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Multiphase Mechanics of Tumor Growth and Control Strategies Trachette L. Jackson University of Michigan Department of Mathematics Historical Relationship Between Mathematics and Biology Attitudes of Early Biologists Attitudes of Early Mathematicians “Beware of mathematicians and all those who make empty prophecies. The danger already exists that the mathematicians have made a covenant with the devil to darken the spirit and confine man in the bonds of hell.” -Saint Augustine (354-430) “In mathematics we find the primitive source of rationality; and to mathematicians must the biologist resort for means to carry out their researches.” In: Positive Philosophy Auguste Comte (1798-1857) Cancer Arises when a cell or small group of cells have undergone a series of mutations which render then insensitive to mitotic and apoptotic cues from the surrounding tissue. These cells and their progeny eventually form a tumor. Avascular Tumor Growth Avascular = before blood vessels Nutrient obtained via diffusion Cells in the center starve Cells on the periphery thrive Cells in the interior are quiescent Growth limited to a few mm in diameter Angiogenesis Formation of new blood vessels from the existing vasculature Hypoxia induces a chemical cascade which stimulates endothelial cells of near by vessels to aggregate, proliferate, and migrate towards the tumor Vascular Tumor Growth 50% Cells 10% Blood vessels 40% Extra cellular matrix (ECM) Vessel structure is disorganized May be benign and encapsulated or milignant Progression of Spatio-Temporal Tumor Modeling First Generation: Avascular Growth Burton, 1966; Greenspan, 1972; Glass, 1973; Adam, 1986-87; Maggelakis, 1990; Byrne and Chaplain, 1993-94 Reaction-diffusion equation coupled with an integrodifferential equation describing tumor radius response to externally supplied nutrient Radial symmetry Must track two free boundaries, Rn(t) defined implicitly Progression of Spatio-Temporal Tumor Modeling First Generation: Avascular Growth Nutrient Equation: ct = Dc Dc – k f(c) Diffusion Consumption Tumor Growth Equation R R d/dt (4pR3/3) = 4p ∫ (f(c) – d1) r2 dr - ∫ d2 r2dr R n 0 Net Growth Necrosis Dc = diffusion coefficient of nutrient k = nutrient consumption parameter d1 = natural death rate; d2 = decomposition rate Parameter Values Parameter Value Reference fo 0.07 h-1 Ward et al., 1997 co 1.5 x 10-8 g/mm3 d1 0.01 h-1 Casciari et al, 1992 Ward et al., 1997 Dc 7.2 mm2/h Hatky et al., 1985 vc 1.77 x 10-6 mm3 k 5.8 x 10-5 g/mm3 Casciari et al., 1992 Casciari et al., 1992 First Generation Model Predictions Time of necrotic core formation: tn= 1 f0 –d1 ln ( 6Dcc0 kfoRn2 )~ 3- 7 days Size of tumor when core develops: 6Dcco Rn = ~ 0.4mm 2 kfoRn Steady state radius of tumor and of necrotic core: Rs Rns ~ 1.87mm ~ 1.64mm Progression of Spatio-Temporal Tumor Modeling First Generation: Avascular Growth Advantages Simplicity Steady state results agree with experimentally grown tumors Reproduces layered structure Analytical predictions possible Disadvantages Cells not explicitly mentioned Difficult to generalize to other geometries Progression of Spatio-Temporal Tumor Modeling Second Generation: Asymmetry Byrne and Chaplain, 1996; Jackson, 2002 Cell proliferation and death produce a velocity field, u = f( c) - d1 D The outer surface of the tumor is a free boundary (B(r,t) = r – R(q,f,t) = 0) moving with the speed of the tumor velocity, n r = n u(R(t),t) Same nutrient equation as before Velocity is often related to pressure via Darcy’s law u=-m p D Curvature effects incorporated via boundary conditions Progression of Spatio-Temporal Tumor Modeling Second Generation: Asymmetry Goal: Determine under what conditions radially symmetric solutions are unstable to asymmetric perturbations. For cases when instability is predicted, the shape of the tumor may alter radically from the symmetric configuration. Advantages Disadvantages --Only non-necrotic solutions apply --More general geometries --Can recover 1st generation models --Cell density not explicitly treated Progression of Spatio-Temporal Tumor Modeling Third Generation: Polyclonality Thompson, 1999; Jackson and Byrne, 2000; Jackson, 2002 Assume tumor contains cell populations with different phenotypes: nt + (uni)x = S(ni) Assume there are no voids within the tumor: S ni = 1 ux = S S(ni) Advantages --More realistic tumor composition --Can predict the effect of cellular heterogeneity Disadvantages --Analysis of asymmetric effects --Cell-Tissue interactions not included Progression of Spatio-Temporal Tumor Modeling Fourth (Present) Generation: Tissue Mechanics Chaplain and Sleeman, 1993; Jones et al., 2000; Chen et al., 2001; Breward et al., 2002; Jackson and Byrne, 2002; Lubkin and Jackson, 2002 Conservation of Mass---Transport equations for tumor cells, normal cells, extracellular matrix, interstitial fluid Conservation of Momentum---Force balance equations prescribing the internal stress and inter phase forces Today’s Topics: Tumor Encapsulation and Novel Chemotherapeutic Strategies Tumor Encapsulation Definition: The cascade of events that result in the formation of a multilayered sheath of epithelium surrounding a tumor. A multilobular tumor is one in which lobes of different sizes are separated by strands of connective tissue. Enhanced chest CT showing an encapsulated and lobulated (arrow) thymoma (T). Capsule Composition and Importance Capsules are composed of ECM (connective tissue) Characteristic of many benign tumors Key feature in determining clinical outcome A physical barrier to invasion Often limits symptoms Capsule Formation Theories Expansive Growth Hypothesis Passive response Tumor expansion compresses the surrounding ECM Foreign Body Hypothesis Active response Host over-expresses collagen in surrounding tissue in direct response to the tumor's growth Experimental Observations Wakasa et. al., 2000. Tumors form capsules more often when their diameter is greater than 2 cm. Nagata et al., 2000. There is no correlation between tumor size and capsule incidence or thickness. Clear Contradictions. Experimental findings are difficult to evaluate. This is the perfect time for MATHEMATICAL MODELING! Mathematical Goals Develop a novel modeling framework which accounts the mechanical interactions of tumors with surrounding ECM and accurately describes the process of tumor encapsulation. Use the model to. Compare the active vs. passive hypotheses for capsule formation. Assist in the understanding of the role of the tumor cell and ECM interactions in capsule formation. Investigate possible mechanism for the transition between benign and invasive growth. Suggest an explanation for the transformation of a simple nonlobular tumor to the more complex multilobular form. Model Development View tissue as a mixture of three interacting continua: cells, extracellular matrix, and interstitial fluid Derive mass and momentum balance equations for each phase Close the system with suitable constitutive relationships Assume a Cartesian geometry with the tumor expanding in the the direction parallel to the xaxis Mass Balance Equations Tumor Cells (n): nt + (vnn)x = Sn Extracellular Matrix (m): Water (w): mt + (vmm)x = Sm wt + (vww)x = Sw vi = the velocity of each phase Si = the rates of production of each phase Assumptions A1: The system is closed in that volume is simply transferred from one state to another, therefore: Sw = - (Sn + Sm) A2: There are no voids in the tissues so that n+m+w=1 Together these assumptions reduce the number of unknowns from six to four. Momentum Conservation Newton’s Second Law (F = ma): The time rate of change of momentum of a particle is equal to the sum of the forces acting on it. In highly damped mechanical systems (like many biological tissues) both the convective momentum transport and inertia (indisposition to motion) can be ignored In this case, momentum conservation reduces force balance equations. 0 = Fnn + Fnm + Fnw 0 = Fmm - Fnm + Fmw 0 = Fww - Fnw - Fmw Fii = intraphase force Fij = interphase force Defining the Forces Denote the stress (force per unit area) in each phase by si for i = n, m, w The intraphase force Fii can be expressed in terms of the average stress weighted by the volume fraction of each phase e.g. Fnn = (n sn)x The interphase force Fij is often expressed as the sum of two components: the static pressure exerted on material of phase I by material of phase j and the frictional drag due to the relative motion of the phases , e.g. Fnm = pnx + k(vm – vn)nm Prescribing Stresses The cell and ECM phases are characterized by additional, isotropic pressures which distinguish them from water. sn = - (p +Sn) sm = - (p +Sm) sw = - p Prescribing Stresses Sn = snn A3: Pressure in cell phase increases as phase density increases Sm = smm(1 + qn) A4: Pressure in ECM increases as phase density increases and tumor causes additional pressure on the ECM Force Balance Equations 0 = (n sn)x + k(vm – vn)nm + k(vw – vn)nw + pnx 0 = (msm)x - k(vm – vn)nm + k(vw – vm)mw + pmx 0 = (w sw)x - k(vw – vn)nw - k(vw – vm)mw + pwx Solving for Pressure and Velocities Add the force balance equations to get an expression for the pressure. px = -(nSn + mSm)x Substitute into cell and ECM balances and solve for the velocities vn = v – v(n)nx and vm = v – v(m)mx v = common velocity = - 1 px k Final Model Equations nt = S n + 1 k [(1-n)(nSn)x – n(mSm)x]x mt = S m + 1 k [(1-m)(mSm)x – m(nSn)x]x Parabolic System of Equations with Cross Diffusion Tumor Growth Sn = ann(1-n-m) - dn ECM Production Sm = amnm(1-n-m) Initial and Boundary Conditions Tumor is initially localized to a region near x = 0 where it has replaced most of the ECM. ECM is at normal, steady state levels except in the vicinity of the tumor where levels have dropped nearly to zero. No flux boundary conditions are imposed at x = 0 and at x = L. The former is due to symmetry across the origin and the latter results from assuming that the tissue is isolated. Foreign Body Hypothesis Tumor ECM Model simulations when only the active response is operative. As the strength of the active response, am, is varied from low (top) to high (bottom), ECM accumulates in the center of the tumor. Summary of Active Response Growth suppression without capsule formation Substantial ECM accumulation Consistent with biopsies of fibrous tumors (Dvorok, 1986; Mckinnell et al., 1999) Consistent with experimental observation that ECM accumulation is associated with reduced tumor cell density (Dvorok, 1986; Lunevicius, 2001) A sufficiently strong active response could eliminate the tumor and is therefore a potentially important mechanism for control, but it not necessary for capsule formation. The Expansive Growth Hypothesis Tumor ECM Model simulations when only the passive response is operative. As pressure that tumor cells generate within the ECM, q, varies from high (top) to low (bottom). Changes in Capsule Structure Capsule Width Capsule Volume Summary of Passive Response Passive alone is sufficient to form a capsule Minimal accumulation of ECM As pressure the tumor generates in the ECM increases, more ECM is compressed a thin, dense capsule forms. The less sensitive tumor cells are to changes in their own density, the thicker the capsule will be. For certain parameter values, the model predicts that the capsule width will remain constant as the tumor grows. Both Active and Passive Responses Tumor ECM Model simulations with both mechanisms operative as the strength of the active response, am, is increased. Key Results Active hypothesis Tumor suppression without capsule formation Passive hypothesis Tumor encapsulation without growth suppression Active + Passive hypotheses Fibrous tumor moving with constant speed is surrounded by a thin, dense capsule Transition from Benign to Invasive Growth As a result of genetic mutations, some tumor cells may acquire the skills necessary to breach the capsule. Tumor cells begin producing proteolytic enzymes or proteases to remove the ECM barrier Pressure Protease Production ECM Degradation ECM Degradation Model Assumptions A5: Tumor cells produce the protease at a constant rate only when the pressure they experience exceeds a threshold value. Pn – Pc 1 rt = Drrxx + mn[1 + tanh( ) ] - lr 2 DP Production Diffusion Decay l = natural decay rate, Drr = diffusion coefficient m = maximum production rate DP = sensitivity of tumor cells to changes in pressure Pc = critical pressure for induces protease production Pn = pressure experienced by tumor cells = p +Sn = snn(1-n) – smm2(1 + qn) ECM Degradation Model Modification Assumptions A6: ECM degradation is proportional to the product of the protease density and ECM volume fraction. Sm = amnm(1-n-m) - grm A7: Protease enhances motility of cells by weakening bonds that attach cells to each other and that maintain the integrity of the ECM. Therefore drag coefficient is assumed to be decreasing function of protease density. k k(r) = 1 + br Breaking Down the Capsule Tumor ECM Protease production leads to destruction of the capsule and tumor invasion. As sensitivity of the drag coefficient to the protease increases (from top to bottom), so does the rate transcapsular spread. Continued Investigations Modify model to include pressure-sensitive tumor growth This should lead to experimentally observable steady state encapsulated tumors Extend model to address issue of multiple lobe formation Polyclonality Variable motility Viscous and poroelastic effects Novel Chemotherapeutic Strategies: The Promise and Potential of MAbs Monoclonal Antibodies (MAbs) Bind to tumor antigens thus marking cancer cells for death Direct Drug Targeting Magic Bullets Drugs attached to Mabs drug The Failure of Mabs Against Solid Tumors Advantages of MAb Therapy Stubborn Solid Tumors High Specificity Lower Toxicity Works well for leukaemia and lymphomas Main Reasons for Failure Against Solid Tumors Antigen Heterogeneity Vascular Permeability Interstitial Pressure New Approach: Two-step Drug Targeting Antibody Enzyme Conjugates for the Activation of anticancer prodrugs Two-phase Approach for Studying Chemotherapeutic Strategies: The Tumor Model Tumor Cells (n): nt + (vnn)x = Sn Water (w): wt + (vww)x = Sw No voids: n + w = 1 wvw = -nvn Momentum Balance nt = Sn + 1 k [n(1-n)2(nSn)x ]x Two-phase Approach for Studying Chemotherapeutic Strategies: The Drug Transport Model Extracellular Drug qt + (vwq)x = Dq(q)xx- l12q + l21p Intracellular Drug pt + (vnp)x = l21q - l21p - l23p Sequestered Drug st + (vws)x = l23p - bgs Goals of Modeling Approach Accurately predict tumor response to traditional chemotherapy Modify model to investigate direct-drug targeting and two-step targeting Isolate the role of convection vs. diffusion of large molecules Acknowledgements Collaborators Helen Byrne, Center for Mathematical Medicine, University of Nottingham Peter Senter, Seattle Genetics Funding NSF Grant # Alfred P. Sloan Foundation