An imaging biomarker of tumor-infiltrating lymphocytes to risk-stratify patients with HPV-associated oropharyngeal cancer

BACKGROUND: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has excellent control rates compared to nonvirally associated OPSCC. Multiple trials are actively testing whether de-escalation of treatment intensity for these patients can maintain oncologic equipoise while reducing treatment-related toxicity. We have developed OP-TIL, a biomarker that characterizes the spatial interplay between tumor-infiltrating lymphocytes (TILs) and surrounding cells in histology images. Herein, we sought to test whether OP-TIL can segregate stage I HPV-associated OPSCC patients into low-risk and high-risk groups and aid in patient selection for de-escalation clinical trials. METHODS: Association between OP-TIL and patient outcome was explored on whole slide hematoxylin and eosin images from 439 stage I HPV-associated OPSCC patients across 6 institutional cohorts. One institutional cohort (n = 94) was used to identify the most prognostic features and train a Cox regression model to predict risk of recurrence and death. Survival analysis was used to validate the algorithm as a biomarker of recurrence or death in the remaining 5 cohorts (n = 345). All statistical tests were 2-sided. RESULTS: OP-TIL separated stage I HPV-associated OPSCC patients with 30 or less pack-year smoking history into low-risk (2-year disease-free survival [DFS] = 94.2%; 5-year DFS = 88.4%) and high-risk (2-year DFS = 82.5%; 5-year DFS = 74.2%) groups (hazard ratio = 2.56, 95% confidence interval = 1.52 to 4.32; P \u3c .001), even after adjusting for age, smoking status, T and N classification, and treatment modality on multivariate analysis for DFS (hazard ratio = 2.27, 95% confidence interval = 1.32 to 3.94; P = .003). CONCLUSIONS: OP-TIL can identify stage I HPV-associated OPSCC patients likely to be poor candidates for treatment de-escalation. Following validation on previously completed multi-institutional clinical trials, OP-TIL has the potential to be a biomarker, beyond clinical stage and HPV status, that can be used clinically to optimize patient selection for de-escalation

Modeling The Spatiotemporal Dynamics Of Cells In The Lung

Multiple research problems related to the lung involve a need to take into account the spatiotemporal dynamics of the underlying component cells. Two such problems involve better understanding the nature of the allergic inflammatory response to explore what might cause chronic inflammatory diseases such as asthma, and determining the rules underlying stem cells used to engraft decellularized lung scaffolds in the hopes of growing new lungs for transplantation. For both problems, we model the systems computationally using agent-based modeling, a tool that enables us to capture these spatiotemporal dynamics by modeling any biological system as a collection of agents (cells) interacting with each other and within their environment. This allows to test the most important pieces of biological systems together rather than in isolation, and thus rapidly derive biological insights from resulting complex behavior that could not have been predicted beforehand, which we can then use to guide wet lab experimentation. For the allergic response, we hypothesized that stimulation of the allergic response with antigen results in a response with formal similarity to a muscle twitch or an action potential, with an inflammatory phase followed by a resolution phase that returns the system to baseline. We prepared an agent-based model (ABM) of the allergic inflammatory response and determined that antigen stimulation indeed results in a twitch-like response. To determine what might cause chronic inflammatory diseases where the twitch presumably cannot resolve back to baseline, we then tested multiple potential defects to the model. We observed that while most of these potential changes lessen the magnitude of the response but do not affect its overall behavior, extending the lifespan of activated pro-inflammatory cells such as neutrophils and eosinophil results in a prolonged inflammatory response that does not resolve to baseline. Finally, we performed a series of experiments involving continual antigen stimulation in mice, determining that there is evidence in the cytokine, cellular and physiologic (mechanical) response consistent with our hypothesis of a finite twitch and an associated refractory period. For stem cells, we made a 3-D ABM of a decellularized scaffold section seeded with a generic stem cell type. We then programmed in different sets of rules that could conceivably underlie the cell\u27s behavior, and observed the change in engraftment patterns in the scaffold over selected timepoints. We compared the change in those patterns against the change in experimental scaffold images seeded with C10 epithelial cells and mesenchymal stem cells, two cell types whose behaviors are not well understood, in order to determine which rulesets more closely match each cell type. Our model indicates that C10s are more likely to survive on regions of higher substrate while MSCs are more likely to proliferate on regions of higher substrate

Individual-based modeling and predictive simulation of fungal infection dynamics

The human-pathogenic fungus Aspergillus fumigatus causes life-threatening infections in immunocompromised patients and poses increasing challenges for the modern medicine. A. fumigatus is ubiquitously present and disseminates via small conidia over the air of the athmosphere. Each human inhales several hundreds to thousands of conidia every day. The small size of conidia allows them to pass into the alveoli of the lung, where primary infections with A. fumigatus are typically observed. In alveoli, the interaction between fungi and the innate immune system of the host takes place. This interaction is the core topic of this thesis and covered by mathematical modeling and computer simulations. Since in vivo laboratory studies of A. fumigatus infections under physiological conditions is hard to realize a modular software framework was developed and implemented, which allows for spatio-temporal agent-based modeling and simulation. A to-scale A. fumigatus infection model in a typical human alveolus was developed in order to simulate and analyze the infection scenario under physiological conditions. The process of conidial discovery by alveolar macrophages was modeled and simulated with different migration modes and different parameter configurations. It could be shown that chemotactic migration was required to find the pathogen before the onset of germination. A second model took advantage of evolutionary game theory on graphs. Here, the course of infection was modeled as a consecutive sequence of evolutionary games related to the complement system, alveolar macrophages and polymorphonuclear neutrophilic granulocytes. The results revealed a central immunoregulatory role of alveolar macrophages. In the case of high infectious doses it was found that the host required fully active phagocytes, but in particular a qualitative response of quantitatively sufficient polymorphonuclear neutrophilic granulocytes.Der human-pathogene Schimmelpilz Aspergillus fumigatus verursacht tödliche Infektionen und Erkrankungen vorrangig bei immunsupprimierten Patienten und stellt die moderne Medizin vor zunehmende Herausforderungen. A. fumigatus ist ubiquitär präsent und verbreitet sich über sehr kleine Konidien durch Luftströmungen in der Athmosphäre. Mehrere Hundert bis Tausende dieser Konidien werden täglich durch jeden Menschen eingeatmet. Die geringe Größe der infektiösen Konidien erlauben es dem Pilz bis in die Alveolen der Lunge des Wirtes vorzudringen,in denen eine Primärinfektionen mit A. fumigatus am häufigsten stattfindet. Die Alveolen sind der zentrale Schauplatz der Interaktion zwischen dem Pilz und dem angeborenen Immunsystem, welche Gegenstand dieser Arbeit ist. Diese Interaktion wird mit Hilfe von mathematischen Modellen und Computersimulationen nachgestellt und untersucht, da eine A. fumigatus Infektion im Nasslabor in vivo unter physiologischen Bedingungen nur sehr schwer realisiert werden kann. Als Grundlage für dieses Vorhaben wurde ein modulares Software-Paket entwickelt, welches agentenbasierte Modellierung und entsprechende Simulationen in Raum und Zeit ermöglicht. Ein maßstabsgetreues mathematisches Infektionsmodell in einer typischen menschlichen Alveole wurde entwickelt und die Suchstrategien von Alveolarmakrophagen unter der Berücksichtigung verschiedener Parameter wie Migrationsgeschwindigkeit, dem Vorhandensein von Chemokinen, dessen Diffusion und Chemotaxis untersucht. Es zeigte sich, dass Chemotaxis, notwendig ist, um die Konidie rechtzeitig finden zu können. In einem weiteren Modell, welches auf das Konzept evolutionärer Spieltheorie auf Graphen zurückgegriff, wurde der Infektionsverlauf als aufeinanderfolgende Serie evolutionärer Spiele mit dem Komplementsystem, Alveolarmakrophagen und Neutrophilen nachgestellt. Aus den Simulationsergebnissen konnte eine zentrale immunregulatorische Rolle von Alveolarmakrophagen entnommen werden

Multimodal Data Fusion and Quantitative Analysis for Medical Applications

Medical big data is not only enormous in its size, but also heterogeneous and complex in its data structure, which makes conventional systems or algorithms difficult to process. These heterogeneous medical data include imaging data (e.g., Positron Emission Tomography (PET), Computerized Tomography (CT), Magnetic Resonance Imaging (MRI)), and non-imaging data (e.g., laboratory biomarkers, electronic medical records, and hand-written doctor notes). Multimodal data fusion is an emerging vital field to address this urgent challenge, aiming to process and analyze the complex, diverse and heterogeneous multimodal data. The fusion algorithms bring great potential in medical data analysis, by 1) taking advantage of complementary information from different sources (such as functional-structural complementarity of PET/CT images) and 2) exploiting consensus information that reflects the intrinsic essence (such as the genetic essence underlying medical imaging and clinical symptoms). Thus, multimodal data fusion benefits a wide range of quantitative medical applications, including personalized patient care, more optimal medical operation plan, and preventive public health. Though there has been extensive research on computational approaches for multimodal fusion, there are three major challenges of multimodal data fusion in quantitative medical applications, which are summarized as feature-level fusion, information-level fusion and knowledge-level fusion: • Feature-level fusion. The first challenge is to mine multimodal biomarkers from high-dimensional small-sample multimodal medical datasets, which hinders the effective discovery of informative multimodal biomarkers. Specifically, efficient dimension reduction algorithms are required to alleviate "curse of dimensionality" problem and address the criteria for discovering interpretable, relevant, non-redundant and generalizable multimodal biomarkers. • Information-level fusion. The second challenge is to exploit and interpret inter-modal and intra-modal information for precise clinical decisions. Although radiomics and multi-branch deep learning have been used for implicit information fusion guided with supervision of the labels, there is a lack of methods to explicitly explore inter-modal relationships in medical applications. Unsupervised multimodal learning is able to mine inter-modal relationship as well as reduce the usage of labor-intensive data and explore potential undiscovered biomarkers; however, mining discriminative information without label supervision is an upcoming challenge. Furthermore, the interpretation of complex non-linear cross-modal associations, especially in deep multimodal learning, is another critical challenge in information-level fusion, which hinders the exploration of multimodal interaction in disease mechanism. • Knowledge-level fusion. The third challenge is quantitative knowledge distillation from multi-focus regions on medical imaging. Although characterizing imaging features from single lesions using either feature engineering or deep learning methods have been investigated in recent years, both methods neglect the importance of inter-region spatial relationships. Thus, a topological profiling tool for multi-focus regions is in high demand, which is yet missing in current feature engineering and deep learning methods. Furthermore, incorporating domain knowledge with distilled knowledge from multi-focus regions is another challenge in knowledge-level fusion. To address the three challenges in multimodal data fusion, this thesis provides a multi-level fusion framework for multimodal biomarker mining, multimodal deep learning, and knowledge distillation from multi-focus regions. Specifically, our major contributions in this thesis include: • To address the challenges in feature-level fusion, we propose an Integrative Multimodal Biomarker Mining framework to select interpretable, relevant, non-redundant and generalizable multimodal biomarkers from high-dimensional small-sample imaging and non-imaging data for diagnostic and prognostic applications. The feature selection criteria including representativeness, robustness, discriminability, and non-redundancy are exploited by consensus clustering, Wilcoxon filter, sequential forward selection, and correlation analysis, respectively. SHapley Additive exPlanations (SHAP) method and nomogram are employed to further enhance feature interpretability in machine learning models. • To address the challenges in information-level fusion, we propose an Interpretable Deep Correlational Fusion framework, based on canonical correlation analysis (CCA) for 1) cohesive multimodal fusion of medical imaging and non-imaging data, and 2) interpretation of complex non-linear cross-modal associations. Specifically, two novel loss functions are proposed to optimize the discovery of informative multimodal representations in both supervised and unsupervised deep learning, by jointly learning inter-modal consensus and intra-modal discriminative information. An interpretation module is proposed to decipher the complex non-linear cross-modal association by leveraging interpretation methods in both deep learning and multimodal consensus learning. • To address the challenges in knowledge-level fusion, we proposed a Dynamic Topological Analysis framework, based on persistent homology, for knowledge distillation from inter-connected multi-focus regions in medical imaging and incorporation of domain knowledge. Different from conventional feature engineering and deep learning, our DTA framework is able to explicitly quantify inter-region topological relationships, including global-level geometric structure and community-level clusters. K-simplex Community Graph is proposed to construct the dynamic community graph for representing community-level multi-scale graph structure. The constructed dynamic graph is subsequently tracked with a novel Decomposed Persistence algorithm. Domain knowledge is incorporated into the Adaptive Community Profile, summarizing the tracked multi-scale community topology with additional customizable clinically important factors

2024 Student Symposium Program and Book of Abstracts

The mission of the UMaine Student Symposium is to give graduate and undergraduate students from UMaine and UMaine Machias the opportunity to showcase their work, research, and creative activities to the greater community, fostering conversations and collaborations that will benefit the future of Maine and beyond

Advances in Bioengineering

The technological approach and the high level of innovation make bioengineering extremely dynamic and this forces researchers to continuous updating. It involves the publication of the results of the latest scientific research. This book covers a wide range of aspects and issues related to advances in bioengineering research with a particular focus on innovative technologies and applications. The book consists of 13 scientific contributions divided in four sections: Materials Science; Biosensors. Electronics and Telemetry; Light Therapy; Computing and Analysis Techniques

Integrated human exposure to air pollution

The book “Integrated human exposure to air pollution” aimed to increase knowledge about human exposure in different micro-environments, or when citizens are performing specific tasks, to demonstrate methodologies for the understanding of pollution sources and their impact on indoor and ambient air quality, and, ultimately, to identify the most effective mitigation measures to decrease human exposure and protect public health. Taking advantage of the latest available tools, such as internet of things (IoT), low-cost sensors and a wide access to online platforms and apps by the citizens, new methodologies and approaches can be implemented to understand which factors can influence human exposure to air pollution. This knowledge, when made available to the citizens, along with the awareness of the impact of air pollution on human life and earth systems, can empower them to act, individually or collectively, to promote behavioral changes aiming to reduce pollutants’ emissions. Overall, this book gathers fourteen innovative studies that provide new insights regarding these important topics within the scope of human exposure to air pollution. A total of five main areas were discussed and explored within this book and, hopefully, can contribute to the advance of knowledge in this field