Cooperativity through Allee Effects drives growth of diffuse midline gliomas impacting the optimal scheduling of therapeutic interventions

Diffuse midline gliomas are a group of tumours for which no effective therapies exist. These tumours have substantial intratumoural heterogeneity and harbour beneficial subclonal interactions. Therapeutic failure due to resistance is a major concern in these tumours. We demonstrate how distinct subpopulations derived from the same tumour can interact with one another to alleviate the impacts of therapeutic intervention. This is achieved through the establishment of a mathematical extension to the Lotka-Volterra competition model, where interactions perturbing the Allee effect were demonstrated to exist. These interactions had substantial downstream consequences as they were determined to be perturbed by therapeutic interventions and strikingly, when simulating a two-drug paradigm, the interactions were demonstrated to substantially later the outcomes of treatment scheduling.