A 3D Approach Using a Control Algorithm to Minimize the Effects on the Healthy Tissue in the Hyperthermia for Cancer Treatment.

According to the World Health Organization, cancer is a worldwide health problem. Its high mortality rate motivates scientists to study new treatments. One of these new treatments is hyperthermia using magnetic nanoparticles. This treatment consists in submitting the target region with a low-frequency magnetic field to increase its temperature over 43 °C, as the threshold for tissue damage and leading the cells to necrosis. This paper uses an in silico three-dimensional Pennes' model described by a set of partial differential equations (PDEs) to estimate the percentage of tissue damage due to hyperthermia. Differential evolution, an optimization method, suggests the best locations to inject the nanoparticles to maximize tumor cell death and minimize damage to healthy tissue. Three different scenarios were performed to evaluate the suggestions obtained by the optimization method. The results indicate the positive impact of the proposed technique: a reduction in the percentage of healthy tissue damage and the complete damage of the tumors were observed. In the best scenario, the optimization method was responsible for decreasing the healthy tissue damage by 59% when the nanoparticles injection sites were located in the non-intuitive points indicated by the optimization method. The numerical solution of the PDEs is computationally expensive. This work also describes the implemented parallel strategy based on CUDA to reduce the computational costs involved in the PDEs resolution. Compared to the sequential version executed on the CPU, the proposed parallel implementation was able to speed the execution time up to 84.4 times.

A Poroelastic Approach for Modelling Myocardial Oedema in Acute Myocarditis.

Myocarditis is a general set of mechanisms that manifest themselves into the inflammation of the heart muscle. In 2017, more than 3 million people were affected by this disease worldwide, causing about 47,000 deaths. Many aspects of the origin of this disease are well known, but several important questions regarding the disease remain open. One of them is why some patients develop a significantly localised inflammation while others develop a much more diffuse inflammation, reaching across large portions of the heart. Furthermore, the specific role of the pathogenic agent that causes inflammation as well as the interaction with the immune system in the progression of the disease are still under discussion. Providing answers to these crucial questions can have an important impact on patient treatment. In this scenario, computational methods can aid specialists to understand better the relationships between pathogens and the immune system and elucidate why some patients develop diffuse myocarditis. This paper alters a recently developed model to study the myocardial oedema formation in acute infectious myocarditis. The model describes the finite deformation regime using partial differential equations to represent tissue displacement, fluid pressure, fluid phase, and the concentrations of pathogens and leukocytes. A sensitivity analysis was performed to understand better the influence of the most relevant model parameters on the disease dynamics. The results showed that the poroelastic model could reproduce local and diffuse myocarditis dynamics in simplified and complex geometrical domains.

Characterisation of Omicron Variant during COVID-19 Pandemic and the Impact of Vaccination, Transmission Rate, Mortality, and Reinfection in South Africa, Germany, and Brazil.

Several variants of SARS-CoV-2 have been identified in different parts of the world, including Gamma, detected in Brazil, Delta, detected in India, and the recent Omicron variant, detected in South Africa. The emergence of a new variant is a cause of great concern. This work considers an extended version of an SIRD model capable of incorporating the effects of vaccination, time-dependent transmissibility rates, mortality, and even potential reinfections during the pandemic. We use this model to characterise the Omicron wave in Brazil, South Africa, and Germany. During Omicron, the transmissibility increased by five for Brazil and Germany and eight for South Africa, whereas the estimated mortality was reduced by three-fold. We estimated that the reported cases accounted for less than 25% of the actual cases during Omicron. The mortality among the nonvaccinated population in these countries is, on average, three to four times higher than the mortality among the fully vaccinated. Finally, we could only reproduce the observed dynamics after introducing a new parameter that accounts for the percentage of the population that can be reinfected. Reinfection was as high as 40% in South Africa, which has only 29% of its population fully vaccinated and as low as 13% in Brazil, which has over 70% and 80% of its population fully vaccinated and with at least one dose, respectively. The calibrated models were able to estimate essential features of the complex virus and vaccination dynamics and stand as valuable tools for quantifying the impact of protocols and decisions in different populations.

Timing the race of vaccination, new variants, and relaxing restrictions during COVID-19 pandemic.

Late in 2019, China identified a new type of coronavirus, SARS-CoV-2, and due to its fast spread, the World Health Organisation (WHO) declared a pandemic named COVID-19. Some variants of this virus were detected, including the Delta, which caused new waves of infections. This work uses an extended version of a SIRD model that includes vaccination effects to measure the impact of the Delta variant in three countries: Germany, Israel and Brazil. The calibrated models were able to reproduce the dynamics of the above countries. In addition, hypothetical scenarios were simulated to quantify the impact of vaccination and mitigation policies during the Delta wave. The results showed that the model could reproduce the complex dynamics observed in the different countries. The estimated increase of transmission rate due to the Delta variant was highest in Israel (7.9), followed by Germany (2.7) and Brazil (1.5). These values may support the hypothesis that people immunised against COVID-19 may lose their defensive antibodies with time since Israel, Germany, and Brazil fully vaccinated half of the population in March, July, and October. The scenario to study the impact of vaccination revealed relative reductions in the total number of deaths between 30% and 250%; an absolute reduction of 300 thousand deaths in Brazil due to vaccination during the Delta wave. The second hypothetical scenario revealed that mitigation policies saved up to 300 thousand Brazilians; relative reductions in the total number of deaths between 24% and 120% in the three analysed countries. Therefore, the results suggest that both vaccination and mitigation policies were crucial in decreasing the spread and the number of deaths during the Delta wave.

A Validated Mathematical Model of the Cytokine Release Syndrome in Severe COVID-19.

By June 2021, a new contagious disease, the Coronavirus disease 2019 (COVID-19), has infected more than 172 million people worldwide, causing more than 3.7 million deaths. Many aspects related to the interactions of the disease's causative agent, SAR2-CoV-2, and the immune response are not well understood: the multiscale interactions among the various components of the human immune system and the pathogen are very complex. Mathematical and computational tools can help researchers to answer these open questions about the disease. In this work, we present a system of fifteen ordinary differential equations that models the immune response to SARS-CoV-2. The model is used to investigate the hypothesis that the SARS-CoV-2 infects immune cells and, for this reason, induces high-level productions of inflammatory cytokines. Simulation results support this hypothesis and further explain why survivors have lower levels of cytokines levels than non-survivors.

The Quixotic Task of Forecasting Peaks of COVID-19: Rather Focus on Forward and Backward Projections.

Over the last months, mathematical models have been extensively used to help control the COVID-19 pandemic worldwide. Although extremely useful in many tasks, most models have performed poorly in forecasting the pandemic peaks. We investigate this common pitfall by forecasting four countries' pandemic peak: Austria, Germany, Italy, and South Korea. Far from the peaks, our models can forecast the pandemic dynamics 20 days ahead. Nevertheless, when calibrating our models close to the day of the pandemic peak, all forecasts fail. Uncertainty quantification and sensitivity analysis revealed the main obstacle: the misestimation of the transmission rate. Inverse uncertainty quantification has shown that significant changes in transmission rate commonly precede a peak. These changes are a key factor in forecasting the pandemic peak. Long forecasts of the pandemic peak are therefore undermined by the lack of models that can forecast changes in the transmission rate, i.e., how a particular society behaves, changes of mitigation policies, or how society chooses to respond to them. In addition, our studies revealed that even short forecasts of the pandemic peak are challenging. Backward projections have shown us that the correct estimation of any temporal change in the transmission rate is only possible many days ahead. Our results suggest that the distance between a change in the transmission rate and its correct identification in the curve of active infected cases can be as long as 15 days. This is intrinsic to the phenomenon and how it affects epidemic data: a new case is usually only reported after an incubation period followed by a delay associated with the test. In summary, our results suggest the phenomenon itself challenges the task of forecasting the peak of the COVID-19 pandemic when only epidemic data is available. Nevertheless, we show that exciting results can be obtained when using the same models to project different scenarios of reduced transmission rates. Therefore, our results highlight that mathematical modeling can help control COVID-19 pandemic by backward projections that characterize the phenomena' essential features and forward projections when different scenarios and strategies can be tested and used for decision-making.

Validation of a yellow fever vaccine model using data from primary vaccination in children and adults, re-vaccination and dose-response in adults and studies with immunocompromised individuals.

BACKGROUND: An effective yellow fever (YF) vaccine has been available since 1937. Nevertheless, questions regarding its use remain poorly understood, such as the ideal dose to confer immunity against the disease, the need for a booster dose, the optimal immunisation schedule for immunocompetent, immunosuppressed, and pediatric populations, among other issues. This work aims to demonstrate that computational tools can be used to simulate different scenarios regarding YF vaccination and the immune response of individuals to this vaccine, thus assisting the response of some of these open questions. RESULTS: This work presents the computational results obtained by a mathematical model of the human immune response to vaccination against YF. Five scenarios were simulated: primovaccination in adults and children, booster dose in adult individuals, vaccination of individuals with autoimmune diseases under immunomodulatory therapy, and the immune response to different vaccine doses. Where data were available, the model was able to quantitatively replicate the levels of antibodies obtained experimentally. In addition, for those scenarios where data were not available, it was possible to qualitatively reproduce the immune response behaviours described in the literature. CONCLUSIONS: Our simulations show that the minimum dose to confer immunity against YF is half of the reference dose. The results also suggest that immunological immaturity in children limits the induction and persistence of long-lived plasma cells are related to the antibody decay observed experimentally. Finally, the decay observed in the antibody level after ten years suggests that a booster dose is necessary to keep immunity against YF.

Characterization of the COVID-19 pandemic and the impact of uncertainties, mitigation strategies, and underreporting of cases in South Korea, Italy, and Brazil.

By April 7th, 2020, the Coronavirus disease 2019 (COVID-19) has infected one and a half million people worldwide, accounting for over 80 thousand of deaths in 209 countries and territories around the world. The new and fast dynamics of the pandemic are challenging the health systems of different countries. In the absence of vaccines or effective treatments, mitigation policies, such as social isolation and lock-down of cities, have been adopted, but the results vary among different countries. Some countries were able to control the disease at the moment, as is the case of South Korea. Others, like Italy, are now experiencing the peak of the pandemic. Finally, countries with emerging economies and social issues, like Brazil, are in the initial phase of the pandemic. In this work, we use mathematical models with time-dependent coefficients, techniques of inverse and forward uncertainty quantification, and sensitivity analysis to characterize essential aspects of the COVID-19 in the three countries mentioned above. The model parameters estimated for South Korea revealed effective social distancing and isolation policies, border control, and a high number in the percentage of reported cases. In contrast, underreporting of cases was estimated to be very high in Brazil and Italy. In addition, the model estimated a poor isolation policy at the moment in Brazil, with a reduction of contact around 40%, whereas Italy and South Korea estimated numbers for contact reduction are at 75% and 90%, respectively. This characterization of the COVID-19, in these different countries under different scenarios and phases of the pandemic, supports the importance of mitigation policies, such as social distancing. In addition, it raises serious concerns for socially and economically fragile countries, where underreporting poses additional challenges to the management of the COVID-19 pandemic by significantly increasing the uncertainties regarding its dynamics.

A personalized computational model of edema formation in myocarditis based on long-axis biventricular MRI images.

BACKGROUND: Myocarditis is defined as the inflammation of the myocardium, i.e. the cardiac muscle. Among the reasons that lead to this disease, we may include infections caused by a virus, bacteria, protozoa, fungus, and others. One of the signs of the inflammation is the formation of edema, which may be a consequence of the interaction between interstitial fluid dynamics and immune response. This complex physiological process was mathematically modeled using a nonlinear system of partial differential equations (PDE) based on porous media approach. By combing a model based on Biot's poroelasticity theory with a model for the immune response we developed a new hydro-mechanical model for inflammatory edema. To verify this new computational model, T2 parametric mapping obtained by Magnetic Resonance (MR) imaging was used to identify the region of edema in a patient diagnosed with unspecific myocarditis. RESULTS: A patient-specific geometrical model was created using MRI images from the patient with myocarditis. With this model, edema formation was simulated using the proposed hydro-mechanical mathematical model in a two-dimensional domain. The computer simulations allowed us to correlate spatiotemporal dynamics of representative cells of the immune systems, such as leucocytes and the pathogen, with fluid accumulation and cardiac tissue deformation. CONCLUSIONS: This study demonstrates that the proposed mathematical model is a very promising tool to better understand edema formation in myocarditis. Simulations obtained from a patient-specific model reproduced important aspects related to the formation of cardiac edema, its area, position, and shape, and how these features are related to immune response.

Delay differential equation-based models of cardiac tissue: Efficient implementation and effects on spiral-wave dynamics.

Delay differential equations (DDEs) recently have been used in models of cardiac electrophysiology, particularly in studies focusing on electrical alternans, instabilities, and chaos. A number of processes within cardiac cells involve delays, and DDEs can potentially represent mechanisms that result in complex dynamics both at the cellular level and at the tissue level, including cardiac arrhythmias. However, DDE-based formulations introduce new computational challenges due to the need for storing and retrieving past values of variables at each spatial location. Cardiac tissue simulations that use DDEs may require over 28 GB of memory if the history of variables is not managed carefully. This paper addresses both computational and dynamical issues. First, we present new methods for the numerical solution of DDEs in tissue to mitigate the memory requirements associated with the history of variables. The new methods exploit the different time scales of an action potential to dynamically optimize history size. We find that the proposed methods decrease memory usage by up to 95% in cardiac tissue simulations compared to straightforward history-management algorithms. Second, we use the optimized methods to analyze for the first time the dynamics of wave propagation in two-dimensional cardiac tissue for models that include DDEs. In particular, we study the effects of DDEs on spiral-wave dynamics, including wave breakup and chaos, using a canine myocyte model. We find that by introducing delays to the gating variables governing the calcium current, DDEs can induce spiral-wave breakup in 2D cardiac tissue domains.

Development of a Computational Model of Abscess Formation.

In some bacterial infections, the immune system cannot eliminate the invading pathogen. In these cases, the invading pathogen is successful in establishing a favorable environment to survive and persist in the host organism. For example, S. aureus bacteria survive in organ tissues employing a set of mechanisms that work in a coordinated and highly regulated way allowing: (1) efficient impairment of the immune response; and (2) protection from the immune cells and molecules. S. aureus secretes several proteins including coagulases and toxins that drive abscess formation and persistence. Unless staphylococcal abscesses are surgically drained and treated with antibiotics, disseminated infection and septicemia produce a lethal outcome. Within this context, this paper develops a simple mathematical model of abscess formation incorporating characteristics that we judge important for an abscess to be formed. Our aim is to build a mathematical model that reproduces some characteristics and behaviors that are observed in the process of abscess formation.

A qualitatively validated mathematical-computational model of the immune response to the yellow fever vaccine.

BACKGROUND: Although a safe and effective yellow fever vaccine was developed more than 80 years ago, several issues regarding its use remain unclear. For example, what is the minimum dose that can provide immunity against the disease? A useful tool that can help researchers answer this and other related questions is a computational simulator that implements a mathematical model describing the human immune response to vaccination against yellow fever. METHODS: This work uses a system of ten ordinary differential equations to represent a few important populations in the response process generated by the body after vaccination. The main populations include viruses, APCs, CD8+ T cells, short-lived and long-lived plasma cells, B cells and antibodies. RESULTS: In order to qualitatively validate our model, four experiments were carried out, and their computational results were compared to experimental data obtained from the literature. The four experiments were: a) simulation of a scenario in which an individual was vaccinated against yellow fever for the first time; b) simulation of a booster dose ten years after the first dose; c) simulation of the immune response to the yellow fever vaccine in individuals with different levels of naïve CD8+ T cells; and d) simulation of the immune response to distinct doses of the yellow fever vaccine. CONCLUSIONS: This work shows that the simulator was able to qualitatively reproduce some of the experimental results reported in the literature, such as the amount of antibodies and viremia throughout time, as well as to reproduce other behaviors of the immune response reported in the literature, such as those that occur after a booster dose of the vaccine.

A New Age-Structured Multiscale Model of the Hepatitis C Virus Life-Cycle During Infection and Therapy With Direct-Acting Antiviral Agents.

The dynamics of hepatitis C virus (HCV) RNA during translation and replication within infected cells were added to a previous age-structured multiscale mathematical model of HCV infection and treatment. The model allows the study of the dynamics of HCV RNA inside infected cells as well as the release of virus from infected cells and the dynamics of subsequent new cell infections. The model was used to fit in vitro data and estimate parameters characterizing HCV replication. This is the first model to our knowledge to consider both positive and negative strands of HCV RNA with an age-structured multiscale modeling approach. Using this model we also studied the effects of direct-acting antiviral agents (DAAs) in blocking HCV RNA intracellular replication and the release of new virions and fit the model to in vivo data obtained from HCV-infected subjects under therapy.

Mathematical modeling based on ordinary differential equations: A promising approach to vaccinology.

New contributions that aim to accelerate the development or to improve the efficacy and safety of vaccines arise from many different areas of research and technology. One of these areas is computational science, which traditionally participates in the initial steps, such as the pre-screening of active substances that have the potential to become a vaccine antigen. In this work, we present another promising way to use computational science in vaccinology: mathematical and computational models of important cell and protein dynamics of the immune system. A system of Ordinary Differential Equations represents different immune system populations, such as B cells and T cells, antigen presenting cells and antibodies. In this way, it is possible to simulate, in silico, the immune response to vaccines under development or under study. Distinct scenarios can be simulated by varying parameters of the mathematical model. As a proof of concept, we developed a model of the immune response to vaccination against the yellow fever. Our simulations have shown consistent results when compared with experimental data available in the literature. The model is generic enough to represent the action of other diseases or vaccines in the human immune system, such as dengue and Zika virus.

Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions.

The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies.

On the coupling of two models of the human immune response to an antigen.

The development of mathematical models of the immune response allows a better understanding of the multifaceted mechanisms of the defense system. The main purpose of this work is to present a scheme for coupling distinct models of different scales and aspects of the immune system. As an example, we propose a new model where the local tissue inflammation processes are simulated with partial differential equations (PDEs) whereas a system of ordinary differential equations (ODEs) is used as a model for the systemic response. The simulation of distinct scenarios allows the analysis of the dynamics of various immune cells in the presence of an antigen. Preliminary results of this approach with a sensitivity analysis of the coupled model are shown but further validation is still required.

On the computational modeling of the innate immune system.

In recent years, there has been an increasing interest in the mathematical and computational modeling of the human immune system (HIS). Computational models of HIS dynamics may contribute to a better understanding of the relationship between complex phenomena and immune response; in addition, computational models will support the development of new drugs and therapies for different diseases. However, modeling the HIS is an extremely difficult task that demands a huge amount of work to be performed by multidisciplinary teams. In this study, our objective is to model the spatio-temporal dynamics of representative cells and molecules of the HIS during an immune response after the injection of lipopolysaccharide (LPS) into a section of tissue. LPS constitutes the cellular wall of Gram-negative bacteria, and it is a highly immunogenic molecule, which means that it has a remarkable capacity to elicit strong immune responses. We present a descriptive, mechanistic and deterministic model that is based on partial differential equations (PDE). Therefore, this model enables the understanding of how the different complex phenomena interact with structures and elements during an immune response. In addition, the model's parameters reflect physiological features of the system, which makes the model appropriate for general use.

Simulations of complex and microscopic models of cardiac electrophysiology powered by multi-GPU platforms.

Key aspects of cardiac electrophysiology, such as slow conduction, conduction block, and saltatory effects have been the research topic of many studies since they are strongly related to cardiac arrhythmia, reentry, fibrillation, or defibrillation. However, to reproduce these phenomena the numerical models need to use subcellular discretization for the solution of the PDEs and nonuniform, heterogeneous tissue electric conductivity. Due to the high computational costs of simulations that reproduce the fine microstructure of cardiac tissue, previous studies have considered tissue experiments of small or moderate sizes and used simple cardiac cell models. In this paper, we develop a cardiac electrophysiology model that captures the microstructure of cardiac tissue by using a very fine spatial discretization (8 µm) and uses a very modern and complex cell model based on Markov chains for the characterization of ion channel's structure and dynamics. To cope with the computational challenges, the model was parallelized using a hybrid approach: cluster computing and GPGPUs (general-purpose computing on graphics processing units). Our parallel implementation of this model using a multi-GPU platform was able to reduce the execution times of the simulations from more than 6 days (on a single processor) to 21 minutes (on a small 8-node cluster equipped with 16 GPUs, i.e., 2 GPUs per node).

Computational modeling of microabscess formation.

Bacterial infections can be of two types: acute or chronic. The chronic bacterial infections are characterized by being a large bacterial infection and/or an infection where the bacteria grows rapidly. In these cases, the immune response is not capable of completely eliminating the infection which may lead to the formation of a pattern known as microabscess (or abscess). The microabscess is characterized by an area comprising fluids, bacteria, immune cells (mainly neutrophils), and many types of dead cells. This distinct pattern of formation can only be numerically reproduced and studied by models that capture the spatiotemporal dynamics of the human immune system (HIS). In this context, our work aims to develop and implement an initial computational model to study the process of microabscess formation during a bacterial infection.