Evaluation of the efficacy of RUTI and ID93GLASE vaccines in tuberculosis treatment: in silico trial through UISSTB simulator Tuberculosis (TB) is one of the deadliest diseases worldwide, with 1,5 million fatalities every year along with potential devastating effects on society, families and individuals. To address this alarming burden, vaccines can play a fundamental role, even though to date no fully effective TB vaccine really exists. Current treatments involve several combinations of antibiotics administered to TB patients for up to two years, leading often to financial issues and reduced therapy adherence. Along with this, the development and spread of drugresistant TB strains is another big complicating matter. Faced with these challenges, there is an urgent need to explore new vaccination strategies in order to boost immunity against tuberculosis and shorten the duration of treatment. Computational modeling represents an extraordinary way to simulate and predict the outcome of vaccination strategies, speeding up the arduous process of vaccine pipeline development and relative time to market. Here, we present EU  funded STriTuVaD project computational platform able to predict the artificial immunity induced by RUTI and ID93GLASE, two specific tuberculosis vaccines. Such an in silico trial will be validated through a phase 2b clinical trial. Moreover, STriTuVaD computational framework is able to inform of the reasons for failure should the vaccinations strategies against M. tuberculosis under testing found not efficient, which will suggest possible improvements.

Generation of digital patients for the simulation of tuberculosis with UISSTB EC funded STriTuVaD project aims to test, through a phase IIb clinical trial, two of the most advanced therapeutic vaccines against tuberculosis. In parallel, we have extended the Universal Immune System Simulator to include all relevant determinants of such clinical trial, to establish its predictive accuracy against the individual patients recruited in the trial, to use it to generate digital patients and predict their response to the HRT being tested, and to combine them to the observations made on physical patients using a new in silicoaugmented clinical trial approach that uses a Bayesian adaptive design. This approach, where found effective could drastically reduce the cost of innovation in this critical sector of public healthcare. One of the most challenging task is to develop a methodology to reproduce biological diversity of the subjects that have to be simulated, i.e., provide an appropriate strategy for the generation of libraries of digital patients. This has been achieved through the the creation of the initial immune system repertoire in a stochastic way, and though the identification of a xe2x80x9cvector of featuresxe2x80x9d that combines both biological and pathophysiological parameters that personalize the digital patient to reproduce the physiology and the pathophysiology of the subject.