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Tooluniverse Precision Medicine Stratification

  • 331 installs
  • 1.6k repo stars
  • Updated August 4, 2026
  • mims-harvard/tooluniverse

tooluniverse-precision-medicine-stratification is a ToolUniverse agent skill that runs a 9-phase genomic-clinical integration workflow to produce a 0-100 Precision Medicine Risk Score with tiered treatment recommendation

About

tooluniverse-precision-medicine-stratification is a Harvard ToolUniverse agent skill that guides coding agents through a 9-phase precision medicine workflow integrating genomic, clinical, and therapeutic inputs. Given a disease name plus germline variants, somatic mutations, expression data, or clinical biomarkers, the skill orchestrates ToolUniverse calls to OpenTargets, ClinVar, Ensembl VEP, PharmGKB, FDA label tools, DrugBank, Reactome, STRING, PubMed, and clinical trial registries. It routes patients through six disease-type pipelines—cancer, metabolic, cardiovascular, neurological, rare, and autoimmune—and grades every finding across four evidence tiers (T1–T4). Phase 9 produces a quantitative Precision Medicine Risk Score from 0–100 with Low, Intermediate, High, or Very High tier assignment, a 1st/2nd/3rd-line treatment algorithm, pharmacogenomic dosing guidance, clinical trial matches, and a monitoring plan. Developers reach for this skill when prototyping clinical decision support, cohort stratification logic, or biomarker-driven study design—not for single-variant lookup or trial search alone.

  • Patient stratification tool endpoints
  • Biomarker-driven cohort rules
  • Treatment subgroup exploration
  • ToolUniverse precision medicine APIs
  • Clinical study design assistance

Tooluniverse Precision Medicine Stratification by the numbers

  • 331 all-time installs (skills.sh)
  • +5 installs in the week ending Aug 4, 2026 (Skillselion tracking)
  • Ranked #561 of 2,064 Data Science & ML skills by installs in the Skillselion catalog
  • Data as of Aug 5, 2026 (Skillselion catalog sync)
npx skills add https://github.com/mims-harvard/tooluniverse --skill tooluniverse-precision-medicine-stratification

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Installs331
repo stars1.6k
Last updatedAugust 4, 2026
Repositorymims-harvard/tooluniverse

How do you stratify patients with genomic and clinical biomarkers?

Support agents defining patient subgroups, treatment strata, and biomarker-driven cohort rules when designing precision medicine studies or clinical decision support prototypes.

Who is it for?

Bioinformatics or clinical software developers building agent-driven precision medicine prototypes who need multi-omic risk scoring across cancer, metabolic, cardiovascular, neurological, rare, and autoimmune disease pro

Skip if: Developers who only need single-variant interpretation, immunotherapy-only prediction, standalone clinical trial search, or drug-drug interaction analysis without full patient stratification.

When should I use this skill?

A user provides a disease plus genomic variants, somatic mutations, gene expression, or clinical biomarkers and asks for patient risk stratification, personalized treatment selection, prognosis prediction, or biomarker-d

What you get

A source-referenced stratification report with EFO-resolved disease ID, Precision Medicine Risk Score (0-100), four-tier risk assignment, 1st/2nd/3rd-line treatment algorithm, pharmacogenomic guidance, clinical trial mat

  • stratification report
  • Precision Medicine Risk Score (0-100)
  • treatment algorithm with PGx guidance

By the numbers

  • Runs analysis across 9 workflow phases from disease disambiguation to integrated scoring
  • Documents 64 ToolUniverse tool API parameter mappings in the Phase 0 reference table
  • Produces a Precision Medicine Risk Score on a 0–100 scale with 4 risk tiers

Files

SKILL.mdMarkdownGitHub ↗

Precision Medicine Patient Stratification

Transform patient genomic and clinical profiles into actionable risk stratification, treatment recommendations, and personalized therapeutic strategies.

Reasoning Before Searching

Stratification means splitting patients into groups that respond differently to a treatment or have different prognoses. Ask these questions before running any tools:

1. What molecular feature predicts response? Candidates: somatic mutation (e.g., EGFR L858R), germline variant (e.g., BRCA1 LoF), expression level (e.g., HER2 overexpression), germline pharmacogenomic variant (e.g., CYP2C19 PM), or composite biomarker (e.g., TMB-H + MSI-H). 2. Is the predictive feature actionable? Knowing it must change treatment — either the drug choice, dose, or monitoring plan. A variant with prognostic value but no therapeutic consequence is not a stratification biomarker. 3. What is the evidence level for the stratifier? FDA-approved companion diagnostic (T1) vs. exploratory (T4) changes how much weight to place on the finding.

Route to the correct Phase 3 path BEFORE running Phase 2 tools — cancer, metabolic, CVD, rare disease, and autoimmune pipelines require different stratifiers.

LOOK UP DON'T GUESS: Never assume a variant is pathogenic, never assume a gene is relevant to a disease, never assign metabolizer status without PharmGKB or CPIC evidence.

KEY PRINCIPLES: 1. Report-first - Create report file FIRST, then populate progressively 2. Disease-specific logic - Cancer vs metabolic vs rare disease pipelines diverge at Phase 3 3. Multi-level integration - Germline + somatic + expression + clinical data layers 4. Evidence-graded - Every finding has an evidence tier (T1-T4) 5. Quantitative output - Precision Medicine Risk Score (0-100) 6. Source-referenced - Every statement cites the tool/database source 7. English-first queries - Always use English terms in tool calls

Reference files (same directory):

  • TOOLS_REFERENCE.md - Tool parameters, response formats, phase-by-phase tool lists
  • SCORING_REFERENCE.md - Scoring matrices, risk tiers, pathogenicity tables, PGx tables
  • REPORT_TEMPLATE.md - Output report template, treatment algorithms, completeness requirements
  • EXAMPLES.md - Six worked examples (cancer, metabolic, NSCLC, CVD, rare, neuro)
  • QUICK_START.md - Sample prompts and output summary

---

COMPUTE, DON'T DESCRIBE

When analysis requires computation (statistics, data processing, scoring, enrichment), write and run Python code via Bash. Don't describe what you would do — execute it and report actual results. Use ToolUniverse tools to retrieve data, then Python (pandas, scipy, statsmodels, matplotlib) to analyze it.

When to Use

Apply when user asks about patient risk stratification, treatment selection, prognosis prediction, or personalized therapeutic strategy for any disease with genomic/clinical data.

NOT for (use other skills instead):

  • Single variant interpretation -> tooluniverse-variant-interpretation
  • Immunotherapy-specific prediction -> tooluniverse-immunotherapy-response-prediction
  • Drug safety profiling only -> tooluniverse-adverse-event-detection
  • Target validation -> tooluniverse-drug-target-validation
  • Clinical trial search only -> tooluniverse-clinical-trial-matching
  • Drug-drug interaction only -> tooluniverse-drug-drug-interaction
  • PRS calculation only -> tooluniverse-polygenic-risk-score

---

Input Parsing

Required

  • Disease/condition: Free-text disease name
  • At least one of: Germline variants, somatic mutations, gene list, or clinical biomarkers

Optional (improves stratification)

  • Age, sex, ethnicity, disease stage, comorbidities, prior treatments, family history
  • Current medications (for DDI and PGx), stratification goal

Disease Type Classification

Classify into one category (determines Phase 3 routing):

CategoryExamples
CANCERBreast, lung, colorectal, melanoma
METABOLICType 2 diabetes, obesity, NAFLD
CARDIOVASCULARCAD, heart failure, AF
NEUROLOGICALAlzheimer, Parkinson, epilepsy
RARE/MONOGENICMarfan, CF, sickle cell, Huntington
AUTOIMMUNERA, lupus, MS, Crohn's

---

Critical Tool Parameter Notes

See TOOLS_REFERENCE.md for full details. Key gotchas:

  • MyGene_query_genes: param is query (NOT q)
  • EnsemblVEP_annotate_rsid: param is variant_id (NOT rsid)
  • ensembl_lookup_gene: REQUIRES species='homo_sapiens'
  • DrugBank tools: ALL require 4 params: query, case_sensitive, exact_match, limit
  • cBioPortal_get_mutations: gene_list is a STRING (space-separated), not array
  • PubMed_search_articles: Returns a plain list of dicts, NOT {articles: [...]}
  • fda_pharmacogenomic_biomarkers: Use limit=1000 for all results
  • gnomAD: May return "Service overloaded" - skip gracefully
  • OpenTargets: Always nested {data: {entity: {field: ...}}} structure

---

Workflow Overview

Phase 1: Disease Disambiguation & Profile Standardization
Phase 2: Genetic Risk Assessment
Phase 3: Disease-Specific Molecular Stratification (routes by disease type)
Phase 4: Pharmacogenomic Profiling
Phase 5: Comorbidity & Drug Interaction Risk
Phase 6: Molecular Pathway Analysis
Phase 7: Clinical Evidence & Guidelines
Phase 8: Clinical Trial Matching
Phase 9: Integrated Scoring & Recommendations

---

Phase 1: Disease Disambiguation & Profile Standardization

1. Resolve disease to EFO ID using OpenTargets_get_disease_id_description_by_name 2. Classify disease type (CANCER/METABOLIC/CVD/NEUROLOGICAL/RARE/AUTOIMMUNE) 3. Parse genomic data into structured format (gene, variant, type) 4. Resolve gene IDs using MyGene_query_genes to get Ensembl/Entrez IDs

Phase 2: Genetic Risk Assessment

1. Germline variant pathogenicity: ClinVar_search_variants, EnsemblVEP_annotate_rsid/_hgvs 2. Gene-disease association: OpenTargets_target_disease_evidence 3. GWAS polygenic risk: gwas_get_associations_for_trait, OpenTargets_search_gwas_studies_by_disease 4. Population frequency: gnomad_get_variant 5. Gene constraint: gnomad_get_gene_constraints (pLI, LOEUF scores)

Scoring: See SCORING_REFERENCE.md for genetic risk score component (0-35 points).

Phase 3: Disease-Specific Molecular Stratification

CANCER PATH

1. Molecular subtyping: cBioPortal_get_mutations, HPA_get_cancer_prognostics_by_gene 2. TMB/MSI/HRD: fda_pharmacogenomic_biomarkers for FDA cutoffs 3. Prognostic stratification: Combine stage + molecular features

METABOLIC PATH

1. Genetic risk integration: GWAS_search_associations_by_gene, OpenTargets_target_disease_evidence 2. Complication risk: Based on HbA1c, duration, existing complications

CVD PATH

1. FH gene check: ClinVar_search_variants for LDLR, APOB, PCSK9 2. Statin PGx: PharmGKB_get_clinical_annotations for SLCO1B1

RARE DISEASE PATH

1. Causal variant identification: ClinVar_search_variants 2. Genotype-phenotype: UniProt_get_disease_variants_by_accession

Scoring: See SCORING_REFERENCE.md for disease-specific tables.

Phase 4: Pharmacogenomic Profiling

1. Drug-metabolizing enzymes: PharmGKB_get_clinical_annotations, PharmGKB_get_dosing_guidelines 2. FDA PGx biomarkers: fda_pharmacogenomic_biomarkers (use limit=1000) 3. Treatment-specific PGx: PharmGKB_get_drug_details

Scoring: See SCORING_REFERENCE.md for PGx risk score (0-10 points).

Phase 5: Comorbidity & Drug Interaction Risk

1. Disease overlap: OpenTargets_get_associated_targets_by_disease_efoId 2. DDI check: drugbank_get_drug_interactions_by_drug_name_or_id, FDA_get_drug_interactions_by_drug_name 3. PGx-amplified DDI: If PM genotype + CYP inhibitor, flag compounded risk

Phase 6: Molecular Pathway Analysis

1. Pathway enrichment: enrichr_gene_enrichment_analysis (libs: KEGG_2021_Human, Reactome_2022, GO_Biological_Process_2023) 2. Reactome mapping: ReactomeAnalysis_pathway_enrichment, Reactome_map_uniprot_to_pathways 3. Network analysis: STRING_get_interaction_partners, STRING_functional_enrichment 4. Druggable targets: OpenTargets_get_target_tractability_by_ensemblID

Phase 7: Clinical Evidence & Guidelines

1. Guidelines search: PubMed_Guidelines_Search (fallback: PubMed_search_articles) 2. FDA-approved therapies: OpenTargets_get_associated_drugs_by_disease_efoId, FDA_get_indications_by_drug_name 3. Biomarker-drug evidence: civic_search_evidence_items, civic_search_assertions

Phase 8: Clinical Trial Matching

1. Biomarker-driven trials: search_clinical_trials with condition + intervention 2. Precision medicine trials: search_clinical_trials for basket/umbrella trials

Phase 9: Integrated Scoring & Recommendations

Score Components (total 0-100)

  • Genetic Risk (0-35): Pathogenicity + gene-disease association + PRS
  • Clinical Risk (0-30): Stage/biomarkers/comorbidities
  • Molecular Features (0-25): Driver mutations, subtypes, actionable targets
  • Pharmacogenomic Risk (0-10): Metabolizer status, HLA alleles

Risk Tiers

ScoreTierManagement
75-100VERY HIGHIntensive treatment, subspecialty referral, clinical trial
50-74HIGHAggressive treatment, close monitoring
25-49INTERMEDIATEStandard guideline-based care, PGx-guided dosing
0-24LOWSurveillance, prevention, risk factor modification

Output

Generate report per REPORT_TEMPLATE.md. See SCORING_REFERENCE.md for detailed scoring matrices.

---

Common Use Patterns

See EXAMPLES.md for six detailed worked examples: 1. Cancer + actionable mutation: Breast cancer, BRCA1, ER+/HER2- -> Score ~55-65 (HIGH) 2. Metabolic + PGx concern: T2D, CYP2C19 PM on clopidogrel -> Score ~55-65 (HIGH) 3. NSCLC comprehensive: EGFR L858R, TMB 25, PD-L1 80% -> Score ~75-85 (VERY HIGH) 4. CVD risk: LDL 190, SLCO1B15, family hx MI -> Score ~50-60 (HIGH) 5. Rare disease: Marfan, FBN1 variant -> Score ~55-65 (HIGH) 6. Neurological risk*: APOE e4/e4, family hx Alzheimer's -> Score ~60-72 (HIGH)

Related skills

How it compares

Choose this skill when you need end-to-end patient stratification with a quantitative risk score and treatment algorithm; use narrower ToolUniverse skills for single-variant interpretation, trial-only search, or PGx-only

FAQ

What inputs does tooluniverse-precision-medicine-stratification require?

tooluniverse-precision-medicine-stratification requires a disease or condition name plus at least one of germline variants, somatic mutations, a gene list, or clinical biomarkers. Optional inputs—age, stage, comorbidities, medications, family history, and ethnicity—improve pharma

What does the Precision Medicine Risk Score output include?

tooluniverse-precision-medicine-stratification calculates a 0–100 Precision Medicine Risk Score and assigns Low, Intermediate, High, or Very High tiers. Phase 9 also delivers a 1st/2nd/3rd-line treatment algorithm, pharmacogenomic dosing guidance, clinical trial matches, monitori

Which ToolUniverse databases does the stratification workflow call?

tooluniverse-precision-medicine-stratification orchestrates OpenTargets, ClinVar, Ensembl VEP, gnomAD, PharmGKB, FDA label tools, DrugBank, Reactome, STRING, PubMed, and clinical trial search APIs. Its Phase 0 reference table documents 64 verified ToolUniverse tool parameter mapp

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