Nonlinear simulations of solid tumor growth using a mixture model: invasion and branching

Mechanistic insight for T-cell exclusion by cancer-associated fibroblasts in human lung cancer

The tumor stroma consists mainly of extracellular matrix, fibroblasts, immune cells, and vasculature. Its structure and functions are altered during malignancy: tumor cells transform fibroblasts into cancer-associated fibroblasts, which exhibit immunosuppressive activities on which growth and metastasis depend. These include exclusion of immune cells from the tumor nest, cancer progression, and inhibition of T-cell-based immunotherapy. To understand these complex interactions, we measure the density of different cell types in the stroma using immunohistochemistry techniques on tumor samples from lung cancer patients. We incorporate these data into a minimal dynamical system, explore the variety of outcomes, and finally establish a spatio-temporal model that explains the cell distribution. We reproduce that cancer-associated fibroblasts act as a barrier to tumor expansion, but also reduce the efficiency of the immune response. Our conclusion is that the final outcome depends on the parameter values for each patient and leads to either tumor invasion, persistence, or eradication as a result of the interplay between cancer cell growth, T-cell cytotoxicity, and fibroblast activity. However, despite the existence of a wide range of scenarios, distinct trajectories, and patterns allow quantitative predictions that may help in the selection of new therapies and personalized protocols.

Efficient numerical approaches with accelerated graphics processing unit (GPU) computations for Poisson problems and Cahn-Hilliard equations

In this computational paper, we focused on the efficient numerical implementation of semi-implicit methods for models in materials science. In particular, we were interested in a class of nonlinear higher-order parabolic partial differential equations. The Cahn-Hilliard (CH) equation was chosen as a benchmark problem for our proposed methods. We first considered the Cahn-Hilliard equation with a convexity-splitting (CS) approach coupled with a backward Euler approximation of the time derivative and tested the performance against the bi-harmonic-modified (BHM) approach in terms of accuracy, order of convergence, and computation time. Higher-order time-stepping techniques that allow for the methods to increase their accuracy and order of convergence were then introduced. The proposed schemes in this paper were found to be very efficient for 2D computations. Computed dynamics in 2D and 3D are presented to demonstrate the energy-decreasing property and overall performance of the methods for longer simulation runs with a variety of initial conditions. In addition, we also present a simple yet powerful way to accelerate the computations by using MATLAB built-in commands to perform GPU implementations of the schemes. We show that it is possible to accelerate computations for the CH equation in 3D by a factor of 80, provided the hardware is capable enough.

1D Thermoembolization Model Using CT Imaging Data for Porcine Liver

Objective

Innovative therapies such as thermoembolization are expected to play an important role in improving care for patients with diseases such as hepatocellular carcinoma. Thermoembolization is a minimally invasive strategy that combines thermal ablation and embolization in a single procedure. This approach exploits an exothermic chemical reaction that occurs when an acid chloride is delivered via an endovascular route. However, comprehension of the complexities of the biophysics of thermoembolization is challenging. Mathematical models can aid in understanding such complex processes and assisting clinicians in making informed decisions. In this study, we used a Hagen-Poiseuille 1D blood flow model to predict the mass transport and possible embolization locations in a porcine hepatic artery.

Method

The 1D flow model was used on imaging data of in-vivo embolization imaging data of three pigs. The hydrolysis time constant of acid chloride chemical reaction was optimized for each pig, and LOOCV method was used to test the model's predictive ability.

Conclusion

This basic model provided a balanced accuracy rate of 66.8% for identifying the possible locations of damage in the hepatic artery. Use of the model provides an initial understanding of the vascular transport phenomena that are predicted to occur as a result of thermoembolization.

A mixture-like model for tumor-immune system interactions

We introduce a mathematical model based on mixture theory intended to describe the tumor-immune system interactions within the tumor microenvironment. The equations account for the geometry of the tumor expansion, and the displacement of the immune cells, driven by diffusion and chemotactic mechanisms. They also take into account the constraints in terms of nutrient and oxygen supply. The numerical investigations analyze the impact of the different modeling assumptions and parameters. Depending on the parameters, the model can reproduce elimination, equilibrium or escape phases and it identifies a critical role of oxygen/nutrient supply in shaping the tumor growth. In addition, antitumor immune cells are key factors in controlling tumor growth, maintaining an equilibrium while protumor cells favor escape and tumor expansion.

A phase-field model for non-small cell lung cancer under the effects of immunotherapy

Formulating mathematical models that estimate tumor growth under therapy is vital for improving patient-specific treatment plans. In this context, we present our recent work on simulating non-small-scale cell lung cancer (NSCLC) in a simple, deterministic setting for two different patients receiving an immunotherapeutic treatment. At its core, our model consists of a Cahn-Hilliard-based phase-field model describing the evolution of proliferative and necrotic tumor cells. These are coupled to a simplified nutrient model that drives the growth of the proliferative cells and their decay into necrotic cells. The applied immunotherapy decreases the proliferative cell concentration. Here, we model the immunotherapeutic agent concentration in the entire lung over time by an ordinary differential equation (ODE). Finally, reaction terms provide a coupling between all these equations. By assuming spherical, symmetric tumor growth and constant nutrient inflow, we simplify this full 3D cancer simulation model to a reduced 1D model. We can then resort to patient data gathered from computed tomography (CT) scans over several years to calibrate our model. Our model covers the case in which the immunotherapy is successful and limits the tumor size, as well as the case predicting a sudden relapse, leading to exponential tumor growth. Finally, we move from the reduced model back to the full 3D cancer simulation in the lung tissue. Thereby, we demonstrate the predictive benefits that a more detailed patient-specific simulation including spatial information as a possible generalization within our framework could yield in the future.

Morphological instability of solid tumors in a nutrient-deficient environment

A phenomenological reaction-diffusion model that includes a nutrient-regulated growth rate of tumor cells is proposed to investigate the morphological instability of solid tumors during the avascular growth. We find that the surface instability could be induced more easily when tumor cells are placed in a harsher nutrient-deficient environment, while the instability is suppressed for tumor cells in a nutrient-rich environment due to the nutrient-regulated proliferation. In addition, the surface instability is shown to be influenced by the growth moving speed of tumor rims. Our analysis reveals that a larger growth movement of the tumor front results in a closer proximity of tumor cells to a nutrient-rich region, which tends to inhibit the surface instability. A nourished length that represents the proximity is defined to illustrate its close relation to the surface instability.

Tumor Evolution Models of Phase-Field Type with Nonlocal Effects and Angiogenesis

In this survey article, a variety of systems modeling tumor growth are discussed. In accordance with the hallmarks of cancer, the described models incorporate the primary characteristics of cancer evolution. Specifically, we focus on diffusive interface models and follow the phase-field approach that describes the tumor as a collection of cells. Such systems are based on a multiphase approach that employs constitutive laws and balance laws for individual constituents. In mathematical oncology, numerous biological phenomena are involved, including temporal and spatial nonlocal effects, complex nonlinearities, stochasticity, and mixed-dimensional couplings. Using the models, for instance, we can express angiogenesis and cell-to-matrix adhesion effects. Finally, we offer some methods for numerically approximating the models and show simulations of the tumor's evolution in response to various biological effects.

Evaluation of innate and adaptive immune system interactions in the tumor microenvironment via a 3D continuum model

Immune cells in the tumor microenvironment (TME) are known to affect tumor growth, vascularization, and extracellular matrix (ECM) deposition. Marked interest in system-scale analysis of immune species interactions within the TME has encouraged progress in modeling tumor-immune interactions in silico. Due to the computational cost of simulating these intricate interactions, models have typically been constrained to representing a limited number of immune species. To expand the capability for system-scale analysis, this study develops a three-dimensional continuum mixture model of tumor-immune interactions to simulate multiple immune species in the TME. Building upon a recent distributed computing implementation that enables efficient solution of such mixture models, major immune species including monocytes, macrophages, natural killer cells, dendritic cells, neutrophils, myeloid-derived suppressor cells (MDSC), cytotoxic, helper, regulatory T-cells, and effector and regulatory B-cells and their interactions are represented in this novel implementation. Immune species extravasate from blood vasculature, undergo chemotaxis toward regions of high chemokine concentration, and influence the TME in proportion to locally defined levels of stimulation. The immune species contribute to the production of angiogenic and tumor growth factors, promotion of myofibroblast deposition of ECM, upregulation of angiogenesis, and elimination of living and dead tumor species. The results show that this modeling approach offers the capability for quantitative insight into the modulation of tumor growth by diverse immune-tumor interactions and immune-driven TME effects. In particular, MDSC-mediated effects on tumor-associated immune species' activation levels, volume fraction, and influence on the TME are explored. Longer term, linking of the model parameters to particular patient tumor information could simulate cancer-specific immune responses and move toward a more comprehensive evaluation of immunotherapeutic strategies.

Mocafe: a comprehensive Python library for simulating cancer development with Phase Field Models

SUMMARY

Mathematical models are effective in studying cancer development at different scales from metabolism to tissue. Phase Field Models (PFMs) have been shown to reproduce accurately cancer growth and other related phenomena, including expression of relevant molecules, extracellular matrix remodeling and angiogenesis. However, implementations of such models are rarely published, reducing access to these techniques. To reduce this gap, we developed Mocafe, a modular open-source Python package that implements some of the most important PFMs reported in the literature. Mocafe is designed to handle both PFMs purely based on differential equations and hybrid agent-based PFMs. Moreover, Mocafe is meant to be extensible, allowing the inclusion of new models in future releases.

AVAILABILITY AND IMPLEMENTATION

Mocafe is a Python package based on FEniCS, a popular computing platform for solving partial differential equations. The source code, extensive documentation and demos are provided on GitHub at URL: https://github.com/BioComputingUP/mocafe. Moreover, we uploaded on Zenodo an archive of the package, which is available at https://doi.org/10.5281/zenodo.6366052.

A continuum mechanical framework for modeling tumor growth and treatment in two- and three-phase systems

The growth and treatment of tumors is an important problem to society that involves the manifestation of cellular phenomena at length scales on the order of centimeters. Continuum mechanical approaches are being increasingly used to model tumors at the largest length scales of concern. The issue of how to best connect such descriptions to smaller-scale descriptions remains open. We formulate a framework to derive macroscale models of tumor behavior using the thermodynamically constrained averaging theory (TCAT), which provides a firm connection with the microscale and constraints on permissible forms of closure relations. We build on developments in the porous medium mechanics literature to formulate fundamental entropy inequality expressions for a general class of three-phase, compositional models at the macroscale. We use the general framework derived to formulate two classes of models, a two-phase model and a three-phase model. The general TCAT framework derived forms the basis for a wide range of potential models of varying sophistication, which can be derived, approximated, and applied to understand not only tumor growth but also the effectiveness of various treatment modalities.

Improved cellular automata model shows that indirect apoptotic cell death due to vascular damage enhances the local control of tumors by single fraction high-dose irradiation

We investigated the effects of indirect apoptotic cell death due to vascular damage on tumor response to a single large dose with an improved two-dimensional cellular automata model. The tumor growth was simulated by considering the oxygen and nutrients supplied to the tumor through the blood vessels. The cell damage processes were modeled by taking account of the direct cell death and the indirect death due to the radiation-induced vascular damages. The radiation increased the permeation of oxygen and nutrients through the blood vessel or caused the breakdown of the vasculature. The amount of oxygen in cancer cells affected the response of cancer cells to radiation and the tumor growth rate after irradiation. The lack of oxygen led to the apoptotic death of cancer cells. We calculated the tumor control probability (TCP) at different radiation doses, the probability of apoptotic death, the threshold of the oxygen level for indirect apoptotic death, the average oxygen level in cancer cells and the vessel survival probability after radiation damage. Due to the vessel damage, indirect cell death led to a 4% increase in TCP for the dose ranging from 15 Gy to 20 Gy. TCP increased with increasing the probability of apoptotic death and the threshold of the oxygen level for indirect apoptotic death due to increased apoptotic death. The variation of TCP as a function of the average oxygen level exhibited the minimum at the average oxygen level of 2.7%. The apoptosis increased as the average oxygen level decreased, leading to an increasing TCP. On the other hand, the direct radiation damage increased, and the apoptosis decreased for higher average oxygen level, resulting in a higher TCP. We showed by modeling the radiation damage of blood vessels in a 2D CA simulation that the indirect apoptotic death of cancer cells, caused by the reduction of the oxygen level due to vascular damage after high dose irradiation, increased TCP.

Mathematical model and computational scheme for multi-phase modeling of cellular population and microenvironmental dynamics in soft tissue

In this paper we introduce a system of partial differential equations that is capable of modeling a variety of dynamic processes in soft tissue cellular populations and their microenvironments. The model is designed to be general enough to simulate such processes as tissue regeneration, tumor growth, immune response, and many more. It also has built-in flexibility to include multiple chemical fields and/or sub-populations of cells, interstitial fluid and/or extracellular matrix. The model is derived from the conservation laws for mass and linear momentum and therefore can be classified as a continuum multi-phase model. A careful choice of state variables provides stability in solving the system of discretized equations defining advective flux terms. A concept of deviation from normal allows us to use simplified constitutive relations for stresses. We also present an algorithm for computing numerical approximations to the solutions of the system and discuss properties of these approximations. We demonstrate several examples of applications of the model. Numerical simulations show a significant potential of the model for simulating a variety of processes in soft tissues.

Mathematical simulation and prediction of tumor volume using RBF artificial neural network at different circumstances in the tumor microenvironment

Uncontrolled proliferation of cells in a tissue caused by genetic mutations inside a cell is referred to as a tumor. A tumor which grows rapidly encounters a barrier when it grows to a certain size in presence of preexisting vasculature. This is the time when it has to find a way to go on the growth. The tumor starts to secrete tumor angiogenic factors (TAFs) and stimulate preexisting vessels to grow new sprouts. These new sprouts will find their way to the tumor in the extracellular matrix (ECM) by the gradient of TAF. As these new capillaries anastomose and reach tumor, fresh oxygen is available for the tumor and it will reinitiate the growth. Number of initial sprouts, distance of initial tumor cells from the vessel(s) and initial density of the tumor at the time of sprout formation are questions which are to be investigated. In the present study, the aim is to find the response of tumor cells and vessels to the reciprocal effects of each other in different circumstances in the tissue. Together with a mathematical formulation, a radial basis function (RBF) neural network is established to predict the number of tumor cells at different circumstances including size and distance of initial tumors from the parent vessel. A final formulation is given for the final number of tumor cells as a function of initial tumor size and distance between a parent vessel and a tumor. Results of this simulation demonstrate that, increasing the distance between a tumor and a parent vessel decreases the number of final tumor cells. Specially, this decrement becomes faster beyond a certain distance. Moreover, initial tumors in bigger domains must become much bigger before inducing angiogenesis which makes it harder for them to survive.

Simulation of 3D centimeter-scale continuum tumor growth at sub-millimeter resolution via distributed computing

Simulation of cm-scale tumor growth has generally been constrained by the computational cost to numerically solve the associated equations, with models limited to representing mm-scale or smaller tumors. While the work has proven useful to the study of small tumors and micro-metastases, a biologically-relevant simulation of cm-scale masses as would be typically detected and treated in patients has remained an elusive goal. This study presents a distributed computing (parallelized) implementation of a mixture model of tumor growth to simulate 3D cm-scale vascularized tissue at sub-mm resolution. The numerical solving scheme utilizes a two-stage parallelization framework. The solution is written for GPU computation using the CUDA framework, which handles all Multigrid-related computations. Message Passing Interface (MPI) handles distribution of information across multiple processes, freeing the program from RAM and the processing limitations found on single systems. On each system, Nvidia's CUDA library allows for fast processing of model data using GPU-bound computing on fewer systems. The results show that a combined MPI-CUDA implementation enables the continuum modeling of cm-scale tumors at reasonable computational cost. Further work to calibrate model parameters to particular tumor conditions could enable simulation of patient-specific tumors for clinical application.

In Silico Mathematical Modelling for Glioblastoma: A Critical Review and a Patient-Specific Case

Glioblastoma extensively infiltrates the brain; despite surgery and aggressive therapies, the prognosis is poor. A multidisciplinary approach combining mathematical, clinical and radiological data has the potential to foster our understanding of glioblastoma evolution in every single patient, with the aim of tailoring therapeutic weapons. In particular, the ultimate goal of biomathematics for cancer is the identification of the most suitable theoretical models and simulation tools, both to describe the biological complexity of carcinogenesis and to predict tumor evolution. In this report, we describe the results of a critical review about different mathematical models in neuro-oncology with their clinical implications. A comprehensive literature search and review for English-language articles concerning mathematical modelling in glioblastoma has been conducted. The review explored the different proposed models, classifying them and indicating the significative advances of each one. Furthermore, we present a specific case of a glioblastoma patient in which our recently proposed innovative mechanical model has been applied. The results of the mathematical models have the potential to provide a relevant benefit for clinicians and, more importantly, they might drive progress towards improving tumor control and patient's prognosis. Further prospective comparative trials, however, are still necessary to prove the impact of mathematical neuro-oncology in clinical practice.

Indirect Contributions to Tumor Dynamics in the First Stage of the Avascular Phase

A continuum model for tumor invasion in a two-dimensional spatial domain based on the interaction of the urokinase plasminogen activation system with a model for cancer cell dynamics is proposed. The arising system of partial differential equations is numerically solved using the finite element method. We simulated a portion of biological tissue imposing no flux boundary conditions. We monitored the cancer cell dynamics, as well the degradation of an extra cellular matrix representative, vitronectin, and the evolution of a specific degrading enzyme, plasmin, inside the biological tissue. The computations were parameterized as a function of the indirect cell proliferation induced by a plasminogen activator inhibitor binding to vitronectin and of the indirect plasmin deactivation due to the plasminogen activator inhibitor binding to the urokinase plasminogen activator. Their role during the cancer dynamical evolution was identified, together with a possible marker helping the mapping of the cancer invasive front. Our results indicate that indirect cancer cell proliferation biases the speed of the tumor invasive front as well as the heterogeneity of the cancer cell clustering and networking, as it ultimately acts on the proteolytic activity supporting cancer formation. Because of the initial conditions imposed, the numerical solutions of the model show a symmetrical dynamical evolution of heterogeneities inside the simulated domain. Moreover, an increase of up to about 12% in the invasion speed was observed, increasing the rate of indirect cancer cell proliferation, while increasing the plasmin deactivation rate inhibits heterogeneities and networking. As cancer cell proliferation causes vitronectin consumption and plasmin formation, the intensities of the concentration maps of both vitronectin and plasmin are superimposable to the cancer cell concentration maps. The qualitative imprinting that cancer cells leave on the extra cellular matrix during the time evolution as well their activity area is identified, framing the numerical results in the context of a methodology aimed at diagnostic and therapeutic improvement.

A Coupled Mass Transport and Deformation Theory of Multi-constituent Tumor Growth

We develop a general class of thermodynamically consistent, continuum models based on mixture theory with phase effects that describe the behavior of a mass of multiple interacting constituents. The constituents consist of solid species undergoing large elastic deformations and compressible viscous fluids. The fundamental building blocks framing the mixture theories consist of the mass balance law of diffusing species and microscopic (cellular scale) and macroscopic (tissue scale) force balances, as well as energy balance and the entropy production inequality derived from the first and second laws of thermodynamics. A general phase-field framework is developed by closing the system through postulating constitutive equations (i.e., specific forms of free energy and rate of dissipation potentials) to depict the growth of tumors in a microenvironment. A notable feature of this theory is that it contains a unified continuum mechanics framework for addressing the interactions of multiple species evolving in both space and time and involved in biological growth of soft tissues (e.g., tumor cells and nutrients). The formulation also accounts for the regulating roles of the mechanical deformation on the growth of tumors, through a physically and mathematically consistent coupled diffusion and deformation framework. A new algorithm for numerical approximation of the proposed model using mixed finite elements is presented. The results of numerical experiments indicate that the proposed theory captures critical features of avascular tumor growth in the various microenvironment of living tissue, in agreement with the experimental studies in the literature.

Optimization of irradiation interval for fractionated stereotactic radiosurgery by a cellular automata model with reoxygenation effects

The current study aims to determine the optimal irradiation interval of fractionated stereotactic radiosurgery (SRS) by using an improved cellular automata (CA) model. The tumor growth process was simulated by considering the amount of oxygen and the density of blood vessels, which supplied oxygen and nutrient required for cell growth. Cancer cells died by the mitotic death process due to radiation, which was quantified by the LQ-model, or the apoptosis due to the lack of nutrients. The radiation caused increased permeation of plasma protein through the blood vessel or the breakdown of the vasculature. Consequently, these changes lead to a change in radiation sensitivity of cancer cells and tumor growth rate after irradiation. The optimal model parameters were determined with experimental data of the rat tumor volume. The tumor control probability (TCP) was defined as the ratio of the number of histories in which all cancer cells died after the irradiation to the total number of the histories per simulation. The optimal irradiation interval was defined as the irradiation interval that TCP was the maximum. For one fractionation treatment, the ratio of hypoxic cells to the total number of cancer cells kept decreasing until day 16th after irradiation; whereas the number of surviving cancer cells begun increasing immediately after irradiation. This intricate relationship between the hypoxia (or reoxygenation) and the number of cancer cells lead to an optimal irradiation interval for the second irradiation. The optimal irradiation interval for two-fraction SRS was six days. The optimum intervals for the first-second irradiations and the second-third irradiations were five and two days, respectively, for three fraction SRS. For 4 and 5-fraction treatments, the optimum first-interval was five days, which was similar to three fraction treatment. The remaining intervals should be one day. We showed that the improved CA model could be used to optimize the irradiation interval by explicitly including the reoxygenation after irradiation in the model.

Complex Far-Field Geometries Determine the Stability of Solid Tumor Growth with Chemotaxis

In this paper, we develop a sharp interface tumor growth model to study the effect of the tumor microenvironment using a complex far-field geometry that mimics a heterogeneous distribution of vasculature. Together with different nutrient uptake rates inside and outside the tumor, this introduces variability in spatial diffusion gradients. Linear stability analysis suggests that the uptake rate in the tumor microenvironment, together with chemotaxis, may induce unstable growth, especially when the nutrient gradients are large. We investigate the fully nonlinear dynamics using a spectrally accurate boundary integral method. Our nonlinear simulations reveal that vascular heterogeneity plays an important role in the development of morphological instabilities that range from fingering and chain-like morphologies to compact, plate-like shapes in two dimensions.

Role of mechanical cues and hypoxia on the growth of tumor cells in strong and weak confinement: A dual in vitro-in silico approach

Characterization of tumor growth dynamics is of major importance for cancer understanding. By contrast with phenomenological approaches, mechanistic modeling can facilitate disclosing underlying tumor mechanisms and lead to identification of physical factors affecting proliferation and invasive behavior. Current mathematical models are often formulated at the tissue or organ scale with the scope of a direct clinical usefulness. Consequently, these approaches remain empirical and do not allow gaining insight into the tumor properties at the scale of small cell aggregates. Here, experimental and numerical studies of the dynamics of tumor aggregates are performed to propose a physics-based mathematical model as a general framework to investigate tumor microenvironment. The quantitative data extracted from the cellular capsule technology microfluidic experiments allow a thorough quantitative comparison with in silico experiments. This dual approach demonstrates the relative impact of oxygen and external mechanical forces during the time course of tumor model progression.

Role of imaging biomarkers for prognostic prediction in patients with pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive tumours. PDAC has a poor prognosis; therefore, it is necessary to perform further risk stratification. Identifying prognostic factors before treatment might help to implement suitable and personalised treatment for individuals and avoid side effects. Conventional staging systems and tumour biomarkers are fundamental to establish prognosis; however, they have obvious limitations. Novel imaging biomarkers extracted from advanced imaging techniques offer opportunities to evaluate underlying tumour physiological characteristics, such as mutational status, cellular composition, local microenvironment, tumour metabolism, and biological behaviour. Thus, imaging biomarkers might help the decision making of oncologists and surgeons. The present review discusses the functions of imaging biomarkers for prognostic prediction in patients with PDAC and their potential value for further translation in clinical practice.

Using mathematics in MRI data management for glioma assesment

Our aim is to review the mathematical tools usefulness in MR data management for glioma diagnosis and treatment optimization. MRI does not give access to organs variations in hours or days. However a lot of multiparametric data are generated. Mathematics could help to override this paradox, the aim of this article is to show how. We first make a review on mathematical modelling using equations. Afterwards we present statistical analysis. We provide detailed examples in both sections. We finally conclude, giving some clues on in silico models.

Parallel splitting solvers for the isogeometric analysis of the Cahn-Hilliard equation

Modeling tumor growth in biological systems is a challenging problem with important consequences for diagnosis and treatment of various forms of cancer. This growth process requires large simulation complexity due to evolving biological and chemical processes in living tissue and interactions of cellular and vascular constituents in living organisms. Herein, we describe with a phase-field model, namely the Cahn-Hilliard equation the intricate interactions between the tumors and their host tissue. The spatial discretization uses highly-continuous isogeometric elements. For fast simulation of the time-dependent Cahn-Hilliard equation, we employ an alternating directions implicit methodology. Thus, we reduce the original problems to Kronecker products of 1 D matrices that can be factorized in a linear computational cost. The implementation enables parallel multi-core simulations and shows good scalability on shared-memory multi-core machines. Combined with the high accuracy of isogeometric elements, our method shows high efficiency in solving the Cahn-Hilliard equation on tensor-product meshes.

A Distributed Control Problem for a Fractional Tumor Growth Model

In this paper, we study the distributed optimal control of a system of three evolutionary equations involving fractional powers of three self-adjoint, monotone, unbounded linear operators having compact resolvents. The system is a generalization of a Cahn–Hilliard type phase field system modeling tumor growth that has been proposed by Hawkins–Daarud, van der Zee and Oden. The aim of the control process, which could be realized by either administering a drug or monitoring the nutrition, is to keep the tumor cell fraction under control while avoiding possible harm for the patient. In contrast to previous studies, in which the occurring unbounded operators governing the diffusional regimes were all given by the Laplacian with zero Neumann boundary conditions, the operators may in our case be different; more generally, we consider systems with fractional powers of the type that were studied in a recent work by the present authors. In our analysis, we show the Fréchet differentiability of the associated control-to-state operator, establish the existence of solutions to the associated adjoint system, and derive the first-order necessary conditions of optimality for a cost functional of tracking type.

Three-dimensional tumor growth in time-varying chemical fields: a modeling framework and theoretical study

Background

Contemporary biological observations have revealed a large variety of mechanisms acting during the expansion of a tumor. However, there are still many qualitative and quantitative aspects of the phenomenon that remain largely unknown. In this context, mathematical and computational modeling appears as an invaluable tool providing the means for conducting in silico experiments, which are cheaper and less tedious than real laboratory experiments.

Results

This paper aims at developing an extensible and computationally efficient framework for in silico modeling of tumor growth in a 3-dimensional, inhomogeneous and time-varying chemical environment. The resulting model consists of a set of mathematically derived and algorithmically defined operators, each one addressing the effects of a particular biological mechanism on the state of the system. These operators may be extended or re-adjusted, in case a different set of starting assumptions or a different simulation scenario needs to be considered.

Conclusion

In silico modeling provides an alternative means for testing hypotheses and simulating scenarios for which exact biological knowledge remains elusive. However, finer tuning of pertinent methods presupposes qualitative and quantitative enrichment of available biological evidence. Validation in a strict sense would further require comprehensive, case-specific simulations and detailed comparisons with biomedical observations.

A Biomechanical Model of Tumor-Induced Intracranial Pressure and Edema in Brain Tissue

Brain tumor growth and tumor-induced edema result in increased intracranial pressure (ICP), which, in turn, is responsible for conditions as benign as headaches and vomiting or as severe as seizures, neurological damage, or even death. Therefore, it has been hypothesized that tracking ICP dynamics may offer improved prognostic potential in terms of early detection of brain cancer and better delimitation of the tumor boundary. However, translating such theory into clinical practice remains a challenge, in part because of an incomplete understanding of how ICP correlates with tumor grade. Here, we propose a multiphase mixture model that describes the biomechanical response of healthy brain tissue-in terms of changes in ICP and edema-to a growing tumor. The model captures ICP dynamics within the diseased brain and accounts for the ability/inability of healthy tissue to compensate for this pressure. We propose parameter regimes that distinguish brain tumors by grade, thereby providing critical insight into how ICP dynamics vary by severity of disease. In particular, we offer an explanation for clinically observed phenomena, such as a lack of symptoms in low-grade glioma patients versus a rapid onset of symptoms in those with malignant tumors. Our model also takes into account the effects tumor-derived proteases may have on ICP levels and the extent of tumor invasion. This work represents an important first step toward understanding the mechanisms that underlie the onset of edema and ICP in cancer-afflicted brains. Continued modeling effort in this direction has the potential to make an impact in the field of brain cancer diagnostics.

Mechanobiological Stability of Biological Soft Tissues

Like all other materials, biological soft tissues are subject to general laws of physics, including those governing mechanical equilibrium and stability. In addition, however, these tissues are able to respond actively to changes in their mechanical and chemical environment. There is, therefore, a pressing need to understand such processes theoretically. In this paper, we present a new rate-based constrained mixture formulation suitable for studying mechanobiological equilibrium and stability of soft tissues exposed to transient or sustained changes in material composition or applied loading. These concepts are illustrated for canonical problems in arterial mechanics, which distinguish possible stable versus unstable mechanobiological responses. Such analyses promise to yield insight into biological processes that govern both health and disease progression.

A Visually Apparent and Quantifiable CT Imaging Feature Identifies Biophysical Subtypes of Pancreatic Ductal Adenocarcinoma

PURPOSE

Pancreatic ductal adenocarcinoma (PDAC) is a heterogeneous disease with variable presentations and natural histories of disease. We hypothesized that different morphologic characteristics of PDAC tumors on diagnostic computed tomography (CT) scans would reflect their underlying biology.

EXPERIMENTAL DESIGN

We developed a quantitative method to categorize the PDAC morphology on pretherapy CT scans from multiple datasets of patients with resectable and metastatic disease and correlated these patterns with clinical/pathologic measurements. We modeled macroscopic lesion growth computationally to test the effects of stroma on morphologic patterns, hypothesizing that the balance of proliferation and local migration rates of the cancer cells would determine tumor morphology.

RESULTS

In localized and metastatic PDAC, quantifying the change in enhancement on CT scans at the interface between tumor and parenchyma (delta) demonstrated that patients with conspicuous (high-delta) tumors had significantly less stroma, higher likelihood of multiple common pathway mutations, more mesenchymal features, higher likelihood of early distant metastasis, and shorter survival times compared with those with inconspicuous (low-delta) tumors. Pathologic measurements of stromal and mesenchymal features of the tumors supported the mathematical model's underlying theory for PDAC growth.

CONCLUSIONS

At baseline diagnosis, a visually striking and quantifiable CT imaging feature reflects the molecular and pathological heterogeneity of PDAC, and may be used to stratify patients into distinct subtypes. Moreover, growth patterns of PDAC may be described using physical principles, enabling new insights into diagnosis and treatment of this deadly disease.

A continuum thermomechanical model of in vivo electrosurgical heating of hydrated soft biological tissues

Radio-frequency (RF) heating of soft biological tissues during electrosurgical procedures is a fast process that involves phase change through evaporation and transport of intra- and extra-cellular water, and where variations in physical properties with temperature and water content play significant role. Accurately predicting and capturing these effects would improve the modeling of temperature change in the tissue allowing the development of improved instrument design and better understanding of tissue damage and necrosis. Previous models based on the Pennes' bioheat model neglect both evaporation and transport or consider evaporation through numerical correlations, however, do not account for changes in physical properties due to mass transport or phase change, nor capture the pressure increase due to evaporation within the tissue. While a porous media approach can capture the effects of evaporation, transport, pressure and changes in physical properties, the model assumes free diffusion of liquid and gas without a careful examination of assumptions on transport parameters in intact tissue resulting in significant under prediction of temperature. These different approaches have therefore been associated with errors in temperature prediction exceeding 20% when compared to experiments due to inaccuracies in capturing the effects of evaporation losses and transport. Here, we present a model of RF heating of hydrated soft tissue based on mixture theory where the multiphase nature of tissue is captured within a continuum thermomechanics framework, simultaneously considering the transport, deformation and phase change losses due to evaporation that occur during electrosurgical heating. The model predictions are validated against data obtained for in vivo ablation of porcine liver tissue at various power settings of the electrosurgical unit. The model is able to match the mean experimental temperature data with sharp gradients in the vicinity of the electrode during rapid low and high power ablation procedures with errors less than 7.9%. Additionally, the model is able to capture fast vaporization losses and the corresponding increase in pressure due to vapor buildup which have a significant effect on temperature prediction beyond 100 °C.

Calibration of Multi-Parameter Models of Avascular Tumor Growth Using Time Resolved Microscopy Data

Two of the central challenges of using mathematical models for predicting the spatiotemporal development of tumors is the lack of appropriate data to calibrate the parameters of the model, and quantitative characterization of the uncertainties in both the experimental data and the modeling process itself. We present a sequence of experiments, with increasing complexity, designed to systematically calibrate the rates of apoptosis, proliferation, and necrosis, as well as mobility, within a phase-field tumor growth model. The in vitro experiments characterize the proliferation and death of human liver carcinoma cells under different initial cell concentrations, nutrient availabilities, and treatment conditions. A Bayesian framework is employed to quantify the uncertainties in model parameters. The average difference between the calibration and the data, across all time points is between 11.54% and 14.04% for the apoptosis experiments, 7.33% and 23.30% for the proliferation experiments, and 8.12% and 31.55% for the necrosis experiments. The results indicate the proposed experiment-computational approach is generalizable and appropriate for step-by-step calibration of multi-parameter models, yielding accurate estimations of model parameters related to rates of proliferation, apoptosis, and necrosis.

Nonlinear studies of tumor morphological stability using a two-fluid flow model

We consider the nonlinear dynamics of an avascular tumor at the tissue scale using a two-fluid flow Stokes model, where the viscosity of the tumor and host microenvironment may be different. The viscosities reflect the combined properties of cell and extracellular matrix mixtures. We perform a linear morphological stability analysis of the tumors, and we investigate the role of nonlinearity using boundary-integral simulations in two dimensions. The tumor is non-necrotic, although cell death may occur through apoptosis. We demonstrate that tumor evolution is regulated by a reduced set of nondimensional parameters that characterize apoptosis, cell-cell/cell-extracellular matrix adhesion, vascularization and the ratio of tumor and host viscosities. A novel reformulation of the equations enables the use of standard boundary integral techniques to solve the equations numerically. Nonlinear simulation results are consistent with linear predictions for nearly circular tumors. As perturbations develop and grow, the linear and nonlinear results deviate and linear theory tends to underpredict the growth of perturbations. Simulations reveal two basic types of tumor shapes, depending on the viscosities of the tumor and microenvironment. When the tumor is more viscous than its environment, the tumors tend to develop invasive fingers and a branched-like structure. As the relative ratio of the tumor and host viscosities decreases, the tumors tend to grow with a more compact shape and develop complex invaginations of healthy regions that may become encapsulated in the tumor interior. Although our model utilizes a simplified description of the tumor and host biomechanics, our results are consistent with experiments in a variety of tumor types that suggest that there is a positive correlation between tumor stiffness and tumor aggressiveness.

A general framework dedicated to computational morphogenesis Part I - Constitutive equations

In order to understand living organisms, considerable experimental efforts and resources have been devoted to correlate genes and their expressions with cell, tissue, organ and whole organisms' phenotypes. This data driven approach to knowledge discovery has led to many breakthrough in our understanding of healthy and diseased states, and is paving the way to improve the diagnosis and treatment of diseases. Complementary to this data-driven approach, computational models of biological systems based on first principles have been developed in order to deepen our understanding of the multi-scale dynamics that drives normal and pathological biological functions. In this paper we describe the biological, physical and mathematical concepts that led to the design of a Computational Morphogenesis (CM) platform baptized Generic Modeling and Simulating Platform (GMSP). Its role is to generate realistic 3D multi-scale biological tissues from virtual stem cells and the intended target applications include in virtuo studies of normal and abnormal tissue (re)generation as well as the development of complex diseases such as carcinogenesis. At all space-scales of interest, biological agents interact with each other via biochemical, bioelectrical, and mechanical fields that operate in concert during embryogenesis, growth and adult life. The spatio-temporal dependencies of these fields can be modeled by physics-based constitutive equations that we propose to examine in relation to the landmark biological events that occur during embryogenesis.

Translational models of tumor angiogenesis: A nexus of in silico and in vitro models

Emerging evidence shows that endothelial cells are not only the building blocks of vascular networks that enable oxygen and nutrient delivery throughout a tissue but also serve as a rich resource of angiocrine factors. Endothelial cells play key roles in determining cancer progression and response to anti-cancer drugs. Furthermore, the endothelium-specific deposition of extracellular matrix is a key modulator of the availability of angiocrine factors to both stromal and cancer cells. Considering tumor vascular network as a decisive factor in cancer pathogenesis and treatment response, these networks need to be an inseparable component of cancer models. Both computational and in vitro experimental models have been extensively developed to model tumor-endothelium interactions. While informative, they have been developed in different communities and do not yet represent a comprehensive platform. In this review, we overview the necessity of incorporating vascular networks for both in vitro and in silico cancer models and discuss recent progresses and challenges of in vitro experimental microfluidic cancer vasculature-on-chip systems and their in silico counterparts. We further highlight how these two approaches can merge together with the aim of presenting a predictive combinatorial platform for studying cancer pathogenesis and testing the efficacy of single or multi-drug therapeutics for cancer treatment.

Predicting the role of microstructural and biomechanical cues in tumor growth and spreading

A continuum porous media model is developed for elucidating the role of the mechanical cues in regulating tumor growth and spreading. It is shown that stiffer matrices and higher cell-matrix adhesion limit tumor growth and spreading toward the surrounding tissue. Higher matrix porosities, conversely, favor the growth and the dissemination of tumor cells. This model could be used for predicting the response of malignant masses to novel therapeutic agents affecting directly the tumor microenvironment and its micromechanical cues.

The influence of soluble fragments of extracellular matrix (ECM) on tumor growth and morphology

A major challenge in matrix-metalloproteinase (MMP) target validation and MMP-inhibitor-drug development for anti-cancer clinical trials is to better understand their complex roles (often competing with each other) in tumor progression. While there is extensive research on the growth-promoting effects of MMPs, the growth-inhibiting effects of MMPs has not been investigated thoroughly. So we develop a continuum model of tumor growth and invasion including chemotaxis and haptotaxis in order to examine the complex interaction between the tumor and its host microenvironment and to explore the inhibiting influence of the gradients of soluble fragments of extracellular matrix (ECM) density on tumor growth and morphology. Previously, it was shown both computationally (in one spatial dimension) and experimentally that the chemotactic pull due to soluble ECM gradients is anti-invasive, contrary to the traditional view of the role of chemotaxis in malignant invasion [1]. With two-dimensional numerical simulation and using a level set based tumor-host interface capturing method, we examine the effects of chemotaxis on the progression and morphology of a tumor growing in nutrient-rich and nutrient-poor microenvironments which was not investigated before. In particular we examine how the geometry of the growing tumor is affected when placed in different environments. We also investigate the effects of varying ECM degradation rate, the production rate of matrix degrading enzymes (MDE), and the conversion of ECM into soluble ECM. We find that chemotaxis due to ECM-fragment gradients strongly influences tumor growth and morphology, and that the instabilities caused by tumor cell proliferation and haptotactic movements can be prevented if chemotaxis is sufficiently strong. The influence of chemotaxis and the above factors on tumor growth and morphology are found to be more prominent in nutrient-poor environments than in nutrient-rich environments. So we extend our investigations of these antinvasive chemotactic influences by examining the effects of cell-cell and cell-ECM adhesion and low proliferation rate for tumors growing in low-nutrient environments. We find that as the extent of chemotaxis increases, the effects of adhesion on tumor growth and shape become negligible. Under conditions of low cell mitosis, chemotaxis may cause the tumor to shrink, as the extent of chemotaxis increases. Both stable and unstable tumor shrinkage are predicted by our model. Unexpectedly, in some cases chemotaxis may contribute toward developing instability where haptotaxis alone induces stable growth.

Model of vascular desmoplastic multispecies tumor growth

We present a three-dimensional nonlinear tumor growth model composed of heterogeneous cell types in a multicomponent-multispecies system, including viable, dead, healthy host, and extra-cellular matrix (ECM) tissue species. The model includes the capability for abnormal ECM dynamics noted in tumor development, as exemplified by pancreatic ductal adenocarcinoma, including dense desmoplasia typically characterized by a significant increase of interstitial connective tissue. An elastic energy is implemented to provide elasticity to the connective tissue. Cancer-associated fibroblasts (myofibroblasts) are modeled as key contributors to this ECM remodeling. The tumor growth is driven by growth factors released by these stromal cells as well as by oxygen and glucose provided by blood vasculature which along with lymphatics are stimulated to proliferate in and around the tumor based on pro-angiogenic factors released by hypoxic tissue regions. Cellular metabolic processes are simulated, including respiration and glycolysis with lactate fermentation. The bicarbonate buffering system is included for cellular pH regulation. This model system may be of use to simulate the complex interactions between tumor and stromal cells as well as the associated ECM and vascular remodeling that typically characterize malignant cancers notorious for poor therapeutic response.

Tissue-scale, personalized modeling and simulation of prostate cancer growth

Recently, mathematical modeling and simulation of diseases and their treatments have enabled the prediction of clinical outcomes and the design of optimal therapies on a personalized (i.e., patient-specific) basis. This new trend in medical research has been termed "predictive medicine." Prostate cancer (PCa) is a major health problem and an ideal candidate to explore tissue-scale, personalized modeling of cancer growth for two main reasons: First, it is a small organ, and, second, tumor growth can be estimated by measuring serum prostate-specific antigen (PSA, a PCa biomarker in blood), which may enable in vivo validation. In this paper, we present a simple continuous model that reproduces the growth patterns of PCa. We use the phase-field method to account for the transformation of healthy cells to cancer cells and use diffusion-reaction equations to compute nutrient consumption and PSA production. To accurately and efficiently compute tumor growth, our simulations leverage isogeometric analysis (IGA). Our model is shown to reproduce a known shape instability from a spheroidal pattern to fingered growth. Results of our computations indicate that such shift is a tumor response to escape starvation, hypoxia, and, eventually, necrosis. Thus, branching enables the tumor to minimize the distance from inner cells to external nutrients, contributing to cancer survival and further development. We have also used our model to perform tissue-scale, personalized simulation of a PCa patient, based on prostatic anatomy extracted from computed tomography images. This simulation shows tumor progression similar to that seen in clinical practice.

A mathematical model of tumor growth and its response to single irradiation

BACKGROUND

Mathematical modeling of biological processes is widely used to enhance quantitative understanding of bio-medical phenomena. This quantitative knowledge can be applied in both clinical and experimental settings. Recently, many investigators began studying mathematical models of tumor response to radiation therapy. We developed a simple mathematical model to simulate the growth of tumor volume and its response to a single fraction of high dose irradiation. The modelling study may provide clinicians important insights on radiation therapy strategies through identification of biological factors significantly influencing the treatment effectiveness.

METHODS

We made several key assumptions of the model. Tumor volume is composed of proliferating (or dividing) cancer cells and non-dividing (or dead) cells. Tumor growth rate (or tumor volume doubling time) is proportional to the ratio of the volumes of tumor vasculature and the tumor. The vascular volume grows slower than the tumor by introducing the vascular growth retardation factor, θ. Upon irradiation, the proliferating cells gradually die over a fixed time period after irradiation. Dead cells are cleared away with cell clearance time. The model was applied to simulate pre-treatment growth and post-treatment radiation response of rat rhabdomyosarcoma tumors and metastatic brain tumors of five patients who were treated with Gamma Knife stereotactic radiosurgery (GKSRS).

RESULTS

By selecting appropriate model parameters, we showed the temporal variation of the tumors for both the rat experiment and the clinical GKSRS cases could be easily replicated by the simple model. Additionally, the application of our model to the GKSRS cases showed that the α-value, which is an indicator of radiation sensitivity in the LQ model, and the value of θ could be predictors of the post-treatment volume change.

CONCLUSIONS

The proposed model was successful in representing both the animal experimental data and the clinically observed tumor volume changes. We showed that the model can be used to find the potential biological parameters, which may be able to predict the treatment outcome. However, there is a large statistical uncertainty of the result due to the small sample size. Therefore, a future clinical study with a larger number of patients is needed to confirm the finding.

A Mathematical Model Coupling Tumor Growth and Angiogenesis

We present a mathematical model for vascular tumor growth. We use phase fields to model cellular growth and reaction-diffusion equations for the dynamics of angiogenic factors and nutrients. The model naturally predicts the shift from avascular to vascular growth at realistic scales. Our computations indicate that the negative regulation of the Delta-like ligand 4 signaling pathway slows down tumor growth by producing a larger density of non-functional capillaries. Our results show good quantitative agreement with experiments.

Incompressible limit of a mechanical model of tumour growth with viscosity

Various models of tumour growth are available in the literature. The first type describe the evolution of the cell number density when considered as a continuous visco-elastic material with growth. The second type describe the tumour as a set, and rules for the free boundary are given related to the classical Hele-Shaw model of fluid dynamics. Following previous papers where the material is described by a purely elastic material, or when active cell motion is included, we make the link between the two types of description considering the 'stiff pressure law' limit. Even though viscosity is a regularizing effect, new mathematical difficulties arise in the visco-elastic case because estimates on the pressure field are weaker and do not immediately imply compactness. For instance, travelling wave solutions and numerical simulations show that the pressure is discontinuous in space, which is not the case for an elastic material.

Mathematically modeling the biological properties of gliomas: A review

Although mathematical modeling is a mainstay for industrial and many scientific studies, such approaches have found little application in neurosurgery. However, the fusion of biological studies and applied mathematics is rapidly changing this environment, especially for cancer research. This review focuses on the exciting potential for mathematical models to provide new avenues for studying the growth of gliomas to practical use. In vitro studies are often used to simulate the effects of specific model parameters that would be difficult in a larger-scale model. With regard to glioma invasive properties, metabolic and vascular attributes can be modeled to gain insight into the infiltrative mechanisms that are attributable to the tumor's aggressive behavior. Morphologically, gliomas show different characteristics that may allow their growth stage and invasive properties to be predicted, and models continue to offer insight about how these attributes are manifested visually. Recent studies have attempted to predict the efficacy of certain treatment modalities and exactly how they should be administered relative to each other. Imaging is also a crucial component in simulating clinically relevant tumors and their influence on the surrounding anatomical structures in the brain.

Towards the Personalized Treatment of Glioblastoma: Integrating Patient-Specific Clinical Data in a Continuous Mechanical Model

Glioblastoma multiforme (GBM) is the most aggressive and malignant among brain tumors. In addition to uncontrolled proliferation and genetic instability, GBM is characterized by a diffuse infiltration, developing long protrusions that penetrate deeply along the fibers of the white matter. These features, combined with the underestimation of the invading GBM area by available imaging techniques, make a definitive treatment of GBM particularly difficult. A multidisciplinary approach combining mathematical, clinical and radiological data has the potential to foster our understanding of GBM evolution in every single patient throughout his/her oncological history, in order to target therapeutic weapons in a patient-specific manner. In this work, we propose a continuous mechanical model and we perform numerical simulations of GBM invasion combining the main mechano-biological characteristics of GBM with the micro-structural information extracted from radiological images, i.e. by elaborating patient-specific Diffusion Tensor Imaging (DTI) data. The numerical simulations highlight the influence of the different biological parameters on tumor progression and they demonstrate the fundamental importance of including anisotropic and heterogeneous patient-specific DTI data in order to obtain a more accurate prediction of GBM evolution. The results of the proposed mathematical model have the potential to provide a relevant benefit for clinicians involved in the treatment of this particularly aggressive disease and, more importantly, they might drive progress towards improving tumor control and patient’s prognosis.

Towards a Mathematical Formalism for Semi-stochastic Cell-Level Computational Modeling of Tumor Initiation

A phenomenological model is formulated to model the early stages of tumor formation. The model is based on a cell-based formalism, where each cell is represented as a circle or sphere in two-and three dimensional simulations, respectively. The model takes into account constituent cells, such as epithelial cells, tumor cells, and T-cells that chase the tumor cells and engulf them. Fundamental biological processes such as random walk, haptotaxis/chemotaxis, contact mechanics, cell proliferation and death, as well as secretion of chemokines are taken into account. The developed formalism is based on the representation of partial differential equations in terms of fundamental solutions, as well as on stochastic processes and stochastic differential equations. We also take into account the likelihood of seeding of tumors. The model shows the initiation of tumors and allows to study a quantification of the impact of various subprocesses and possibly even of various treatments.

USNCTAM perspectives on mechanics in medicine

Over decades, the theoretical and applied mechanics community has developed sophisticated approaches for analysing the behaviour of complex engineering systems. Most of these approaches have targeted systems in the transportation, materials, defence and energy industries. Applying and further developing engineering approaches for understanding, predicting and modulating the response of complicated biomedical processes not only holds great promise in meeting societal needs, but also poses serious challenges. This report, prepared for the US National Committee on Theoretical and Applied Mechanics, aims to identify the most pressing challenges in biological sciences and medicine that can be tackled within the broad field of mechanics. This echoes and complements a number of national and international initiatives aiming at fostering interdisciplinary biomedical research. This report also comments on cultural/educational challenges. Specifically, this report focuses on three major thrusts in which we believe mechanics has and will continue to have a substantial impact. (i) Rationally engineering injectable nano/microdevices for imaging and therapy of disease. Within this context, we discuss nanoparticle carrier design, vascular transport and adhesion, endocytosis and tumour growth in response to therapy, as well as uncertainty quantification techniques to better connect models and experiments. (ii) Design of biomedical devices, including point-of-care diagnostic systems, model organ and multi-organ microdevices, and pulsatile ventricular assistant devices. (iii) Mechanics of cellular processes, including mechanosensing and mechanotransduction, improved characterization of cellular constitutive behaviour, and microfluidic systems for single-cell studies.