Applying Mathematical Models to Study the Role of the Immune System in Chronic Myelogenous Leukemia

Although tyrosine kinase inhibitors (TKIs) such as imatinib have transformed chronic myelogenous leukemia (CML) into a chronic condition, these therapies are not curative in the majority of cases. Most patients must continue TKI therapy indefinitely, a requirement that is both expensive and that compromises a patient's quality of life. While TKIs are known to reduce leukemic cells' proliferative capacity and to induce apoptosis, their effects on leukemic stem cells, the immune system, and the microenvironment are not fully understood. A more complete understanding of their global therapeutic effects would help us to identify any limitations of TKI monotherapy and to address these issues through novel combination therapies. Mathematical models are a complementary tool to experimental and clinical data that can provide valuable insights into the underlying mechanisms of TKI therapy. Previous modeling efforts have focused on CML patients who show biphasic and triphasic exponential declines in BCR-ABL ratio during therapy. However, our patient data indicates that many patients treated with TKIs show fluctuations in BCR-ABL ratio yet are able to achieve durable remissions. To investigate these fluctuations, we construct a mathematical model that integrates CML with a patient's autologous immune response to the disease. In our model, we define an immune window, which is an intermediate range of leukemic concentrations that lead to an effective immune response against CML. While small leukemic concentrations provide insufficient stimulus, large leukemic concentrations actively suppress a patient's immune system, thus limiting it's ability to respond. Our patient data and modeling results suggest that at diagnosis, a patient's high leukemic concentration is able to suppress their immune system. TKI therapy drives the leukemic population into the immune window, allowing the patient's immune cells to expand and eventually mount an efficient response against the residual CML. This response drives the leukemic population below the immune window, causing the immune population to contract and allowing the leukemia to partially recover. The leukemia eventually reenters the immune window, thus stimulating a sequence of weaker immune responses as the two populations approach equilibrium. We hypothesize that a patient's autologous immune response to CML may explain the fluctuations in BCR-ABL ratio that are regularly seen during TKI therapy. These fluctuations may serve as a signature of a patient's individual immune response to CML. By applying our modeling framework to patient data, we are able to construct an immune profile that can then be used to propose patient-specific combination therapies aimed at further reducing a patient's leukemic burden. Our characterization of a patient's anti-leukemia immune response may be especially valuable in the study of drug resistance, treatment cessation, and combination therapy.

Salvianolic Acid B Inhibits Growth of Cervical Cancer Cells in vitro via Induction of Apoptosis through the Extrinsic Pathway

In 2014 alone, over 12,000 women are expected to be diagnosed with cervical cancer. Of these women who are diagnosed, about 3,909 will result in death. Despite developments in prevention methods, cervical cancer remains a major health concern for women. Growing evidence suggests that Salvianolic acid B (Sal B), a major component of the Chinese herb Danshen, may inhibit cancer cell growth and help fight against cervical cancer. This study characterizes the potential of Sal B as a cervical cancer drug through in vitro testing on HeLa cells. We hypothesized that application of Sal B to HeLa cells will result in decreased cell viability and increased apoptosis in a dose dependent manner. HeLa cells were treated with varying concentrations of Sal B: 25µM, 50µM, 100µM, and 200µM. Cell viability was determined through colony formation assay, cell death ELISA, and nuclear morphology. An inhibitor study was also conducted for further apoptosis pathway analysis. Colony formation assay demonstrated a significant decrease in cell viability with increasing concentrations of Sal B with 75% viability at 50µM down to 0% viability at 200µM. Cell death ELISA and the analysis of nuclear morphology via Hoechst staining reported significant levels of apoptosis at concentrations equal to 50µM and greater. Furthermore, experiments using caspase inhibitors indicated that Sal B’s apoptotic effects are caspase-8 dependent. In conclusion, our results demonstrate that Sal B inhibits cancer cell growth by a mechanism that involves apoptosis induction through the extrinsic pathway.