Reviewer #3 (Public Review):
Liu et al. combined mechanistic modeling with in vitro experiments and data from a clinical trial to develop an in silico model to describe response of T cells against tumor cells when bi-specific T cell engager (BiTE) antigens, a standard immunotherapeutic drug, are introduced into the system. The model predicted responses of T cell and target cell populations in vitro and in vivo in the presence of BiTEs where the model linked molecular level interactions between BiTE molecules, CD3 receptors, and CD19 receptors to the population kinetics of the tumor and the T- cells. Furthermore, the model predicted tumor killing kinetics in patients and offered suggestions for optimal dosing strategies in patients undergoing BiTE immunotherapy. The conclusions drawn from this combined approach are interesting and are supported by experiments and modeling reasonably well. However, the conclusions can be tightened further by making some moderate to minor changes in their approach. In addition, there are several limitations in the model which deserves some discussion.
Strengths
A major strength of this work is the ability of the model to integrate processes from the molecular scales to the populations of T cells, target cells, and the BiTE antibodies across different organs. A model of this scope has to contain many approximations and thus the model should be validated with experiments. The authors did an excellent job in comparing the basic and the in vitro aspects of their approach with in vitro data, where they compared the numbers of engaged target cells with T cells as the numbers of the BiTE molecules, the ratio of effector and target cells, and the expressions of the CD3 and CD19 receptors were varied. The agreement with the model with the data were excellent in most cases which led to several mechanistic conclusions. In particular, the study found that target cells with lower CD19 expressions escape the T cell killing.
The in vivo extension of the model showed reasonable agreements with the kinetics of B cell populations in patients where the data were obtained from a published clinical trial. The model explained differences in B cell population kinetics between responders and non-responders and found that the differences were driven by the differences in the T cell numbers between the groups. The ability of the model to describe the in vivo kinetics is promising. In addition, the model leads to some interesting conclusions, e.g., the model shows that the bone marrow harbors tumor growth during the BiTE treatment. The authors then used the model to propose an alternate dosage scheme for BiTEs that needed a smaller dose of the drug.
Weaknesses
There are several weaknesses in the development of the model. Multiscale models of this nature contain parameters that need to be estimated by fitting the model with data. Some these parameters are associated with model approximations or not measured in experiments. Thus, a common practice is to estimate parameters with some 'training data' and then test model predictions using 'test data'. Though Supplementary file 1 provides values for some of the parameters that appeared to be estimated, it was not clear which dataset were used for training and which for test. The confidence intervals of the estimated parameters and the sensitivity of the proposed in vivo dosage schemes to parameter variations were unclear.
The model appears to show few unreasonable behaviors and does not agree with experiments in several cases which could point to missing mechanisms in the model. Here are some examples. The model shows a surprising decrease in the T cell-target cell synapse formation when the affinity of the BiTEs to CD3 was increased; the opposite should have been more intuitive. The authors suggest degradation of CD3 could be a reason for this behavior. However, this probably could be easily tested by removing CD3 degradation in the model. Another example is the increase in the % of engaged effector cells in the model with increasing CD3 expressions does not agree well with experiments (Fig. 3d), however, a similar fold increase in the % of engaged effector cells in the model agrees better with experiments for increasing CD19 expressions (Fig. 3e). It is unclear how this can be explained given CD3 and CD19 appears to be present in similar copy numbers per cell (~104 molecules/cell), and both receptors bind the BiTE with high affinities (e.g., koff < 10-4 s-1).
The model does not include signaling and activation of T cells as they form the immunological synapse (IS) with target cells. The formation IS leads to aggregation of different receptors, adhesion molecules, and kinases which modulate signaling and activation. Thus, it is likely the variations of the copy numbers of CD3, and the CD19-BiTE-CD3 will lead to variations in the cytotoxic responses and presumably to CD3 degradation as well. Perhaps some of these missing processes are responsible for the disagreements between the model and the data shown in Fig. 3. In addition, the in vivo model does not contain any development of the T cells as they are stimulated by the BiTEs. The differences in development of T cells, such as generation of dysfunctional/exhausted T cells could lead to the differences in responses to BiTEs in patients. In particular, the in vivo model does not agree with the kinetics of B cells after day 29 in non-responders (Fig. 6d); could the kinetics of T cell development play a role in this?
Addressing these concerns and a discussion of the limitations will make the conclusions of the study stronger and will provide cues for extending the approach for future studies.