Research article Special Issues

A meta-analysis of the comparing of the first-generation and next-generation TKIs in the treatment of NSCLC

  • BackgroundThe current standard approach to the treatment of patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)—sensitizing mutations has been the treatment with a first-generation EGFR-TKIs. While, with resistance developed against first-generation EGFR-TKIs, second/third-generation TKIs have attracted all the attention, and replaced first-generation EGFR- TKIs upon disease progression due to the greater efficacy and more favorable tolerability. In the past few years, this strategy has been challenged by clinical evidence when next-generation EGFR-TKIs are used in patients with advanced NSCLC.
    ObjectiveIn this study, we performed a meta- analysis to investigate the efficacy of next-generation TKIs comparison with first-generation TKIs in the treatment of NSCLC.
    MethodsThe multiple databases including Pubmed, Embase, Cochrane library databases were adopted to search for the relevant studies, and full-text articles involving to comparison of next-generation TKIs and first-generation TKIs were reviewed. After rigorous reviewing on quality, the data was extracted from eligible randomized controlled trial (RCT). Meta-analysis Revman 5.3 software was used to analyze the combined pooled ORs with the corresponding 95% confidence interval using fixed- or random-effects models according to the heterogeneity.
    ResultsA total of 5 randomized controlled trials were included in this analysis. The group of next-generation TKIs did achieved benefit in progression-free survival (PFS) (OR = 0.58, 95%CI = 0.45-0.75, P < 0.0001), overall survival (OS) (OR = 0.76, 95%CI = 0.65-0.90, P = 0.001) as well with the objective response rate (ORR) (OR = 1.27, 95%CI = 1.01-1.61, P = 0.04), respectively. In the results of subgroup analysis of PFS with EGFR mutations, there is also significant differences with exon 19 deletion (OR = 0.56, 95%CI = 0.41-0.77, P = 0.0003) and exon 21 (L858R) mutation (OR = 0.60, 95%CI = 0.49-0.75, P < =0.00001). While, the treatment-related severe adverse event (SAE) between the next-generation TKIs and first-generation TKIs did not have statistical significance (OR = 1.48, 95%CI = 0.62-3.55, P = 0.38).
    ConclusionThe next-generation TKIs significantly improved efficacy outcomes in the treatment of EGFR mutation-positive advanced NSCLC compared with the first-generation TKIs, with a manageable safety profile. These results are potentially important for clinical decision making for these patients.

    Citation: Yongxing Li, Jianye Yang, Yufen Xu, Ming Zhang, Xiaoping Zhang, Wenyu Chen, Xiaodong Lv. A meta-analysis of the comparing of the first-generation and next-generation TKIs in the treatment of NSCLC[J]. Mathematical Biosciences and Engineering, 2019, 16(5): 5687-5696. doi: 10.3934/mbe.2019283

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  • BackgroundThe current standard approach to the treatment of patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)—sensitizing mutations has been the treatment with a first-generation EGFR-TKIs. While, with resistance developed against first-generation EGFR-TKIs, second/third-generation TKIs have attracted all the attention, and replaced first-generation EGFR- TKIs upon disease progression due to the greater efficacy and more favorable tolerability. In the past few years, this strategy has been challenged by clinical evidence when next-generation EGFR-TKIs are used in patients with advanced NSCLC.
    ObjectiveIn this study, we performed a meta- analysis to investigate the efficacy of next-generation TKIs comparison with first-generation TKIs in the treatment of NSCLC.
    MethodsThe multiple databases including Pubmed, Embase, Cochrane library databases were adopted to search for the relevant studies, and full-text articles involving to comparison of next-generation TKIs and first-generation TKIs were reviewed. After rigorous reviewing on quality, the data was extracted from eligible randomized controlled trial (RCT). Meta-analysis Revman 5.3 software was used to analyze the combined pooled ORs with the corresponding 95% confidence interval using fixed- or random-effects models according to the heterogeneity.
    ResultsA total of 5 randomized controlled trials were included in this analysis. The group of next-generation TKIs did achieved benefit in progression-free survival (PFS) (OR = 0.58, 95%CI = 0.45-0.75, P < 0.0001), overall survival (OS) (OR = 0.76, 95%CI = 0.65-0.90, P = 0.001) as well with the objective response rate (ORR) (OR = 1.27, 95%CI = 1.01-1.61, P = 0.04), respectively. In the results of subgroup analysis of PFS with EGFR mutations, there is also significant differences with exon 19 deletion (OR = 0.56, 95%CI = 0.41-0.77, P = 0.0003) and exon 21 (L858R) mutation (OR = 0.60, 95%CI = 0.49-0.75, P < =0.00001). While, the treatment-related severe adverse event (SAE) between the next-generation TKIs and first-generation TKIs did not have statistical significance (OR = 1.48, 95%CI = 0.62-3.55, P = 0.38).
    ConclusionThe next-generation TKIs significantly improved efficacy outcomes in the treatment of EGFR mutation-positive advanced NSCLC compared with the first-generation TKIs, with a manageable safety profile. These results are potentially important for clinical decision making for these patients.


    Recently, different kinds of viral infection such as HIV (human immunodeficiency virus), HCV (hepatitis C virus) and HBV (hepatitis B virus) have received many attention. Different mathematical models have been formulated to describe the dynamics of virus population in vivo [1,2,3,4,5,6]. The basic viral infection model of within-host can be described by the following three dimensional system [7]:

    {dxdt=sβxvd1x,dydt=βxvd2y,dvdt=kyuv. (1.1)

    Here x(t),y(t), and v(t) represent uninfected target cells, infected cells and free virus, respectively. Uninfected cells are produced at a constant rate s, die at rate d1x, and become infected at rate βxv. Infected cells are produced at rate βxv and die at rate by. Free virus are produced from infected cells at rate ky and die at rate uv. It was showed that, for system (1.1), there exist a critical threshold named as the basic reproduction number of virus R0=βskd1d2 to determine its global dynamical behavior [8].

    During viral infections, the adaptive immune response is mediated by lymphocytes expressing antigen specific receptors, T and B lymphocytes, namely, humoral and cellular immunity. To study the population dynamics of immune response, Nowak et al. [9] introduced the CTL population into system (1.1) and obtain the following four dimensional system:

    {dxdt=sβxvd1x,dydt=βxvd2ypyz,dvdt=kyuv,dzdt=cyzd3z. (1.2)

    Here z(t) denotes CTLs, which is produced at rate cyz because of the stimulation of infected cells, and die at rate d3z. The infected cells are eliminated by CTLs at rate pyz. Following [9], many authors present and develop mathematical models for the cell-mediated immune response [10,11,12,13] and the humoral immunity [14,15,16,17].

    Recently study indicates that the self-proliferation of immune cells can not be neglected besides the stimulation of infected cells. In order to mimic the spontaneous proliferation of CTLs, a logistic proliferation term for CTLs was incorporated in virus infection models in [18], where a rigorous mathematical analysis of the effect of self-proliferation of CTLs on the dynamics of viral infection is necessary. In order to understand the effect of self-proliferation and delayed activation of immune cells in a virus model, we propose the following virus infection model:

    {dxdt=sβxvd1x,dydt=βxvd2ypyz,dvdt=kyuv,dzdt=cy(tτ)z(tτ)+rz(1zm)d3z. (1.3)

    Here the logistic proliferation term rz(1z/m) describes the self-proliferation of CTLs, in which parameter r denotes a per capita self-proliferation rate, and m means the capacity of CTLs population. Time delay term cy(tτ)z(tτ) represents a sequence of events such as antigenic activation and selection. It has been shown that time delays cannot be ignored in models for viral immune response including intracellular delay during viral infection [19,20,21,22] and time delay of CTLs stimulating proliferation [23,24].

    Note that the turnover of virus is much faster than that of infection cells within-host [25,26]. A plausible quasi steady-state assumption is proposed to mimic the fast time-scale[27,28]. In other words, v can be replaced by kyu in (1.3). Let ˆβ=βku and also note as β to simplify the parameter, system (1.3) can be written as:

    {dxdt=sβxyd1x,dydt=βxyd2ypyz,dzdt=cy(tτ)z(tτ)+rz(1zm)d3z. (1.4)

    This paper is organized as follows. In section 2, some preliminary results are obtained, including non-negativity and boundedness of the solution of system (1.4), the existence of equilibria under different self-proliferation intensities of CTLs. Section 3 investigate the local and global stability of the boundary equilibria. Section 4 study the effects of delayed activation of immune cells on the existence of Hopf bifurcation. The direction and stability of Hopf bifurcation is investigated in section 5. Some numerical simulations are given to quantify the impact of self-proliferation and delayed activation of CTLs in section 6. Finally, some conclusions and discusses are presented in section 7.

    In this section, we first discuss the non-negativity and boundedness of solutions of system (1.4). For τ>0, let C=C([τ,0],R3+) denote the Banach space of continuous function mapping the interval [τ,0] into R3+ with the topology of uniform convergence. The initial conditions are given by

    x(ξ)=ϕ1(ξ),y(ξ)=ϕ2(ξ),z(ξ)=ϕ3(ξ) (2.1)

    with ϕi(ξ)0, ξ[τ,0] and ϕi(0)>0 (i=1,2,3).

    Theorem 2.1. The solutions of system (1.4) satisfying the initial conditions (2.1) are non-negative and ultimately bounded.

    Proof. We first define the right-hand side function of system (1.4) as

    G(t,K(t))=(sβxyd1xβxyd2ypyzcy(tτ)z(tτ)+rz(1zm)d3z),

    where K(t)=(K1(t),K2(t),K3(t))T and K1(t)=x, K2(t)=y, K3(t)=z. It is obvious that the function G(t,K(t)) is locally Lipschitz and by the standard theory of functional differential equation, we know that there exists a unique solution for a given initial conditions. To prove the non-negativity of solutions of system (1.4), we first prove the non-negativity over the time interval [0,τ]. Considering the right-hand side functions of system (1.4) over the time interval [0,τ], we have

    G(t,K(t))=(G1(t,K(t))G2(t,K(t))G3(t,K(t)))Ki(t)=0=(s0cy(tτ)z(tτ))=(s0cϕ2(ξ)ϕ3(ξ)),

    where ξ[τ,0]. Note that the positivity of parameters and nonnegativity of initial functions. It can be seen from the above expression that each component Gi(t,K(t))0. It follows that the solutions of system (1.4) remain nonnegative in [0,τ]. Similarly, we can repeat the process over [τ,2τ] and so on by using the method of steps [29], it can be proved that for any finite interval [0,t], the solutions of system (1.4) remains non-negative.

    Now we consider the boundeness of the solutions. Define a new variable X(t)=x(t)+y(t)+pcz(t+τ), and let d=min{1,d1,d2}. By the non-negativity of the solutions of system (1.4), we have

    dXdt=sd1xd2y+prcz(t+τ)(1z(t+τ)m)d3z(t+τ)=sd1xd2ypcz(t+τ)+pcz(t+τ)(1+rrz(t+τ)m)d3z(t+τ)sd1xd2ypcz(t+τ)+pm(1+r)24rcs+pm(1+r)24rcdX(t). (2.2)

    Taking M=s+pm(1+r)24rc, we know lim suptX(t)Md. So the solutions of system(1.4) are ultimately bounded. The equilibria of (1.4) are the solutions of the following algebraic equations:

    {sβxyd1x=0,βxyd2ypyz=0,cyz+rz(1zm)d3z=0. (2.3)

    It is easy to see that system (1.4) always has infection-free equilibrium Eyz0=(x0,0,0), where x0=sd1. According to the definition in [30], we obtain the basic reproduction number of virus R0=βsd1d2. Now we define x1=d2β,y1=d1(R01)β,x2=sd1,z2=m(rd3)r. Based on (2.3), after some simple calculations, it is easy to get the following results.

    Proposition 2.2. (i) Suppose that R0>1. The immunity-inactivated infection equilibrium Ez0=(x1,y1,0) always exists. Especially, besides Ez0, an infection-free but immunity-activated equilibrium Ey0=(x2,0,z2) will appear if r>d3. (ii) Suppose that 0rd3. If R0>1+β(d3r)cd1, system (1.4) has a unique immunity-activated infection equilibrium E1=(x1,y1,z1), where

    x1=d2+pz1β,y1=rz1+m(d3r)mc,

    and z1 is the unique positive root of the quadratic equation A1z2+B1z+C1=0, in which

    A1=prβ,B1=(d2rβ+pmcd1+βpm(d3r)),C1=mcd1d2(R01)βmd2(d3r).

    (iii) Suppose that r>d3. If R0>1+pm(rd3)rd2, system (1.4) has a unique immunity-activated infection equilibrium E2=(x2,y2,z2), where

    x2=sd1+βy2,z2=m(cy2+rd3)r,

    and y2 is the unique positive root of the quadratic equation A2y2+B2y+C2=0, in which

    A2=pmcβ,B2=pmβ(rd3)+d2rβ+pmcd1,C2=rd1d2(R01)+pmd1(rd3).

    In order to study the stability of equilibrium, we linearize system (1.4) about one equilibrium E=(x,y,z) and obtain the following linear system

    {dxdt=(βyd1)xβxy,dydt=βyx+(βxd2pz)ypyz,dzdt=czy(tτ)+cyz(tτ)+(rd32rzm)z. (3.1)

    When r=0, it follows from the study of Michael Y. Li and Hongying Shu [23] that time delay τ does not change the stability of the boundary equilibria.

    When r>0, by using the linear system (3.1) and constructing Lyapunov function, we can obtain the following results.

    Proposition 3.1. Suppose that 0<r<d3. Then we have

    (i) The infection-free equilibrium Eyz0 is globally asymptotically stable if R0<1, and it is unstable when R0>1.

    (ii) The immunity-inactivated infection equilibrium Ez0 is globally asymptotically stable if 1<R0<1+β(d3r)cd1, and it is unstable when R0>1+β(d3r)cd1.

    Proof. (ⅰ) By the linear system (3.1), we can obtain the characteristic equation of system(1.4) at Eyz0 as

    (λ+d1)(λ(rd3))(λ+d1d2(1R0))=0. (3.2)

    So the eigenvalues are

    λ1=d1<0,λ2=rd3<0,λ3=d1d2(R01).

    As a result, if R0<1, the infection-free equilibrium Eyz0 is locally asymptotically stable, and Eyz0 is unstable if R0>1.

    In order to obtain the global stability of equilibrium Eyz0, we consider a Lyapunov function given by

    L1=xx0x0lnxx0+y+pcz+p0τy(t+θ)z(t+θ)dθ.

    Taking the time derivative of L1 along the solution of system (1.4), we have

    dL1dt=(1x0x)(sβxyd1x)+βxyd2ypyz+pc[cy(tτ)z(tτ)+rz(1zm)d3z]+pyzpy(tτ)z(tτ)=d1(xx0)2x+(βx0d2)y+pc(rd3)zprz2cm=d1(xx0)2x+d2(R01)y+pc(rd3)zprz2cm.

    Notice that r<d3 and R0<1. We have L10 for all x(t),y(t),z(t)>0, and L1=0 only if x=x0, y=0 and z=0. It can be verified that the maximal compact invariant set in L1=0 is the singleton Eyz0. By the LaSalle's invariance principle, we know the infection-free equilibrium Eyz0 is globally asymptotically stable.

    (ⅱ) The characteristic equation of system(1.4) at Ez0 is

    (λ2+d1R0λ+β2x1y1)(λ(rd3+cy1eλτ))=0. (3.3)

    When τ=0 and R0<1+β(d3r)cd1, the roots of (3.3) are negative. When τ>0, the local stability of equilibrium Ez0 is solely determined by

    λ(rd3+cy1eλτ)=0. (3.4)

    Let λ=iω(τ)(ω(τ)>0) be the root of Eq (3.4). Separating real and imaginary parts yields

    {d3r=cy1cos(ωτ),ω=cy1sin(ωτ). (3.5)

    Squaring and adding Eq (3.5) gives

    ω2(cy1)2+(d3r)2=0.

    Note that

    (cy1)2(d3r)2=(cd1(R01)β(d3r))21<0

    if R0<1+β(d3r)cd1. Then we konw that (3.3) has no root that can across the imaginary axis, which indicate that the immunity-inactivated infection equilibrium Ez0 is locally asymptotically stable when R0<1+β(d3r)cd1.

    In order to obtain the global stability of Ez0, we construct the following Lyapunov functions:

    L2=xx1x1lnxx1+yy1y1lnyy1+pcz+p0τy(t+θ)z(t+θ)dθ.

    Taking the time derivative of L2 along the solution of system(1.4), we get

    dL2dt=(1x1x)(sβxyd1x)+(1y1y)(βxyd2ypyz)+pc(cy(tτ)z(tτ)+rz(1zm)d3z)+pyzpy(tτ)z(tτ)=sd1xsx1x+βx1y+d1x1d2yβxy1+d2y1+py1z+pc(rd3)zprz2cm.

    Using s=βx1y1+d1x1 and d2=βx1, we have

    dL2dt=(d1x1+βx1y1)(2xx1x1x)+p(y1d3rc)zprz2cm=(d1x1+βx1y1)(2xx1x1x)+pd1β(R01β(d3r)cd1)zprz2cm.

    Using the LaSalle's invariance principle, we can obtain that Ez0 is globally asymptotically stable.

    Proposition 3.2. Suppose that r=d3. Then we have

    (i) The infection-free equilibrium Eyz0 is globally asymptotically stable if R0<1, and it is unstable when R0>1.

    (ii) The immunity-inactivated infection equilibrium Ez0 is unstable as long as it appears, i.e., R0>1.

    Proof. (ⅰ) The characteristic equation of system (1.4) at Eyz0 is

    λ(λ+d1)(λ+d1d2(1R0))=0. (3.6)

    So the eigenvalues are

    λ1=0,λ2=d1<0,λ3=d1d2(R01).

    So if R0<1, the infection-free equilibrium Eyz0 is locally asymptotically stable and if R0>1, the equilibrium Eyz0 is unstable.

    In order to obtain the global stability of Eyz0, we construct the following Lyapunov functions:

    L3=xx0x0lnxx0+y+pcz+p0τy(t+θ)z(t+θ)dθ.

    Taking the time derivative of L3 along the solution of system (1.4), we have

    dL3dt=(1x0x)(sβxyd1x)+βxyd2ypyz+pc(cy(tτ)z(tτ)rz2m)+pyzpy(tτ)z(tτ)=d1(xx0)2x+(βx0d2)yprz2cm=d1(xx0)2x+d2(R01)yprz2cm.

    Using the LaSalle's invariance principle, we can obtain that Eyz0 is globally asymptotically stable.

    (ⅱ)The characteristic equation of system (1.4) at Ez0 is

    (λ2+d1R0λ+β2x1y1)(λcy1eλτ)=0. (3.7)

    It can be showed that there exist positive real root for the characteristic Eq (4.3), which indicates that the infection-free equilibrium Ez0 is unstable. This completes the proof.

    Proposition 3.3. Suppose that r>d3. Then we have

    (i) The infection-free equilibrium Eyz0 is unstable.

    (ii) The immunity-inactivated infection equilibrium Ez0 is unstable.

    (iii) If R0<1+pm(rd3)rd2, the infection-free equilibrium Ey0 is locally asymptotically stable, moreover if R0<1, the infection-free equilibrium Ey0 is globally asymptotically stable; if R0>1+pm(rd3)rd2, Ey0 is unstable.

    Proof. (ⅰ) The characteristic equation of system (1.4) at Eyz0 is

    (λ+d1)(λ(rd3))(λ+d1d2(1R0))=0. (3.8)

    So the eigenvalues are

    λ1=d1,λ2=rd3,λ3=d1d2(R01).

    It follows from λ2=rd3>0 that the infection-free equilibrium Eyz0 is always unstable. So we can easily get the infection-free equilibrium Eyz0 is always unstable when τ>0.

    (ⅱ) The characteristic equation of system (1.4) at Ez0 is

    (λ2+d1R0λ+β2x1y1)(λ(rd3+cy1eλτ))=0. (3.9)

    Note that r>d3. It can be shown that there exist positive real root for the characteristic equation above, which indicates that the immunity-inactivated infection equilibrium Ez0 is unstable.

    (ⅲ) The characteristic equation of system (1.4) at Ey0 is

    (λ+d1)(λ+rd3)(λsβd1+d2+pm(rd3)r)=0. (3.10)

    The eigenvalues are

    λ1=d1,λ2=(rd3),λ3=sβd1d2pm(rd3)r.

    Note that

    sβd1d2pm(rd3)r=d2(R01)pm(rd3)r<0R0<1+pm(rd3)rd2.

    Thus, the infection-free equilibrium Ey0 is locally asymptotically stable if R0<1+pm(rd3)rd2, and Ey0 is unstable if R0>1+pm(rd3)rd2.

    In order to obtain the global stability of Ey0, we construct the following Lyapunov function:

    L4=xx2x2lnxx2+y+pc(zz2z2lnzz2)+pcz+p0τy(t+θ)z(t+θ)dθ.

    Taking the time derivative of L4 along the solution of system (1.4) and using a computation process similar to that of Theorem 3.9, we have

    dL4dt=(1x2x)(sβxyd1x)+βxyd2ypyz+pc(1z2z)(cy(tτ)z(tτ)+rz(1zm)d3z)=d1(xx2)2x+d2(R01)ypz2y(tτ)z(tτ)zrpcm(zz2)2.

    Thus, dL4dt0 if R0<1, and dL4dt=0 only if x=x2,y=0 and z=z2, i.e., the maximal invariant subset in {(x,y,z):dL4dt|(1.4)=0} is the singleton {Ey0}. As a result, Ey0 is globally asymptotically stable based on the LaSalle's invariance principle. This complete the proof.

    Remark 3.4. From Proposition 3.1 to Proposition 3.3, we can see that the delay τ does not affect the stability of infection-free equilibrium Eyz0, Ey0 and immune-unactivated Ez0 equilibrium.

    In this section, we take the discrete delay τ as a bifurcation parameter and show that when the positive equilibrium E2 loses its stability and a Hopf bifurcation appears when the delay τ passes through a critical value. We point out there also exists a Hopf bifurcation at positive equilibrium E1 as the delay τ passes through a critical value and the proof is similar.

    The characteristic equation of system (1.4) at E2 is

    λ3+B1λ2+B2λ+B3+(C1λ2+C2λ+C3)eλτ=0, (4.1)

    where

    B1=2rz2mr+d3+d1+βy2,B2=(d1+βy2)(2rz2mr+d3)+β2x2y2,B3=(2rz2mr+d3)β2x2y2,C1=cy2,C2=(d1+βy2)cy2+pcy2z2,C3=cy2β2x2y2+(d1+βy2)pcy2z2.

    When τ=0, the characteristic equation of system (1.4) at E2 is

    λ3+A1λ2+A2λ+A3=0,

    where

    A1B1+C1=d1+βy2+cy2+rd3>0,A2B2+C2=(d1+βy2)(cy2+rd3)+β2x2y2+pcy2z2>0,A3B3+C3=pcy2z2(d1+βy2)+(cy2+rd3)β2x2y2>0.

    After some calculations, we have

    A1A2A3=(cy2+rd3)(pcy2z2+(d1+βy2)2)+(d1+βy2)(β2x2y2+(cy2+rd3)2)>0.

    It follows from the Routh-Hurwitz criterion that E2 is locally asymptotically stable when time delay is absent.

    When τ>0, putting λ=iω into characteristic Eq (4.1) and separating real and imaginary parts, we have

    B1ω2B3=(C3C1ω2)cos(ωτ)+C2ωsin(ωτ), (4.2)
    ω3B2ω=(C3C1ω2)sin(ωτ)+C2ωcos(ωτ). (4.3)

    Since sin2(ωτ)+cos2(ωτ)=1, squaring and adding the two Eqs (4.2) and (4.3), we have

    ω6+p1ω4+p2ω2+p3=0, (4.4)

    where

    p1=B212B2C21,p2=B22+2C1C3C222B1B3,p3=B23C23.

    Let u=ω2, Eq (4.4) becomes

    G(u)=u3+p1u2+p2u+p3=0. (4.5)

    If Eq (4.5) has a positive real root u, the characteristic Eq (4.1) has a purely imaginary root iω=iu; otherwise, Eq (4.1) has no purely imaginary root.

    Note that

    G(u)=3u2+2p1u+p2. (4.6)

    Let

    Δ=p213p2.

    Then we know that G(u) is monotonically increasing if Δ0, which indicates that Eq (4.5) has no positive root when p30 and Δ0.

    If Δ>0, the function G(u) has two critical points

    u=p1+Δ3,u=p1Δ3.

    Thus we know that Eq (4.5) has unique positive root u0 with G(u0)>0 if one of the following two conditions hold:

    (H1)Δ>0, p3<0, u<0 and u>0;

    (H2)Δ>0, p3<0, u>0 and G(u)<0.

    Equation (4.5) has two positive roots u1<u2 with G(u1)<0 and G(u2)>0 if the following assumption is satisfied:

    (H3)Δ>0, p3>0, u>0 and G(u)<0.

    Let ωk=uk,k=0,1,2. It follows from Eqs (4.2) and (4.3) that the value of τ associated with the purely imaginary root iωk should satisfy

    (B1ω2kB3)(C3C1ω2k)+(ω3kB2ωk)C2ωk=((C3C1ω2k)2+C22ω2k)cos(ωkτ).

    For k=0,1,2, we define

    τkn=1ωkarccos((B1ω2kB3)(C3C1ω2k)+(ω3kB2ωk)C2ωk(C3C1ω2k)2+C22ω2k)+2nπωk,n=0,1,2. (4.7)

    Then at increasing sequences of τ values,

    τ00<τ01<τ02<<τ0n,τ10<τ11<τ12<<τ1n,τ20<τ21<τ22<<τ2n,

    Eq (4.1) has purely imaginary roots iωk,k=0,1,2.

    Now we consider the transversality conditions associated with Hopf bifurcation. Substituting λ(τ) into Eq (4.1) and differentiating the resulting equation in τ, we obtain

    (dλdτ)1=3λ2+2B1λ+B2+(2C1λ+C2)eλτ+(C1λ2+C2λ+C3)(τ)eλτλeλτ(C1λ2+C2λ+C3)=(3λ2+2B1λ+B2)eλτλ(C1λ2+C2λ+C3)+2C1λ+C2λ(C1λ2+C2λ+C3)τλ.

    which indicates that

    sign{d(Reλ)dτ}|λ=iωk=sign{Re(dλdτ)1}|λ=iωk=sign{3ω4k+2(B212B2C21)ω2k+(B22+2C1C3C222B1B3)(C3C1ω2k)2+C22ω2k}=sign{G(ω2k)(C3C1ω2k)2+C22ω2k}.

    Since G(u0)>0, G(u1)<0 and G(u2)>0, then for n=0,1,2,..., we have

    sign{d(Reλ)dτ|τ=τkn}=sign{Re(dλdτ)1|τ=τkn}>0,(k=0,2),

    and

    sign{d(Reλ)dτ|τ=τkn}=sign{Re(dλdτ)1|τ=τkn}<0,(k=1).

    Then we know that at each τ0n and τ2n, n=0,1,2,, a pair of characteristic roots of Eq (4.1) cross the imaginary axis to the right. At each τ1n, n=0,1,2,, a pair of characteristic roots of Eq (4.1) cross the imaginary axis to the left. Then the transversality condition required by the Hopf bifurcation theorem is satisfied.

    Note that ωk=uk and u1<u2. We have ω1<ω2, which indicates that

    τ1nτ1n1=2πω1>2πω2=τ2nτ2n1,n=0,1,2....

    Then there exists a positive integer k such that

    τ20<τ10<τ21<τ11<τ2k<τ2k+1<τ1k.

    We thus obtain the following result.

    Theorem 4.1. For system (1.4), we have

    (i) If Δ0 and p30 holds, E2 is asymptotically stable for all τ>0.

    (ii) If one of the conditions (H1) and (H2) holds, E2 is asymptotically stable when τ[0,τ00) and unstable when τ>τ00, that is system (1.4) undergoes a Hopf bifurcation at E2 when τ=τ00.

    (iii) If the condition (H3) holds, system (1.4) undergoes a Hopf bifurcation at E2 along two sequences of τ values τ1,2n, n=0,1,2.... Furthermore there exists a positive integer k such that E2 is stable when

    τ[0,τ20)(τ10,τ21)(τ1k1,τ2k);

    E2 is unstable when

    τ(τ20,τ10)(τ21,τ11)(τ2k1,τ1k1)(τ2k,+).

    In the previous section, we know that system (1.4) undergoes a Hopf bifurcation at E2 along some sequences of τ values. Let τ be one of the Hopf bifurcation points. As pointed out in Hassard et al. [31], it is interesting to determine the direction, stability and period of these periodic solutions.

    Let μ=ττ, and then μ is new bifurcation parameter of the system. Define

    X(t)=(xx2,yy2,zz2)T,Xt(θ)=X(t+θ),θ[τ,0].

    System (1.4) may be written as:

    X(t)=LμXt+f(Xt(.),μ),   Lμϕ=F1ϕ(0)+F2ϕ(τ), (5.1)

    where

    f(ϕ,μ)=[βϕ1(0)ϕ2(0)βϕ1(0)ϕ2(0)pϕ2(0)ϕ3(0)cϕ2(τ)ϕ3(τ)rmϕ32(0)],
    F1=[βy2d1βx20βy2d2pz2py200rd32rz2m],

    and

    F2=[0000000cz2cy2].

    By Riesz representation theorem, there exists a matrix η(θ,μ):[τ,0]R3 whose components are bounded variation functions such that

    Lμϕ=0τdη(θ,μ)ϕ(θ),

    where

    dη(θ,μ)=F1δ(θ)dθ+F2δ(θ+τ)dθ

    and δ(θ) is the Dirac delta function.

    For ϕC([τ,0],R3), we define

    A(μ)ϕ(θ)={dϕ(θ)dθ,θ[τ,0),0τdη(ξ,μ)ϕ(ξ),θ=0,

    and

    R(μ)ϕ(θ)={0,θ[τ,0),f(ϕ,μ),θ=0.

    Then system (1.4) is equivalent to the following operator equation

    Xt(θ)=A(μ)Xt(θ)+R(μ)Xt(θ). (5.2)

    For φC([0,τ],R3), we define the adjoint operator of A(0) as A(0), where

    A(0)φ(s)={dφ(s)ds,s(0,τ],0τdηT(ξ,0)ϕ(ξ),s=0.

    For the convenience of research, we simply write A for A(0), A for A(0), R for R(0), η(θ) for η(θ,0), for φC([0,τ],R3) and ϕC([τ,0],R3).

    Define a bilinear form as

    φ,ϕ=ˉφT(0)ϕ(0)0θ=τθξ=0ˉφ(ξθ)dη(θ)ϕ(ξ)dξ.

    Let q(θ) and q(s) to be the eigenvectors of matric A and A corresponding to eigenvalue iω0 and iω0, respectively. Then

    Aq(θ)=iω0q(θ),       Aq(s)=iω0q(s).

    We can choose appropriate q(θ) and q(s) such that <q(θ),q(s)>=1,

    where

    q(θ)=(1,q2,q3)Teiω0θ,   q(s)=D(1,q2,q3)Teiω0s,

    and

    q2=βy2+d1+iω0βx2,q3=β2y2x2+(βy2+d1+iω0)(d2+pz2+iω0)py2βx2,q2=βy2+d1iω0βy2,q3=[β2y2x2+(βy2+d1iω0)(d2+pz2iω0)]eiω0τcβy2z2.

    Note that

    <q,q>=ˉDˉqT(0)q(0)0θ=τθs=0ˉDˉqT(sθ)dη(θ)q(s)ds=ˉD(1+ˉq2q2+ˉq3q30θ=τθs=0(1,ˉq2,ˉq3)e(sθ)iω0(1,q2,q3)Teiω0sdsdη(θ))=ˉD(1+ˉq2q2+ˉq3q30θ=τ(cˉq2z+cq3y)θeiω0θdη(θ))=ˉD(1+ˉq2q2+ˉq3q3+(cˉq2z+cq3y)q3τeiω0τ).

    Then we can choose ˉD as

    ˉD=[1+ˉq2q2+ˉq3q3+(cˉq2z2+cq3y2)q3τeiω0τ]1

    such that <q(θ),q(s)>=1.

    According to the notations in Hassard et al. [31], we need to compute the center manifold C0 at μ=0. Let ut be the solution of Eq (5.1) when μ=0 and define

    Z(t)=<q,ut>,  W(t,0)=ut(0)2Re{Z(t)q(θ)}. (5.3)

    On the center manifold C0, we have W(t,0)=W(Z(t),ˉZ(t),θ), where

    W(Z,ˉZ,θ)=W20(θ)Z22+W11(θ)ZˉZ+W02(θ)ˉZ22+,

    Z and ˉZ are local coordinates for center manifold C0 in the direction of q and ˉq. Note that if Xt is real, W is real. We only consider the real solutions. For the solution of the Eq (5.1) XtC0, we have

    ˙Z(t)=iωZ+ˉq(θ)f(0,W(Z,ˉZ,θ))+2Re{Zq(θ)}=iωZ+ˉq(0)f0(Z,ˉZ).

    Now we rewrite this equation as ˙Z(t)=iωZ+g(Z,ˉZ), where

    g(Z,ˉZ)=ˉq(0)f0(Z,ˉZ)=g20Z22+g11ZˉZ+g02ˉZ22+g21Z2ˉZ2+. (5.4)

    Note that ut(θ)=W(t,θ)+Zq(θ)+ˉZˉq(θ). We have

    g(Z,ˉZ)=ˉq(0)f0(Z,ˉZ)=ˉD{βu1t(0)u2t(0)+q2(βu1t(0)u2t(0)pu2t(0)u3t(0))+q3(cu2t(τ)u3t(τ)rmu23t(0))}=ˉD{(q2β)(Z+ˉZ+W(1)20(0)Z22+W(1)11(0)ZˉZ+W(1)02(0)ˉZ22)(q2Z+¯q2ˉZ+W(3)20(0)Z22+W(3)11(0)ZˉZ+W(3)02(0)ˉZ22)pq2(q2Z+¯q2ˉZ+W(2)20(0)Z22+W(2)11(0)ZˉZ+W(2)02(0)ˉZ22)(q3Z+¯q3ˉZ+W(3)20(0)Z22+W(3)11(0)ZˉZ+W(3)02(0)ˉZ22)+q3c(q2Zeiω0τ+¯q2ˉZeiωτ+W(2)20(τ)Z22+W(2)11(τ)ZˉZ+W(2)02(τ)ˉZ22)(q4Zeiω0τ+¯q4ˉZeiωτ+W(3)20(τ)Z22+W(3)11(τ)ZˉZ+W(3)02(τ)ˉZ22)rmq3(q3Z+¯q3ˉZ+W(3)20(0)Z22+W(3)11(0)ZˉZ+W(3)02(0)ˉZ22)2}.

    Comparing the coefficients with Eq (5.4), we have

    g20=2ˉD{(q2β)q2+q3q2q3ce2iωτq2q2q3prmq3q23},g11=2ˉD{(q2β)Re{q2}+q3cRe{¯q2q3}e2iωτq2pRe{¯q2q3}rmq3q3¯q3},g02=2ˉD{(q2β)¯q2+q3¯q2¯q3ce2iωτq2¯q2¯q3prmq3¯q32},g21=2ˉD{(q2β)(W(2)11(0)+W(2)20(0)2+¯q2W(1)20(0)2+q2W(1)11(0))+q3c(q2eiωτW(3)11(τ)+q3eiωτW(2)11(τ)+¯q2W(3)20(τ)2eiωτ+¯q3W(2)20(τ)2eiωτ)q2p(q2W(3)11(0)+¯q2W(3)20(0)2+¯q3W(2)20(0)2+q3W(2)11(0))rmq3(2q3W(3)11(0)+¯q3W(3)20(0))}. (5.5)

    It remains to compute W11(0) and W20(0) in g21. From Eqs (5.2) and (5.3), we have

    ˙W=˙xt˙Zq¯˙Zq={AW2Re{ˉq(0)f0q(θ)},θ[1,0),AW2Re{ˉq(0)f0q(0)}+f0,θ=0. (5.6)

    We rewrite the Eq (5.6) as

    ˙W=AW+H(Z,ˉZ,θ) (5.7)

    where

    H(Z,ˉZ,θ)=H20(θ)Z22+H11(θ)ZˉZ+H02(θ)ˉZ22+.

    Thus

    (A2iω)W20(θ)=H20(θ),    AW11(θ)=H11(θ). (5.8)

    From Eq (5.7), we know that for θ[1,0)

    H(Z,ˉZ,θ)=¯q(0)f0q(θ)q(0)¯f0ˉq(θ)=gq(θ)ˉgˉq(θ).

    Comparing the coefficients with Eq (5.8), we obtain

    H20(θ)=g20q(θ)ˉg20ˉq(θ), (5.9)
    H11(θ)=g11q(θ)ˉg11ˉq(θ). (5.10)

    From Eqs (5.8) and (5.9) and the definition of A, we have

    ˙W20(θ)=2iωW20(θ)+g20q(θ)+ˉg02ˉq(θ),

    where q(θ)=(1,q2,q3)Teiθωτ. Hence

    W20(θ)=ig20ωeiωθq(0)+iˉg023ωeiωθˉq(0)+E20e2iωθ

    where

    E20=2(2iωF1F2e2iωτ)1[βq2βq2pq2q3cq2q3e2iωτrmq23].

    Similarly, from Eqs (5.8) and (5.10) we obtain

    W11(θ)=ig11ωeiωθq(0)+iˉg11ωeiωθˉq(0)+E11,

    where

    E11=2(F1F2)1[βRe{q2}βRe{q2}pRe{q2ˉq3}cRe{q2¯q3}rm{q23}].

    So far, we have calculated g20, g11, g02, g21 in Eq (5.5) and then we can obtain

    c1(0)=i2ω(g11g202g112g0223)+g212,ν2=Re(c1(0))Re(λ(τ)),β2=2Re(c1(0)),T2=(Im{c1(0)}+ν2Im{λ(τ)})ω. (5.11)

    It is well known that ν2 and β2 will determine the direction and stability of the Hopf bifurcation, and T2 determines the period of the bifurcated periodic solutions, respectively. In particular, the Hopf bifurcation is supercritical (subcritical) if ν2>0(ν2<0), and the bifurcated periodic solutions exist for τ>τ0(τ<τ0). The bifurcated periodic solutions are stable (unstable) if β2<0 (β2>0) and the period will become longer (shorter) if T2>0 (T2<0).

    In this section, we carry out some numerical simulations to display some qualitative behaviours of system (1.4). Table 1 lists the values or ranges of parameters for system (1.4) referring to [21].

    We first study the effect of logistic growth on the dynamics of system (1.4). According to the ranges of parameters in Table 1, we take the following parameters

    s=10,β=0.02,d1=0.2,d2=0.5,d3=0.2,p=0.05,c=0.4,m=20. (6.1)
    Table 1.  Meanings and units of parameters.
    Parameters Descriptions Ranges Units
    s Source rate of uninfected cell 110 cells mL1day1
    β Virus-to-cell infection rate 0.000250.5 mL virion1day1
    p Predation rate of infection cell by CTLs 14.048×104 mL cell1day1
    r Breath rate of CTLs 0.00513.912 mL cell1day1
    m Capacity of immune cells 6.25235999.9 mL cell1
    c Development rate of CTLs 0.00513.912 mL cell1day1
    d1 Death rate of uninfected cell 0.0070.1 day1
    d2 Death rate of infected cell 0.20.3 day1
    d3 Death rate of immune cell 0.0010.3 day1

     | Show Table
    DownLoad: CSV

    Figure 1 presents the bifurcation diagrams of the solutions for system (1.4) with respect to τ and different logistic growth rate r. One can see that the positive equilibrium E1 of system (1.4) is local asymptotically stable when τ<τ=0.8 and the bifurcated periodic solutions occurs through Hopf bifurcations when τ>τ. Similarly, the positive equilibrium E2=(49.42,0.12,9.77) of system (1.4) is local asymptotically stable when τ=8<τ=8.655 and the bifurcated periodic solutions occur through Hopf bifurcations when τ=9>τ. At the same time, one can note that, except r=0, the values of Hopf bifurcation points increase with the increase of r. On the other hand, the amplitude of the bifurcated periodic solution increase with the increase of time delay τ and decrease with the increase of r.

    Figure 1.  Bifurcation diagrams of system (1.4) with respect to τ and different r. Parameter values are given by (6.1).

    Figure 2 presents phase diagrams of the solutions for system (1.4) with r=0.3 and different values of τ. One can see that the positive equilibrium E2=(49.42,0.12,9.77) is local asymptotically stable when τ=8<τ=8.655 and the bifurcated periodic solutions occur through Hopf bifurcations when τ=9>τ. Furthermore, using the given parameter values (6.1), we can obtain c1(0)=19.651+26.769i by some calculations and then we know that μ2>0, β2<0, T2<0 by (5.11). According to the conclusion in [31], we know that the Hopf bifurcation at τ=8.655 is supercritical, and the bifurcating periodic solution is stable.

    In order to investigate the stability switch of equilibrium, we take the following parameters

    s=10,β=0.2,d1=0.2,d2=0.3,d3=0.2,p=0.05,c=0.5,r=1.6,m=50. (6.2)
    Figure 2.  Phase diagrams of the solutions for system (1.4) with r=0.3 and different values of τ. The other parameters values are given by (6.1).

    We obtain there exists positive equilibrium E2=(18.8775,1.6487,69.5102) and the characteristic equation of system (1.4) have two pure virtual roots ω1=0.4464 and ω2=1.4748. Then by (4.7) we get

    τ10=0.8365,τ11=8.1911,τ12=12.4513;

    and

    τ20=3.9309,τ21=14.9113.

    Noting that τ21>τ12, we know that E2 is asymptotically stable when τ[0,τ10)(τ20,τ11) and is unstable when τ(τ10,τ20)(τ11,+). Figure 3 presents time series diagrams of the solutions for system (1.4) with different values of τ. One can see that there exists stability switch of equilibrium E2 as τ increases and some periodic solutions are bifurcated by Hopf bifurcation.

    Figure 3.  Time series diagrams of the solutions for system (1.4) showing stability switch with increase of τ. Parameter values are given by (6.2).

    In this paper, a viral infection model with self-proliferation of cytotoxic T lymphocytes (CTLs) and activation time delay of immune cells is proposed. We mainly focus on two topics. First, we study the global dynamics of system (1.4) through constructing appropriate Lyapunov functions. Then we examine the impact of the activation time delay of immune cells on the existence of periodic solutions. The global dynamical properties of system (1.4) can be summarized in the following Table 2. Numerical simulations verify the theoretical analyses. In particular, we find that for different values of the delay in CTL response, the system can stabilize at the positive equilibrium when the delay is small, or stabilize at a stable periodic oscillation when the delay is large. The amplitudes of bifurcated periodic solutions increase with the increase of activation time delay of immune cells and decrease with the increase of r (Figure 1). It is also found that there exists stability switch phenomenon under some conditions (Figure 3). The results indicate that the self-proliferation intensity and activation time delay of immune cells can significantly affect the kinetics of viral infection.

    Table 2.  Global properties of system (1.4) with τ>0.
    Case Conditions Equilibria and its stability
    r=0 R0<1 Eyz0 is GAS
    1<R0<1+βd3cd1 Eyz0 is US, Ez0 is GAS
    R0>1+βd3cd1 Eyz0 and Ez0 are US, E (Hopf)
    r<d3 R0<1 Eyz0 is GAS
    1<R0<1+β(d3r)cd1 Eyz0 is US, Ez0 is GAS
    R0>1+β(d3r)cd1 Eyz0 and Ez0 are US, E (Hopf)
    r=d3 R0<1 Eyz0 is GAS
    R0>1 Eyz0 and Ez0 are US, E (Hopf)
    r>d3 R0<1 Eyz0 is US, Ey0 is GAS
    1<R0<1+pm(rd3)rd2 Eyz0 and Ez0 are US, Ey0 is GAS
    R0>1+pm(rd3)rd2 Eyz0, Ez0 and Ey0 are US, E (Hopf)
    Note: GAS means globally asymptotically stable; US means unstable.

     | Show Table
    DownLoad: CSV

    Some aspects of the viral infection problem remain to be studied in the future. For instance, we plan to extend our analysis to global Hopf bifurcation analysis. Some other factors that influence the dynamics of viral infection including the heterogeneity of space and movement of cells may be investigated.

    The authors would like to thank the reviewers and the editor for their careful reading, helpful comments and suggestions that greatly improved the paper. This work is supported by the National Natural Science Foundation of China (Grant Nos. 11701472, 11771448, 11871403).

    The authors declare that they have no conflict of interest.



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