title: 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.
authors.affiliation: Tytgat Institute for Liver and Intestinal Research, Academic Medical Center , Amsterdam , Netherlands.
authors.forename: Anje A
authors.initials: AA
authors.lastname: Te Velde
authors.affiliation: Immunowell Foundation , Utrecht , Netherlands.
authors.forename: Tjitske
authors.initials: T
authors.lastname: Bezema
authors.affiliation: Bioinformatics Laboratory, Clinical Epidemiology, Biostatistics and Bioinformatics (KEBB), Academic Medical Center, Amsterdam, Netherlands; Biosystems Data Analysis, Swammerdam Institute for Life Sciences (SILS), University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Antoine H C
authors.initials: AH
authors.lastname: van Kampen
authors.affiliation: Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands; Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands.
authors.forename: Aletta D
authors.initials: AD
authors.lastname: Kraneveld
authors.affiliation: Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neuroscience, University Medical Center, University of Groningen, Groningen, Netherlands.
authors.forename: Bert A
authors.initials: BA
authors.lastname: 't Hart
authors.affiliation: Institute of Psychology, Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University , Leiden , Netherlands.
authors.forename: Henriët
authors.initials: H
authors.lastname: van Middendorp
authors.affiliation: Laboratory of Translational Immunology, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Erik C
authors.initials: EC
authors.lastname: Hack
authors.affiliation: Division of Pediatrics, Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Joris M
authors.initials: JM
authors.lastname: van Montfrans
authors.affiliation: Laboratory of Microbiology, Wageningen University , Wageningen , Netherlands.
authors.forename: Clara
authors.initials: C
authors.lastname: Belzer
authors.affiliation: Department of Psychology and Educational Sciences, Open University , Heerlen , Netherlands.
authors.forename: Lilian
authors.initials: L
authors.lastname: Jans-Beken
authors.affiliation: Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands; Institute for Life Sciences and Chemistry, HU University of Applied Sciences Utrecht, Utrecht, Netherlands.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Pieters
authors.affiliation: Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands; Immunology Platform, Nutricia Research, Utrecht, Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: Knipping
authors.affiliation: Institute for Positive Health , Amersfoort , Netherlands.
authors.forename: Machteld
authors.initials: M
authors.lastname: Huber
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen , Groningen , Netherlands.
authors.forename: Annemieke M H
authors.initials: AM
authors.lastname: Boots
authors.affiliation: Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands; Immunology Platform, Nutricia Research, Utrecht, Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Garssen
authors.affiliation: Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Tim R
authors.initials: TR
authors.lastname: Radstake
authors.affiliation: Institute of Psychology, Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University , Leiden , Netherlands.
authors.forename: Andrea W M
authors.initials: AW
authors.lastname: Evers
authors.affiliation: Laboratory of Translational Immunology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Berent J
authors.initials: BJ
authors.lastname: Prakken
authors.affiliation: Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Centre , Nijmegen , Netherlands.
authors.forename: Irma
authors.initials: I
authors.lastname: Joosten
keywords: chronic immune disorders; common pathways; data integration; life style; psychosocial factors