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Laubenbacher R, Adler F, An G, Castiglione F, Eubank S, Fonseca LL, Glazier J, Helikar T, Jett-Tilton M, Kirschner D, Macklin P, Mehrad B, Moore B, Pasour V, Shmulevich I, Smith A, Voigt I, Yankeelov TE, Ziemssen T. Toward mechanistic medical digital twins: some use cases in immunology. Front Digit Health 2024; 6:1349595. [PMID: 38515550 PMCID: PMC10955144 DOI: 10.3389/fdgth.2024.1349595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
A fundamental challenge for personalized medicine is to capture enough of the complexity of an individual patient to determine an optimal way to keep them healthy or restore their health. This will require personalized computational models of sufficient resolution and with enough mechanistic information to provide actionable information to the clinician. Such personalized models are increasingly referred to as medical digital twins. Digital twin technology for health applications is still in its infancy, and extensive research and development is required. This article focuses on several projects in different stages of development that can lead to specific-and practical-medical digital twins or digital twin modeling platforms. It emerged from a two-day forum on problems related to medical digital twins, particularly those involving an immune system component. Open access video recordings of the forum discussions are available.
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Affiliation(s)
| | - Fred Adler
- Department of Mathematics and School of Biological Sciences, University of Utah, Salt Lake, UT, United States
| | - Gary An
- Department of Surgery, University of Vermont, Burlington, VT, United States
| | - Filippo Castiglione
- Biotechnology Research Center, Technology Innovation Institute, Abu Dhabi, United Arab Emirates
| | - Stephen Eubank
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, United States
| | - Luis L. Fonseca
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - James Glazier
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, United States
| | - Tomas Helikar
- Department of Biochemistry, University of Nebraska, Lincoln, NE, United States
| | - Marti Jett-Tilton
- U.S. Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Denise Kirschner
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Paul Macklin
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, United States
| | - Borna Mehrad
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Beth Moore
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Virginia Pasour
- U.S. Army Research Office, Research Triangle Park, NC, United States
| | | | - Amber Smith
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Isabel Voigt
- Center for Clinical Neuroscience, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Thomas E. Yankeelov
- Department of Biomedical Engineering, Oden Institute for Computational Engineering and Sciences, Austin, TX, United States
- Departments of Biomedical Engineering, Diagnostic Medicine, Oncology, The University of Texas, Austin, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Austin, TX, United States
| | - Tjalf Ziemssen
- Center for Clinical Neuroscience, Carl Gustav Carus University Hospital, Dresden, Germany
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Laubenbacher R, Adler F, An G, Castiglione F, Eubank S, Fonseca LL, Glazier J, Helikar T, Jett-Tilton M, Kirschner D, Macklin P, Mehrad B, Moore B, Pasour V, Shmulevich I, Smith A, Voigt I, Yankeelov TE, Ziemssen T. Forum on immune digital twins: a meeting report. NPJ Syst Biol Appl 2024; 10:19. [PMID: 38365857 PMCID: PMC10873299 DOI: 10.1038/s41540-024-00345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
Medical digital twins are computational models of human biology relevant to a given medical condition, which are tailored to an individual patient, thereby predicting the course of disease and individualized treatments, an important goal of personalized medicine. The immune system, which has a central role in many diseases, is highly heterogeneous between individuals, and thus poses a major challenge for this technology. In February 2023, an international group of experts convened for two days to discuss these challenges related to immune digital twins. The group consisted of clinicians, immunologists, biologists, and mathematical modelers, representative of the interdisciplinary nature of medical digital twin development. A video recording of the entire event is available. This paper presents a synopsis of the discussions, brief descriptions of ongoing digital twin projects at different stages of progress. It also proposes a 5-year action plan for further developing this technology. The main recommendations are to identify and pursue a small number of promising use cases, to develop stimulation-specific assays of immune function in a clinical setting, and to develop a database of existing computational immune models, as well as advanced modeling technology and infrastructure.
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Affiliation(s)
| | - Fred Adler
- Department of Mathematics and School of Biological Sciences, University of Utah, Salt Lake City, UT, USA
| | - Gary An
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Filippo Castiglione
- Biotechnology Research Center, Technology Innovation Institute, Abu Dhabi, UAE
| | - Stephen Eubank
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Luis L Fonseca
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - James Glazier
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Tomas Helikar
- Department of Biochemistry, University of Nebraska, Lincoln, NE, USA
| | | | - Denise Kirschner
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Paul Macklin
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Borna Mehrad
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Beth Moore
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Virginia Pasour
- U.S. Army Research Office, Research Triangle Park, Raleigh, NC, USA
| | | | - Amber Smith
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Thomas E Yankeelov
- Department of Biomedical Engineering, Oden Institute for Computational Engineering and Sciences, Departments of Biomedical Engineering, Diagnostic Medicine, Oncology, The University of Texas, Austin, TX, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Koelle K, Ratmann O, Rasmussen DA, Pasour V, Mattingly J. A dimensionless number for understanding the evolutionary dynamics of antigenically variable RNA viruses. Proc Biol Sci 2011; 278:3723-30. [PMID: 21543353 PMCID: PMC3203497 DOI: 10.1098/rspb.2011.0435] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Antigenically variable RNA viruses are significant contributors to the burden of infectious disease worldwide. One reason for their ubiquity is their ability to escape herd immunity through rapid antigenic evolution and thereby to reinfect previously infected hosts. However, the ways in which these viruses evolve antigenically are highly diverse. Some have only limited diversity in the long-run, with every emergence of a new antigenic variant coupled with a replacement of the older variant. Other viruses rapidly accumulate antigenic diversity over time. Others still exhibit dynamics that can be considered evolutionary intermediates between these two extremes. Here, we present a theoretical framework that aims to understand these differences in evolutionary patterns by considering a virus's epidemiological dynamics in a given host population. Our framework, based on a dimensionless number, probabilistically anticipates patterns of viral antigenic diversification and thereby quantifies a virus's evolutionary potential. It is therefore similar in spirit to the basic reproduction number, the well-known dimensionless number which quantifies a pathogen's reproductive potential. We further outline how our theoretical framework can be applied to empirical viral systems, using influenza A/H3N2 as a case study. We end with predictions of our framework and work that remains to be done to further integrate viral evolutionary dynamics with disease ecology.
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Affiliation(s)
- Katia Koelle
- Department of Biology, Duke University, PO Box 90338, Durham, NC 27708, USA
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