are minimized along with the masked gene expression prediction loss during the pre-training. The novel loss component guide scCello to learn the cell-type-specific representation and the structural relation between cell types from the cell ontology graph, respectively. We pre-trained scCello on 22 million cells from CellxGene database leveraging their cell-type labels mapped to the cell ontology graph from Open Biological and Biomedical Ontology Foundry. Our TFM demonstrates competitive generalization and transferability performance over the existing TFMs on biologically important tasks including identifying novel cell types of unseen cells, prediction of cell-type-specific marker genes, and cancer drug responses. Source code and model weights are available at https://github.com/DeepGraphLearning/scCello.

Identification of cell subclasses using single-cell RNA-Sequencing (scRNA-Seq) data is of paramount importance since it uncovers the hidden biological processes within the cell population. While the nonnegative matrix factorization (NMF) model has been reported to be effective in various unsupervised clustering tasks, it may still produce inappropriate results for some scRNA-Seq datasets with heterogeneous structures. In this paper, we propose the use of an orthogonally constrained NMF (ONMF) model for the subclass identification problem of scRNA-Seq datasets. The ONMF model in general can provide improved clustering performance, but is challenging to solve. We present a computationally efficient algorithm based on optimization techniques of variable splitting and alternating direction method of multipliers (ADMM). Through two scRNA-Seq datasets, we show that the proposed method can yield promising performance in identifying cell subclasses and detecting key genes over the existing methods. Moreover, the key genes identified by the proposed method are shown biologically significant via the gene set enrichment analysis.