Adaptive receptor expression and the emergence of disease as loss of signaling homeostasis

Our bodies have evolved to maintain homeostasis through regulatory systems that continuously adapt to keep physiological processes within a normal range. From this perspective, complex chronic disease can be understood as a breakdown of compensatory mechanisms, resulting in loss of homeostasis. Here we propose that adaptive receptor expression dynamics may serve as one such compensatory mechanism, increasing receptor surface expression when external ligand is insufficient, and clearing it when signaling is excessive. To explore this, we adapt a previously published agent-based model and simulate it under a range of scenarios. We find that the system of adaptive receptor expression is robust to oscillatory perturbations but not to chronic stress. We propose that receptor turnover dynamics may be better understood as an adaptive, environmentally responsive process rather than a fixed biological property, and that in some cases, disease manifests only after compensatory mechanisms have been pushed past their limits. We conclude with a discussion of implications for understanding complex chronic diseases, for thinking about epigenetic and mutational change as escalating layers of adaptation, and for how we model receptor dynamics in the context of receptor-mediated drug activity.