Optimising efficacy of antibiotics against systemic infection by varying dosage quantities and times.

Mass production and use of antibiotics has led to the rise of resistant bacteria, a problem possibly exacerbated by inappropriate and non-optimal application. Antibiotic treatment often follows fixed-dose regimens, with a standard dose of antibiotic administered equally spaced in time. But are such fixed-dose regimens optimal or can alternative regimens be designed to increase efficacy? Yet, few mathematical models have aimed to identify optimal treatments based on biological data of infections inside a living host. In addition, assumptions to make the mathematical models analytically tractable limit the search space of possible treatment regimens (e.g. to fixed-dose treatments). Here, we aimed to address these limitations by using experiments in a Galleria mellonella (insect) model of bacterial infection to create a fully parametrised mathematical model of a systemic Vibrio infection. We successfully validated this model with biological experiments, including treatments unseen by the mathematical model. Then, by applying artificial intelligence, this model was used to determine optimal antibiotic dosage regimens to treat the host to maximise survival while minimising total antibiotic used. As expected, host survival increased as total quantity of antibiotic applied during the course of treatment increased. However, many of the optimal regimens tended to follow a large initial 'loading' dose followed by doses of incremental reductions in antibiotic quantity (dose 'tapering'). Moreover, application of the entire antibiotic in a single dose at the start of treatment was never optimal, except when the total quantity of antibiotic was very low. Importantly, the range of optimal regimens identified was broad enough to allow the antibiotic prescriber to choose a regimen based on additional criteria or preferences. Our findings demonstrate the utility of an insect host to model antibiotic therapies in vivo and the approach lays a foundation for future regimen optimisation for patient and societal benefits.

One model to rule them all? Modelling approaches across OneHealth for human, animal and plant epidemics.

One hundred years after the 1918 influenza outbreak, are we ready for the next pandemic? This paper addresses the need to identify and develop collaborative, interdisciplinary and cross-sectoral approaches to modelling of infectious diseases including the fields of not only human and veterinary medicine, but also plant epidemiology. Firstly, the paper explains the concepts on which the most common epidemiological modelling approaches are based, namely the division of a host population into susceptible, infected and removed (SIR) classes and the proportionality of the infection rate to the size of the susceptible and infected populations. It then demonstrates how these simple concepts have been developed into a vast and successful modelling framework that has been used in predicting and controlling disease outbreaks for over 100 years. Secondly, it considers the compartmental models based on the SIR paradigm within the broader concept of a 'disease tetrahedron' (comprising host, pathogen, environment and man) and uses it to review the similarities and differences among the fields comprising the 'OneHealth' approach. Finally, the paper advocates interactions between all fields and explores the future challenges facing modellers. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'. This issue is linked with the subsequent theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'.

Optimising Antibiotic Usage to Treat Bacterial Infections.

The increase in antibiotic resistant bacteria poses a threat to the continued use of antibiotics to treat bacterial infections. The overuse and misuse of antibiotics has been identified as a significant driver in the emergence of resistance. Finding optimal treatment regimens is therefore critical in ensuring the prolonged effectiveness of these antibiotics. This study uses mathematical modelling to analyse the effect traditional treatment regimens have on the dynamics of a bacterial infection. Using a novel approach, a genetic algorithm, the study then identifies improved treatment regimens. Using a single antibiotic the genetic algorithm identifies regimens which minimise the amount of antibiotic used while maximising bacterial eradication. Although exact treatments are highly dependent on parameter values and initial bacterial load, a significant common trend is identified throughout the results. A treatment regimen consisting of a high initial dose followed by an extended tapering of doses is found to optimise the use of antibiotics. This consistently improves the success of eradicating infections, uses less antibiotic than traditional regimens and reduces the time to eradication. The use of genetic algorithms to optimise treatment regimens enables an extensive search of possible regimens, with previous regimens directing the search into regions of better performance.

Maternal effects on offspring consumption can stabilize fluctuating predator-prey systems.

Maternal effects, where the conditions experienced by mothers affect the phenotype of their offspring, are widespread in nature and have the potential to influence population dynamics. However, they are very rarely included in models of population dynamics. Here, we investigate a recently discovered maternal effect, where maternal food availability affects the feeding rate of offspring so that well-fed mothers produce fast-feeding offspring. To understand how this maternal effect influences population dynamics, we explore novel predator-prey models where the consumption rate of predators is modified by changes in maternal prey availability. We address the 'paradox of enrichment', a theoretical prediction that nutrient enrichment destabilizes populations, leading to cycling behaviour and an increased risk of extinction, which has proved difficult to confirm in the wild. Our models show that enriched populations can be stabilized by maternal effects on feeding rate, thus presenting an intriguing potential explanation for the general absence of 'paradox of enrichment' behaviour in natural populations. This stabilizing influence should also reduce a population's risk of extinction and vulnerability to harvesting.

The evolution of costly acquired immune memory.

A key feature of the vertebrate adaptive immune system is acquired immune memory, whereby hosts launch a faster and heightened response when challenged by previously encountered pathogens, preventing full infection. Here, we use a mathematical model to explore the role of ecological and epidemiological processes in shaping selection for costly acquired immune memory. Applying the framework of adaptive dynamics to the classic SIR (Susceptible-Infected-Recovered) epidemiological model, we focus on the conditions that may lead hosts to evolve high levels of immunity. Linking our work to previous theory, we show how investment in immune memory may be greatest at long or intermediate host lifespans depending on whether immunity is long lasting. High initial costs to gain immunity are also found to be essential for a highly effective immune memory. We also find that high disease infectivity and sterility, but intermediate virulence and immune period, increase selection for immunity. Diversity in host populations through evolutionary branching is found to be possible but only for a limited range of parameter space. Our model suggests that specific ecological and epidemiological conditions have to be met for acquired immune memory to evolve.

A limited host immune range facilitates the creation and maintenance of diversity in parasite virulence.

A vast theoretical literature has explored the evolutionary dynamics of parasite virulence. The classic result from this modelling work is that, assuming a saturating transmission-virulence trade-off, there is a single evolutionary optimum where the parasite optimizes the epidemiological R 0. However, there are an increasing number of models that have shown how ecological and epidemiological feedbacks to evolution can instead result in the creation and maintenance of multiple parasite strains. Here, we fully explore one such example, where recovered hosts have a limited 'immune range' resulting in partial cross-immunity to parasite strains that they have not previously encountered. Taking an adaptive dynamics approach, we show that, provided this immune range is not too wide, high levels of diversity can evolve and be maintained through multiple branching events. We argue that our model provides a more realistic picture of disease dynamics in vertebrate host populations and may be a key explanatory factor in the high levels of parasite diversity seen in natural systems.

Evolutionary behaviour, trade-offs and cyclic and chaotic population dynamics.

Many studies of the evolution of life-history traits assume that the underlying population dynamical attractor is stable point equilibrium. However, evolutionary outcomes can change significantly in different circumstances. We present an analysis based on adaptive dynamics of a discrete-time demographic model involving a trade-off whose shape is also an important determinant of evolutionary behaviour. We derive an explicit expression for the fitness in the cyclic region and consequently present an adaptive dynamic analysis which is algebraic. We do this fully in the region of 2-cycles and (using a symbolic package) almost fully for 4-cycles. Simulations illustrate and verify our results. With equilibrium population dynamics, trade-offs with accelerating costs produce a continuously stable strategy (CSS) whereas trade-offs with decelerating costs produce a non-ES repellor. The transition to 2-cycles produces a discontinuous change: the appearance of an intermediate region in which branching points occur. The size of this region decreases as we move through the region of 2-cycles. There is a further discontinuous fall in the size of the branching region during the transition to 4-cycles. We extend our results numerically and with simulations to higher-period cycles and chaos. Simulations show that chaotic population dynamics can evolve from equilibrium and vice-versa.