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A Mathematical Model of the Dual Immune Response Won You CS 296L June 15, 2001 Abstract: This paper will propose a system of nonlinear differential equations, built upon systems theory, which models the human body’s immune response to disease and cancer. To accomplish this task, two models of the human immune system will be presented, one derived by Kirschner and Panetta and the other by Rundell et al. These two models provide the foundation on which the dual immune system response model is built. Next, this paper will discuss the computer implementation of the models that was used to test and validate their accuracy. Also, a proposal is made on how the cancer vaccine Theratope can be incorporated with a set of equations into the dual immune response model. Lastly, an overview of the major immune processes will be presented in order to illustrate some of the more fundamental traits of the model. Motivation: According to the World Health Organization, more than 1.2 million people, around the world, will be diagnosed with breast cancer in this year alone (2001). Unfortunately, in spite of the staggering number of people afflicted with this deadly disease, there is still little progress made in preventing and curing the victims. In light of this dire situation, it is useful to investigate from a control systems view the mechanisms and relationships between the human immune response and breast cancer. A mathematical model allows the simulation and in-depth analysis of the immune system processes on removing cancer and the possible reasons why it fails to clear all of the tumor cells. But in order to introduce such a model of the immune system dynamics, a better understanding of immunology must be obtained. An Introduction to the Immunology: All vertebrates are protected by a dual immune system, featuring cellular and humoral immunity. When cancer cells proliferate to a detectable threshold number in a given physiological space of the human anatomy, the body’s own natural immune system is triggered into a search-anddestroy mode. However, this immune response is only possible if the cancer cells possess distinctive surface markers known as tumor-specific antigens. In other words, the immune system must, first, be able to identify the cancer cells as foreign. The immune response begins when a white blood cell called a macrophage encounters a virus and consumes it. Next, the macrophage digests the virus and displays pieces of the virus called antigens on its surface. Once this happens, helper T cells recognizes the antigen displayed and binds to the macrophage. This union stimulates the production of chemical substances—such as interleukin-1 (IL-1) and tumor necrosis factor (TNF) by the macrophage, and interleukin-2 (IL-2) and gamma interferon (IFNy) by the T cell—that allow intercellular communication. Continuing this immune response, IL2 instructs other helper T cells and the killer T cells to multiply. In this manner, helper T cells are responsible for organizing the immune response. On the other hand, killer T cells, also 2 known as CTLs, attack virus-infected cells. The proliferating helper T cells also release substances that cause B cells to multiply and produce antibodies. B cells make antibodies, which are Y-shaped molecules that attach to and neutralize viruses floating free in the bloodstream, thereby preventing the viruses from infecting other cells. As this process is taking place, the B cells continue to clone and differentiate into plasma cells and memory cells. Plasma cells are what secrete the antibodies, and the memory cells identify and record the information about the virus for future attacks. Once the virus or foreign substance is brought under control, suppressor T cells causes the activated T and B cells to turn off. If, in the future, the body is re-invaded by the same virus or antigen, the memory cells will be reactivated and respond faster and more powerfully to destroy the virus. This is the principle behind the vaccinations that are given to children against the measles or mumps. The steps involved in the deployment of the immune response are illustrated in the following diagrams: Figure 1: The broad graphical look at the two immune responses taken from http://www.people.virginia.edu/~rjh9u/imresp.html 3 Figure 2: This diagram is taken from the following website: http://defiant.wbc.edu/wbc/jjohnson/Pages/InfDis/ImmuneResponse.html This figure shows the humoral immune response that occurs after a B cell encounters an antigen or binds to an epitope. The B cells begin to clone themselves and start to differentiate into shortlived and long-lived plasma cells and memory cells. 4 Figure: Gives a flow chart diagram of the various phases of both the humoral and cellular immune response 5 Now research shows that some degree of immune response against cancer exists in animals and humans. Moreover, elements of the immune system are capable of recognizing cancer cells and have even been identified in patients with certain cancers through various research. Although progress is being made in this field, scientists still do not completely understand precisely how the immune system works to suppress cancer and why it sometimes fails to do so. While there are several techniques and methodologies being researched to enhance the natural immune response, this paper will focus primarily on specific active cancer immunotherapy. The Purpose of Theratope With active specific immunotherapy (ASI), the subject is actively immunized against a defined cancer by using a specific cancer-associated antigenic determinant or epitope in a germane formulation. In order to produce this formulation, however, an epitope had to be first identified; one such epitope was found in mucins. The cells in the human body produce mucins, which are large molecular weight glycoproteins. However, the mucins on cancer cells have been found to be underglycosylated. This aberration provides an epitope by which cancer cells can be distinguished from normal cells. One of these epitopes associated with adenocarcinomas is the carbohydrate, Sialyl-Tn (STn). Biomira’s vaccine Theratope uses a synthetized mimic of the cancer-associated antigen STn conjugated to the protein carrier Keyhole Limpet Hemocyanin (KLH). For the first few treatments Theratope is administered with the immune adjuvant Detox-B Stable Emulsion, to augment the immune response to the vaccine. Also, preceding the first treatment of Theratope is a single low-dose administration of cyclophosphamide. This is a kind of chemotherapy done to help overcome the activity of suppressor T cells. It is hypothesized that when a cancer mucin sheds in the body the mucin causes the stimulation of suppressor T cells, which can impede the effectiveness of the cancer vaccine. Some Findings by Biomira In a paper published in 1993, Biomira reported the promising findings of their experiments. Using STn-conjugated human serum albumin in a solid-phase enzyme-linked immunosorbent assay, Biomira’s scientists found that all patients treated with the vaccine had an increase in the production of IgM and IgG antibodies reactive with natural STn determinants. Unfortunately, this paper only published brief tabulations of the results from their experiments. In their conclusion, they write that their study demonstrates the specificity of the humoral anti-hapten response. Because of the lack of data available to simulate their findings, the scope of this paper will be limited to proposing a possible model for simulating the dynamics induced or stimulated by ASI. Since the company’s experiments give evidence of both a humoral and cellular response, this suggests that the model should incorporate both of these responses, first. This 6 merging of the two immune responses will be the first to be done for mathematical models. In the appendix, an alternative method of modeling the dual immune response is discussed, one which uses cellular automata theory. Be that as it may, there are several papers that do address the human immune response. Unfortunately, these papers concentrate on either the humoral response or the cellular response, each in isolation of the other; no attempt is made to merge the two. Therefore, to formulate the dual immune response model, the cell-mediated response model given in a paper by Kirschner and Panetta will be combined with the humoral immune response model, written by Rundell et al. To begin, this paper will examine the Kirschner-Panetta model. Existing Models 1. Kirschner-Panetta Model: While there have been no models developed specifically for Theratope or other specific active cancer immunotherapy (ACI), there has been work done on specific passive cancer immunotherapy. Vaccines are considered active immunotherapy agents because the body is stimulated to make its own antibodies, whereas with passive immunotherapy the subject is administered a synthesized injection of effector cell stimulating serum. One model which presents the interaction of cancer cells with a type of specific passive cancer therapy is the Kirschner-Panetta model. This model explores cancer treatment by adoptive cellular immunotherapy. This type of treatment serves to boost the immune system’s capacity to fight the cancer. The immunotherapy here attempts to use cytokines, the communication/stimulation proteins produced, released, and used by cells, to enhance cellular activity. The cytokine used in the Kirschner-Panetta model is interleukin-2 (IL-2). Interleukin-2 is the main cytokine responsible for lymphocyte activation, growth and differentiation. In general, adoptive cellular immunotherapy refers to the injection of cultured immune cells that have anti-tumor reactivity into tumor bearing hosts. Therefore, with adoptive cellular immunotherapy, the patient is injected with cells derived from lymphocytes recovered from the patient’s tumors. Before injection, these recovered cells are incubated with high concentrations of IL-2 in vitro along with natural killer cells and cytotoxic T cells. More importantly, this injection of antigen-sensitized T cells provides a growth stimulus for other lymphocytes to proliferate into a high enough cell number capable of mounting an effective attack against cancer. The processes involved in the immune response are described by cellular and molecular kinetics, along with the principles of conservation and mass-action. From these principles, a set of differential equations are written with the state variables, representing the different cellular populations as concentrations. The equations which encapsulate the adoptive cellular immunotherapy dynamic is presented below: 7 k EI dE k1T k 2 E 3 L s1 dt k4 I L k ET dT k 6 (1 k11T )T 7 dt k5 T k ET dI L 8 k10 I L s 2 dt k9 T Initial Conditions: E ( 0) E 0 T (0) T0 I L ( 0) I L 0 Parameter Values: Kirschner-Panetta Parameter Names c This Paper’s Parameter Names k1 Values 0 c 0.05 g1 g2 g3 μ2 k4 k5 k9 k2 2e7 (1/ml) 1e5 (1/ml) 1e3 (1/ml) 0.03 (1/day) μ3 k10 10 (1/day) p1 k3 0.1245 (1/day) p2 k8 5 (1/day) a k7 1 (1/day) b k11 1e-9 (1/ml) 8 Description The antigenicity of the tumor, the ability of a substance to trigger an immune response in a particular organism. Half-life for effector cells Half-life for tumor cells Half-life for Interleukin-2 The removal rate constant for effector cells The removal rate constant for Interleukin The rate constant for the selflimiting production of effector cells The rate constant for the selflimiting production of IL-2 The rate constant that represents the strength of the immune response, modeled by MichaelisMenten kinetics to indicate the limited immune response to the tumor. The growth limiting constant r2 k6 0.18 (1/day) The logistic growth constant E: The concentration of the effector cells, such as cytotoxic T-cells, macrophages, and natural killer cells. T: The concentration of the tumor cells. IL: The concentration of IL-2 in the single tumor-site compartment being modeled. s1,s2: The external input of LAK or IL-2 to the site, respectively. r2(T): The logistic growth function of the tumor cells. In their model, cancer treatment by immunotherapy is presented as a competition between normal and cancer cells, the classic predator-prey model. The anti-cancer cells i.e. the effector cells are thought of as predators to the cancer cells. The tumor-immune dynamics represented here surround three primary concentrations: the effector cells, tumor cells, and the cytokine (IL2). Several terms are of the Michaelis-Menton form to indicate the plateau that results from the saturation that occurs. For example, in equation (1), the third term indicates the saturated effects of the immune response. Effector cells have a natural lifespan of a few days. 2. The Rundell-DeCarlo-HogenEsch-Doerschuk Model: This model examines the humoral immune response of the human body to Haemophilus influenzae Type b. While this model certainly does not address the production of antibodies against cancer cells, the dynamics involved are very similar and worth investigating. Specifically, this model explicitly incorporates the interaction between the memory cells, T-zone and germinal center (GC) B cell dynamics, IgM and IgG antibodies, avidity maturation, and IC presentation by FDCs. 3.1 An Overview and Elaboration of the Humoral Immune Response: The humoral response can be summarized by three major phases: the primary response, the late follicular response, and the secondary response. In the primary response, the immune system is just beginning to mount a response to the foreign agent, which, in this case, happens to be influenza. The secondary response describes the immune response when the body re-encounters the bacteria after having developed immunity to it. Primary Response summary: 1) Antigen activates naive helper T-cells and B-cells 2) Proliferation of B-cells 3) Some B-cells become B-blasts 4) B-blasts differentiate into short lived plasma cells which produce low avidity antibodies 5) Remaining B-blasts either die or migrate to the primary follicles 9 6) Migrating B-blasts form germinal centers (GCs), the factory that supports B-cell proliferation 7) Mutations of the immunoglobulin genes cause avidity maturation and an increase in the strength of antibody-antigen bond 8) Majority of the GC B-blasts undergo apoptosis 9) Remaining higher avidity cells become memory B-cells or long lived plasma cells that produce antibodies Late Follicular Response: 1) Memory B-cell activation by immune complex presenting follicular dendritic cells creates pockets of low level B-cell proliferation 2)These late-B-blasts differentiate into long lived plasma or memory B-cells Secondary Response: All subsequent encounters with the foreign substance or agent will be met by earlier antibody production, higher antibody titers and avidity. Also, the IgG isotope antibodies tend to characterize the secondary response. To review, when a vertebrate first encounters an antigen, it exhibits a primary humoral immune response in which the B-cells begin to proliferate and differentiate. The progeny lymphocytes include not only effector cells but also clone of memory cells, which retain the capacity to produce both effector and memory cells upon subsequent stimulation by the original antigen. The effector cells live for a few days; therefore, the antibody titer increases and decreases within a month. However, the memory cells live for a lifetime and can be reactivated with a secondary response. Thus when an antigen is encountered a second time, its memory cells quickly produce effector cells which can rapidly produce massive quantities of antibodies. The primary response begins with IgG, and then switches to IgM. Based on the summary of the triggering events described above, the Rundell et al paper creates the an 11th order system of nonlinear ordinary differential equations, listed on the following page: Note: Appendix A shows the entire set of equations, which include auxiliary functions not shown here. 10 dAg k1 Ag k 2 K M Ag AbM k 3 K G ( PL , PS , K ) Ag AbG dt dA (2) bM k 4 I SF ( BG ) Ps k 6 k 2 K M Ag AbM k 7 AbM dt dAbG (3) k 8 [1 I SF ( BG )]Ps k 8 PL k 9 k 3 K G ( PL , Ps , K )TAbG k10 AbG dt dP (4) S k11k12 {1 k13 H Z (t k14 )}xBZ (t k14 )1 (t k14 ) k16 PS dt dP (5) L k15 ( S , K )k17 {1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k18 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k19 PL (1) dBZ k 20 H Z (t k14 )U NB ( B g (t k14 ) B z (t k14 )) x1 (t k14 ) k 21k13 H Z BZ k12 [1 k13 H Z ]BZ dt dB g (7 ) {k 22 ( B g )k12 [1 k13 H Z (t k14 )]BZ (t k14 ) x1 (t k14 ) k 23 H Zm (t k14 ) M (t k14 ) dt Bg x1 (t k14 ) k 24 ( K )k13 H g SB g }2 x(1 ) k17 [1 k13 SH g ]B g B g max ( 6) dM k 25 ( B g )k17 [1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k 26 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k 23 H Zm M k 27 M (8) dI c k 28 K M Ag AbM k 29 K G ( PL , PS , K ) Ag AbG k 30 H g M k 31 I c dt dK K (10) k 32 AMR ( B g , I C ) SK (1 ) dt K max (9) (11) dS RUA ( A g )k 33 S k 33 S dt Ag = the antigen concentration; AbM = IgM antibody concentration; AbG = IgG antibody concentration; Ps = short-lived plasma cell concentration; PL = long-lived plasma cell concentration; M = memory cell concentration; Bz = T-zone B-blasts concentration; Bg = GC Bblasts concentration; Ic = immune complex concentration; K = avidity; S = stimulation factor 11 The following is a simpler and more visual representation of the main terms of the differential equations. The rate of change of bacteria = dAg/dt Replication Rate = Removal by complexing with IgM Removal by complexing with IgG The antibodies produced by the humoral immune system destroys the bacteria upon antigenantibody complexing. The rate of change of the IgM antibody = dAbM/dt = Production Rate Removal by complexing with Ag Half-Life Removal The rate of change of IgG antibody = dAbG/dt = Production Rate Removal by complexing with Ag Half-Life Removal The rate of change in the stimulation factor = dS/dt = Antigen induced Stimulation Decay of Stimulation The rate of change of the short lived plasma cells = dPs/dt = Differentiation from Tzone B-blasts Half-Life Removal The rate of change of the long lived plasma cells = dPL/dt = Differentiation from GC B-blasts Differentiation from Ic activated memory 12 HalfLife removal The rate of change immune complex presentation = dIc/dt = Uptake of IgM complexes Uptake of IgG complexes Activation of memory cells Half-Life removal The rate of change in the GC B-blast avidity maturation rate = dK/dt = Avidity Maturation Physiological constraint on avidity maximum Computer Simulation: To reproduce the findings of both the Kirschner-Panetta and the Rundell et al model, a computer simulation program called VisSim was used. VisSim is a software program for the modeling and simulation of complex dynamic systems that allows the user to build a system model with block diagrams. This program was chosen for its ease of use and its robust simulation engine that provides fast and accurate solutions for linear, nonlinear, continuous and discrete time, and timevarying designs. All of the runs were conducted on Pentium-powered PCs under the Windows operating system. The integration method employed was the Bulirsh-Stoer method for stiff ordinary differential equations (ODE). This method is an adaptive numerical analysis method which compensates for the vast variations in the rate of change between the numerous state variables. Other integration methods, such as the Euler and Runge-Kutta 5th order method, were also used to test the models, with equal success. The figures shown below illustrate the results. 13 Figure: This screenshot shows a portion of the VisSim configuration for the Rundell et al model. 60000 40000 20000 0 0 6 IgM (microgram/ml) Antigen (cfu/ml) Antigen Concentration following primary response 80000 100 200 300 Time (hour) 400 500 Primary Antibody Response 5 4 3 2 1 0 0 14 100 200 300 Time (hour) 400 500 8 6 4 2 500 80000 70000 60000 50000 40000 30000 20000 10000 0 0 Primary Plasma Cell Response 400000 GC B-Blast Concentration (cells/ml) 2000 125 250 375 Time (hour) Primary Plasma Cell Response 90000 1750 1500 1250 1000 750 500 250 0 0 100 30000000 200 300 Time (sec) 400 Primary GC B-Blast Response 150000 100000 50000 100 Primary IC response 15000000 10000000 5000000 200 300 Time (hour) 400 500 15 200 300 Time (hour) 400 500 400 500 Primary Avidity Maturation 9 8 7 6 5 0 100 500 200000 0 0 20000000 400 250000 500 25000000 200 300 Time (hour) 300000 10 0 0 100 350000 Avidity (ml/microgram) Plasma Cell Concentration (cells/ml) 0 0 IC Concentration (Complexes/ml) Plasma Cell Concentration (cells/ml) IgG (microgram/ml) Primary Antibody Response 10 100 200 300 Time (hour) .8 .6 .4 .2 T-zone B-blast Concentration (cells/ml) 0 0 90000 100 200 300 Time (hour) 400 500 Memory B-cell Concentration (cells/ml) Stimulation Factor (unitless) Primary Simulation Factor 1.0 70000 60000 50000 40000 30000 20000 10000 100 200 300 Time (sec) 400 500 16 Primary Memory Cell Response 50000 40000 30000 20000 10000 0 0 Primary T-zone B-blast response 80000 0 0 60000 100 200 300 Time (hour) 400 500 The following are the results for the simulation of the Kirschner-Panetta model with c = k1 = 0.01, c = 0.02, and c = 0.035: Effector Cell Concentration 40000000 200000000 IL Concentration 20000000 Tumor Cell Concentration 175000000 20000000 10000000 Volume Volume Volume 15000000 150000000 30000000 125000000 100000000 75000000 10000000 5000000 50000000 25000000 0 0 500 1000 1500 Time (sec) 2000 0 0 Effector Cell Concentration 200000 400000 500 1000 1500 Time (sec) 0 0 2000 Tumor Cell Concentration 50000 Volume Volume Volume 50000 300000 100000 250000 200000 150000 10000 50000 500 1000 1500 Time (sec) 2000 0 0 500 Effector Cell Concentration 200000 50000 40000 Volume Volume 30000 30000 1000 Time (sec) 1500 0 0 2000 Tumor Cell Concentration 30000 175000 25000 150000 20000 Volume 0 0 40000 20000 100000 60000 IL Concentration 60000 350000 150000 500 1000 1500 2000 Time (sec) 125000 100000 75000 10000 50000 5000 10000 25000 0 0 500 1000 1500 Time (sec) 0 0 500 2000 17 1000 Time (sec) 1500 2000 1000 1500 Time (sec) 2000 IL Concentration 15000 20000 0 0 500 500 1000 1500 Time (sec) 2000 The Proposal Before offering a proposal of the active specific immunotherapy model, it is important to present the integration of the Kirschner-Panetta (KP) and Rundell et al model for covering the dual immune system response to antigens. Now, the three equations of the Kirschner-Panetta model will be added to the Rundell et al model in the following manner: 1) The rate of change of the tumor cell concentration from the KP model will be combined with the rate of change of the antigen concentration, since in this case, the tumor cells are the antigens. Therefore, the notation of Ag has been replaced by T. 2) The exogenous input terms s1 and s2 are set equal to 0, because the dual immune response model will only represent the immune response to some initial cancer cell or antigen population when there is no treatment. 3) Continuing this set of differential equations are the equations derived from the Rundell et al model. (1) k EI dE k1T k 2 E 3 L dt k4 I L ( 2) k ET dI L 8 k10 I L dt k9 T (3) k ET dT k1T 49 k 2 K M TAbM k 3 K G ( PL , PS , K )TAbG dt k 50 T dAbM k 4 I SF ( BG ) Ps k 6 k 2 K M TAbM k 7 AbM dt dA (5) bG k 8 [1 I SF ( BG )]Ps k 8 PL k 9 k 3 K G ( PL , Ps , K )TAbG k10 AbG dt dP (6) S k11k12 {1 k13 H Z (t k14 )}xBZ (t k14 )1 (t k14 ) k16 PS dt dP (7) L k15 ( S , K )k17 {1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k18 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k19 PL ( 4) (8) dBZ k 20 H Z (t k14 )U NB ( B g (t k14 ) B z (t k14 )) x1 (t k14 ) k 21k13 H Z BZ k12 [1 k13 H Z ]BZ dt 18 (9) dB g dt {k 22 ( B g )k12 [1 k13 H Z (t k14 )]BZ (t k14 ) x1 (t k14 ) k 23 H Zm (t k14 ) M (t k14 ) x1 (t k14 ) k 24 ( K )k13 H g SB g }2 x(1 Bg B g max ) k17 [1 k13 SH g ]B g dM k 25 ( B g )k17 [1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k 26 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k 23 H Zm M k 27 M (10) dI c k 28 K M TAbM k 29 K G ( PL , PS , K )TAbG k 30 H g M k 31 I c dt dK K (12) k 32 AMR ( B g , I C ) SK (1 ) dt K max (11) (13) dS RUA (T )k 33 S k 33 S dt For the purposes of this paper, the pharmacokinetics of the cancer vaccine, Theratope will be limited to a certain extent. By this, I mean that some of the interactions derived by the introduction of Theratope into the body will be represented as simply and naively as possible. This may seem a little unwarranted, but it is a result of the scarcity of information available on the manner in which the drug interacts with the body. As a result, this paper will offer a beginning look into the complex manner by which active specific immunotherapy affects the growth of cancer cells. More specifically, this paper will attempt to unravel the dynamics between the immune system, the cancer cells, and the normal cell population. This will help to reveal whether or not the dual response of the immune response will be successful in eliminating the cancer cells before the tumor cells overtake the normal cells. This will be done by integrating the different equations provided in the preceding models. Also, it is also worthy to note that the use of cyclophosphamide will also be excluded from this study. Since cyclophosphamide has the effect of destroying both cancer cells and normal cells, I will treat its overall influence as being negated in the long term dynamics between the immune system and cancer cells. Incidentally, cyclophosphamide is used to abrogate the activity of suppressor T-cells which are known to be activated by shed mucin cells. But this model can be easily implemented in later versions of the model. For instance, the single dose treatment of cyclophosphamide can be represented as a two or three compartment model, with one exogenous input, u1. The initial compartment can be the blood pool, which is directly attached to the body, with a leak. Some of the possible additions to the model are: 1) Now that the pharmacokinetics are being examined, I introduced a u1 to the effector cell concentration. Also, several additional inputs may be required due to the existence of several 19 substances in the Theratope treatment. The first injection is the cyclophosphamide; the next is four treatments of Detox-B, and the last treatment is the cancer vaccine itself. 2) An equation may have to be introduced to handle the adoptive stimulation of the immune response. This may be taken care of either by making the antigenicity of the cellular response a function of the input of ASI and/or by adding a term in the avidity maturation equation which dependent on the presence of the vaccine. The motivation behind these changes is that the cancer vaccine increases the ability of the B cells and T cells to identify the otherwise stealthy tumor cells. One way of interpreting this may be to say that the vaccine increases the antigenicity of the tumor cells and/or the avidity of the binding to the tumor cells. Investigation into the published papers of Biomira, the vaccine’s manufacturer showed that little is known about the actual mechanics, governing the vaccine’s elicitation of the immune response. Moreover, correspondence with one of the company’s scientists revealed that no formal studies were done on the vaccine’s pharmacokinetics, at least none that she was aware of. What is known is that this vaccine is primarily aimed at metastatic breast cancer, although there are several other adaptations of the vaccine in development for other diseases. The drug is predicated on the belief that the immune system fails to identify and thus attack cancer cells, because of their secretion of mucins. More specifically, the glycoprotein, MUC-1 gene has been discovered to be particularly overexpressed in breast tumors, making it a good candidate for immunotherapy. By synthesizing cancer antigens, Biomira’s scientists have found an effective way of tricking the body into recognizing the cancerous cells as foreign. To accomplish this, the vaccine is formulated with a protein marker that is carried on the surfaces of breast cancer cells, along with another protein that stimulates a general immune response. In essence, the aim here is to stimulate T-cells to become active killer T-cells and eradicate tumors in patients. 3) A final consideration for the implementation of the Theratope vaccine on the immune system is to carefully decide whether or not another equation is needed to represent the interaction between the T cells and the B cells. The T cells and B cells, as explained earlier in the immunology review, communicate and in some ways, regulate one another. This may require some further rumination. More auxiliary functions may be incorporated to fit the interaction, or the influence the two responses have on each other may be embedded in a black-box model or function. 2) As far as the humoral immune response is concerned, the notation of Ag has been replaced by T. Originally, Ag was used to represent the bacterial concentration. And to reflect the enhanced sensitivity to the STn epitope, there is also a k constant added to the stimulation factor equation (Equation 10) No other changes have been made to the other 11 equations. With equation 1, the rate of change for the effector-cell population is determined by two factors, besides its current population: the recruitment of effector cells, which is determined by the amount of tumors multiplied by the tumor’s antigenicity (the constant c) and the growth source from the stimulation by lymphokines, represented by the third term in the equation. The third 20 term is of the Michaelis-Menton form, in order to reflect the saturation effects of the immune response. Equation 2 marks the rate of change of the tumor cells. The rate constant a represents the strength of the immune response and is modeled by MichaelisMenton kinetics to indicate the limited immune response to the tumor. The third equation represents the rate of change of the normal cells or non-cancerous cells. The remaining equations display the complicated manner by which the B-cells are activated in the human body in reaction to an antigen. The final refinements give the following: 21 (1) k EI dE k1T k 2 E 3 L u1 dt k4 I L ( 2) k ET dI L 8 k10 I L dt k9 T k ET dT k1T 49 k 2 K M TAbM k 3 K G ( PL , PS , K )TAbG dt k 50 T dA (4) bM k 4 I SF ( BG ) Ps k 6 k 2 K M TAbM k 7 AbM dt dA (5) bG k 8 [1 I SF ( BG )]Ps k 8 PL k 9 k 3 K G ( PL , Ps , K )TAbG k10 AbG dt dP (6) S k11k12 {1 k13 H Z (t k14 )}xBZ (t k14 )1 (t k14 ) k16 PS dt dP (7) L k15 ( S , K )k17 {1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k18 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k19 PL (3) dBZ k 20 H Z (t k14 )U NB ( B g (t k14 ) B z (t k14 )) x1 (t k14 ) k 21k13 H Z BZ k12 [1 k13 H Z ]BZ dt dB g (9) {k 22 ( B g )k12 [1 k13 H Z (t k14 )]BZ (t k14 ) x1 (t k14 ) k 23 H Zm (t k14 ) M (t k14 ) dt Bg x1 (t k14 ) k 24 ( K )k13 H g SB g }2 x(1 ) k17 [1 k13 SH g ]B g B g max (8) dM k 25 ( B g )k17 [1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k 26 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k 23 H Zm M k 27 M (10) dI c k 28 K M TAbM k 29 K G ( PL , PS , K )TAbG k 30 H g M k 31 I c dt dK K (12) k 32 AMR ( B g , I C ) SK (1 ) dt K max (11) (13) dS RUA (T )k 33 S k 33 S dt 22 (14) dB g dt { g ( B g ) dZ [1 2 H Z (t d )]BZ (t d ) x1 (t d ) n 2 H Zm (t d ) M (t d ) x1 (t d ) pg ( K ) 2 H g SB g }2 x(1 Bg B g max ) dg [1 2 SH g ]B g dS kRUA (T ) e S e S dt dM (16) gZ ( B g ) dZ [1 2 S (t d ) H g (t d )}xBg (t d )1 (t d ) p Mic H g (t 2 d ) dt xM (t 2 d )1 (t 2 d ) n 2 H Zm M M M (15) dI c i M K M TAbM i G K G ( PL , PS , K )TAbG Mic2 H g M ic I c dt dK K (18) k AMR ( B g , I c ) SK (1 ) dt K max (17) (19) xi (t 0 ) xio 0, i 1,2 (20) I SF ( B g ) 1 1 1 Bg (21)U NB ( B g , BZ ) 1 1 2 ( B g BZ ) T Tgth T (22) RUA (23)1 (t d ) 0 : t d (24)1 (t d ) 1 : t d (25) H Z KMT 1 KMT KT 1 KT KI c (27) H g 1 KI c (26) H Zm 23 Parameter Estimation: Although one of the goals of this paper was to construct a model which accurately captures the essence of the dynamics of Theratope and to put this model through the rigors of parameter estimation, it became clear after an extensive search of the available medical database that the necessary experimental data did not exist. Despite the best efforts to find experimental data on other diseases that may help to validate the model of the dual immune response, no success was made. The list of parameters, which require further investigation and experimental data are: 1) k1 = antigen growth rate for breast cancer; the current k1 value for Haemophilus influenzae is 0.15/hr 2) k2 = removal rate constant of IgM bound breast cancer cells; the current k2 value for the bacteria is 0.10/hr 3) k3 = removal rate constant of IgG bound breast cancer cells; the current k3 value for the bacteria is 0.10/hr 4) k13 = the differentiation rate constant of T-zone B cells to short lived plasma cells 5) k11 = Maximal percentage of germinal center B-blasts that continue to proliferate 6) k25 = Differentiation rate of germinal center B-blasts to memory cells Some other necessary modifications is the conversion of parameters’ units found in the Kirschner-Panetta model. The units must be made uniform. Conclusions: A mathematical model of the dual immune response is offered in this paper, including a method for studying active specific immunotherapy. This paper helps to establish the basis for future work by presenting the prerequisite background in immunology, as well as investigating the dynamics shown in the immune response from several papers. The results in the published papers were duplicated using a computer visualization program called VisSim. The difficult task of evaluating and testing the accuracy of the models’ mechanisms and behaviors was not made, because of the lack of supporting data. Future Work And Considerations: The greatest challenge that remains in this project is the elicitation of the parameter values related to the human immune response to breast cancer. In the process of conducting the research necessary to develop a mathematical model of the pharmacokinetics of the breast cancer vaccine Theratope, it was discovered that no experimental data was available for the immune response to breast cancer—in the form that is needed, anyway— in the medical literature and research; this prevents the completion and full analysis of the quality of the model. One 24 alternative to this problem is to recruit parameter values for another well-documented disease for which experimental data is plentiful, such as HIV, the adeno virus, or other bacteria. So far, this too has not led anywhere, as there is still no information for the immune system parameter values. Moreover, many of the papers published by Biomira on Theratope as well as other papers found in the medical literature measure the cellular response through a bioassay, say enzymelinked immunosorbent assay (ELISA) for example. Perhaps, in the future, more data may become available, but until that time, the formulation and validation of the model cannot be completed. Also, another approach to the problem may be to identify the possible values or range of values for the numerous parameters in my model and test the effects on the model, to, at least, limit the possibilities. Lastly, future work will also be needed in the areas of parameter identification, parameter sensitivity, and parameter estimation. 25 References: Evidence of Cellular Immune Response Against Sialyl-Tn in Breast and Ovarian Cancer Patients After High-Dose Chemotherapy, Stem Cell Rescue, and Immunization with Theratope STn-KLH Cancer Vaccine. Journal of Immunotherapy. 22(1), 1999: 54-66. Asachenkov, A., Marchuk, G., Mohler, R. & Zuev, S. (1994b). Immunology and Disease Control: A Systems Approach. IEEE Trans. Biomed. Eng. 41(10), 943-953. Homberg, B. & Oparin, D., & Gooley, T., & Lilleby. K., & Bensiner W., & Reddish, M., & MacLean, G., & Longenecker, B., & Sandmaier, B. Clinical Outcome of Breast and Ovarian Cancer Patients Treated with High-Dose Chemotherapy, Autologous Stem Cell Rescue and Theratope STnKLH Cancer Vaccine. Bone Marrow Transplantation (2000) 25, 1233-1241. Kirschner, D & Panetta, JC. Modeling Immunotherapy Of The Tumor-immune Interaction. Journal of Mathematical Biology, 1998 Sep, 37(3): 235-52. Kohler, B., Puzone, R., Seiden, P., & Celada, F. A Systematic Approach to Vaccine Complexity Using an Automaton Model of the Cellular And Humoral Immune System I. Viral characteristics and polarized responses. Vaccine (2000)19, 862-876. Longenecker, B. Active Specific Immunotherapy (ASI) of Carcinomas Using Synthetic Cancer Antigen ‘Vaccines’. Clinical Chemistry, 1992 ,Vol. 38(6): 933-934. MacLean, G., & Miles, D., & Rubens, R., & Reddish, M., & Longenecker, B. Enhancing the Effect of Theratope STn-KLH Cancer Vaccine in Patients with Metastatic Breast Cancer By Pretreatment with Low-Dose Intravenous Cyclophosphamide. Journal of Immunotherapy, (1996), 19(4), pp. 309-316. MacLean, G. & Reddish, M.& Koganty & T., Wong, T & Gandhi, S. & Smolenski, M. & Samuel, J. & Nabholtz, J & Longenecker, B. Immunization of Breast Cancer Patients Using a Synthetic Sialyl-Tn Glycoconjugate Plus Detox Adjuvant. Cancer Immunology Immunotherapy, 1993, 36:215-222. Nani, F & Freedman, HI. A Mathematical Model Of Cancer Treatment By Immunotherapy. Mathematical Biosciences, 2000 Feb, 163(2):159-99. Rundell, A. & DeCarlo, R. & Hogenesch, H. & Doerschuk, P. (1998). The Humoral Immune Response to Haemophilus influenzae Type b: A Mathematical Model Based on Tzone and Germinal Center B-cell Dynamics. Journal of Theoretical Biology, 1998 Oct 7, 194(3):341- 81. Rundell, A. & DeCarlo, R. & Hogenesch, H. & Ventkataramanan, B. (1998). Systematic Method for Determining Intravenous Drug Treatment Strategies Aiding the Humoral Immune Response. IEEE Transactions on Biomed. Engineering, 1998 April, 45(4): 429- 39. Visual Solutions, http://www.vissim.com 26 Appendix A: Main Model Equations In Rundell et. al’s Humoral Immune Response Model dAg k1 Ag k 2 K M Ag AbM k 3 K G ( PL , PS , K ) Ag AbG dt dA (2) bM k 4 I SF ( BG ) Ps k 6 k 2 K M Ag AbM k 7 AbM dt dA (3) bG k 8 [1 I SF ( BG )]Ps k 8 PL k 9 k 3 K G ( PL , Ps , K )TAbG k10 AbG dt dP (4) S k11k12 {1 k13 H Z (t k14 )}xBZ (t k14 )1 (t k14 ) k16 PS dt dP (5) L k15 ( S , K )k17 {1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k18 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k19 PL (1) dBZ k 20 H Z (t k14 )U NB ( B g (t k14 ) B z (t k14 )) x1 (t k14 ) k 21k13 H Z BZ k12 [1 k13 H Z ]BZ dt dB g (7 ) {k 22 ( B g )k12 [1 k13 H Z (t k14 )]BZ (t k14 ) x1 (t k14 ) k 23 H Zm (t k14 ) M (t k14 ) dt Bg x1 (t k14 ) k 24 ( K )k13 H g SB g }2 x(1 ) k17 [1 k13 SH g ]B g B g max ( 6) dM k 25 ( B g )k17 [1 k13 S (t k14 ) H g (t k14 )}xBg (t k14 )1 (t k14 ) k 26 H g (t 2k14 ) dt xM (t 2k14 )1 (t 2k14 ) k 23 H Zm M k 27 M (8) dI c k 28 K M Ag AbM k 29 K G ( PL , PS , K ) Ag AbG k 30 H g M k 31 I c dt dK K (10) k 32 AMR ( B g , I C ) SK (1 ) dt K max (9) (11) dS RUA ( A g )k 33 S k 33 S dt 27 Appendix B: Auxiliary Functions for the Humoral Immune Response Model By Rundell et. al Hz K M Ag 1 K M Ag H Zm Hg KAg 1 KAg KI C 1 KI C KP KP PL PS 1 K G ( PL , PS , K ) 1 1 k 34 B g I SF ( B g ) 2S 1 )( k 41 tan 1 (k 42 ( K k 43 )) k 44 ) 3 3 1 U NB ( B g , BZ ) 1 k 35 ( B g BZ ) k15 ( S , K ) k15 ( k 22 ( B g ) k 22 1 k 36 B g k 24 ( K ) k 24 (k 38 tan 1 ( K k 39 ) k 40 ) k 25 ( S ) k 25 (1 AMR ( B g , I C ) RUA ( Ag ) 2S ) 3 Bg k 37 I C 1 Ag Agth Ag 28 Appendix C: Rundell et al. Model Parameters Rundell Parameter Names λ1 This Paper’s Parameter Name k1 Primary Value αbM k2 0.1 (1/hr) αbG k3 0.1 (1/hr) ρM k4 1.7e-6 (microgram/hr) (1/cell) χ1 k5 1.7e-5 (ml/cells) ηM k6 1.6e-8 (microgram/cfu) α2M k7 ρG k8 ηG k9 2.4e-9 (microgram/cfu) α2G k10 0.002 (1/hr) γSZ k11 0.80 κdZ k12 0.06 γ2 k13 0.70 τd k14 0.15 (1/hr) 0.0042 (microgram/cfu) 1.72e-6 (microgram/hr)(1/cell) 6 hr γ1g k15 0.001 αS k16 0.014 (1/hr) κdg k17 0.009 (1/hr) ρMg k18 1.04e-5 (1/hr) 29 Description Hib growth rate constant Removal rate constant of IgM bound bacteria Removal rate constant of IgG bound bacteria IgM production rate constant Normalizing Isotope switching parameter Conversion factor for multivalency and unit conversions IgM half-life removal rate constant IgG production rate constant Conversion factor for multivalency and unit conversions IgG half-life removal rate constant Differentiation rate constant of Bz to short lived plasma cells T-zone B-blast cell differentiation/migration/death rate constant Maximal percentage of blast for continued proliferation Cell Differentiation Delay Differentiation rate constant of low avidity Bg to long lived plasma cells Short lived plasma cells life-span removal rate constant GC B-blast cell differentiation/death rate constant Plasma cell maintenance rate constant αL k19 0.0014 (1/hr) ρn1 k20 1157 (cell/ml)(1/hr) κpZ k21 0.01 (1/hr) γgZ k22 0.0098 ρn2 k23 0.048 (1/hr) κpG k24 0.0624 (1/hr) γmg k25 0.10 ρMic k26 0.000828 (1/hr) αM k27 0.00085 (1/hr) ρiM k28 10 (complex/cfu)(1/hr) ρiG k29 10 (complex/cfu)(1/hr) ρMic2 k30 αic ρk k31 k32 1.04e-5 (complex/cell)(1/hr) 0.000463 (1/hr) 6.85e-8 (1/hr) βe k33 0.014 (1/hr) χ1 k34 1.7e-5 (ml/cell) χ2 k35 1e-6 (ml/cell) χ3 k36 0.0001 (ml/cell) χ4 γk ηK βK k37 k38 k39 k40 1e-10 (cells/complex) 0.5351 10.27 (ml/microgram) 1.7375 γ1 k41 106.088 η11 k42 3 η12 k43 12 (ml/microgram) 30 Long lived plasma cells life-span removal rate constant Naive cell stimulation factor Proliferation adjustment parameter for B-blast cell cycle in T-zone Migration rate constant Stimulation rate constant of memory Bcells by free antigen Proliferation adjustment parameter for low avidity B-blast cell cycle in GC Differentiation rate parameter of Bg to memory B-cells Memory maintenance rate constant Memory cells effective average life-span removal rate constant Uptake rate constant of IgM ICs by FDCs Uptake rate constant of IgG ICs by FDCs IC removal rate constant by activating Memory IC half-life removal rate constant Avidity maturation rate constant Maximum stimulation decay rate constant Normalizing isotype switching parameter Normalizing naive recruitment factor Normalizing migration exclusion parameter IC normalization rate constant Arctan parameter for Bg cell cycle Arctan parameter for Bg cell cycle Arctan parameter for Bg cell cycle Arctan parameter for Bg to long lived plasma cells Arctan parameter for Bg to long lived plasma cells Arctan parameter for Bg to long lived plasma cells β1 k44 162.492 Km Kmin Kmax Agth Bgmax Km Kmin Kmax Agth Bgmax 0.77 5.14 (ml/microgram) 20.55 (ml/microgram) 0.000333333 (cfu/ml) 5e7 (cells/ml) 31 Arctan parameter for Bg to long lived plasma cells IgM constant avidity IgG low avidity IgG maximum avidity Threshold of antigen elimination GC limiting cell concentration Appendix D: Cellular Automata: An Alternative Method of Modeling the Dual-Immune Response Introduction: First conceived in the 1940’s by Stanislaw Ulam and John von Neumann, cellular automata (CA) theory was introduced as a means for simulating complex dynamical systems at a time when computer computational power was limited. To begin, a cellular automaton consists of an ndimensional grid of cells, which can be in one of k possible states. Each cell is identical and is updated synchronously in discrete time steps according to local interaction and behavioral rules. Hence, by its very nature, CAs are limited to a strictly defined world. However, although cellular automatons are discrete dynamical systems that are confined by discrete time and space, it can still be designed to model complex continuous dynamic behaviors and interactions. For instance, an early computer implementation of CA theory was a program called the Game of Life (GOL), developed by John Horton Conway. This game was invented to represent the microscopic cycles that exist in biological population growth, patterns such as an exponential increase from plentiful resources and a decrease related to overpopulation and competition. The Game of Life is played on a finite two-dimensional grid or lattice that is in one of two states: alive, represented by the number 1, or dead, represented by 0. The set of rules governing the cells’ states are as follows: For each time step t, a dead cell becomes alive at time t+1 if exactly three of the eight neighboring cells at time t were alive. For each time step t, a live cell becomes dead when at time t less than two or greater than three neighboring cells are alive. While these rules may seem deceptively simple, it belies the rich tapestry of patterns that can emerge, reflecting, too, the colorful variations seen in the real world. CA provides an inside look at the microscopic events of a system while preserving its general trends, such as growth or diffusion and the like. As a result, CA theory can be applied to modeling other phenomena, such as basic heat and wave equations from physics and predator-prey dynamics from biology, to name a few. In recent years, CA theory has resurfaced from its humble beginnings to be applied to more complicated problems. The most interesting application with respect to this paper is the problem of modeling the dual-immune response to various diseases. IMMSIM and its Computer Implementation: In 1992, F. Celada and P.E. Seiden from Princeton University proposed a simulation program by the name of IMMSIM to model the human immune response. The first version of this program was implemented under Windows 95, using the programming language APL2. Since then, IMMSIM has undergone numerous modifications along with an extension of its features. Some more recent developments have been in rewriting the software in both C and C++. However, 32 the most significant enhancement has been the addition of the cell-mediated immune response. Prior to this year (2001), the program was only designed to simulate the humoral immune response. At its core, IMMSIM applies the fundamentals of CA theory to the major players of the immune system. For example, IMMSIM tracks six cellular entities: B cells, T cells, antigen-presenting cells (APC), antibodies, antigens, and immune complexes. Each of these entities follows a strict set of probabilistic interaction rules for behavior, described within modules. As an analogy, the entities can be thought of as finite state machines (FSM) that are allowed to travel in physical space, which, in this case, is the human body. Also, modules are logical units that allow the program to decompose the simulation into several smaller self-contained set of processes or a piece of physical space. For instance, the modules are the lymph node, thyroid, bone marrow, and the environment. The program allows a user to optionally specify the initial parameter values of the system—the half-life of the plasma cells for example. Then IMMSIM displays the population of the B-cells, antigen, immune complexes, etc, with respect to the number of time steps (shown in the figure below). Figure: This is screenshot of the type of results that can be found using IMMSIM++ 33 The current version of IMMSIM utilizes a triangular lattice, which is intended to represent a small portion of the human body. A population of six entities inhabit each site, distributed in a random manner. When simulation begins, the interaction rules are applied to each entity. These rules are probabilistic rather than the usual deterministic variety. Once all of the rules are applied, the birth of new cells is determined. In regards to the implementation of this program, listed below is the half-lives used by IMMSIM: Entity APC B cell Th cell Tc cell Epithelial cell Plasma cell Active state of an APC Active state of a Th cell Active state of a Tc cell Anergy state Antibody Damage Time steps 50 50 50 50 100 10 50 50 50 100 10 3 Bound MHC/peptide complexes and antigen half-lives are given the exorbitantly high value of 10,000, to allow these cells to be long-lasting. Other important traits of the computer implementation of this model are that: The size of the body array is 16x15 sites The diffusion rate is chosen so that entities spread uniformly over the site and its six neighbors on one time step. Epithelial cells do not diffuse. All runs are terminated at 2000 time steps (and called chronic) if they have not previously terminated due to cure or death. Cure results when all antigen is eliminated. Death results when 50% of the epithelial cells are infected or the viral load is greater than 200,000. As mentioned before, there are four different modules that comprise the IMMSIM model: Module boneMarrow thymus Description produces a steady stream of new B-Cells, T-Cells and APCs which flow to the lymphNode and thymus modules simulates positive and negative selection of T-Cells which eventually flow to the lymphNode module 34 lymphNode simulates the interactions between the cells and molecules of the IMMSIM model handles Antigen injections to the lymphNode module environment An example of the interaction rules for APCs and antigens are given below: APC Event DEATH Description ln 2 STEP BIND_ANTIGEN BIND_T_CELL BIND_IMMUNE_COMPLEX Use Pdie e where , the half-life, is tauAPC, to determine if the APC will die. Update internal state information such as age. If an MPC is being presented, remove it with probability pRemoveAg. If an Antigen has been bound then internalize it, process its peptides and present an MPC. After binding to an Antigen, an APC will subsume it. Any Antigen that had previously been internalized is removed. Internalized Antigen is processed and presented during the STEP event. APCs that are exposing MPC can interact with T-Cells. After an APC binds a T-Cell, it will remove any MPCs which were exposed on its surface. This is exactly the same as BIND_ANTIGEN. In this case the Antigen, is the FC of the Immune Complex. Antigen Event DEATH DIVIDE STEP Description ln 2 Use Pdie e where , the half-life, is tauAg, to determine if the Antigen will die (i.e., be removed from the simulation). Each time step, Antigens divide at a rate specified by agMultRate. This provides a means of simulating the growth of live antigens such as bacteria. Update internal state information such as age. Discussion: The findings of Kleinstein and Seiden demonstrate that IMMSIM simulates the general behavior of a real immune response. This was accomplished by running a simulation of the system for 100 time steps after the injection of an antigen. As expected, after the first injection of the 35 antigen, the antibody production was slow, a result of the time-consuming cloning process of the relatively small naive B cell population. But after a second injection, a far more rapid production of antibodies was witnessed, a familiar secondary response found in nature. Overall, Kleinstein and Seiden were able to show that their program is a useful research and educational tool for studying aspects of clonal selection, mutation, and affinity maturation. Other advantages of the IMMSIM program are that it is easily expandable and adaptive. New interactions can be added to program very easily, and behaviors can be modified simply by changing the parameter values. Future Work: In the future, it may be worthwhile to make a comparison between the accuracy and quality of the results produced using a mathematical model versus a CA model. But there are no immediate plans to try to develop a hybrid model that unifies CA theory as well as mathematical modeling theory. References: http://www.ifs.tuwien.ac.at/~aschatt/info/ca/ca.html http://lslwww.epfl.ch/~moshes/ca_main.html 36 37