Embracing Complexity beyond Systems Medicine: A New Approach to Chronic Immune Disorders

Abstract

In order to combat chronic immune disorders (CIDs), it is an absolute necessity to understand the bigger picture, one that goes beyond insights at a one-disease, molecular, cellular, and static level. To unravel this bigger picture we advocate an integral, cross-disciplinary approach capable of embracing the complexity of the field. This paper discusses the current knowledge on common pathways in CIDs including general psychosocial and lifestyle factors associated with immune functioning. We demonstrate the lack of more in-depth psychosocial and lifestyle factors in current research cohorts and most importantly the need for an all-encompassing analysis of these factors. The second part of the paper discusses the challenges of understanding immune system dynamics and effectively integrating all key perspectives on immune functioning, including the patient's perspective itself. This paper suggests the use of techniques from complex systems science in describing and simulating healthy or deviating behavior of the immune system in its biopsychosocial surroundings. The patient's perspective data are suggested to be generated by using specific narrative techniques. We conclude that to gain more insight into the behavior of the whole system and to acquire new ways of combatting CIDs, we need to construct and apply new techniques in the field of computational and complexity science, to an even wider variety of dynamic data than used in today's systems medicine.

Keywords: chronic immune disorders; common pathways; data integration; life style; psychosocial factors.

Figure 1

Immune functioning: embracing complexity. (A) A wide variety of determinants influencing immune function. (B) Process overview of the immune system behavior. (C) Qualitative criteria for the behavior of the immune system. At step 2 “recognize and localize” the system must be able to discriminate between true threats and harmless organisms or cells. The discriminating capacity of the system might be low in disorders like allergies, some autoimmune diseases, and immunodeficiencies. Between steps 3 and 5, the swiftness or speed of alarming, mobilizing, and destroying is key for the immune system’s effectiveness in combatting pathogens before they start growing or mutating. The same applies to the thoroughness of destroying and cleaning up pathogens in steps 5 and 6 so that no or very little strain on the body remains after the infection. The capacity to restore any damage after the infection at step 7 and the speed at which the system returns to an attemptive calmness is an often forgotten aspect of the immune system’s capabilities. In autoimmune diseases, this might be disrupted. In conclusion, the whole duration of the immune reaction to a certain pathogen can also be an indicator for (un)healthy behavior. Icons in panels (B,C) made by Katarina Stefanikova (lightning cloud) and Freepik (other icons) are from www.flaticon.com.