Original article Biomath 2 (2013), 1212101, 1–6 B f Volume ░, Number ░, 20░░ BIOMATH ISSN 1314-684X Editor–in–Chief: Roumen Anguelov B f BIOMATH h t t p : / / w w w . b i o m a t h f o r u m . o r g / b i o m a t h / i n d e x . p h p / b i o m a t h / Biomath Forum Impact of Perfect Drug Adherence on Immunopathogenic Mechanism for Dynamical System of Psoriasis Priti Kumar Roy∗ and Abhirup Datta∗ ∗ Centre for Mathematical Biology and Ecology Department of Mathematics Jadavpur University, Kolkata 700032, India Emails: pritiju@gmail.com, abhirupdattajumath@gmail.com Received: 15 July 2012, accepted: 10 December 2012, published: 04 January 2013 Abstract—Psoriasis is a frequent autoimmune chronic skin disease differentiated by T-Cells agreeable hyperpro- liferation of epidermal Keratinocytes. The feature of T- Cells held up Psoriatic scratches is the epidermal pen- etration of basically oligoclonal CD8+ T-Cells and also of CD4+ T-Cells in the dermis. Psoriatic lesions are sharply distinguished, red and enlarged scratches together with whitish silver scales. In this research article, we propose a mathematical depiction for Psoriasis, involving a set of differential equations, regarding T-Cells, Dendritic Cells, CD8+ T-Cells and epidermal Keratinocytes. Here, we specially introduce the interaction between Dendritic Cells and CD8+ T-Cells to monitor the impact of this interaction upon the system dynamics. We also analyze the mathematical model both in presence and absence of effectiveness of two drugs. We study the system analyti- cally and numerically to comprehend the significance of effectiveness of the drugs, integrated in the model system. Here, we reduce the Keratinocyte population to restrict Psoriasis by applying the combination of two drugs and able to enlighten the perspective of the disease dynamics for Psoriasis. Keywords-T-Cells; Dendritic Cells; CD8+ T-Cells; Ker- atinocytes; MHC; pMHC; T-Cells Receptor; Dermis; Epi- dermis; Lymphocytes; Monocytes; Neutrophils; Cytokines; Drug Efficacy I. INTRODUCTION In spite of precise fundamental and experimental studies for more than a few decades, many queries continue relating to Psoriasis. Inflammatory tissues re- spond along with enormous influxes of T-Cells and Dendritic Cells (Nickoloff, 2000). A “Perfect Cytokine Storm” is produced through this multicellular scheme that synchronizes the cellular attack and links mutually with connection of both soluble intermediaries and cel- lular ingredients (Uyemura et. al., 1993, Nickoloff and Nestle, 2004) [1]. Psoriasis has been measured as a dermatological chaos, in which T-Cells and epidermal Keratinocytes perform a relevant pathogenic function. DCs play an essential role in pathogenesis of Psoriasis by attending antigens throughout principal major histo com- patibility (MHC) complex II molecules [2]. Psoriasis is observed as a widespread inflammatory skin chaos with an inherited contact. It is illustrious through epidermal hyperplasia by means of cellular diffusion of Lympho- cytes, Monocytes and Neutrophils [3]. Local production of T-Cells is observed as a significant immunological constituent of Psoriatic lesions. The enormous numbers of Dendritic Cells below the hyperplastic epidermis, are surrounded by T-Cells within the Psoriatic plaques [4]. Roy and Bhadra [5] have clarified that, suppression made on Dendritic Cells will reduce the expansion of Keratinocytes and will give better effect than suppression made on T-Cells. For suppression made on T-Cells, the pathogenesis continues due to auxiliary basis in presence of DCs, as the suppression on DCs presents a superior result. In our very recent work, we have formed a set Citation: P. Roy, A. Datta, Impact of Perfect Drug Adherence on Immunopathogenic Mechanism for Dynamical System of Psoriasis, Biomath 2 (2013), 1212101, http://dx.doi.org/10.11145/j.biomath.2012.12.101 Page 1 of 6 http://www.biomathforum.org/biomath/index.php/biomath http://dx.doi.org/10.11145/j.biomath.2012.12.101 P. Roy et al., Impact of Perfect Drug Adherence on Immunopathogenic Mechanism... of differential equations to exhibit a course of stable connection to the growth of epidermal Keratinocytes through negative feedback control, that is comparable to the favorable drug management. We also integrate a time delay in our model to furnish the time from creation of T-Cells and DCs to the enhancement of epidermal Keratinocytes [6]. In our present research article, we introduce CD8+ T-Cells population which interacts with DCs in the dynamical system. This interaction leads to generate Keratinocytes, which in turn supports to expand the Keratinocytes growth. Cyclosporin and FK506 are applied as drugs, that perform to restrict Psoriasis [7]. To confine this growth, we apply drug at the interaction between CD8+ T-Cells and DCs. Another method to create Keratinocytes is the interaction between T-Cells and Keratinocytes itself. Here, we also set the drug in that interaction to control the growth of Keratinocytes, whose surplus production directs to create Psoriasis. In this article, we study the effectiveness of two drugs on the cell biological scheme to build a comparative analysis for the drugs to restrain the disease. II. THE BASIC ASSUMPTIONS AND FORMULATION OF THE MATHEMATICAL MODEL We consider the mathematical model of Psoriasis to describe the dynamical cell biological system. Let us assume l(t), m(t), c(t) and k(t) to represent the densities of T-Cells, Dendritic Cells, CD8+ T-Cells and epidermal Keratinocytes correspondingly at a specific time t to attain a set of differential equations. In the region proximity, the accumulation of T-Cells is considered at a constant rate a and the accumulation of Dendritic Cells is taken at a constant rate b at the appropriate regime. It is assumed that, the rate of activation of T-Cells by DCs is δ and β is the rate of activation of DCs by T-Cells. Expansion of Keratinocytes density is taken to be proportional to the production of T-Cells and DCs densities with a rate η. The rate of activation of Keratinocytes by T-Cells due to T- Cells mediated Cytokines is referred as γ1 and γ2 is the rate at which growth of Keratinocytes takes place. The per capita removal rate of T-Cells is denoted by µ and µ′ is the per capita removal rate of Dendritic Cells throughout normal procedure. The premature Den- dritic Cells turn into mature in the course of some cell biological procedures and move into the lymph node. In that lymph node, the mature DCs interrelate with CD8+ T-Cells at a rate qn, where q is the average peptide specific T-Cells Receptor (TCR) and n is the average number of the related pMHC complexes per DCs and this contact gives a negative effect to DCs as well as positive effect to CD8+ T-Cells. The CD8+ T-Cell proliferation is stimulated by similar antigen presenting DCs at a rate r. We assume here also that, α is the rate of interaction between DCs and CD8+ T-Cells. It gives negative impact to CD8+ T-Cell population. In addition, Keratinocytes are produced through interaction between DCs and CD8+ T-Cells at a rate α1. Again, we assume ξ and λ as the per capita removal rate of CD8+ T-Cells and epidermal Keratinocytes respectively. All the parameters, described above, are always positive. Here, we assimilate the combination of two drug efficacy parameters u1 and u2, placed between the interaction of T-Cells and epidermal Keratinocytes and Dendritic Cells and CD8+ T-Cells respectively to restrain the growth of epidermal Keratinocytes, whose excess production is one of the main reasons to form Psoriasis. Accumulating collectively the above assumptions, we can formulate the mathematical model given below: dl dt = a − δlm − γ1lk(1 − u1) − µl, dm dt = b − βlm − qnmc − µ′m, dc dt = rqnmc − αmc(1 − u2) − ξc, (1) dk dt = ηlm + γ2lk(1 − u1) + α1mc(1 − u2) − λk, where l(0) > 0, m(0) > 0, c(0) > 0 and k(0) > 0 at a specific time period t. The communication is organized as follows: We com- prise the general outlook and discuss about the effective- ness of drugs on the cell biological system of Psoriasis in section I. In section II, we represent the mathematical model of Psoriasis including basic assumptions. Section III describes theoretical analysis of the model system (1). This section is also integrated with two equilibrium points of the system dynamics. Theoretical explanation of the model parameters, centering on its stability and associated features are discussed in the same section. In section IV, we include results from numerical simulation of the system and finally section V ends with the conclusion of the model dynamics. III. LOCAL STABILITY ANALYSIS FOR THE SYSTEM The RHS of the equation (1) is a smooth function of l(t), m(t), c(t) and k(t) and also the parameters, as long as these quantities are non-negative. For that reason, local existence and uniqueness properties hold in the positive octant. Biomath 2 (2013), 1212101, http://dx.doi.org/10.11145/j.biomath.2012.12.101 Page 2 of 6 http://dx.doi.org/10.11145/j.biomath.2012.12.101 P. Roy et al., Impact of Perfect Drug Adherence on Immunopathogenic Mechanism... 0 20 40 60 80 100 0 200 400 600 800 1000 Time ( Day −1 ) C e l l P o p u l a t i o n ( m m − 3 ) (a) λ=0.4 0 20 40 60 80 100 0 200 400 600 800 1000 Time ( Day −1 ) l(t) m(t) c(t) k(t) (b) λ=0.6 0 20 40 60 80 100 0 200 400 600 800 Time ( Day −1 ) (c) λ=0.8 Fig. 1. Behaviors of different cell biological masses of the system (1) with u1=0.5 and u2=0.7 for λ = 0.4 (Panel a), λ = 0.6 (Panel b) and λ = 0.8 (Panel c), keeping other parameters at their standard values as in Table 1. A. Equilibria of the Model System The model equation (1) has two equilibrium points, i.e., Ẽ(l̃, m̃, 0, k̃) and E∗(l∗,m∗,c∗,k∗). Now, m̃= b βl̃+µ′ , k̃= a−δl̃m̃−µl̃ γ1l̃(1−u1) and l̃ is the positive root of the equation Al̃3 − Bl̃2 + Cl̃ + D = 0, (2) where A = βδγ1γ2m̃(1 − u1) + βγ1γ2µ(1 − u1) > 0, B = aβγ1γ2(1 − u1) + bηγ21 (1 − u1) + δγ1m̃(βλ− γ2µ ′) + γ1µ(βλ − γ2µ′) + γ1γ2µ′u1(δm̃ + µ) > 0, C = aγ1(βλ − γ2µ′) + γ1µ′(aγ2u1 − δλm̃ − µλ) > 0, D = aγ1µ′λ > 0. This cubic equation (2) has positive real root if the coefficients of l̃3, −l̃2 and l̃ are positive. Now, consid- ering Descartes’ rule of sign, we may conclude that the equation Al̃3 −Bl̃2 + Cl̃ + D = 0 has two positive real roots (multiplicities of roots are adequate) [8] if and only if the following conditions are hold: (i) βλ > γ2µ ′ and (ii) aγ2u1 > λ(δm̃ + µ). From the second equation of system (1), we include m̃ is always positive by our necessary assumptions. From the first equation of system (1), we state that k̃ is realistic if a > l̃(δm̃ + µ). As a result, if (i) and (ii) are persuaded, then we may bring to an end that, the equation (2) has two positive real roots and henceforth positive equilibrium point Ẽ(l̃, m̃, 0, k̃) of the system (1) exists. Finally, for the interior equilibrium point E∗(l∗,m∗,c∗,k∗), l∗, m∗, c∗ and k∗ are the non- trivial solutions of the model equation (1). Remark 1. The system (1) exists if the two conditions are hold, (a) the product of the rate of activation of DCs by T-Cells and the per capita removal rate of Keratinocytes should be greater than the product of the rate of growth of Keratinocytes due to T-Cells mediated Cytokines and the per capita removal rate of DCs and (b) the rate of accumulation of T-Cells itself and the product of the rate of accumulation of T-Cells, the rate of growth of Keratinocytes due to T-Cells mediated Cytokines and the first drug efficacy parameter must be greater than a pre-assigned positive quantity. The characteristic equation of the matrix related to the equilibrium point Ẽ(l̃, m̃, 0, k̃) in presence of effectiveness of both drugs (u1 = u2 = 1) is illustrated by, (−λ − φ)(rqnm̃ − ξ − φ)[φ2 − (trace V )φ +det V ] = 0, where trace V = −(βl̃ + δm̃ + µ + µ′) < 0 and det V = βµl̃ + δµ′m̃ + µµ′ > 0. Now, φ1 (=−λ) is always negative, φ2=rqnm̃−ξ and the roots of the equation φ2 − (trace V )φ + det V = 0 are negative since trace V < 0 and det V > 0. Hence the equilibrium point Ẽ(l̃, m̃, 0, k̃) in presence of effectiveness of both drugs is stable only if m̃ < ξ rqn . Remark 2. The CD8+ T-Cells free equilibrium point in presence of effectiveness of both drugs is stable if DC population is less than some pre-determined positive value. The characteristic equation of the matrix related to the equilibrium point Ẽ(l̃, m̃, 0, k̃) in absence of effectiveness of both drugs (u1 = u2 = 0) is furnished by, (rqnm̃ − αm̃ − ξ − ψ)(ψ3 + A1ψ2 + A2ψ + A3) = 0. Here, ψ1=rqnm̃ − αm̃ − ξ and from Routh-Hurwitz criterion, A1 > 0 if β > γ2, A3 > 0 if ηγ1 > δγ2, βλ > γ2µ ′ and k̃ l̃ > γ2µ γ1λ and A1A2 − A3 > 0 if β > γ2. Thus the equilibrium point Ẽ(l̃, m̃, 0, k̃) in absence of effectiveness of both drugs is stable if m̃ < ξ rqn−α , β >max[γ2, γ2µ ′ λ ] and γ2 γ1 α. Biomath 2 (2013), 1212101, http://dx.doi.org/10.11145/j.biomath.2012.12.101 Page 3 of 6 http://dx.doi.org/10.11145/j.biomath.2012.12.101 P. Roy et al., Impact of Perfect Drug Adherence on Immunopathogenic Mechanism... 0 20 40 60 80 100 0 200 400 600 800 1000 Time ( Day −1 ) C e l l P o p u l a t i o n ( m m − 3 ) u 1 =u 2 =0.5 (a) 0 20 40 60 80 100 0 200 400 600 800 1000 Time ( Day −1 ) l(t) m(t) c(t) k(t) u 1 =0.9, u 2 =0.5 (b) 0 20 40 60 80 100 0 200 400 600 800 1000 Time ( Day −1 ) (c) u 1 =0.5, u 2 =0.9 Fig. 2. Behaviors of different cell biological masses of the system (1) for different values of two drug efficacy parameters u1 and u2, keeping other parameters at their standard values as in Table 1. Remark 3. The CD8+ T-Cells free equilibrium point in absence of effectiveness of both drugs is stable if (1) DC population is less than some pre-assigned positive quantity, (2) the rate of activation of DCs by T-Cells should be always greater than the maximum of [γ2, γ2µ ′ λ ] and (3) the ratio of γ2 and γ1 should be always less than the minimum of [ η δ , λk̃ µl̃ ]. Also we study another two cases, i.e., first drug (u1) is present and second drug (u2) is absent and vice-versa in the system dynamics. The characteristic equation of the matrix related to the equilibrium point Ẽ(l̃, m̃, 0, k̃) in presence of effectiveness of first drug (u1 = 1) and absence of effectiveness of second drug (u2 = 0) is illustrated by, (−λ − ϕ)(rqnm̃ − αm̃ − ξ − ϕ)[ϕ2 − (trace W)ϕ +det W ] = 0, where trace W = −(βl̃ + δm̃ + µ + µ′) < 0 and det W = βµl̃ + δµ′m̃ + µµ′ > 0. Now, ϕ1 (=−λ) is always negative, ϕ2=rqnm̃−αm̃−ξ and the roots of the equation ϕ2−(trace W)ϕ+det W = 0 are negative since trace W < 0 and det W > 0. Hence the equilibrium point Ẽ(l̃, m̃, 0, k̃) in presence of effectiveness of first drug (u1 = 1) and absence of effectiveness of second drug (u2 = 0) is stable only if m̃ < ξ rqn−α , provided rqn > α. Remark 4. The CD8+ T-Cells free equilibrium point in presence of effectiveness of first drug and absence of effectiveness of second drug is stable if DC popu- lation is less than some pre-determined positive value, provided the product of the rate at which CD8+ T-Cell proliferation is stimulated by antigen presenting DCs, average peptide specific T-Cells Receptor (TCR) and average number of the related pMHC complexes per DCs is greater than the rate of interaction between DCs and CD8+ T-Cells. The characteristic equation of the matrix related to the equilibrium point Ẽ(l̃, m̃, 0, k̃) in absence of effectiveness of first drug (u1 = 0) and presence of effectiveness of second drug (u2 = 1) is demonstrated by, (rqnm̃ − ξ − χ)(χ3 + B1χ2 + B2χ + B3) = 0. Here, χ1=rqnm̃ − ξ and from Routh-Hurwitz criterion, we obtain β > γ2, ηγ1 > δγ2, βλ > γ2µ ′ and k̃ l̃ > γ2µ γ1λ . Thus the equilibrium point Ẽ(l̃, m̃, 0, k̃) in absence of effectiveness of first drug (u1 = 0) and presence of effectiveness of second drug (u2 = 1) is stable if m̃ < ξ rqn , β >max[γ2, γ2µ ′ λ ] and γ2 γ1 rqn and m∗ < ξ rqn . Hence the interior equilibrium point E∗(l∗, m∗, c∗, k∗) in presence of effectiveness of both drugs (u1 = u2 = 1) is stable if rqn