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HypoKG: Evidence-Disciplined Biomedical Hypothesis Generation Beyond Endpoint Knowledge

arXiv:2609.12260v1 Announce Type: cross Abstract: Large language models (LLMs) can generate biomedical hypotheses, but it remains unclear whether they truly reason from scientific evidence or simply produce convincing-sounding ideas. To study this, we combine three major biological databases: the Kyoto Encyclopedia of Genes and Genomes (KEGG), Rhea, and UniProt, into a unified biochemical knowledge graph and construct a benchmark of 550 paths connecting enzyme sources to rare disease endpoints, yielding 13,200 hypotheses from six LLMs under four conditions varying the biological information each model receives: source enzyme only, full biological path, or source and disease endpoint only. Hypotheses are scored using an expert-derived five-criterion rubric on a 1-5 scale per criterion. We find that models given both the source and disease endpoint often produce the highest-scoring hypotheses, showing that LLMs can generate compelling ideas from minimal information. However, these hypotheses are less grounded in the evidence. In contrast, models given the full biological path generate hypotheses more consistent with known mechanistic relationships. We call this evidence-disciplined reasoning. To confirm this effect, we shuffled intermediate path steps while keeping endpoints fixed. Evidence grounding dropped significantly (delta = -0.793, p

Diffusion learning reveals viable parameter manifolds and compensation geometry in biological dynamical systems

arXiv:2607.03671v2 Announce Type: replace-cross Abstract: Models of complex systems often have many parameters, yet are constrained by far fewer experimentally accessible observables; consequently, similar activity can emerge from coordinated parameter changes. We formalize these compatible parameter sets as \emph{viable parameter manifolds}: the inverse images of target dynamical features under a parameter-to-feature map. The relevant codimension is not the number of reported features, but the effective rank of that map at the target scale. Locally redundant features lower the effective codimension, while poor conditioning, high curvature, or regime mixing degrade learnability. We train conditional score-based diffusion models on simulated parameter--feature pairs and use them as amortized samplers of prior-weighted viable sets. In the Lorenz system, scalar trajectory statistics generate thin viable sheets, and a finite-tolerance conditioning localizes a transition-adjacent corridor. In the Izhikevich neuron model, four firing descriptors lie close to a nearly two-dimensional family of features, and the learned inverse images reveal distinct regular and irregular compensation geometries. In a deterministic ODE reduction of finite spiking networks, the same framework reveals excitatory--inhibitory compensation, timescale--coupling tradeoffs, and viable manifolds across 4--12 parameter dimensions. In this view, robustness, compensation, and hidden parameter dependencies are organized as inverse geometry, with diffusion models providing practical tools for sampling, visualizing, and interrogating that geometry.

Explainable Multi-Task Retinal Imaging Reveals Microvascular Signals for Systemic Risk Stratification in Type 2 Diabetes: A Pilot Study

arXiv:2605.24913v1 Announce Type: cross Abstract: Retinal imaging provides a non-invasive window into systemic microvascular health and has emerged as a potential biomarker for systemic diseases. However, whether retinal features encode biologically meaningful systemic signals that can be reliably interpreted using explainable artificial intelligence (XAI) remains unclear. An explainable multi-task deep learning framework was developed to investigate associations between retinal microvascular features and systemic abnormalities in Type 2 Diabetes Mellitus. A total of 11,011 fundus images from 2,719 individuals were analysed using a shared neural network with task-specific heads for glycaemic status, kidney abnormality, and multi-system involvement. Model interpretability was evaluated using Gradient-weighted Class Activation Mapping (Grad-CAM), anatomical masking, and vessel alignment analysis. The framework demonstrated task-dependent predictive performance, with the best discrimination observed for kidney abnormality (AUC up to 0.63), whereas glycaemic status prediction showed limited performance (AUC = 0.49-0.61). Explainability analyses consistently localized model attention to retinal vessels and peripapillary regions. Masking experiments showed that occlusion of vascular regions caused the greatest performance decline, indicating that retinal vessels were the primary predictive source. Different architectures exhibited heterogeneous attention patterns, suggesting multiple representational pathways for systemic signal encoding. This pilot study demonstrates that retinal microvascular features contain measurable signals associated with systemic abnormalities, particularly microvascular damage. By integrating multi-task learning with quantitative XAI validation, this framework advances retinal imaging toward interpretable digital biomarkers for systemic risk stratification in diabetes.

FragmentNet: Adaptive Graph Fragmentation for Graph-to-Sequence Molecular Representation Learning

arXiv:2502.01184v2 Announce Type: replace-cross Abstract: Molecular representation learning methods typically tokenize molecules as individual atoms or use rigid, rule-based fragment decompositions, limiting their ability to capture meaningful chemical substructure context. We introduce FragmentNet, a graph-to-sequence model built around a novel adaptive, learned tokenizer that decomposes molecular graphs into chemically valid fragments of adjustable granularity, complemented by chemically aware spatial positional encodings that preserve molecular topology in the resulting sequence. Extending masked pre-training strategies from natural language processing to the molecular domain, we mask and reconstruct molecules at the level of chemically meaningful fragments rather than individual atoms. Evaluating across multiple property prediction benchmarks, we find that pre-training at fragment granularity leads to improved downstream performance on the majority of tasks, demonstrating that tokenization granularity is an important design choice for molecular representation learning.

A Multimodal Foundation Model of Spatial Transcriptomics and Histology for Biological Discovery and Clinical Prediction

arXiv:2604.03630v1 Announce Type: new Abstract: Spatial transcriptomics (ST) enables gene expression mapping within anatomical context but remains costly and low-throughput. Hematoxylin and eosin (H\&E) staining offers rich morphology yet lacks molecular resolution. We present \textbf{\ours} (\textbf{S}patial \textbf{T}ranscriptomics and hist\textbf{O}logy \textbf{R}epresentation \textbf{M}odel), a foundation model trained on 1.2 million spatially resolved transcriptomic profiles with matched histology across 18 organs. Using a hierarchical architecture integrating morphological features, gene expression, and spatial context, STORM bridges imaging and omics through robust molecular--morphological representations. STORM enhances spatial domain discovery, producing biologically coherent tissue maps, and outperforms existing methods in predicting spatial gene expression from H\&E images across 11 tumor types. The model is platform-agnostic, performing consistently across Visium, Xenium, Visium HD, and CosMx. Applied to 23 independent cohorts comprising 7,245 patients, STORM significantly improves immunotherapy response prediction and prognostication over established biomarkers, providing a scalable framework for spatially informed discovery and clinical precision medicine.

Good Rankings, Wrong Probabilities: A Calibration Audit of Multimodal Cancer Survival Models

arXiv:2604.04239v1 Announce Type: cross Abstract: Multimodal deep learning models that fuse whole-slide histopathology images with genomic data have achieved strong discriminative performance for cancer survival prediction, as measured by the concordance index. Yet whether the survival probabilities derived from these models - either directly from native outputs or via standard post-hoc reconstruction - are calibrated remains largely unexamined. We conduct, to our knowledge, the first systematic fold-level 1-calibration audit of multimodal WSI-genomics survival architectures, evaluating native discrete-time survival outputs (Experiment A: 3 models on TCGA-BRCA) and Breslow-reconstructed survival curves from scalar risk scores (Experiment B: 11 architectures across 5 TCGA cancer types). In Experiment A, all three models fail 1-calibration on a majority of folds (12 of 15 fold-level tests reject after Benjamini-Hochberg correction). Across the full 290 fold-level tests, 166 reject the null of correct calibration at the median event time after Benjamini-Hochberg correction (FDR = 0.05). MCAT achieves C-index 0.817 on GBMLGG yet fails 1-calibration on all five folds. Gating-based fusion is associated with better calibration; bilinear and concatenation fusion are not. Post-hoc Platt scaling reduces miscalibration at the evaluated horizon (e.g., MCAT: 5/5 folds failing to 2/5) without affecting discrimination. The concordance index alone is insufficient for evaluating survival models intended for clinical use.

Interpretable Electrophysiological Features of Resting-State EEG Capture Cortical Network Dynamics in Parkinsons Disease

arXiv:2604.01475v1 Announce Type: new Abstract: Parkinsons disease (PD) alters cortical neural dynamics, yet reliable non-invasive electrophysiological biomarkers remain elusive. This study examined whether interpretable EEG features capturing complementary aspects of neural dynamics can discriminate Parkinsonian neural states. A comprehensive set of interpretable features was extracted and grouped into Standard descriptors (spectral power, phase synchronization, time-domain statistics) and Dynamical descriptors (aperiodic activity, cross-frequency coupling, scale-free dynamics, neuronal avalanche statistics, and instantaneous frequency measures). A multi-head attention transformer classifier was trained using strict LOSO validation. Group-level comparisons were performed to identify electrophysiological differences associated with disease and medication state. Standard feature sets achieved strongest performance in discriminating medication states (PDoff vs PDon), whereas Dynamical performed competitively in contrasts between PD patients and healthy controls. Random feature ablation analyses indicated that Dynamical descriptors provide complementary information distributed across features while correlation analysis revealed low redundancy within both feature sets. Group-level comparisons revealed medication-sensitive reductions in delta power and voltage variance, modulation of neuronal avalanche statistics, persistent increases in theta phase synchronization in PD patients, and disease-related alterations in cross-frequency interactions. Traditional spectral and synchronization features primarily reflect medication-related neural modulation, whereas dynamical descriptors reveal broader alterations in cortical network organization associated with disease but also with medication. These findings support multivariate EEG representations as a promising framework for developing non-invasive biomarkers of PD.

BIOGEN: Evidence-Grounded Multi-Agent Reasoning Framework for Transcriptomic Interpretation in Antimicrobial Resistance

arXiv:2510.16082v5 Announce Type: replace-cross Abstract: Interpreting gene clusters from RNA sequencing (RNA-seq) remains challenging, especially in antimicrobial resistance studies where mechanistic insight is important for hypothesis generation. Existing pathway enrichment methods can summarize co-expressed modules, but they often provide limited cluster-specific explanations and weak connections to supporting literature. We present BIOGEN, an evidence-grounded multi-agent framework for post hoc interpretation of RNA-seq transcriptional modules. BIOGEN combines biomedical retrieval, structured reasoning, and multi-critic verification to generate traceable cluster-level explanations with explicit evidence and confidence labels. On a primary Salmonella enterica dataset, BIOGEN achieved strong biological grounding, including BERTScore 0.689, Semantic Alignment Score 0.715, KEGG Functional Similarity 0.342, and a hallucination rate of 0.000, compared with 0.100 for an LLM-only baseline. Across four additional bacterial RNA-seq datasets, BIOGEN also maintained zero hallucination under the same fixed pipeline. In comparisons with representative open-source agentic AI baselines, BIOGEN was the only framework that consistently preserved zero hallucination across all five datasets. These findings suggest that retrieval alone is not enough for reliable biological interpretation, and that evidence-grounded orchestration is important for transparent and source-traceable transcriptomic reasoning.

Quantifying Cross-Modal Interactions in Multimodal Glioma Survival Prediction via InterSHAP: Evidence for Additive Signal Integration

arXiv:2603.29977v1 Announce Type: cross Abstract: Multimodal deep learning for cancer prognosis is commonly assumed to benefit from synergistic cross-modal interactions, yet this assumption has not been directly tested in survival prediction settings. This work adapts InterSHAP, a Shapley interaction index-based metric, from classification to Cox proportional hazards models and applies it to quantify cross-modal interactions in glioma survival prediction. Using TCGA-GBM and TCGA-LGG data (n=575), we evaluate four fusion architectures combining whole-slide image (WSI) and RNA-seq features. Our central finding is an inverse relationship between predictive performance and measured interaction: architectures achieving superior discrimination (C-index 0.64$\to$0.82) exhibit equivalent or lower cross-modal interaction (4.8\%$\to$3.0\%). Variance decomposition reveals stable additive contributions across all architectures (WSI${\approx}$40\%, RNA${\approx}$55\%, Interaction${\approx}$4\%), indicating that performance gains arise from complementary signal aggregation rather than learned synergy. These findings provide a practical model auditing tool for comparing fusion strategies, reframe the role of architectural complexity in multimodal fusion, and have implications for privacy-preserving federated deployment.

Learning Inter-Atomic Potentials without Explicit Equivariance

arXiv:2510.00027v3 Announce Type: replace-cross Abstract: Accurate and scalable machine-learned inter-atomic potentials (MLIPs) are essential for molecular simulations ranging from drug discovery to new material design. Current state-of-the-art models enforce roto-translational symmetries through equivariant neural network architectures, a hard-wired inductive bias that can often lead to reduced flexibility, computational efficiency, and scalability. In this work, we introduce TransIP: Transformer-based Inter-Atomic Potentials, a novel training paradigm for interatomic potentials achieving symmetry compliance without explicit architectural constraints. Our approach guides a generic non-equivariant Transformer-based model to learn SO(3)-equivariance by optimizing its representations in the embedding space. Trained on the recent Open Molecules (OMol25) collection, a large and diverse molecular dataset built specifically for MLIPs and covering different types of molecules (including small organics, biomolecular fragments, and electrolyte-like species), TransIP attains comparable performance in machine-learning force fields versus state-of-the-art equivariant baselines. Further, compared to a data augmentation baseline, TransIP achieves 40% to 60% improvement in performance across varying OMol25 dataset sizes. More broadly, our work shows that learned equivariance can be a powerful and efficient alternative to equivariant or augmentation-based MLIP models. Our code is available at: https://github.com/Ahmed-A-A-Elhag/TransIP.

Budget-Sensitive Discovery Scoring: A Formally Verified Framework for Evaluating AI-Guided Scientific Selection

arXiv:2603.12349v1 Announce Type: cross Abstract: Scientific discovery increasingly relies on AI systems to select candidates for expensive experimental validation, yet no principled, budget-aware evaluation framework exists for comparing selection strategies -- a gap intensified by large language models (LLMs), which generate plausible scientific proposals without reliable downstream evaluation. We introduce the Budget-Sensitive Discovery Score (BSDS), a formally verified metric -- 20 theorems machine-checked by the Lean 4 proof assistant -- that jointly penalizes false discoveries (lambda-weighted FDR) and excessive abstention (gamma-weighted coverage gap) at each budget level. Its budget-averaged form, the Discovery Quality Score (DQS), provides a single summary statistic that no proposer can inflate by performing well at a cherry-picked budget. As a case study, we apply BSDS/DQS to: do LLMs add marginal value to an existing ML pipeline for drug discovery candidate selection? We evaluate 39 proposers -- 11 mechanistic variants, 14 zero-shot LLM configurations, and 14 few-shot LLM configurations -- using SMILES representations on MoleculeNet HIV (41,127 compounds, 3.5% active, 1,000 bootstrap replicates) under both random and scaffold splits. Three findings emerge. First, the simple RF-based Greedy-ML proposer achieves the best DQS (-0.046), outperforming all MLP variants and LLM configurations. Second, no LLM surpasses the Greedy-ML baseline under zero-shot or few-shot evaluation on HIV or Tox21, establishing that LLMs provide no marginal value over an existing trained classifier. Third, the proposer hierarchy generalizes across five MoleculeNet benchmarks spanning 0.18%-46.2% prevalence, a non-drug AV safety domain, and a 9x7 grid of penalty parameters (tau >= 0.636, mean tau = 0.863). The framework applies to any setting where candidates are selected under budget constraints and asymmetric error costs.

Distilling and Adapting: A Topology-Aware Framework for Zero-Shot Interaction Prediction in Multiplex Biological Networks

arXiv:2603.06618v1 Announce Type: cross Abstract: Multiplex Biological Networks (MBNs), which represent multiple interaction types between entities, are crucial for understanding complex biological systems. Yet, existing methods often inadequately model multiplexity, struggle to integrate structural and sequence information, and face difficulties in zero-shot prediction for unseen entities with no prior neighbourhood information. To address these limitations, we propose a novel framework for zero-shot interaction prediction in MBNs by leveraging context-aware representation learning and knowledge distillation. Our approach leverages domain-specific foundation models to generate enriched embeddings, introduces a topology-aware graph tokenizer to capture multiplexity and higher-order connectivity, and employs contrastive learning to align embeddings across modalities. A teacher-student distillation strategy further enables robust zero-shot generalization. Experimental results demonstrate that our framework outperforms state-of-the-art methods in interaction prediction for MBNs, providing a powerful tool for exploring various biological interactions and advancing personalized therapeutics.

ViroGym: Realistic Large-Scale Benchmarks for Evaluating Viral Proteins

arXiv:2603.06740v1 Announce Type: cross Abstract: Protein language models (pLMs) have shown strong potential in prediction of the functional effects of missense variants in zero-shot settings. Despite this progress, benchmarking pLMs for viral proteins remains limited and systematic strategies for integrating in silico metrics with in vitro validation to guide antigen and target selection are underdeveloped. Here, we introduce ViroGym, a comprehensive benchmark designed to evaluate variant effect prediction in viral proteins and to facilitate selecting rational antigen candidates. We curated 79 deep mutational scanning (DMS) assays encompassing eukaryotic viruses, collectively comprising 552,937 mutated amino acid sequences across 7 distinct phenotypic readouts, and 21 influenza virus neutralisation tasks and a real-world predictive task for SARS-CoV-2. We benchmark well-established pLMs on fitness landscapes, antigenic diversity, and pandemic forecasting to provide a framework for vaccine selection, and show that pLMs selected using in vitro experimental data excel at predicting dominant circulating mutations in real world.

Neural Control and Learning of Simulated Hand Movements With an EMG-Based Closed-Loop Interface

arXiv:2603.07364v1 Announce Type: cross Abstract: The standard engineering approach when facing uncertainty is modelling. Mixing data from a well-calibrated model with real recordings has led to breakthroughs in many applications of AI, from computer vision to autonomous driving. This type of model-based data augmentation is now beginning to show promising results in biosignal processing as well. However, while these simulated data are necessary, they are not sufficient for virtual neurophysiological experiments. Simply generating neural signals that reproduce a predetermined motor behaviour does not capture the flexibility, variability, and causal structure required to probe neural mechanisms during control tasks. In this study, we present an in silico neuromechanical model that combines a fully forward musculoskeletal simulation, reinforcement learning, and sequential, online electromyography synthesis. This framework provides not only synchronised kinematics, dynamics, and corresponding neural activity, but also explicitly models feedback and feedforward control in a virtual participant. In this way, online control problems can be represented, as the simulated human adapts its behaviour via a learned RL policy in response to a neural interface. For example, the virtual user can learn hand movements robust to perturbations or the control of a virtual gesture decoder. We illustrate the approach using a gesturing task within a biomechanical hand model, and lay the groundwork for using this technique to evaluate neural controllers, augment training datasets, and generate synthetic data for neurological conditions.

CITS: Nonparametric Statistical Causal Modeling for High-Resolution Neural Time Series

arXiv:2508.01920v2 Announce Type: replace Abstract: Identifying causal interactions in complex dynamical systems is a fundamental challenge across the computational sciences. Existing functional connectivity methods capture correlations but not causation. While addressing directionality, popular causal inference tools such as Granger causality and the Peter-Clark algorithm rely on restrictive assumptions that limit their applicability to high-resolution time-series data, such as the large-scale recordings now standard in neuroscience. Here, we introduce CITS (Causal Inference in Time Series), a nonparametric framework for inferring statistically causal structure from multivariate time series. CITS models dynamics using a structural causal model of arbitrary Markov order and statistical tests for lagged conditional independence. We prove consistency under mild assumptions and demonstrate superior accuracy over state-of-the-art baselines across simulated linear, nonlinear, and recurrent neural network benchmarks. Applying CITS to large-scale neuronal recordings from the mouse visual cortex, thalamus, and hippocampus, we uncover stimulus-specific causal pathways and inter-regional hierarchies that align with known anatomy while revealing new functional insights. We further highlight CITS ability in accurately identifying conditional dependencies within small inferred neuronal motifs. These results establish CITS as a theoretically grounded and empirically validated method for discovering interpretable statistically causal networks in neural time series. Beyond neuroscience, the framework is broadly applicable to causal discovery in complex temporal systems across domains.

HarmonyCell: Automating Single-Cell Perturbation Modeling under Semantic and Distribution Shifts

arXiv:2603.01396v2 Announce Type: replace Abstract: Single-cell perturbation studies face dual heterogeneity bottlenecks: (i) semantic heterogeneity--identical biological concepts encoded under incompatible metadata schemas across datasets; and (ii) statistical heterogeneity--distribution shifts from biological variation demanding dataset-specific inductive biases. We propose HarmonyCell, an end-to-end agent framework resolving each challenge through a dedicated mechanism: an LLM-driven Semantic Unifier autonomously maps disparate metadata into a canonical interface without manual intervention; and an adaptive Monte Carlo Tree Search engine operates over a hierarchical action space to synthesize architectures with optimal statistical inductive biases for distribution shifts. Evaluated across diverse perturbation tasks under both semantic and distribution shifts, HarmonyCell achieves a 95% valid execution rate on heterogeneous input datasets (versus 0% for general agents) while matching or even exceeding expert-designed baselines in rigorous out-of-distribution evaluations. This dual-track orchestration enables scalable automatic virtual cell modeling without dataset-specific engineering.

RadDiff: Retrieval-Augmented Denoising Diffusion for Protein Inverse Folding

arXiv:2512.00126v2 Announce Type: replace-cross Abstract: Protein inverse folding, the design of an amino acid sequence based on a target protein structure, is a fundamental problem of computational protein engineering. Existing methods either generate sequences without leveraging external knowledge or relying on protein language models~(PLMs). The former omits the knowledge stored in natural protein data, while the latter is parameter-inefficient and inflexible to adapt to ever-growing protein data. To overcome the above drawbacks, in this paper we propose a novel method, called $\underline{\text{r}}$etrieval-$\underline{\text{a}}$ugmented $\underline{\text{d}}$enoising $\underline{\text{diff}}$usion~($\mbox{RadDiff}$), for protein inverse folding. In RadDiff, a novel retrieval-augmentation mechanism is designed to capture the up-to-date protein knowledge. We further design a knowledge-aware diffusion model that integrates this protein knowledge into the diffusion process via a lightweight module. Experimental results on the CATH, TS50, and PDB2022 datasets show that $\mbox{RadDiff}$ consistently outperforms existing methods, improving sequence recovery rate by up to 19\%. Experimental results also demonstrate that RadDiff generates highly foldable sequences and scales effectively with database size.

CryoNet.Refine: A One-step Diffusion Model for Rapid Refinement of Structural Models with Cryo-EM Density Map Restraints

arXiv:2602.22263v2 Announce Type: replace-cross Abstract: High-resolution structure determination by cryo-electron microscopy (cryo-EM) requires the accurate fitting of an atomic model into an experimental density map. Traditional refinement pipelines such as Phenix.real_space_refine and Rosetta are computationally expensive, demand extensive manual tuning, and present a significant bottleneck for researchers. We present CryoNet.Refine, an end-to-end deep learning framework that automates and accelerates molecular structure refinement. Our approach utilizes a one-step diffusion model that integrates a density-aware loss function with robust stereochemical restraints, enabling rapid optimization of a structure against experimental data. CryoNet.Refine provides a unified and versatile solution capable of refining protein complexes as well as DNA/RNA-protein complexes. In benchmarks against Phenix.real_space_refine, CryoNet.Refine consistently achieves substantial improvements in both model-map correlation and overall geometric quality metrics. By offering a scalable, automated, and powerful alternative, CryoNet.Refine aims to serve as an essential tool for next-generation cryo-EM structure refinement. Web server: https://cryonet.ai/refine; Source code: https://github.com/kuixu/cryonet.refine.

ERDES: A Benchmark Video Dataset for Retinal Detachment and Macular Status Classification in Ocular Ultrasound

arXiv:2508.04735v2 Announce Type: replace-cross Abstract: Retinal detachment (RD) is a vision-threatening condition that requires prompt intervention to preserve sight. A critical factor in treatment urgency and visual prognosis is macular involvement -- whether the macula is intact or detached. Point-of-care ultrasound (POCUS) is a fast, non-invasive and cost-effective imaging tool commonly used to detect RD in various clinical settings. However, its diagnostic utility is limited by the need for expert interpretation, especially in resource-limited environments. Deep learning has the potential to automate RD detection on ultrasound, but there are no clinically available models, and prior research has not addressed macular status -- an essential distinction for surgical prioritization. Additionally, no public dataset currently supports macular-based RD classification using ultrasound video. We introduce Eye Retinal DEtachment ultraSound (ERDES), the first open-access dataset of ocular ultrasound clips labeled for (i) presence of RD and (ii) macula-detached vs. macula-intact status. ERDES enables machine learning development for RD detection. We also provide baseline benchmarks by training 40 models across eight architectures, including 3D convolutional networks and transformer-based models.

Contextual Invertible World Models: A Neuro-Symbolic Agentic Framework for Colorectal Cancer Drug Response

arXiv:2603.02274v1 Announce Type: cross Abstract: Precision oncology is currently limited by the small-N, large-P paradox, where high-dimensional genomic data is abundant, but high-quality drug response samples are often sparse. While deep learning models achieve high predictive accuracy, they remain black boxes that fail to provide the causal mechanisms required for clinical decision-making. We present a Neuro-Symbolic Agentic Framework that bridges this gap by integrating a quantitative machine learning World Model with an LLM-based agentic reasoning layer. Our system utilises a forensic data pipeline built on the Sanger GDSC dataset (N=83), achieving a robust predictive correlation (r=0.504) and a significant performance gain through the explicit modelling of clinical context, specifically Microsatellite Instability (MSI) status. We introduce the concept of Inverse Reasoning, where the agentic layer performs in silico CRISPR perturbations to predict how specific genomic edits, such as APC or TP53 repair, alter drug sensitivity. By distinguishing between therapeutic opportunity and contextual resistance, and validating these findings against human clinical data (p=0.023), our framework provides a transparent, biologically grounded path towards explainable AI in cancer research.
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