The high heterogeneity of the disease microenvironment is a critical factor contributing to therapeutic failure and the emergence of drug resistance; however, predicting drug responses with precision at single-cell resolution remains a substantial challenge. Traditional pharmacogenomic studies are constrained by averaged signals at the population level, which frequently obscure rare yet lethal resistant subpopulations. This article reviews a closed-loop strategy that integrates computational pharmacology with cell biology to address this dilemma. First, we explore computational frameworks based on Deep Transfer Learning and Domain Adaptation, such as scDEAL and SCAD. These algorithms can transfer pharmacological knowledge from large-scale cell lines to clinical single-cell data, thereby enabling virtual prediction of cellular drug sensitivity in the absence of experimental labels. Second, based on algorithmic predictions, we elucidate chemotherapy-induced Transcriptional Stress States and their co-evolutionary mechanisms with inflammatory stromal cells, as well as interactions that construct an immunosuppressive barrier protecting residual disease. Finally, we demonstrate the feasibility of reprogramming these specific pathological states using small-molecule drugs (e.g., decitabine, benzofuran derivatives), including the reversal of macrophage polarization imbalance in spinal cord injury and the amelioration of osteogenic differentiation disorders in osteoporosis. This integrated “algorithm prediction–mechanism elucidation–drug intervention” strategy provides a novel paradigm for precision therapy to reverse disease-associated cell fates.
Ma et al. (Wed,) studied this question.