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Generation of digital patients for the simulation of tuberculosis with UISS-TB

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 Added by Marzio Pennisi
 Publication date 2019
and research's language is English




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EC funded STriTuVaD project aims to test, through a phase IIb clinical trial, two of the most advanced therapeutic vaccines against tuberculosis. In parallel, we have extended the Universal Immune System Simulator to include all relevant determinants of such clinical trial, to establish its predictive accuracy against the individual patients recruited in the trial, to use it to generate digital patients and predict their response to the HRT being tested, and to combine them to the observations made on physical patients using a new in silico-augmented clinical trial approach that uses a Bayesian adaptive design. This approach, where found effective could drastically reduce the cost of innovation in this critical sector of public healthcare. One of the most challenging task is to develop a methodology to reproduce biological diversity of the subjects that have to be simulated, i.e., provide an appropriate strategy for the generation of libraries of digital patients. This has been achieved through the the creation of the initial immune system repertoire in a stochastic way, and though the identification of a vector of features that combines both biological and pathophysiological parameters that personalize the digital patient to reproduce the physiology and the pathophysiology of the subject.

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Tuberculosis (TB) is one of the deadliest diseases worldwide, with 1,5 million fatalities every year along with potential devastating effects on society, families and individuals. To address this alarming burden, vaccines can play a fundamental role, even though to date no fully effective TB vaccine really exists. Current treatments involve several combinations of antibiotics administered to TB patients for up to two years, leading often to financial issues and reduced therapy adherence. Along with this, the development and spread of drug-resistant TB strains is another big complicating matter. Faced with these challenges, there is an urgent need to explore new vaccination strategies in order to boost immunity against tuberculosis and shorten the duration of treatment. Computational modeling represents an extraordinary way to simulate and predict the outcome of vaccination strategies, speeding up the arduous process of vaccine pipeline development and relative time to market. Here, we present EU - funded STriTuVaD project computational platform able to predict the artificial immunity induced by RUTI and ID93/GLA-SE, two specific tuberculosis vaccines. Such an in silico trial will be validated through a phase 2b clinical trial. Moreover, STriTuVaD computational framework is able to inform of the reasons for failure should the vaccinations strategies against M. tuberculosis under testing found not efficient, which will suggest possible improvements.
SARS-CoV-2 is a severe respiratory infection that infects humans. Its outburst entitled it as a pandemic emergence. To get a grip on this, outbreak specific preventive and therapeutic interventions are urgently needed. It must be said that, until now, there are no existing vaccines for coronaviruses. To promptly and rapidly respond to pandemic events, the application of in silico trials can be used for designing and testing medicines against SARS-CoV-2 and speed-up the vaccine discovery pipeline, predicting any therapeutic failure and minimizing undesired effects. Here, we present an in silico platform that showed to be in very good agreement with the latest literature in predicting SARS- CoV-2 dynamics and related immune system host response. Moreover, it has been used to predict the outcome of one of the latest suggested approach to design an effective vaccine, based on monoclonal antibody. UISS is then potentially ready to be used as an in silico trial platform to predict the outcome of vaccination strategy against SARS-CoV-2.
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Agent-Based Models are a powerful class of computational models widely used to simulate complex phenomena in many different application areas. However, one of the most critical aspects, poorly investigated in the literature, regards an important step of the model credibility assessment: solution verification. This study overcomes this limitation by proposing a general verification framework for Agent-Based Models that aims at evaluating the numerical errors associated with the model. A step-by-step procedure, which consists of two main verification studies (deterministic and stochastic model verification), is described in detail and applied to a specific mission critical scenario: the quantification of the numerical approximation error for UISS-TB, an ABM of the human immune system developed to predict the progression of pulmonary tuberculosis. Results provide indications on the possibility to use the proposed model verification workflow to systematically identify and quantify numerical approximation errors associated with UISS-TB and, in general, with any other ABMs.
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