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The alignment of tissue between histopathological whole-slide-images (WSI) is crucial for research and clinical applications. Advances in computing, deep learning, and availability of large WSI datasets have revolutionised WSI analysis. Therefore, the current state-of-the-art in WSI registration is unclear. To address this, we conducted the ACROBAT challenge, based on the largest WSI registration dataset to date, including 4,212 WSIs from 1,152 breast cancer patients. The challenge objective was to align WSIs of tissue that was stained with routine diagnostic immunohistochemistry to its H&E-stained counterpart. We compare the performance of eight WSI registration algorithms, including an investigation of the impact of different WSI properties and clinical covariates. We find that conceptually distinct WSI registration methods can lead to highly accurate registration performances and identify covariates that impact performances across methods. These results establish the current state-of-the-art in WSI registration and guide researchers in selecting and developing methods.

Adaptive therapy is a dynamic cancer treatment protocol that updates (or "adapts") treatment decisions in anticipation of evolving tumor dynamics. This broad term encompasses many possible dynamic treatment protocols of patient-specific dose modulation or dose timing. Adaptive therapy maintains high levels of tumor burden to benefit from the competitive suppression of treatment-sensitive subpopulations on treatment-resistant subpopulations. This evolution-based approach to cancer treatment has been integrated into several ongoing or planned clinical trials, including treatment of metastatic castrate resistant prostate cancer, ovarian cancer, and BRAF-mutant melanoma. In the previous few decades, experimental and clinical investigation of adaptive therapy has progressed synergistically with mathematical and computational modeling. In this work, we discuss 11 open questions in cancer adaptive therapy mathematical modeling. The questions are split into three sections: 1) the necessary components of mathematical models of adaptive therapy 2) design and validation of dosing protocols, and 3) challenges and opportunities in clinical translation.

Cancer cell population dynamics often exhibit remarkably replicable, universal laws despite their underlying heterogeneity. Mechanistic explanations of universal cell population growth remain partly unresolved to this day, whereby population feedback between the microscopic and mesoscopic configurations can lead to macroscopic growth laws. We here present a unification under density-dependent birth events via contact inhibition. We consider five classical tumor growth laws: exponential, generalized logistic, Gompertz, radial growth, and fractal growth, which can be seen as manifestations of a single microscopic model. Our theory is substantiated by agent based simulations and can explain growth curve differences in experimental data from in vitro cancer cell population growth. Thus, our framework offers a possible explanation for the large number of mean-field laws that can adequately capture seemingly unrelated cancer or microbial growth dynamics., Comment: 23 pages, 4 main figures, 39 references, 2 supplementary figures

Deterministic continuum models formulated in terms of non-local partial differential equations for the evolutionary dynamics of populations structured by phenotypic traits have been used recently to address open questions concerning the adaptation of asexual species to periodically fluctuating environmental conditions. These deterministic continuum models are usually defined on the basis of population-scale phenomenological assumptions and cannot capture adaptive phenomena that are driven by stochastic variability in the evolutionary paths of single individuals. In this paper, we develop a stochastic individual-based model for the coevolution between two competing phenotype-structured cell populations that are exposed to time-varying nutrient levels and undergo spontaneous, heritable phenotypic variations with different probabilities. The evolution of every cell is described by a set of rules that result in a discrete-time branching random walk on the space of phenotypic states. We formally show that the deterministic continuum counterpart of this model comprises a system of non-local partial differential equations for the cell population density functions coupled with an ordinary differential equation for the nutrient concentration. We compare the individual-based model and its continuum analogue, focussing on scenarios whereby the predictions of the two models differ. Our results clarify the conditions under which significant differences between the two models can emerge due to stochastic effects associated with small population levels. These differences arise in the presence of low probabilities of phenotypic variation, and become more apparent when the two populations are characterised by less fit initial mean phenotypes and smaller initial levels of phenotypic heterogeneity., Comment: 15 pages, 9 figures

Living species, ranging from bacteria to animals, exist in environmental conditions that exhibit spatial and temporal heterogeneity which requires them to adapt. Risk-spreading through spontaneous phenotypic variations is a known concept in ecology, which is used to explain how species may survive when faced with the evolutionary risks associated with temporally varying environments. In order to support a deeper understanding of the adaptive role of spontaneous phenotypic variations in fluctuating environments, we consider a system of non-local partial differential equations modelling the evolutionary dynamics of two competing phenotype-structured populations in the presence of periodically oscillating nutrient levels. The two populations undergo spontaneous phenotypic variations at different rates. The phenotypic state of each individual is represented by a continuous variable, and the phenotypic landscape of the populations evolves in time due to variations in the nutrient level. Exploiting the analytical tractability of our model, we study the long-time behaviour of the solutions to obtain a detailed mathematical depiction of evolutionary dynamics. The results suggest that when nutrient levels undergo small and slow oscillations, it is evolutionarily more convenient to rarely undergo spontaneous phenotypic variations. Conversely, under relatively large and fast periodic oscillations in the nutrient levels, which bring about alternating cycles of starvation and nutrient abundance, higher rates of spontaneous phenotypic variations confer a competitive advantage. We discuss the implications of our results in the context of cancer metabolism., Comment: 33 pages, 8 figures

The importance of individual cells in a developing multicellular organism is well known but precisely how the individual cellular characteristics of those cells collectively drive the emergence of robust, homeostatic structures is less well understood. For example cell communication via a diffusible factor allows for information to travel across large distances within the population, and cell polarisation makes it possible to form structures with a particular orientation, but how do these processes interact to produce a more robust and regulated structure? In this study we investigate the ability of cells with different cellular characteristics to grow and maintain homeostatic structures. We do this in the context of an individual-based model where cell behaviour is driven by an intra-cellular network that determines the cell phenotype. More precisely, we investigated evolution with 96 different permutations of our model, where cell motility, cell death, long-range growth factor (LGF), short-range growth factor (SGF) and cell polarisation were either present or absent. The results show that LGF has the largest positive impact on the fitness of the evolved solutions. SGF and polarisation also contribute, but all other capabilities essentially increase the search space, effectively making it more difficult to achieve a solution. By perturbing the evolved solutions, we found that they are highly robust to both mutations and wounding. In addition, we observed that by evolving solutions in more unstable environments they produce structures that were more robust and adaptive. In conclusion, our results suggest that robust collective behaviour is most likely to evolve when cells are endowed with long range communication, cell polarisation, and selection pressure from an unstable environment.

In this review we summarize our recent efforts in trying to understand the role of heterogeneity in cancer progression by using neural networks to characterise different aspects of the mapping from a cancer cells genotype and environment to its phenotype. Our central premise is that cancer is an evolving system subject to mutation and selection, and the primary conduit for these processes to occur is the cancer cell whose behaviour is regulated on multiple biological scales. The selection pressure is mainly driven by the microenvironment that the tumour is growing in and this acts directly upon the cell phenotype. In turn, the phenotype is driven by the intracellular pathways that are regulated by the genotype. Integrating all of these processes is a massive undertaking and requires bridging many biological scales (i.e. genotype, pathway, phenotype and environment) that we will only scratch the surface of in this review. We will focus on models that use neural networks as a means of connecting these different biological scales, since they allow us to easily create heterogeneity for selection to act upon and importantly this heterogeneity can be implemented at different biological scales. More specifically, we consider three different neural networks that bridge different aspects of these scales and the dialogue with the micro-environment, (i) the impact of the micro-environment on evolutionary dynamics, (ii) the mapping from genotype to phenotype under drug-induced perturbations and (iii) pathway activity in both normal and cancer cells under different micro-environmental conditions.

Cancer cells are known to modify their micro-environment such that it can sustain a larger population, or, in ecological terms, they construct a niche which increases the carrying capacity of the population. It has however been argued that niche construction, which benefits all cells in the tumour, would be selected against since cheaters could reap the benefits without paying the cost. We have investigated the impact of niche specificity on tumour evolution using an individual based model of breast tumour growth, in which the carrying capacity of each cell consists of two components: an intrinsic, subclone-specific part and a contribution from all neighbouring cells. Analysis of the model shows that the ability of a mutant to invade a resident population depends strongly on the specificity. When specificity is low selection is mostly on growth rate, while high specificity shifts selection towards increased carrying capacity. Further, we show that the long-term evolution of the system can be predicted using adaptive dynamics. By comparing the results from a spatially structured vs.\ well-mixed population we show that spatial structure restores selection for carrying capacity even at zero specificity, which a poses solution to the niche construction dilemma. Lastly, we show that an expanding population exhibits spatially variable selection pressure, where cells at the leading edge exhibit higher growth rate and lower carrying capacity than those at the centre of the tumour., Comment: Major revisions compared to previous version. The paper is now aimed at tumour modelling. We now start out with an agent-based model for which we derive a mean-field ODE-model. The ODE-model is further analysed using the theory of adaptive dynamics

Research into mechanisms of hematogenous metastasis has largely become genetic in focus, attempting to understand the molecular basis of `seed-soil' relationships. Preceeding this biological mechanism is the physical process of dissemination of circulating tumour cells (CTCs). We utilize a `filter-flow' paradigm to show that assumptions about CTC dynamics strongly affect metastatic efficiency: without data on CTC dynamics, any attempt to predict metastatic spread in individual patients is impossible., Comment: pre-publication draft, 2 figures, 2 tables

A small but growing number of people are finding interesting parallels between ecosystems as studied by ecologists (think of a Savanna or the Amazon rain forest or a Coral reef) and tumours1-3. The idea of viewing cancer from an ecological perspective has many implications but fundamentally, it means that we should not see cancer just as a group of mutated cells. A more useful definition of cancer is to consider it a disruption in the complex balance of many interacting cellular and microenvironmental elements in a specific organ. This perspective means that organs undergoing carcinogenesis should be seen as sophisticated ecosystems in homeostasis that cancer cells can disrupt. It also makes cancer seem even more complex but may ultimately provides isights that make it more treatable. Here we discuss how ecological principles can be used to better understand cancer progression and treatment, using several mathematical and computational models to illustrate our argument., Comment: 6 figures, 1 example

A tumor can be thought of as an ecosystem, which critically means that we cannot just consider it as a collection of mutated cells but more as a complex system of many interacting cellular and microenvironmental elements. At its simplest, a growing tumor with increased proliferation capacity must compete for space as a limited resource. Hypercellularity leads to a contact-inhibited core with a competitive proliferating rim. Evolution and selection occurs, and an individual cell's capacity to survive and propagate is determined by its combination of traits and interaction with the environment. With heterogeneity in phenotypes, the clone that will dominate is not always obvious as there are both local interactions and global pressures. Several combinations of phenotypes can coexist, changing the fitness of the whole. To understand some aspects of heterogeneity in a growing tumor we build an off-lattice agent based model consisting of individual cells with assigned trait values for proliferation and migration rates. We represent heterogeneity in these traits with frequency distributions and combinations of traits with density maps. How the distributions change over time is dependent on how traits are passed on to progeny cells, which is our main inquiry. We bypass the translation of genetics to behavior by focussing on the functional end result of inheritance of the phenotype combined with the environmental influence of limited space., Comment: 36 pages, 15 figures

Skin is one of the largest human organ systems whose primary purpose is the protection of deeper tissues. As such, the skin must maintain a homeostatic balance in the face of many microenvironmental and genetic perturbations. At its simplest, skin homeostasis is maintained by the balance between skin cell growth and death such that skin architecture is preserved. This study presents a hybrid multiscale mathematical model of normal skin (vSkin). The model focuses on key cellular and microenvironmental variables that regulate homeostatic interactions among keratinocytes, melanocytes and fibroblasts, key components of the skin. The model recapitulates normal skin structure, and is robust enough to withstand physical as well as biochemical perturbations. Furthermore, the vSkin model revealed the important role of the skin microenvironment in melanoma initiation and progression. Our experiments showed that dermal fibroblasts, which are an important source of growth factors in the skin, adopt a phenotype that facilitates cancer cell growth and invasion when they become senescent. Based on these experimental results, we incorporated senescent fibroblasts into vSkin model and showed that senescent fibroblasts transform the skin microenvironment and enhance the growth and invasion of normal melanocytes as well as early stage melanoma cells. These predictions are consistent with our experimental results as well as clinical observations. Our co-culture experiments show that the senescent fibroblasts promote the growth and invasion of non-tumorigenic melanoma cells. We also observed increased proteolytic activity in stromal fields adjacent to melanoma lesions in human histology. Collectively, senescent fibroblasts create a pro-oncogenic environment that synergizes with mutations to drive melanoma initiation and progression and should therefore be considered as a potential future therapeutic target., Comment: 33 pages, 16 figures

The evolutionary process has been modelled in many ways using both stochastic and deterministic models. We develop an algebraic model of evolution in a population of asexually reproducing organisms in which we represent a stochastic walk in phenotype space, constrained to the edges of an underlying graph representing the genotype, with a time-homogeneous Markov Chain. We show its equivalence to a more standard, explicit stochastic model and show the algebraic model's superiority in computational efficiency. Because of this increase in efficiency, we offer the ability to simulate the evolution of much larger populations in more realistic genotype spaces. Further, we show how the algebraic properties of the Markov Chain model can give insight into the evolutionary process and allow for analysis using familiar linear algebraic methods., Comment: 12 pages, 3 figures

Since the discovery of a cancer initiating side population in solid tumours, studies focussing on the role of so-called cancer stem cells in cancer initiation and progression have abounded. The biological interrogation of these cells has yielded volumes of information about their behaviour, but there has, as of yet, not been many actionable generalised theoretical conclusions. To address this point, we have created a hybrid, discrete/continuous computational cellular automaton model of a generalised stem-cell driven tissue and explored the phenotypic traits inherent in the inciting cell and the resultant tissue growth. We identify the regions in phenotype parameter space where these initiating cells are able to cause a disruption in homeostasis, leading to tissue overgrowth and tumour formation. As our parameters and model are non-specific, they could apply to any tissue cancer stem-cell and do not assume specific genetic mutations. In this way, our model suggests that targeting these phenotypic traits could represent generalizable strategies across cancer types and represents a first attempt to identify the hallmarks of cancer stem cells., Comment: 8 pages, 4 figures

Two models of circulating tumor cell (CTC) dynamics have been proposed to explain the phenomenon of tumor 'self-seeding', whereby CTCs repopulate the primary tumor and accelerate growth: Primary Seeding, where cells from a primary tumor shed into the vasculature and return back to the primary themselves; and Secondary Seeding, where cells from the primary first metastasize in a secondary tissue and form microscopic secondary deposits, which then shed cells into the vasculature returning to the primary. These two models are difficult to distinguish experimentally, yet the differences between them is of great importance to both our understanding of the metastatic process and also for designing methods of intervention. Therefore we developed a mathematical model to test the relative likelihood of these two phenomena in the subset of tumours whose shed CTCs first encounter the lung capillary bed, and show that Secondary Seeding is several orders of magnitude more likely than Primary seeding. We suggest how this difference could affect tumour evolution, progression and therapy, and propose several possible methods of experimental validation., Comment: 20 pages, 4 figures

In this paper we consider chemotherapy in a spatial model of tumor growth. The model, which is of reaction-diffusion type, takes into account the complex interactions between the tumor and surrounding stromal cells by including densities of endothelial cells and the extra-cellular matrix. When no treatment is applied the model reproduces the typical dynamics of early tumor growth. The initially avascular tumor reaches a diffusion limited size of the order of millimeters and initiates angiogenesis through the release of vascular endothelial growth factor (VEGF) secreted by hypoxic cells in the core of the tumor. This stimulates endothelial cells to migrate towards the tumor and establishes a nutrient supply sufficient for sustained invasion. To this model we apply cytostatic treatment in the form of a VEGF-inhibitor, which reduces the proliferation and chemotaxis of endothelial cells. This treatment has the capability to reduce tumor mass, but more importantly, we were able to determine that inhibition of endothelial cell proliferation is the more important of the two cellular functions targeted by the drug. Further, we considered the application of a cytotoxic drug that targets proliferating tumor cells. The drug was treated as a diffusible substance entering the tissue from the blood vessels. Our results show that depending on the characteristics of the drug it can either reduce the tumor mass significantly or in fact accelerate the growth rate of the tumor. This result seems to be due to complicated interplay between the stromal and tumor cell types and highlights the importance of considering chemotherapy in a spatial context., Comment: revised version, 25 pages, 9 figures, minor misprints corrected

We present multiscale models of cancer tumor invasion with components at the molecular, cellular, and tissue levels. We provide biological justifications for the model components, present computational results from the model, and discuss the scientific-computing methodology used to solve the model equations. The models and methodology presented in this paper form the basis for developing and treating increasingly complex, mechanistic models of tumor invasion that will be more predictive and less phenomenological. Because many of the features of the cancer models, such as taxis, aging and growth, are seen in other biological systems, the models and methods discussed here also provide a template for handling a broader range of biological problems.