Mathematical Biosciences
○ Elsevier BV
Preprints posted in the last 30 days, ranked by how well they match Mathematical Biosciences's content profile, based on 49 papers previously published here. The average preprint has a 0.04% match score for this journal, so anything above that is already an above-average fit.
Liu, S.; Wu, J.; Lou, Y.; Jia, C.
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Non-exponential residence times give rise to history-dependent or memory effects in epidemic dynamics, yet their mathematical formulations remain fragmented. Here we develop a unified framework for a history-dependent SEIR model with general latent- and infectious-period distributions. We first establish the equivalence between the stage-age and renewal formulations and show that both admit a unified transition-flow representation. We then introduce the concept of a transition-flow multiplier, which provides a direct link between residence-time distributions and transition flows. When the multiplier is a weighted sum of shifted power functions, the model admits an exact representation in terms of Riemann-Liouville or tempered Riemann-Liouville fractional operators, providing a first-principles foundation for fractional epidemic models. Finally, using Euler-Lotka equations and stochastic-order arguments, we characterize how the latent- and infectious-period distributions shape epidemic growth and decay. A longer latent period slows both early growth and late decay, while, at fixed means, greater variability in the latent period accelerates early growth but slows late decay, whereas greater variability in the infectious period slows both.
Toranj Simin, P.; Boelle, P.-y.; Poletto, C.
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Host immunity acquired through prior infections is a key factor shaping the spread of emerging variants. However, accounting for complete infection histories in mathematical models is challenging because the number of possible histories grows exponentially with the number of variants. Here, we present a flexible framework for modeling the co-circulation of multiple variants emerging at arbitrary times while incorporating cross-immunity and variant-specific characteristics. We introduce three tractable approximations: truncation, which retains only infection histories up to a given number of strains; one variant at a time, which is exact when variants circulation does not overlap; and two variants at a time, which is exact when at most two strains co-circulate. We systematically evaluate these approximations across a range of cross-immunity levels and inter-variant emergence delays. Truncation approximations perform best under short emergence delays and strong cross-immunity, whereas the other approaches outperform them at longer delays. When applied to SARS-CoV-2 variant dynamics, the second-order truncation and the two variants at a time approximation accurately capture incidence patterns, whereas the other approaches perform well only for specific subsets of variants. These results identify the parameter regimes in which simplifying assumptions remain valid, provide guidance for model selection, and highlight the key role of infection history in shaping epidemic trajectories.
Violaris, I. G.; Pinotsis, D.; Tsipouras, M.; Kalafatakis, K.
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In this study, we develop a mathematical model of the hypothalamic pituitary adrenal (HPA) axis and systematically investigate the model complexity required to reproduce observed hormone dynamics. The model is fitted to ACTH and cortisol measurements from five healthy volunteers reported in the literature. We show that simultaneous reproduction of both hormone profiles requires a delay differential equation model with at least five state variables among the model architectures considered. Following fitting the volunteer data, we investigate the response of the model to sustained stress using bifurcation analysis. The coupled system exhibits bifurcations over a range of stress intensities. This analysis reveals bifurcations whose critical stress thresholds depend strongly on the modulatory state of the system. These results provide a mathematical framework for investigating transitions between physiological and dysregulated HPA axis dynamics, which may be related to states of health and disease.
De Almeida, A.; Hocquart, S.; Rosalie, M.
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Blooms of the toxic dinoflagellate Ostreopsis cf. ovata can cause respiratory irritation in beach users, yet their environmental drivers and temporal dynamics remain poorly understood. Here, we use a dynamical-systems approach to investigate how environmental conditions shape bloom dynamics from long-term time series of algal abundance and abiotic variables. Using the global modelling framework GPoM, we reconstruct nonlinear ordinary differential equation systems and identify candidate models capable of reproducing key features of the observed dynamics, including chaotic behaviour. Topological and statistical analyses reduce the candidate models to two systems that best capture the observed distributions and dynamical patterns. These models reveal distinct combinations of environmental conditions associated with bloom occurrence and amplitude, providing a framework for interpreting bloom trajectories and a potential basis for short-term prediction.
Sadhu, G.; Jolly, M. K.; Maini, P. K.
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We propose a minimal mathematical framework to describe the go-or-grow dynamics of tumor cells comprising two phenotypically distinct populations. One population is migratory and undergoes constant diffusion, while the other proliferates in an oxygen-dependent manner. The local oxygen concentration governs transitions between these phenotypes. We then ask whether the time scale of cyclic hypoxia, where oxygen is spatially homogeneous but fluctuates between normoxic and hypoxic levels over time, alters the dynamics of the reduced generalist model in the fast phenotype-switching regime compared with the full go-or-grow model. We observe that the reduced generalist phenotype model fails to capture the go-or-grow dynamics under rapid oxygen fluctuations. Our results predict that the tumor growth rate increases in the generalist-phenotype model under rapid oxygen fluctuations compared with tumors of the proposed go-or-grow model. We then explore whether oxygen consumption, which leads to spatial heterogeneity in oxygen concentration, plays a role in distinguishing the dynamics of the reduced model from the proposed go-or-grow model. We demonstrate that the tumor in the proposed go-or-grow model exhibits a higher growth rate than the tumor in the reduced generalist-phenotype model under a slow oxygen consumption rate.
Dogru, S.; Suresh, A.; Bowman, E. P.; Marathe, A.; Hussain, A. M.; Popel, A. S.
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TROP2-targeted antibody-drug conjugates (ADCs) have demonstrated promising clinical activity in triple-negative breast cancer (TNBC) as monotherapies; however, therapeutic benefit varies among patients. Combination strategies pairing TROP2-targeted ADCs with immune checkpoint inhibitors are also being investigated. Elucidating the mechanistic drivers of ADC monotherapy variability and enabling the rational development of combination regimens require computational frameworks that integrate ADC pharmacology with tumor-immune interactions. A quantitative systems pharmacology (QSP) model is presented that incorporates an ADC module into our established immuno-oncology model for TNBC. The module captures ADC and payload pharmacokinetics and pharmacodynamics. TNBC heterogeneity is represented by two tumor cell clones with high and low TROP2 expression, informed by prior characterizations, and differential sensitivity to the ADC payload is incorporated as an intrinsic property of each clone. Although generalizable, the model was applied to the TROP2-targeted ADC sacituzumab govitecan (SG, TRODELVY). A virtual patient cohort was generated using Latin hypercube sampling and calibrated against objective response rate (ORR) data from SG Phase I/II TNBC basket trial. The model predicted an ORR of 33.2% consistent with ASCENT study (NCT02574455). Simulations suggest TROP2-mediated delivery contributes modestly to SG efficacy with tumor exposure driven largely by systemically released SN-38 payload being sufficient to induce cytotoxicity. Tumor heterogeneity emerged as a key determinant of response with ORR increasing as the fraction of payload-sensitive clones increased. Overall, this QSP framework for TROP2-targeted ADCs accounts for TNBC heterogeneity and is extendable to other ADCs and targets enabling interrogation of ADC mechanisms of action in conjunction with tumor-immune interactions.
Yadollahzadeh Chari, F.; Gholami Davodi, A.
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Fractional differential equations are increasingly used to represent temporal memory in tumour immune and pharmacokinetic models, but changing the derivative order without a consistent time scale can make comparisons difficult to interpret. We study a dimensionless, commensurate Caputo system for tumour, immune, normal cell, and drug states. We establish positivity, boundedness, the tumour invasion threshold, and local stability conditions. We then use a fractional Adams Bashforth Moulton predictor corrector method with an explicit mesh convergence study. Two conclusions correct potentially misleading interpretations of the model. First, the equilibrium locations are independent of the fractional order: decreasing the order changes transient time scales but does not by itself alter the model's asymptotic states. Second, after a unit bolus the drug equation has the exact solution C({tau})=E(-K{tau}). Its maximum is therefore the initial concentration, not a delayed peak. For 0<<1, the algebraic tail makes the infinite-horizon area under the concentration curve diverge. In the illustrative coupled simulations, the apparent late tumour reduction at small is consequently driven by persistent modelled drug exposure and must not be read as evidence of superior therapy. All parameters are dimensionless and illustrative; no patient data are fitted. Source code and generated tables are included to make every numerical statement reproducible.
Atuhaire, F.; Simmonds, R. E.; Hoyle, R. B.
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Buruli ulcer (BU) is a neglected tropical skin disease caused by infection with Mycobacterium ulcerans. The mode of its transmission into the skin has not been fully clarified, but it is believed to involve mechanical transfer, perhaps by insect bites. M. ulcerans secretes a toxin called mycolactone which causes necrosis of the skin and formation of large skin lesions. Understanding the development of these skin lesions over time is crucial to understand the pathogenesis of BU. We formulate a mathematical model to describe the space-time dynamics of M. ulcerans bacteria, mycolactone and skin cell densities as well as fibrin deposition. We investigate the relative contributions to ulcer formation of direct cytotoxicity of mycolactone and ischaemia following the loss of coagulation control. Our results are consistent with existing biological evidence that higher mycolactone concentrations accelerate cell death. Furthermore, the model indicates that the rate of wound expansion is primarily controlled by the diffusion and net birth rate of bacteria, which sets the overall scaling for the speed of wound expansion, along with two dimensionless constants that define the shape of the trajectory of wound edge position against time, namely the ratio of the mycolactone diffusion coefficient to the bacterial diffusion coefficient, and the ratio of the mycolactone degradation rate to the bacterial net birth rate. When mycolactone diffuses significantly faster than bacteria spread or when mycolactone degrades more slowly than bacteria reproduce, the initial development of the wound is faster. In contrast, the long-term wound expansion speed appears to be relatively unchanged across a wide range of the dimensionless parameters.
Rosales, Z. R.; Nava-Sedeno, J. M.
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Species at the highest trophic levels are generally the least resilient to perturbations, yet the factors that determine their persistence remain poorly understood. We ask how the intrinsic self-regulation of a basal host governs the persistence of the trophic levels above it. To address this question, we use a minimal discrete-time model of a host-parasitoid-hyperparasitoid system motivated by the biology of trigonalid wasps, obligate hyperparasitoids that complete development only when their caterpillar host is also attacked by a primary parasitoid. We compare two forms of host self-regulation in the absence of natural enemies: scramble (Ricker) fecundity, appropriate when the parasitoid is the host's principal enemy and which recovers the classical model of Beddington and Hammond as a special case; and contest (Beverton-Holt) fecundity, appropriate when the host is held in check by many additional enemies. Using numerical continuation, Lyapunov exponents, and direct computation of the model's trajectories, we find that the form of host regulation is decisive for persistence at the top trophic level. Under scramble host dynamics, coexistence is extremely fragile with respect to both parameter values and initial conditions. Under contest host dynamics, coexistence is robust across broad parameter ranges and loses stability only gradually, through a supercritical Neimark--Sacker bifurcation and a subsequent torus-doubling route to chaos. Therefore, in at least some trophic networks, the resilience of the highest levels can be determined at the base of the network.
Zhou, M.; Jia, C.
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Moment-closure methods provide a widely used approach for approximating low-order statistics of stochastic biochemical reaction networks, but the resulting closed equations may exhibit physically meaningless dynamics. Here, we systematically investigate the stability of second-order moment-closure approximations for a bursty gene expression model with nonlinear protein degradation. We consider the Gaussian, log-normal, and negative-binomial closures. By analyzing the resulting dynamical systems, we show that the Gaussian closure fails the proposed stability criterion for all parameter values, whereas both the log-normal and negative-binomial closures possess a unique physically accessible fixed point and are stable if and only if kB(1 + 2B) [≥] 1, where B is the mean burst size and k is the dimensionless protein synthesis rate. Moreover, this condition is automatically satisfied when the steady-state mean protein copy number is at least one, suggesting that it is mild in biologically relevant regimes. Numerical comparisons over a broad parameter range further show that the negative-binomial closure is the most accurate, while the Gaussian closure is the least accurate. We further develop higher-order negative-binomial moment-closure schemes and demonstrate that increasing the closure order substantially improves predictive accuracy. These results highlight the importance of considering dynamical stability, in addition to numerical accuracy, when assessing moment-closure approximations.
Ganguly, P. S.; Huang, W.
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Oncogene amplification on circular extrachromosomal DNA (ecDNA) has been linked to poor prognosis and higher treatment resistance in multiple types of human cancer. ecDNA are mobile genetic elements lacking centromeres that are partitioned unevenly into daughter cells at mitosis. While random segregation of ecDNA contributes to gene-copy-number heterogeneity among tumour cells, how ecDNA contribute to phenotypic heterogeneity, via mRNA and proteins, and how this affects targeted therapy outcomes is still not understood. In fact, cancer cell populations with ecDNA show remarkable heterogeneity in mRNA concentrations, which is not explained by gene-copy-number heterogeneity alone. In this paper, we use a stochastic model of gene transcription to mathematically model mRNA production and decay in cancer cells with ecDNA, extending a method that has been used to study phenotypic heterogeneity in eurokaryotic and prokaryotic cells. Using our model, we explore the space of possible mRNA distributions from a given ecDNA distribution, under different model parameter regimes. Our model is able to produce realistic mRNA distributions and we use it to estimate transcriptional parameters from single-cell measurements of ecDNA and mRNA counts in cell-line data. We discover a remarkable similarity in estimated parameters across cell lines and amplification types, indicating similar processes underlying transcription in ecDNA and chromosomal amplifications. We also model genotoxic therapy and use our model to predict the mRNA composition of persisting cells, showing the usefulness of such a modelling framework to understanding the origins of treatment resistance in ecDNA-containing cancers.
Tunstall, T.; Zaccone, A.
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We develop a general geometrical framework for growth processes in which the growth rate depends exponentially on the number of active growth-supporting components. The framework separates the fraction of active components from the size of the accessible component space, allowing qualitatively different growth laws to arise from the same underlying construction. Bacterial population growth provides an example of a fixed-size component space controlled primarily by activation and deactivation, whereas examples such as human population growth or speciation provide an expanding component space in which interactions between individuals promote further growth. This motivates a Replicative geometrical law, dX/dt= X exp({beta} X^{gamma}), whose exponent characterizes the scaling of the effective growth-supporting component space and is tested against historical human-population regimes and eukaryotic lineage-through-time data. For innovation indicators such as patents and arXiv manuscript submissions, where an existing item need not itself reproduce, the same construction motivates a Direct Geometrical production law without the prefactor X. The framework therefore provides a common description of fixed and expanding component spaces while distinguishing Replicative from Direct Geometrical growth.
Gunputh, N. D.; Maki, K. L.; Carichino, L.; Woeller, C. F.
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Allergic conjunctivitis is an inflammation of the conjunctiva caused by allergen; it is common disorder affecting up to 40% of the population. In this work, we study seasonal allergic conjunctivitis (SAC), also called "hay fever eyes", which is caused by exposure to airborne pollens. We develop a mathematical model quantifying the ocular immune system response to the allergens. First, we present a simplified qualitative description of the immunopathogenesis of SAC. Then, we express each chosen immunopathological mechanism mathematically to construct a system of thirty-one ordinary differential equations. We compare summary statistics of the predicted observable immune signals to experimental measurements and find our model captures key qualitative features of SAC progression. We then compare our predicted time series of histamine concentration to symptom scores and find a strong correlation suggesting the model predicts relevant clinically trends. Next, we calibrate the model through multi-step process. We find the most influential parameters are the production and depletion rates of IL-4, and the production rates of IL-5 and IL-8. These cytokines are targeted in treatments for asthma, atopic dermatitis, and severe eosinophilic associated disorder and suggest potential therapeutic targets for SAC. Our calibrated model mimics most of the summary statistics of the experimentally observable immune signals with discrepancies for IL-5 and IL-13 indicating that additional immunopathological mechanisms could be important.
Tari, H.; Kessler, K.; Izquierdo, E.; Jones, C.; Sottoriva, A.
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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.
Rajendra, D.; Neumann, J.; Kaiser, T. S.; Gokhale, C. S.
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Regular environmental cycles such as day and night or the lunar cycle are ubiquitous and drive many biological processes. Many organisms have evolved endogenous time-keeping mechanisms to anticipate these cycles to accurately time their behavior or synchronize physiological processes. The evolution of such synchronization to environmental cycles and their variability is not very well understood. As an example, we use the marine insect Clunio (Diptera, Chironomidae), which synchronize adult emergence and reproduction with the lunar cycle, and show different emergence patterns across populations. We use a model constructed with replicator-mutator dynamics to provide a novel outlook at the evolution of these emergence patterns. In particular, we investigate the effect of two traits of individual phenotypic variability of emergence, the spread and shape, on population-wide emergence patterns. We find that the semilunar and lunar emergence patterns are alternatively stable and occur when the phenotypic distribution has a narrow and is roughly flat. Arrhythmic emergence occurs when the phenotypic distribution is wide and nearly flat. The semi-lunar pattern can only be observed when the parameter of rhythmicity is changed. With our model, we introduce the concepts of frequency-dependent selection and individual phenotypic variability into the theory of chronobiology, which gives us insights into the evolution of rhythmicity in these organisms.
Karalis, V.
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The aim of this study was to develop a framework for assessing the incremental value of decisions on drug amount, timing, input structure, cessation and restart. The LOGOS (Longitudinal Optimization of Global Outcomes and Strategies) approach combines matched nested regimen classes, mechanism-specific benchmarks and evidence requirements in a single longitudinal comparison. Thus, the contribution of additional regimen freedom is assessed separately from improvements due to different resources, constraints or evaluation horizons. Nested feasible classes have nondecreasing objective suprema, whereas a strict gain requires a feasible witness above a valid bound for the smaller class. The approach is illustrated through analytical examples of periodic smoothing, matched desensitization, relaxed exposure allocation, finite-course loading and safety after cessation. In a normalized finite Emax model, integrated benefit increased from 0.629606 for three equal boluses to 0.672945 after optimization of amounts, 0.677043 for an amount-and-time candidate and 0.679553 for a globally certified loading-maintenance-coast solution. The adjacent observed gains were 6.88%, 0.61% and 0.37%, respectively, and all schedules satisfied the full-tail injury bound. In addition, a periodic factorial example separated response curvature from a joint recovery and repair process, including a null case and results dependent on feasibility constraints. The LOGOS framework allows assessment of whether additional regimen flexibility improves benefit, provides no added value or restores feasibility. These dimensionless examples support conditional mathematical and model-based conclusions; clinical superiority and safe restart in patients have not been established.
Gurarie, D.; King, C. H.
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Background. Classical macroparasite models commonly represent worm burden heterogeneity through prescribed Poisson or negative-binomial (NB) distributions, while transmission dynamics are formulated in terms of aggregate quantities such as mean worm burden and prevalence. We revisit these assumptions using a stratified worm burden (SWB) framework that explicitly tracks the distribution of parasite burdens across heterogeneous host classes and allows demographic turnover, transmission, and interventions to be analyzed within a unified model. Methods. We derive equilibrium distributions of the SWB system under homogeneous and heterogeneous infection processes and compare them with the classical Poisson and NB distributions used in macroparasite epidemiology and control policymaking. The framework is then extended to include host demography, coupled human-snail transmission dynamics, and periodic mass drug administration (MDA). Corresponding SWB and NB-type MacDonald models are calibrated to comparable endemic prevalence and mean worm burden, allowing direct comparison of potential transmission breakpoints and intervention outcomes. Results. In the absence of demographic turnover, the SWB framework naturally generates Poisson and NB equilibrium distributions as limiting cases of homogeneous and heterogeneous infection processes. Incorporating demographic recruitment and mortality alters these benchmark distributions, producing endemic burden structures that differ systematically from their classical counterparts. Analysis of coupled human-snail systems reveals that transmission breakpoints and bistable equilibria occur only within a relatively restricted region of SWB parameter space. In contrast, comparable NB-MacDonald formulations exhibit breakpoint behavior over substantially broader parameter ranges with the net effect of overestimating the likelihood of interruption of transmission. Although calibrated models can reproduce near identical endemic prevalence and mean worm burden, they often generate markedly different responses to MDA, including differences in rebound dynamics, persistence, and elimination thresholds. Conclusions. The SWB framework links classical statistical descriptions of worm aggregation to mechanistic burden-resolved population dynamics, clarifying how endemic distributions emerge and how they are modified by demography and control interventions. Our results suggest that transmission breakpoints are not a universal feature of helminth systems but depend strongly on model structure, and that predictions of elimination and post-treatment recovery may be considerably more model-dependent than implied by prevalence-based calibration alone. The SWB approach therefore provides a flexible alternative framework for evaluating parasite transmission dynamics and predicting the outcomes of control strategies.
Sridhar, G.; Wyart, C.; Costa, A. C.
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Behavioral variability reflects differences in internal and external parameters and provides a substrate for natural selection. However, uncovering its structure is challenging because behavior evolves nonlinearly across multiple timescales. Our goal is to reconstruct phenotypic variation from finite behavioral observations without prescribing the scales at which individuals should be compared. To achieve this, we introduce a multiscale dissimilarity that compares dynamics across all statistically resolvable resolutions by constructing reduced transfer operators at progressively finer scales and weighting their differences by finite-sampling uncertainty. This dissimilarity defines a geometry of dynamical phenotypes, which we reconstruct using diffusion maps. We show that the resulting phenotypic coordinates locally follow the parameter directions to which dynamics are most sensitive. We validate our approach in a stochastic model and apply it to bacterial and larval zebrafish behavior. In bacteria, we identify run speed as a major component of inter-individual variability, associated with the chemotaxis protein CheB. In zebrafish, we find that prior prey experience reshapes behavioral dynamics and phenotypic variability, with paramecia experience concentrating fish in a prey-capture-associated region of phenotypic space. Together, these results provide a framework for identifying internal and environmental variables that structure dynamical phenotypes across scales.
Das, H. K.; Stephens, P.; Martins Stolerman, L.
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Nitrogen dioxide (NO2) is a widespread air pollutant associated with the risk and prevalence of various respiratory infectious diseases. Epidemiological studies have reported associations between NO2 exposure and COVID-19 incidence, and biological evidence indicates that NO2 exposure increases vulnerability to infection. Motivated by these findings and by the scarcity of mechanistic epidemic models that incorporate air pollutant data, here we introduce an NO2- and mobility-informed metapopulation model and study the first COVID-19 wave in Oklahoma. County-level NO2 concentrations enter the infection rates through a first-order parameterization, alongside high-resolution mobility patterns capturing heterogeneous inter-county connectivity. Using numerical simulations, we demonstrate that higher environmental sensitivity produces earlier and more synchronized outbreaks across counties, while lower sensitivity yields delayed, asynchronous trajectories. When fitted to county-level COVID-19 incidence data, our model outperformed the classic SIR model (fitted independently in each county) in over 75% of counties in Oklahoma across all standard error metrics. The improvements were even more pronounced in forecasting tasks across epidemic stages, with county-level win rates against the SIR model of 59.74% (surge), 87.01% (peak), 80.52% (post-peak), and 88.31% (decline) by nRMSE. To isolate the contribution of NO2, we compared our model against a mobility-only model with NO2 removed and homogeneous infection rates across counties. The NO2 term improved county-level forecasts during the surge (94.81% of counties by nRMSE), post-peak (88.31%), and peak (62.34%) stages, though not during the early and decline stages, suggesting that NO2 information can generate better forecasts than mobility alone during periods of high incidence. Our results demonstrate that environmental exposure can enter the transmission structure of a mechanistic epidemic model directly and that doing so yields measurable forecasting gains.
Chu, Y.; Sheng, X.; Zhang, X.; Wang, Z.
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Cancer progression often requires the accumulation of multiple driver mutations, yet the same set of drivers may be acquired in different orders. How these alternative mutation-order pathways jointly shape tumor clonal structure remains unclear. We develop a multitype branching-process model in which malignant transformation requires two driver mutations and distinguish malignant cells both by their mutation order and by the independent transformation event that founded their clone. Under a successive exponential approximation, we establish point-process limits for the pathway-specific clone-size processes and derive a closed-form expression for the limiting expected Simpson's index of the combined malignant population. When the two mutation orders produce malignant cells with the same net growth rate, the limiting index separates into effective pathway weights, determined by mutation rates and birth-death dynamics at preceding stages, and within-pathway concentration terms, determined by intermediate-to-malignant growth-rate ratios. This decomposition shows that a driver's effect on heterogeneity depends critically on when it is acquired. A strong driver acquired early expands the intermediate lineage and increases the supply of independent malignant founders, whereas the same driver acquired at the final transition strengthens the growth and age advantage of early-founded malignant clones. Under additive fitness effects, these counteracting mechanisms can produce a non-monotone relationship between selective advantage and clonal concentration. We further show that threshold-like non-additive fitness effects can generate highly concentrated malignant populations, while order-dependent terminal fitness leads the faster-growing pathway to dominate asymptotically. Together, these results reveal how mutation order, mutational accessibility, selection, and epistasis jointly determine lineage-level intratumor heterogeneity.