1
|
Mahasa KJ, Ouifki R, de Pillis L, Eladdadi A. A Role of Effector CD 8 + T Cells Against Circulating Tumor Cells Cloaked with Platelets: Insights from a Mathematical Model. Bull Math Biol 2024; 86:89. [PMID: 38884815 DOI: 10.1007/s11538-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024]
Abstract
Cancer metastasis accounts for a majority of cancer-related deaths worldwide. Metastasis occurs when the primary tumor sheds cells into the blood and lymphatic circulation, thereby becoming circulating tumor cells (CTCs) that transverse through the circulatory system, extravasate the circulation and establish a secondary distant tumor. Accumulating evidence suggests that circulating effector CD 8 + T cells are able to recognize and attack arrested or extravasating CTCs, but this important antitumoral effect remains largely undefined. Recent studies highlighted the supporting role of activated platelets in CTCs's extravasation from the bloodstream, contributing to metastatic progression. In this work, a simple mathematical model describes how the primary tumor, CTCs, activated platelets and effector CD 8 + T cells participate in metastasis. The stability analysis reveals that for early dissemination of CTCs, effector CD 8 + T cells can present or keep secondary metastatic tumor burden at low equilibrium state. In contrast, for late dissemination of CTCs, effector CD 8 + T cells are unlikely to inhibit secondary tumor growth. Moreover, global sensitivity analysis demonstrates that the rate of the primary tumor growth, intravascular CTC proliferation, as well as the CD 8 + T cell proliferation, strongly affects the number of the secondary tumor cells. Additionally, model simulations indicate that an increase in CTC proliferation greatly contributes to tumor metastasis. Our simulations further illustrate that the higher the number of activated platelets on CTCs, the higher the probability of secondary tumor establishment. Intriguingly, from a mathematical immunology perspective, our simulations indicate that if the rate of effector CD 8 + T cell proliferation is high, then the secondary tumor formation can be considerably delayed, providing a window for adjuvant tumor control strategies. Collectively, our results suggest that the earlier the effector CD 8 + T cell response is enhanced the higher is the probability of preventing or delaying secondary tumor metastases.
Collapse
Affiliation(s)
- Khaphetsi Joseph Mahasa
- Department of Mathematics and Computer Science, National University of Lesotho, Roma, Maseru, Lesotho.
| | - Rachid Ouifki
- Department of Mathematics and Applied Mathematics, Mafikeng Campus, North-West University, Private Bag X2046, Mmabatho, 2735, South Africa
| | | | - Amina Eladdadi
- Division of Mathematical Sciences, The National Science Foundation, Alexandria, VA, USA
| |
Collapse
|
2
|
Yuan Z, Zou Y, Liu X, Wang L, Chen C. Longitudinal study on blood and biochemical indexes of Tibetan and Han in high altitude area. Front Public Health 2023; 11:1282051. [PMID: 38035283 PMCID: PMC10685451 DOI: 10.3389/fpubh.2023.1282051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective This study aims to review the blood routine and biochemical indicators of the plateau population for three consecutive years, and analyze the impact of the plateau on these blood indicators of the Tibetan population and the Han immigrant population. Method These parameters were extracted from the Laboratory Department of Ali District People's Hospital in Tibet from January 2019 to December 2021, including blood routine, liver and kidney function, blood lipids, myocardial enzyme spectrum, and rheumatic factor indicators. Changes in these parameters were analyzed over 3 consecutive years according to inclusion and exclusion criteria. Result A total of 114 Tibetans and 93 Hans participated in the study. These parameters were significantly different between Tibetan and Han populations. Red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), mean hemoglobin content (MCH), mean corpuscular hemoglobin concentration (MCHC), white blood cells (WBC), lymphocytes (LYMPH) and monocytes (MONO) were significantly higher in Hans than Tibetans (p < 0.05). Biochemically, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), urea nitrogen (Urea), creatinine (Cr), uric acid (UA), glucose (GLU), triglycerides (TG) and creatine kinase isoenzyme (CKMB) were significantly higher in Hans than Tibetans; aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), antistreptolysin (ASO), and C-reactive protein (CRP) were significantly higher in Tibetans than Hans (p < 0.05). There were no obvious continuous upward or downward trend of the parameters for 3 consecutive years. Conclusion In high-altitude areas, Han immigrants have long-term stress changes compared with Tibetans. The main differences are reflected in the blood system, liver and kidney functions, etc., which provide basic data for further research on the health status of plateau populations.
Collapse
Affiliation(s)
- ZhiMin Yuan
- Department of Clinical Laboratory, Shaanxi Provincial Cancer Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
- Department of Clinical Laboratory, Ali District People's Hospital, Tibet Ali, China
| | - YuanWu Zou
- Department of Clinical Laboratory, Tuberculosis Prevent and Care Hospital of Shanxi Province, Xi’an, China
| | - XiaoXing Liu
- Department of Clinical Laboratory, Ali District People's Hospital, Tibet Ali, China
| | - LongHao Wang
- Department of Otolaryngology and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Cheng Chen
- Department of Clinical Laboratory, Ali District People's Hospital, Tibet Ali, China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
3
|
Rösler W, Altenbuchinger M, Baeßler B, Beissbarth T, Beutel G, Bock R, von Bubnoff N, Eckardt JN, Foersch S, Loeffler CML, Middeke JM, Mueller ML, Oellerich T, Risse B, Scherag A, Schliemann C, Scholz M, Spang R, Thielscher C, Tsoukakis I, Kather JN. An overview and a roadmap for artificial intelligence in hematology and oncology. J Cancer Res Clin Oncol 2023; 149:7997-8006. [PMID: 36920563 PMCID: PMC10374829 DOI: 10.1007/s00432-023-04667-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Artificial intelligence (AI) is influencing our society on many levels and has broad implications for the future practice of hematology and oncology. However, for many medical professionals and researchers, it often remains unclear what AI can and cannot do, and what are promising areas for a sensible application of AI in hematology and oncology. Finally, the limits and perils of using AI in oncology are not obvious to many healthcare professionals. METHODS In this article, we provide an expert-based consensus statement by the joint Working Group on "Artificial Intelligence in Hematology and Oncology" by the German Society of Hematology and Oncology (DGHO), the German Association for Medical Informatics, Biometry and Epidemiology (GMDS), and the Special Interest Group Digital Health of the German Informatics Society (GI). We provide a conceptual framework for AI in hematology and oncology. RESULTS First, we propose a technological definition, which we deliberately set in a narrow frame to mainly include the technical developments of the last ten years. Second, we present a taxonomy of clinically relevant AI systems, structured according to the type of clinical data they are used to analyze. Third, we show an overview of potential applications, including clinical, research, and educational environments with a focus on hematology and oncology. CONCLUSION Thus, this article provides a point of reference for hematologists and oncologists, and at the same time sets forth a framework for the further development and clinical deployment of AI in hematology and oncology in the future.
Collapse
Affiliation(s)
- Wiebke Rösler
- Department for Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Altenbuchinger
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Tim Beissbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Gernot Beutel
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Robert Bock
- IMMS Institute for Microelectronics and Mechatronics Systems GmbH (NPO), Ilmenau, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan-Niklas Eckardt
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Chiara M L Loeffler
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | | | - Thomas Oellerich
- Medizinische Klinik 2-Haematology/Oncology, University Hospital, Frankfurt am Main, Germany
| | - Benjamin Risse
- Computer Vision and Machine Learning Systems Group, Institute for Geoinformatics, University of Münster, Münster, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | | | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Rainer Spang
- Department of Statistical Bioinformatics, University of Regensburg, Regensburg, Germany
| | | | - Ioannis Tsoukakis
- Department of Hematology and Oncology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Jakob Nikolas Kather
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany.
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
| |
Collapse
|
4
|
Topf V, Kheifetz Y, Daum S, Ballhausen A, Schwarzer A, Trung KV, Stocker G, Aigner A, Lordick F, Scholz M, Knödler M. Individual hematotoxicity prediction of further chemotherapy cycles by dynamic mathematical models in patients with gastrointestinal tumors. J Cancer Res Clin Oncol 2023; 149:6989-6998. [PMID: 36854800 PMCID: PMC10374676 DOI: 10.1007/s00432-023-04601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Hematotoxicity is a common side-effect of cytotoxic gastrointestinal (GI) cancer therapies. An unsolved problem is to predict the individual risk therefore to decide on treatment adaptions. We applied an established biomathematical prediction model and primarily evaluated its predictive value in patients undergoing chemotherapy for GI cancers in curative intent. METHODS In a prospective, observational multicenter study on patients with gastro-esophageal or pancreatic cancer (n = 28) receiving myelosuppressive adjuvant or neoadjuvant chemotherapy (FLO(T) or FOLFIRINOX), individual model parameters were learned based on patients' observed laboratory values during the first chemotherapy cycle and further external data resources. Grades of hematotoxicity of subsequent cycles were predicted by model simulation and compared with observed data. RESULTS The most common high-grade hematological toxicity was neutropenia [19/28 patients (68%)]. For the FLO(T) regimen, individual grades of thrombocytopenia and leukopenia could be well predicted for cycles 2-4, as well as grades of neutropenia for cycle 2. Prediction accuracy for neutropenia in the third and fourth cycle differed by one toxicity grade on average. For the FOLFIRINOX-regimen, thrombocytopenia predictions showed a maximum deviation of one toxicity grade up to the end of therapy (8 cycles). Deviations of predictions were less than one degree on average up to cycle 4 for neutropenia, and up to cycle 6 for leukopenia. CONCLUSION The biomathematical model showed excellent short-term and decent long-term prediction performance for all relevant hematological side effects associated with FLO(T)/FOLFIRINOX. Clinical utility of this precision-medicine approach needs to be further investigated in a larger cohort.
Collapse
Affiliation(s)
- Vivien Topf
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Yuri Kheifetz
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Severin Daum
- Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Alexej Ballhausen
- Medical Department, Division of Hematology, Oncology and Tumor Immunology, Charité University Medicine Berlin, Campus Virchow Hospital (CVK), Berlin, Germany
| | | | - Kien Vu Trung
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Gertraud Stocker
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Achim Aigner
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Maren Knödler
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany.
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany.
- Charité Comprehensive Cancer Center (CCCC), Charité University Medicine Berlin, Campus Charité Mitte (CCM), Virchowweg 23, 10117, Berlin, Germany.
| |
Collapse
|
5
|
Steinacker M, Kheifetz Y, Scholz M. Individual modelling of haematotoxicity with NARX neural networks: A knowledge transfer approach. Heliyon 2023; 9:e17890. [PMID: 37483774 PMCID: PMC10362198 DOI: 10.1016/j.heliyon.2023.e17890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Cytotoxic cancer therapy often results in dose-limiting haematotoxic side effects. Predicting an individual's risk is a major objective in precision medicine of cancer treatment. In this regard, patient heterogeneity presents a significant challenge. In this paper, we explore the use of hypothesis-free machine learning models based on recurrent nonlinear auto-regressive networks with exogenous inputs (NARX) as an approach to achieve this goal. Also, we propose a knowledge transfer approach to ameliorate the issue of sparse individual data, which typically hampers learning of individual networks. We demonstrate the feasibility of our approach based on a virtual patient population generated using a semi-mechanistic model of haematopoiesis and imposing different cytotoxic therapy scenarios on it. Employing different techniques of model optimisation, we derive robust and parsimonious individual networks with good generalisation performances. Moreover, we analyse in detail possible factors influencing the generalisation performance. Results suggest that our transfer learning approach using NARX networks can provide robust predictions of individual patient's response to treatment. As a practical perspective, we apply our approach to individual time series data of two patients with non-Hodgkin's lymphoma.
Collapse
Affiliation(s)
- Marie Steinacker
- Center for Scalable Data Analytics and Artificial Intelligence (ScaDS.AI) Dresden/Leipzig, Leipzig University, Germany
- Leipzig University, Medical Faculty, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Germany
- Leipzig University, Faculty of Mathematics and Computer Science, Germany
| | - Yuri Kheifetz
- Leipzig University, Medical Faculty, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Germany
| | - Markus Scholz
- Leipzig University, Medical Faculty, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Germany
- Leipzig University, Faculty of Mathematics and Computer Science, Germany
| |
Collapse
|
6
|
A comprehensive regulatory and industry review of modeling and simulation practices in oncology clinical drug development. J Pharmacokinet Pharmacodyn 2023; 50:147-172. [PMID: 36870005 PMCID: PMC10169901 DOI: 10.1007/s10928-023-09850-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
Exposure-response (E-R) analyses are an integral component in the development of oncology products. Characterizing the relationship between drug exposure metrics and response allows the sponsor to use modeling and simulation to address both internal and external drug development questions (e.g., optimal dose, frequency of administration, dose adjustments for special populations). This white paper is the output of an industry-government collaboration among scientists with broad experience in E-R modeling as part of regulatory submissions. The goal of this white paper is to provide guidance on what the preferred methods for E-R analysis in oncology clinical drug development are and what metrics of exposure should be considered.
Collapse
|
7
|
Kheifetz Y, Kirsten H, Scholz M. On the Parametrization of Epidemiologic Models—Lessons from Modelling COVID-19 Epidemic. Viruses 2022; 14:v14071468. [PMID: 35891447 PMCID: PMC9316470 DOI: 10.3390/v14071468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
Abstract
Numerous prediction models of SARS-CoV-2 pandemic were proposed in the past. Unknown parameters of these models are often estimated based on observational data. However, lag in case-reporting, changing testing policy or incompleteness of data lead to biased estimates. Moreover, parametrization is time-dependent due to changing age-structures, emerging virus variants, non-pharmaceutical interventions, and vaccination programs. To cover these aspects, we propose a principled approach to parametrize a SIR-type epidemiologic model by embedding it as a hidden layer into an input-output non-linear dynamical system (IO-NLDS). Observable data are coupled to hidden states of the model by appropriate data models considering possible biases of the data. This includes data issues such as known delays or biases in reporting. We estimate model parameters including their time-dependence by a Bayesian knowledge synthesis process considering parameter ranges derived from external studies as prior information. We applied this approach on a specific SIR-type model and data of Germany and Saxony demonstrating good prediction performances. Our approach can estimate and compare the relative effectiveness of non-pharmaceutical interventions and provide scenarios of the future course of the epidemic under specified conditions. It can be translated to other data sets, i.e., other countries and other SIR-type models.
Collapse
Affiliation(s)
- Yuri Kheifetz
- Correspondence: (Y.K.); (M.S.); Tel.: +49-341-97-16348 (Y.K.); +49-341-97-16190 (M.S.)
| | | | - Markus Scholz
- Correspondence: (Y.K.); (M.S.); Tel.: +49-341-97-16348 (Y.K.); +49-341-97-16190 (M.S.)
| |
Collapse
|
8
|
Krishnatry AS, Hanze E, Bergsma T, Dhar A, Prohn M, Ferron-Brady G. Exposure-response analysis of adverse events associated with molibresib and its active metabolites in patients with solid tumors. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 11:556-568. [PMID: 34648693 PMCID: PMC9124358 DOI: 10.1002/psp4.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Molibresib (GSK525762) is an investigational orally bioavailable small‐molecule bromodomain and extraterminal (BET) protein inhibitor for the treatment of advanced solid tumors. In the first‐time‐in‐human BET115521 study of molibresib in patients with solid tumors, thrombocytopenia was the most frequent treatment‐related adverse event (AE), QT prolongation was an AE of special interest based on preclinical signals, and gastrointestinal (GI) AEs (nausea, vomiting, diarrhea, and dysgeusia) were often observed. The aims of this analysis were the following: (i) develop a population pharmacokinetic (PK)/pharmacodynamic (PD) model capable of predicting platelet time courses in individual patients after administration of molibresib and identify covariates of clinical interest; (ii) evaluate the effects of molibresib (and/or its two active metabolites [GSK3529246]) exposure on cardiac repolarization by applying a systematic modeling approach using high‐quality, intensive, PK time‐matched 12‐lead electrocardiogram measurements; (iii) evaluate the exposure–response (ER) relationship between molibresib and/or GSK3529246 exposures and the occurrence of Grade 2 or higher GI AEs. Overall, the PK/PD model (including a maximal drug effect model and molibresib concentration) adequately described platelet counts following molibresib treatment and was used to simulate the impact of molibresib dosing on thrombocytopenia at different doses and regimens. ER analyses showed no clinically meaningful QT interval prolongation with molibresib at up to 100 mg q.d., and no strong correlation between molibresib exposure and the occurrence of Grade 2 or higher GI AEs. The models described here can aid dosing/schedule and drug combination strategies and may support a thorough QT study waiver request for molibresib.
Collapse
Affiliation(s)
- Anu Shilpa Krishnatry
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Eva Hanze
- qPharmetra LLC, Nijmegen, the Netherlands
| | | | - Arindam Dhar
- Epigenetics Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | - Geraldine Ferron-Brady
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| |
Collapse
|
9
|
Pin C, Collins T, Gibbs M, Kimko H. Systems Modeling to Quantify Safety Risks in Early Drug Development: Using Bifurcation Analysis and Agent-Based Modeling as Examples. AAPS JOURNAL 2021; 23:77. [PMID: 34018069 PMCID: PMC8137611 DOI: 10.1208/s12248-021-00580-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
Quantitative Systems Toxicology (QST) models, recapitulating pharmacokinetics and mechanism of action together with the organic response at multiple levels of biological organization, can provide predictions on the magnitude of injury and recovery dynamics to support study design and decision-making during drug development. Here, we highlight the application of QST models to predict toxicities of cancer treatments, such as cytopenia(s) and gastrointestinal adverse effects, where narrow therapeutic indexes need to be actively managed. The importance of bifurcation analysis is demonstrated in QST models of hematologic toxicity to understand how different regions of the parameter space generate different behaviors following cancer treatment, which results in asymptotically stable predictions, yet highly irregular for specific schedules, or oscillating predictions of blood cell levels. In addition, an agent-based model of the intestinal crypt was used to simulate how the spatial location of the injury within the crypt affects the villus disruption severity. We discuss the value of QST modeling approaches to support drug development and how they align with technological advances impacting trial design including patient selection, dose/regimen selection, and ultimately patient safety.
Collapse
Affiliation(s)
- Carmen Pin
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge Science Park, Milton Road, Cambridge, UK
| | - Teresa Collins
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge Science Park, Milton Road, Cambridge, UK
| | - Megan Gibbs
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Holly Kimko
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA.
| |
Collapse
|
10
|
Kheifetz Y, Scholz M. Individual prediction of thrombocytopenia at next chemotherapy cycle: Evaluation of dynamic model performances. Br J Clin Pharmacol 2021; 87:3127-3138. [PMID: 33382112 DOI: 10.1111/bcp.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Thrombocytopenia is a common major side-effect of cytotoxic cancer therapies. A clinically relevant problem is to predict an individual's thrombotoxicity in the next planned chemotherapy cycle in order to decide on treatment adaptation. To support this task, 2 dynamic mathematical models of thrombopoiesis under chemotherapy were proposed, a simple semimechanistic model and a comprehensive mechanistic model. In this study, we assess the performance of these models with respect to existing thrombocytopenia grading schemes. METHODS We consider close-meshed individual time series data of 135 non-Hodgkin's lymphoma patients treated with 6 cycles of CHOP/CHOEP chemotherapies. Individual parameter estimates were derived on the basis of these data considering a varying number of cycles per patient. Parsimony assumptions were applied to optimize parameter identifiability. Models' predictability are assessed by determining deviations of predicted and observed degrees of thrombocytopenia in the next cycles. RESULTS The mechanistic model results in better agreement of model prediction and individual time series data. Prediction accuracy of future cycle toxicities by the mechanistic model is higher even if the semimechanistic model is provided with data of more cycles for calibration. CONCLUSION We successfully established a quantitative and clinically relevant method for assessing prediction performances of biomathematical models of thrombopoiesis under chemotherapy. We showed that the more comprehensive mechanistic model outperforms the semimechanistic model. We aim at implementing the mechanistic model into clinical practice to assess its utility in real life clinical decision-making.
Collapse
Affiliation(s)
- Yuri Kheifetz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
11
|
Bächer C, Bender M, Gekle S. Flow-accelerated platelet biogenesis is due to an elasto-hydrodynamic instability. Proc Natl Acad Sci U S A 2020; 117:18969-18976. [PMID: 32719144 PMCID: PMC7431004 DOI: 10.1073/pnas.2002985117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Blood platelets are formed by fragmentation of long membrane extensions from bone marrow megakaryocytes in the blood flow. Using lattice-Boltzmann/immersed boundary simulations we propose a biological Rayleigh-Plateau instability as the biophysical mechanism behind this fragmentation process. This instability is akin to the surface tension-induced breakup of a liquid jet but is driven by active cortical processes including actomyosin contractility and microtubule sliding. Our fully three-dimensional simulations highlight the crucial role of actomyosin contractility, which is required to trigger the instability, and illustrate how the wavelength of the instability determines the size of the final platelets. The elasto-hydrodynamic origin of the fragmentation explains the strong acceleration of platelet biogenesis in the presence of an external flow, which we observe in agreement with experiments. Our simulations then allow us to disentangle the influence of specific flow conditions: While a homogeneous flow with uniform velocity leads to the strongest acceleration, a shear flow with a linear velocity gradient can cause fusion events of two developing platelet-sized swellings during fragmentation. A fusion event may lead to the release of larger structures which are observable as preplatelets in experiments. Together, our findings strongly indicate a mainly physical origin of fragmentation and regulation of platelet size in flow-accelerated platelet biogenesis.
Collapse
Affiliation(s)
- Christian Bächer
- Biofluid Simulation and Modeling, Theoretische Physik VI, University of Bayreuth, 95447 Bayreuth, Germany;
| | - Markus Bender
- Institute of Experimental Biomedicine I, University Hospital and Rudolf Virchow Center, 97080 Würzburg, Germany
| | - Stephan Gekle
- Biofluid Simulation and Modeling, Theoretische Physik VI, University of Bayreuth, 95447 Bayreuth, Germany;
| |
Collapse
|
12
|
Hoffmann K, Cazemier K, Baldow C, Schuster S, Kheifetz Y, Schirm S, Horn M, Ernst T, Volgmann C, Thiede C, Hochhaus A, Bornhäuser M, Suttorp M, Scholz M, Glauche I, Loeffler M, Roeder I. Integration of mathematical model predictions into routine workflows to support clinical decision making in haematology. BMC Med Inform Decis Mak 2020; 20:28. [PMID: 32041606 PMCID: PMC7011438 DOI: 10.1186/s12911-020-1039-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/29/2020] [Indexed: 02/05/2023] Open
Abstract
Background Individualization and patient-specific optimization of treatment is a major goal of modern health care. One way to achieve this goal is the application of high-resolution diagnostics together with the application of targeted therapies. However, the rising number of different treatment modalities also induces new challenges: Whereas randomized clinical trials focus on proving average treatment effects in specific groups of patients, direct conclusions at the individual patient level are problematic. Thus, the identification of the best patient-specific treatment options remains an open question. Systems medicine, specifically mechanistic mathematical models, can substantially support individual treatment optimization. In addition to providing a better general understanding of disease mechanisms and treatment effects, these models allow for an identification of patient-specific parameterizations and, therefore, provide individualized predictions for the effect of different treatment modalities. Results In the following we describe a software framework that facilitates the integration of mathematical models and computer simulations into routine clinical processes to support decision-making. This is achieved by combining standard data management and data exploration tools, with the generation and visualization of mathematical model predictions for treatment options at an individual patient level. Conclusions By integrating model results in an audit trail compatible manner into established clinical workflows, our framework has the potential to foster the use of systems-medical approaches in clinical practice. We illustrate the framework application by two use cases from the field of haematological oncology.
Collapse
Affiliation(s)
- Katja Hoffmann
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Cazemier
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christoph Baldow
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Silvio Schuster
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yuri Kheifetz
- Institute for Medical Informatics, Statistics and Epidemiology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Sibylle Schirm
- Institute for Medical Informatics, Statistics and Epidemiology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Ernst
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Constanze Volgmann
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Thiede
- Department of Internal Medicine, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine, Medical Clinic I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Meinolf Suttorp
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Ingo Roeder
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.
| |
Collapse
|
13
|
Notification of Republication: Modeling individual time courses of thrombopoiesis during multi-cyclic chemotherapy. PLoS Comput Biol 2019; 15:e1007110. [PMID: 31163030 PMCID: PMC6548350 DOI: 10.1371/journal.pcbi.1007110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|