Objective: Inflammation is both central to proper wound healing and a key driver of chronic tissue injury via a positive-feedback loop incited by incidental cell damage. We seek to derive actionable insights into the role of inflammation in wound healing in order to improve outcomes for individual patients. Approach: To date, dynamic computational models have been used to study the time evolution of inflammation in wound healing. Emerging clinical data on histo-pathological and macroscopic images of evolving wounds, as well as noninvasive measures of blood flow, suggested the need for tissue-realistic, agent-based, and hybrid mechanistic computational simulations of inflammation and wound healing. Innovation: We developed a computational modeling system, Simple Platform for Agent-based Representation of Knowledge, to facilitate the construction of tissue-realistic models. Results: A hybrid equation-agent-based model (ABM) of pressure ulcer formation in both spinal cord-injured and -uninjured patients was used to identify control points that reduce stress caused by tissue ischemia/reperfusion. An ABM of arterial restenosis revealed new dynamics of cell migration during neointimal hyperplasia that match histological features, but contradict the currently prevailing mechanistic hypothesis. ABMs of vocal fold inflammation were used to predict inflammatory trajectories in individuals, possibly allowing for personalized treatment. Conclusions: The intertwined inflammatory and wound healing responses can be modeled computationally to make predictions in individuals, simulate therapies, and gain mechanistic insights.
INTRODUCTIONWound healing is a complex process that is initiated and driven by inflammation.1,2 The first phase of the wound healing response involves the degranulation of platelets and infiltration of inflammatory cells, followed by proliferation of fibroblasts and epithelial cells that deposit collagen and cause contraction of wounds. Inflammatory mediators such as tumor necrosis factor alpha (TNF-a), 3 interferon-c, 4 interleukin (IL)-6, 5 IL-10, 6 transforming growth factor beta-1 (TGF-b1), 7 and nitric oxide 8,9 modulate the wound-healing response. Wound healing is well studied in animal systems. 10,11 However, even though some experimental methodologies are emerging that may allow for the study of time courses of wound healing in humans, 11 it is difficult to collect time courses of primary samples from humans suffering from chronic wound-healing diseases without disturbing the very process which is being measured. An alternative method for studying such a complex, clinically realistic system is to use a mechanistic computational model based on literature knowledge, which could be validated experimentally or clinically, which, in turn, may have applications in diagnosing/predicting wound healing trajectories of individuals or possibly in the design of novel therapeutic modalities for wound healing. Extensive work has gone into computational studies of wound healing, spanning many stages of this proces...